![Page 1: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/1.jpg)
Rebecca King RN, CSN, MSN, MEdSchool Nurse Liaison
WVDE-Office of Healthy Schools
Changing the Way We Do Business: Working
SMARTER not HARDER?
![Page 2: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/2.jpg)
Hats Off To…
![Page 3: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/3.jpg)
Objective #1:
• Participants will be knowledgeable of the vision for school health service initiatives at a national, state and local level.
![Page 4: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/4.jpg)
WV Department of Education
WV State Board of Education(Promulgate educational rule for PreK-12,
adult vocational, institutional education facilities and the school for the deaf and blind)
State Superintendent of
Schools
WVDE Offices
Deputy Superintendent
RESA OEPA
![Page 5: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/5.jpg)
Coordinated-School Public Health Partnership
![Page 6: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/6.jpg)
The West Virginia Story…
Coordinated School-Public Health Structure
![Page 7: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/7.jpg)
2011 RESA-RSWS Focus
• Work Plan – Local Wellness– Bullying (S3 high schools)– Substance Abuse (SBIRT)– Suicide Prevention (ASPEN)– Teen Pregnancy (HEAP, PREP grants)– Physical Activity (Let’s Move)– Nutrition (current WVDE-OCN
initiatives)– Tobacco Prevention (Quit Kits)
![Page 8: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/8.jpg)
What’s on the books?• SN ratio of 1:1500 K-7 (W.Va. Code §18-5-22)
• WVBE Policy 2422.7-Standards for Basic and Specialized Health Care Procedures in the School Setting
• WVBE Policy 2422.8-Medication Administration (Prescribed and OTC)
• WVBE Policy 2423-Communicable Disease Control (HIV & Comm. Dx Inservices)
![Page 9: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/9.jpg)
What’s on the books?
• WVBE Policy 5200- Certification…Authorization, Permit, Full Certification, Short or Long-Term Substitute and PPST
• Asthma laws-W.Va. Code §18-5-22b
• Diabetes laws- W.Va. Code §18-2K-1
• High Acuity Funding-W.Va. Code §18-5-22
• School Nurse National Certification- W.Va. Code §18A-4-2b
![Page 10: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/10.jpg)
Top 5 Medical Diagnoses/Procedures2010/11 School Nurse Needs Assessment
Medical Diagnoses In-School Specialized Health Care Procedures
Asthma Inhalers for Asthma
Behavioral Disorders Emergency Medications
Anaphylactic Reaction Long-Term Medications
Obesity Special Diets per Federal Form
Mental Disorders (Depression, Bipolar, Schizophrenic, Suicidal)
Seizure Management
Close 5th places…..Ear, Nose and Throat/Migraine or Severe Headache/Seizures
![Page 11: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/11.jpg)
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
238 8522147
4213
11491
16145
2010/11 Student Medical Diagnoses
Series1
![Page 12: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/12.jpg)
School HealthEfficiency
• Multidisciplinary Team (SN, LPN, Aides, Health Clerk/Secretary)
• Utilization HealthCheck examination for new school enterers…No mass school screenings
• Evidence-based practices and policies (BMI, Scoliosis, Screenings, Lice, Prevention Programs, etc.)
• SBHC with full array medical, dental and mental
Model
• YOUR County
WVDE-Healthy Schools at http://wvde.state.wv.us/healthyschools/quicklinks.html.
![Page 13: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/13.jpg)
NationalSchool Nurses to Student Ratio
1:750 Well child
1:225 Chronic conditions
1:125 Complex conditions
1:1 as needed for multiple disabilities
![Page 14: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/14.jpg)
What does the Student to School Nurse ratio look like on paper?
1340 + 150 + 10 + 2 =750 225 125 1
1.66 + .66 + .08 + 2 = 5.28 nurses
![Page 15: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/15.jpg)
Multidisciplinary Approach
1340 + 150 + 10 + 2 =750 225 125 1
1.66 + .66 + .08 + 2 = 2 RNs 1 P/T LPN 1 clerk
![Page 16: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/16.jpg)
NASN Research Priority
• Identify school nurse delivery models (school nurse caseloads, credentials, experience, etc.) necessary for quality nursing care
• School nurses must identify and measure outcomes expected as a result of quality school nursing care
![Page 17: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/17.jpg)
School nurse sensitive outcomes
• Identify factors that measure the impact of nursing care over and above other factors
• Outcomes “sensitive” enough to distinguish between the effects of family and community and the effects of the quality and the quantity school nursing interventions on child, family and school community outcomes
![Page 18: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/18.jpg)
Health Care Reform• WV children with increased insurance
coverage• Expansion of Primary Care Center
services and funding (currently serving 1 in 5 West Virginians)
– School-Based Health Services • Dental• Mental Health• Family Planning
Helping us move to full-service communities/schools
![Page 19: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/19.jpg)
Objective #2:
• Participants will be familiar with evidence-based practice recommendations in school health and challenged to fully utilize them in daily practice.
