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Chapter 29

School Health

The healthy development of children and adolescents is influenced by many societal institutions. After the family, the school is the primary institution responsible for the development of young people in the United States.

– Centers for Disease Control and Prevention (CDC, 2011)

Academic Success

It is impossible to achieve success in school without maximizing the health of the students.

Poor academic performance is strongly correlated with uninsured status of youth; acquisition of health insurance leads to an increase in school performance.

Health problems lead to increase in absenteeism.

The school nurse has a unique opportunity to make a positive impact on the nation’s youth.

History of School Health

1840: First mandatory education

1850: Shattuck Report

Proposed that health education was a vital component in the prevention of disease.

1860s: Prevention program for smallpox

1870: Smallpox vaccination required

1902: NYC hired the first school nurses

Lillian Wald was able to show that the presence of school nurses could reduce absenteeism by 50%.

History of School Health (Cont.)

Early 20th century: Health education and “gymnastics” introduced

1918: NEA and AMA published Minimum Health Requirements for Rural Schools

1921: Schools required physical and health education; fire drills required

1946: National School Lunch Program

Included School Breakfast Program in 1976

History of School Health (Cont.)

1960s: First NP programs with inclusion of primary care services in schools

1975: Education for the Handicapped Act

1976: First National School Conference

1986: Drug-Free Schools and Community Act

1994: Above act expanded to include violence prevention measures

1990s: CDC Division of Adolescent and School Health formed

History of School Health (Cont.)

1990s: School-based health centers

2001: No Child Left Behind Act

Safe and Drug Free Schools and Communities focused on prevention of school violence and illegal use of alcohol, tobacco, and drugs

2010: Patient Protection and Affordable Care Act (ACA)

Awarded funds to 278 school-based health centers to create new sites and expand services

Expansion of services in medically underserved areas

Components of School Health Programs

Health education

Physical education

Health services

Nutrition services

Counseling, psychological, and social services

Healthy school environment

Health promotion for staff

Family and community involvement

Components of School Health Programs (Cont.)

Figure 29-1

Health Education

CDC guidelines and priority areas:

Alcohol and drug use

Injury and violence (including suicide)

Tobacco use

Poor nutrition

Lack of physical activity

Sexual behavior that results in STDs or unwanted pregnancies

National Health Education Standards

Established to promote positive health behaviors for students in all grades.

Gives students, families, and communities a framework for development of health education programs in schools.

The students will…

…comprehend concepts related to health promotion and disease prevention to enhance health.

…analyze the influence of family, peers, culture, media, technology, and other factors on health behaviors.

National Health Education Standards (Cont.)

The student will demonstrate the ability to…

…access valid information, products, and services to enhance health.

…use interpersonal communication skills to enhance health and avoid or reduce health risks.

…use decision-making skills to enhance health.

…use goal-setting skills to enhance health.

…practice health-enhancing behaviors and avoid or reduce health risks.

…advocate for personal, family, and community health.

– CDC (2011)

Youth Risk Behavior Survey

Conducted by the CDC every 2 years among selected high school students in the U.S.

http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Reports provide valuable information that can help improve health education programs in schools.

Youth Risk Behavior Survey (Cont.)

Purposes of YRBS (CDC, 2007):

Determine the prevalence and age of initiation of health risk behaviors.

Asses whether health risk behaviors increase, decrease, or remain the same over time.

Examine the co-occurrence of health risk behaviors.

Provide comparable data among subpopulations of youth.

Provide comparable national, state, territorial, tribal, and local data.

Monitor progress toward achieving the Healthy People 2020 objectives and other program indicators.

Injury Prevention

Should be taught early and be age appropriate

Bicycle safety and helmets

Proper use of backpacks

Schoolyard and playground safety

Motor vehicle safety for adolescents

Sports safety

Equipment

Hydration and frequent rest periods

Stretching, warm-up, and cool-down activities

Pool safety

Related school policies, recommendations, data collection on injuries, and staff training

Tobacco Use

Tobacco

Smoking is the single leading preventable cause of death in the United States.

An estimated 80% of adults who use tobacco began before the age of 18 years.

Adolescents who use smokeless tobacco are more likely to become cigarette smokers.

Adolescents targeted by tobacco advertising.

Teach adolescents the negative consequences associated with tobacco.

Substance Abuse

Alcohol

Use of alcohol and other drugs is associated with problems in school, injuries, violence, and motor vehicle deaths.

The most commonly used and abused drug among children and adolescents is alcohol.

Illicit drugs

The most commonly used illicit drug among youth in the United States is marijuana.

Use of illegal anabolic steroids has decreased, but remains a concern.

Sex Education

Teens are becoming sexually active at earlier ages, and, despite recent declines, pregnancy rates continue to be high.

Sex education in the school setting is a controversial topic.

