I. School Health Services - Introduction

School Health Services are established at the school site to promote the health of students through disease prevention, early case finding, referral for intervention and remediation of specific health problems. The school health services are vitally necessary in order to provide first aid and triage for illness and injuries, to provide direct services for students with special needs, and to provide health counseling and education for students, staff, and parents.

To this end a professionally prepared School Nurse plans, implements, and evaluates the school's Health Services Program based on the health and educational needs of the students and the school community.


Purpose of the School Health Services Program

The primary purpose of the School Health Services Program is to promote the physical and emotional health of students and staff thereby maximizing the educational process. School Health Services are intended to play an integral part in support of the health care provided by parents; indeed, the School Nurse often serves as the student's vital link to medical and other community resources.

Adapted, and used with permission, from School Health: Policy and Practice ©1993. Committee on School Health, American Academy of Pediatrics, P.O. Box 927, 141 Northwest Point Blvd., Elk Grove Village, IL 60009-0927

The goals of the School Health Services Program are to:

  1. Facilitate students' access to a regular source of primary health care
  2. Provide a system for expert handling of emergency medical situations
  3. Provide mandated health screening programs and monitor or improve immunization status
  4. Assist in the identification and resolution of students' health and educational problems
  5. Ensure comprehensive and appropriate health education is provided
  6. Promote a healthful and safe school environment which facilitates learning
  7. Provide a system for evaluation of the effectiveness of the school health program

These goals form a framework for the development of specific program activities. A school needs-assessment and inventory of existing and potential community resources will identify priorities most crucial to each unique school district. The outcomes of an effective School Health Services Program should have measurable impact on students, staff, and community.

The Continuum of Health Care

Partners in the Continuum of Care of Community Health: School Health Services, School Nurse, and Community Physicians

Health Services traditionally are the cornerstone of a comprehensive school health program. A qualified, registered professional School Nurse (RN) serves to identify, assess, and intervene in the treatment of a myriad of minor and major health problems.

These health services are not intended to supersede the parents' health care responsibilities nor to supplant the role of the physician.

Optimally, school health services are a significant component in a continuum of care from the family to the community health care system. This continuum is necessary to maintain students' health thereby promoting optimal participation in their educational process.

The Formal Health Services Plan

A quality health services program has a formalized, written plan, specifying policy and procedures for assessment, screening and delivery of health services to both students and staff A comprehensive range of preventive and primary health services are available and supported by appropriate medical and administrative protocols.

HUMAN RESOURCE REQUIREMENTS of the Health Services Plan

The formal plan of the school's Health Services program identifies human resource requirements essential to a quality program by:

  • specifying staffing patterns,
  • delineating individual responsibilities in job descriptions,
  • designating supervision and evaluation requirements.

Staffing patterns are set in accordance with national standards for ratios of School Nurse to students (1:750).

Different ratios have been established for populations of students with special needs (1:225 -- mainstreamed, 1:125 -- severely/profoundly disabled)* wherein school nurses participate in the development of individualized education plans (IEPs) which explicitly address each unique student's health need.

(*Note: Although this ratio is the recommended standard nationally, Nebraska's School Health Advisory Committee recommends a ratio of 2:125 -- i.e., 2 nurses for every 125 severely/profoundly disabled students.)

MATERIAL RESOURCES REQUIRED by the Health Services Plan

The formal plan also identifies material resources which include appropriate facilities.

The school's health office must assure that the nurse has privacy for verbal communication with students and staff, as well as for confidential telephone communication with parents and medical providers.

It is also imperative that restrooms and handwashing facilities be within or immediately adjacent to the health room.

Funding must be designated for equipment, supplies, and professional educational materials.

Nebraska's Comprehensive School Health Education Plan

"Healthier Children -- Healthy Nebraska"

"Healthier Children -- Healthy Nebraska" ... A Health Enhancement Program for School and Community

Professionally certificated School Nurses actively support all nine components of Nebraska's Comprehensive School Health Education Program:

  1. sequential health instruction
  2. health services
  3. healthful school environment
  4. staff health promotion
  5. physical education
  6. counseling-psychological services
  7. nutrition-food services
  8. parent-community partnerships, and
  9. program management

References and Recommended Resources

RESOURCES for Additional Information on School Health Services

Confidentiality and Collaboration: Information Sharing in Interagency Efforts, (1992). No. AR-92-1. Education Commission of the States (ECS), Distribution Center, Suite 2700, 707 17th Street, Denver, CO 80202-3427

Evaluating School Nursing Practice: A Guide for Administrators, First Edition, (1987). American School Health Association, P.O. Box 708, Kent, OH 44240

Full-Service Schools Dryfoos, Joy; Jossey-Bass, 350 Samsome St., San Francisco, CA 94104

Guidelines for the Delineation of Roles and Responsibilities for the Safe Delivery of Specialized Health Care in the Educational Setting (1990). The Joint Task Force for the Management of Children with Special Health Needs, Council for Exceptional Children, 1920 Association Drive, Reston, VA 22091- 1589

Healthy People 2000: National Health Promotion and Disease Prevention Objectives (1990). No. PHS 91-50213, Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20220-1498

Healthy Youth 2000 (1992). American Medical Association, Department of Adolescent Health, 535 N. Dearborn St., Chicago, IL 60610

Recommendations for Delivery of Comprehensive Primary Health Care to Children and Youth in the School Setting (1988). American School Health Association, P.O. Box 708, Kent, OH 44240

School Health: Policy and Practice (1993). Committee on School Health, American Academy of Pediatrics, P.O. Box 927, 141 Northwest Point Blvd., Elk Grove Village, IL 60009-0927

School Nursing Practice: Roles and Standards (1993). Proctor, S.T., Lordi, S.L. and Zaiger, D.S.; National Association of School Nurses, Inc., P.O. Box 1300, Scarborough, ME 04074-1300