![Page 20: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/20.jpg)
WHY EBIs…so students can get safe, quality standardized care
![Page 21: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/21.jpg)
Prioritize
• Immunizations, Immunizations, Immunizations
• HealthCheck, Parent and Provider Education, HealthCheck, Common language, HealthCheck, Medical home concept
• Evidence-based Practice and Programs
![Page 22: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/22.jpg)
Talk the Talk and Walk the Walk
• Know the data and the research, STOP the routines and start utilizing the facts to make school health programming and procedure decisions!
![Page 23: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/23.jpg)
BMI…• USPSTF recommends Medical
provider screening for 6 -18 year old with comprehensive weight management program. Inclusive of counseling, diet, physical activity and behavioral interventions which are beyond our scope as nurses.
![Page 24: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/24.jpg)
BMI…
• CDC (2007) recommends surveillance only not census or population-based screening by school personnel.
• Health and physical education including modeling school meals and physical activity for schools.
• Medical home management.
![Page 25: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/25.jpg)
Acanthosis nigricans (AN) Markers…
• CDC is aware that some groups are interested in AN screening of children in school settings to identify those at high risk to develop type 2 diabetes. Although some studies have observed that half the children with type 2 diabetes had AN, insufficient evidence exists for us to conclude that having AN will lead to type 2 diabetes. Therefore, at this time, CDC scientists strongly discourage AN screening of children in school or community settings.
![Page 26: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/26.jpg)
Acanthosis nigricans (AN) Markers…
• While AN is a reliable and independent marker of hyperinsulinemia, the extent to which AN predicts the development of type 2 diabetes is unclear. In this study, none of the 233 students screened had hyperglycemia.
• CDC scientists are not aware of any systematic guidelines for clinical detection of AN or a uniform AN case definition. The repeatability, reliability, and validity of AN screening, relative to expert diagnosis (gold standard), is unknown. This makes it impossible to meaningfully interpret AN screening results. Therefore, the utility of using AN as a screening tool for diabetes prevalence or as a predictor of developing diabetes is currently unknown.
![Page 27: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/27.jpg)
Acanthosis nigricans (AN) Markers…
• Those adolescents who have AN can be stigmatized by the screening process and subsequent identification. We are also concerned that if AN status becomes a part of adolescents' medical records, it might jeopardize their future insurance benefits.
• Most importantly, there are now no known interventions or protocols to treat those who have AN. There is some evidence that those with AN might benefit from physical activity. Because improved physical activity benefits everyone in school or communities, it makes sense to encourage physical activity for all children, regardless of AN status.
• Medical home screening.
![Page 28: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/28.jpg)
Acanthosis nigricans (AN) Markers…
• Given the absence of a uniform case definition and intervention protocols for those with AN and considering the risk of stigmatization for those with AN, CDC scientists believe that it is not ethical or cost-effective to mass screen children for AN. CDC recommends that state diabetes control programs consider an alternative primary prevention approach and use available resources to improve physical activity and nutrition in schools and communities.
![Page 29: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/29.jpg)
Scoliosis Screenings...• Affects only 2-3% of entire US Population.
Do the math.• USPSTF did not find GOOD evidence to
support this screening for early detection.• Accuracy of current screening test
(forward bending or scoliometer) is VARIABLE.
• Only a small amount (minute) of the nationally 2-3 % cases actually have health benefits more cases are not clinically significant.
![Page 30: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/30.jpg)
Scoliosis Screenings...
• USPSTF found idiopathic scoliosis detected through screening leads to MODERATE HARM…concluding that harms of screening out weigh the potential benefits.
![Page 31: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/31.jpg)
Dental Screening…
• By West Virginia Dental Laws, this is outside of the scope of a nurse.
• We do individual “oral health assessments” based on an individual complaint NOT massive screenings.
![Page 32: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/32.jpg)
Massive Screenings• Are massive screening conducive to
accurate screenings?• Do they detect a high population of
needs?• Can you do a diagnosis, treat or
referral to a specialist?• Is the medical home an unneeded
entity in a child’s life?• Do you coordinate health services and
share health information with them?