21 states mandate sex education be taught

No research concludes that sex education in the schools increases sexual activity

Other Educational Topics

Tattoos and body piercing

Making healthy decisions about body and sanitary conditions where procedures are performed

Dental health

Proper oral hygiene and regular dental check-ups

Relationship between high-sugar foods and dental caries

Physical education

Promotion of lifelong physical activity

Health Services

Immunizations

All states now require proof of current immunization status or evidence of immunity before school entrance.

Health screenings

Vision is required in most states

Hearing screenings

Scoliosis or postural screening

High blood pressure screening

EPSDT: Early and Periodic Screening, Diagnosis, and Treatment created by Medicaid

Health Services (Cont.)

Emergency care

First aid, CPR, Emergency Care Plans (ECP)

Care of ill children

Management of acute and chronic health

conditions

Medication administration

Children with special health needs

Public Law 99-142 (1976) gave all children the right to public education in the least restrictive environment possible regardless of mental or physical disabilities

Individuals with Disabilities Education Act of 1990

Health Services (Cont.)

Student Health Records should include:

Immunization status

Pertinent history

Results of screenings and examinations

IHPs (Individualized Health Care Plan)

Family Educational Rights and Privacy Act (FERPA)—strong privacy protection act of education and health records

Health Insurance Portability and Accountability Act of 1996 (HIPAA)—confidentiality of personal health information

Health Services (Cont.)

Delegation of tasks by the school nurse

Not all schools have a nurse; a nurse may be assigned to multiple schools.

Nurse is responsible, but each state’s nurse practice act stipulates what can be delegated.

Nurse must provide appropriate education, written procedures, and ongoing supervision and evaluation of the caregivers for tasks delegated to others.

Responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated.

Health Services (Cont.)

Nutritional concerns

Junk food and school vending machines

Skipping meals, especially breakfast

Unhealthy snacks

Identifying nutritional problems, counseling and making appropriate referrals

Eating disorders

Anorexia, bulimia, and binge eating

Obesity—fastest rising public health concern

Nutrition education programs

Female Athlete Triad

A syndrome consisting of…

eating disorders,

amenorrhea, and

osteoporosis.

A complex problem with psychological and physiological factors.

Can result in menstrual irregularities, premature osteoporosis, and decreased bone mineral density; if taken to the extreme, it can become life threatening

– Data from Nemours Foundation: Female Athlete Triad (2010) www.KidsHealth.org/teen/food_fitness/sports/triad.html

Counseling, Psychological, and Social Services

Promotion of mental health

Reduction or removal of threats to mental health

Depression

Substance abuse

Conduct disorders

Self-esteem issues

Suicidal ideation

Eating disorders

Under- or over-achievement

Healthy School Environment

“All students and staff have an inherent right to learn and work in a healthy school environment, and that the school nurse can assess the school environment for risk factors, advocate for the school community, to address environmental pollution issues, and educate the community to the impacts of environmental issues and exposures.”

– NASN (2012)

Healthy School Environment (Cont.)

Violence is a major public health problem because it threatens the health and well-being, both physical and psychological, of many children and adolescents.

Be aware of risk factors and signs that could indicate a tendency toward violence.

Violence prevention programs

Stress management

Conflict and anger resolution

Personal and self-esteem development

Healthy School Environment (Cont.)

Terrorism

Every school is expected to have an emergency management plan.

Many states mandate plans for potential threat of terrorist attack or natural or man-made disaster.

Nurse is a potential first responder and should be an active participant in planning and policy development.

Health Promotion for School Staff

Health promotion programs at the work site produce beneficial results.

Positive effects on blood pressure control

Daily physical activity

Smoking cessation

Weight control

Improve morale

Reduce job stress and absenteeism

Heighten interest in teaching health-related topics to students

Family and Community Involvement

The school nurse is a resource to the community; performs many roles:

Educator

Resource/leadership role

Consultant

Advocate

Students who have parental support are more successful, experience less emotional distress, eat healthier, and are more actively engaged in learning (see Family Risk Index)

Family Risk Index (Annie E. Casey Foundation, 2002)

Children living in families with four or more of the following characteristics are considered “high risk” …

Child is not living with two parents

Household head is a high school dropout

Family income is below the poverty line

Child is living with parent(s) who does not have steady, full-time employment

Family is receiving welfare benefits

Child does not have health insurance

Percentage of children living in "high-risk" families, based on the definition above, is 10%

School Nursing …

… is a specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning.

– National Association of School Nurses (2000)

School Nursing Practice

Education needed by school nurse:

Growth and development

Public health

Mental health nursing

Case management

Program management

Family theory

Leadership

Cultural sensitivity

Bachelor’s degree or higher recommended

Roles of the School Nurse

Care provider

Student advocate

Educator

Community liaison

Case manager

Delegate cares and supervise others

Practice independently as a member of an interdisciplinary team

Conduct research

School-Based Health Centers

One of best ways to offer comprehensive health care to children and adolescents.

An interdisciplinary team approach

Nurse practitioners

Social workers

Psychologists

Physicians

Provide services on site

Works in collaboration with, but does not take the place of the school nurse.