This budget includes funds for equipment, supplies, and appropriate facilities.
The Superintendent of Schools
The Board of Education delegates authority to the Superintendent of Schools to implement the policies and regulations set forth. The Superintendent is the key person in the development and implementation of a quality school health services program. Clear communication of the relationship of health to the educational process will assure health services are properly placed in the administrative organization of the school district.
The Superintendent delegates responsibility for the total school health services program to a coordinator, preferably the School Nurse. School Health Service goals are reviewed periodically and evaluated annually with the School Nurse managing the program. The School Health Services Program is most effective when the School Nurse manager is included at the administrative decision-making level.
A school-community Health Advisory Council should be formed to assure child health is a priority issue and to foster cooperation and collaboration among agencies serving families and children.
Members of the community at-large should be invited to serve on this Health Advisory Council, including representatives from health care, labor, business, government, and financial institutions along with student leadership, the parent-teacher association, school administrators and staff.
The Importance of School Administrative Support
Administrative support can create a comprehensive school health model which becomes a major initiator and promoter of health care in the community. Such school health models help assure:
Beyond The Health Room (1991). Resource Center on Educational Equity, Council of Chief State School Officers, Suite 379, 400 N. Capitol Street, N. W., Washington, D.C. 20001
Building a Healthy Future (1990). West Virginia Task Force on School Health, West Virginia Dept. of Education, Attention: Lenore Zedosky, Room B309, Capital Complex, 1990 Kenewil Blvd., Charleston, West Virginia 25305
Code Blue: Uniting for Healthier Youth, (1990). National Association of State Boards of Education, 1012 Cameron Street, Alexandria, VA 23314
Crossing the Boundaries Between Health and Education, (1990). National Commission to Prevent Infant Mortality, Room 2014, Switzer Building, 330 C Street, S.W., Washington, D.C. 20201
Healthy Kids for the Year 2000: An Action Plan for Schools, (1990). American Association of School Administrators, 1801 North Moore Street, Arlington, VA 22209
On the Right Track for Health: A Guide for Implementing Comprehensive School Health and Wellness Programs in New York State (1992). The University of the State of New York and The State Education Department, Division of Pupil Health and Fitness, Albany, NY 12234
Principles and Practices of Student Health: School Health, Volume 11 (1992). Wallace, H.M.; Patrick, K.P.; Parcel, G.S. & Igoe, J.B.; Third Party Publishing Company, P.O. Box 13306, Montclair Station, Oakland, CA 94661-0306
School Health: Helping Children Learn, (1991). National School Boards Association, 1680 Duke Street, Alexandria, VA 22314
The State of America's Children (1993). Children's Defense Fund, 122 C Street, N.W., Washington, D.C. 20001
Recognizing environmental factors play a major role in the health and safety of both students and staff, schools should attend to the social and emotional environment as well as to the physical environment .
Physical Environment /Health Office / Classroom Environment / Laboratories / Food Programs / Outdoor Activities / School Playground / Americans with Disabilities Act
The School Nurse, in accordance with local administrative policy, and using OSHA guidelines as a resource (OSHA, Federal Register, 29 CPR, Parts 1910.1030, pages 64175 to 64182), should implement universal, precautions for all staff as an infection control measure against blood borne pathogens and other potentially infectious materials. Job descriptions should identify specific staff at risk for exposure to Hepatitis B. These staff should be counseled about Hepatitis B prophylaxis, and all staff must be made aware of the importance of immediately notifying administration and a medical provider should an exposure occur. All potentially infectious materials shall be disposed of in accordance with OSHA guidelines.
Biological Hazards
Biological hazards besides bacteria and viruses also exist, e.g., molds, parasites, poisonous plants, insects and animals. Therefore, science teachers must also follow universal precautions. Animals used in classrooms should be limited to caged varieties, e.g., rabbits, hamsters, guinea pigs, gerbils, or laboratory mice and rats. Only teachers or assigned students (with parental permission) using proper protective equipment should handle and feed animals. If bites occur, the local law enforcement officer should be notified and the health department may be contacted for advice on how to proceed.
The health office should be located near the administrative offices where students, parents and staff may find easy access. The health office must provide toilet and hand washing facilities (soap and warm, running water) to ensure appropriate infection control procedures are maintained during the management of ill and/or injured students.
Adequate privacy, space, and cots (1:400 students) should be available to allow students who become ill students to rest. Students with contagious diseases must be excluded according to public health guidelines.
Students' right to confidentiality must always be protected; therefore, health records should be maintained in locked files and appropriate telephone services should always be available in the health office.
A model plan for structuring a health office is available from the Nebraska Health and Human Services, School Health Program. Guidelines for suggested materials and supplies are found later in this section. (See School Health Equipment & Supplies later in this section.)
The plant management staff shall maintain appropriate environmental standards for temperature, humidity, noise, and light. They should perform preventive maintenance assuring adequate ventilation and removal of environmental contaminants such as pesticides, improperly diluted cleaning agents, combustion gases from cafeterias and laboratories, and cigarette smoke. It is critical that all schools establish a smoke-free and tobacco-free environment not only to address the air quality issue, but also to reinforce health teaching about the hazards of tobacco use and the dangers of exposure to second-hand tobacco smoke.