![Page 33: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/33.jpg)
Massive Screenings
• Outdated• Lack of supportive research to show
need or true gaps in birth up to three year old screenings and medical home care.
• The concept of surveillance and screening in a medical home is continuity of care.
![Page 34: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/34.jpg)
![Page 35: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/35.jpg)
WHY?
• PreK is the new enterer with approximately 15, 000 (71%)students entering last year leaving only 6,000 new enterers in kindergarten.
• Follow PreK rule under WVBE…HealthCheck and now Superintendent’s Interpretation from 2007 which is rule for 6,000 kindergarten enterers.
• Prioritize your time stop rescreening!
![Page 36: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/36.jpg)
Objective #3:
• Participants will be provided with the current status of school nursing and school health services in the state of West Virginia (changing of the guards, current data and trends, national certification and continued recruitment, working toward full-service schools, etc.).
![Page 37: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/37.jpg)
Retirements
• School Nurses• Principals• Health Services Directors• Superintendents• Offsite PreK collaboratives
![Page 38: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/38.jpg)
WV Data• Lack of preventive care.• Adolescents without well-child visits
and immunizations.• Poor oral hygiene and health.• 17% increase in teen pregnancy
population.• Below proficiency on HEAP scores
throughout the state.• Leading in Asthma, Obesity, Hepatitis
B and C, prescription drug abuse, etc.
![Page 39: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/39.jpg)
Developing a Collaborative Team• Completing Electronic Data Entry
(Immunizations required on WVEIS, Ipad Grant requires HealthCheck data, High Acuity funds require HCP for certain specialized health procedures, medication logs, sick bay). PreK Child Accomplishment Summaries.
• Increasing the use of WV Statewide Immunization Information System (WVSIIS)…feeding into WVEIS.
![Page 40: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/40.jpg)
Developing a Collaborative Team
• Capitalization of funding sources…what are they?
• Training of staff to recognize early signs and symptoms of communicable diseases, provide fluoride rinse programs, health promotion programs, enhancing health and physical education, physical activity, nutritional programs, relationships with hospitals, programming to assist school health, filling in the resource gaps, etc.
![Page 41: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/41.jpg)
Developing a Collaborative Team
• Ensuring children receive annual Well Child visit and Dental exam for continued health promotion and prevention practices
• Incorporation of nursing students (LPN to NP and Doctorate in the school setting) and others.
• Developing MOUs/Contracts for a county medical director (Primary Care Centers, School-Based Health Centers, Private) or Medical Advisory Board
![Page 42: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/42.jpg)
Developing a Collaborative Team
• Ensuring children receive annual Well Child visit and Dental exam for continued health promotion and prevention practices.
• Developing and maintaining working relationships.
• Developing supports at the RESA
• Developing a seamless health and medical record with the most influential people working together for the best of each student.
![Page 43: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/43.jpg)
Full Service School
• School which provides for the whole child with integration of the eight components of school health through medical, behavioral and dental services, parent supports and services in the school, community supports…Making your school friendly with a whole child, family and community focus.
![Page 44: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/44.jpg)
Become Nationally Certified
• Ensures leadership skills, quality care, efficiency, annual professional development and evidence-based practice.
![Page 45: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/45.jpg)
How do we get there?
![Page 46: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/46.jpg)
Strategies• Know legislative rule, state rules and county
policy.• Know your nursing practice act and the role
of LPN and UAPs.• Support the Medical and Dental Home
concept to move West Virginia towards preventive health.
• Validate immunization records and follow provisional enrollments through to completion.
• Make adolescent vaccinations and well-child visits YOUR priority NOT an AFTER THOUGHT!
![Page 47: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/47.jpg)
Strategies• Follow and implement evidence-based
practice. Obtain a medical consultant or form medical advisory board for your county’s school health services program.
• Form collaborative teams/ relationships with public health.• Form collaborative teams/initiatives with
medical, dental and behavioral health providers/communities.
![Page 48: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/48.jpg)
Together we serve the WHOLE CHILD
![Page 49: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/49.jpg)
THANK YOU!
Have a WONDERFUL Thanksgiving!
![Page 50: Rebecca King RN, CSN, MSN, MEd School Nurse Liaison WVDE-Office of Healthy Schools](https://reader038.vdocument.in/reader038/viewer/2022110102/568134a8550346895d9bb234/html5/thumbnails/50.jpg)
Rebecca King
WVDE-Coordinator
School Health
and Coordinated School-Public Health
304.558.8830