Classroom Temperature and Humidity
All staff should be aware that temperature extremes affect performance and health. Comfort depends on the simultaneous control of temperature, humidity and air movement. Classroom temperatures should be set at a minimum of 68 degrees Fahrenheit during the winter and at a high of 79 degrees Fahrenheit during the summer. Optimum humidity levels, taken at the level of the seated student, should be between 40 and 60 percent. (Refer to Nebraska Clean Indoor Air Act. 71-5701 to 71-5713.)
Science , Industrial and Fine Arts Labs
The staff responsible for science, industrial and fine arts labs must adhere to safety recommendations regarding proper storage of chemicals, availability of safety equipment and protective gear, and the use of safety practices. Teachers should complete each experiment themselves before assigning it to students. All students should be familiar with emergency procedures. Protective eye wear and proper eye washing facilities should be available. Material Safety Data Sheets (MSDS) on all chemicals should be provided to the health office.
All waste products should be disposed of in an environmentally safe manner. All asbestos fiber identification and removal must be in accordance with federal and local standards and guidelines. All schools must test for lead if they did not identify and replace water coolers containing lead components. (Refer to Nebraska Asbestos Control Act, 71-6301 to 71-6317; and Nebraska Safe Drinking Water Act, 71-5301 to 71-5313.)
School Lunch and Breakfast Programs
The health promoting quality of school breakfast and lunch programs must be assured. Foods should be prepared in a healthful manner and served attractively to provide powerful messages to students that equate nutritional choices with positive health consequences. Vending machines should be turned off during lunch hours. Indeed, school policy should support replacing vending machine 'junk food' with healthy food choices.
The staff should utilize the heat and humidity index and wind-chill factor to determine whether conditions are safe for outdoor student activities. Sun stroke and heat exhaustion are likely to occur when the heat index reaches 105 0 (Fahrenheit). Bitter cold will cause human flesh to freeze in one hour at a temperature of 18 ° (Fahrenheit) and a wind speed of 22 miles per hour. Therefore, children should be kept indoors at a very cold wind-chill equivalent of 15 - (F).
All school playgrounds should have adequate surface protection under equipment to soften falls. Playground equipment should be developmentally appropriate and inspected regularly to ensure proper maintenance and safety. Students should be supervised by adequate numbers of adults during play. Factors contributing to the largest number and most severe injuries on the playground should be reviewed regularly and addressed. Prevention should be taught in the classroom.
The Americans with Disabilities Act
The Americans with Disabilities Act of 1990 guarantees people with disabilities equal access to employment, transportation, public services, public accommodations, and telecommunications. School must either remove physical barriers or provide alternative methods of providing services. (See Section VII, for a summary of the Act.)
Teaching practices like cooperative learning can foster social and emotional growth as students work in teams, sharing strengths and weaknesses, which benefit each other's learning style. Specific social skills, like sharing, apologizing, negotiating, avoiding fights, and dealing with peer pressure, can also be taught directly through cooperative learning activities. Role play allows students to practice such skills.
Planning and organization of the school day are also important aspects of the emotional climate. Scheduling should include time for students to take care of their basic physical needs. Emphasis on healthful living habits, such as appropriate handwashing after toileting and before eating, can influence students' current and lifelong health status.
Schools should have student assistance programs in place to identify students who are experiencing academic, social or emotional problems in school and to direct them to qualified persons for help. Appropriate discipline plans also enhance the school environment. The focus of such a plan should be on building student self-esteem and problem solving skills. Conflict resolution skills should be taught to all students at the earliest possible age in an effort to stem the trend toward youth violence.
Many events in the school community may affect the emotional well-being of students and staff. A crisis team composed of administrators, nurses, counselors, and teachers may be needed to intervene in such traumas as attempted suicide, death, violence or natural disasters directly affecting the school. A district plan should assure appropriate personnel are trained, confidentiality is protected, proper dissemination of information occurs so that individual emotional needs are served while minimizing rumor or over-reaction.
SITE SELECTION AND SAFETY
The school shall be so located as to provide the student with the maximum amount of health and safety possible as it relates to access and usage. In addition, the site shall be large enough to accommodate such things as playground area, water and sewage systems if community systems are not conveniently available. Consideration with regard to site selection should also be given to such things as noise and odors.
The grounds, including playground equipment and structures, shall be maintained so as not to present any unreasonable health and safety hazard.
STRUCTURE, PREMISE SANITATION AND VECTOR CONTROL
All school buildings shall be structurally sound and of such construction as to include materials which enables the facility to be properly cleaned.
Proper premise sanitation is to be practiced both within the school structure and the adjacent grounds so as to prevent the school area from being an attractant for rodents and insects.
Failure to follow such practices will eventually result in costly structural damage and pose a potential health hazard to school staff, students and visitors.
In relation to the proper storage and use of pesticides, schools having insect and/or rodent related problems or questions are to contact the Nebraska Health and Human Services, Division of Drinking Water and Environmental Sanitation for assistance.
HEATING, LIGHTING and VENTILATION
Adequate heating, lighting and ventilation systems are a must. An inadequacy of any of these three systems will affect the health of an individual, and in the case of a student, serve as an irritant, thereby preventing the student from getting the most out of the educational process.
The following minimum standards should be met:
WATER SYSTEMS AND PLUMBING
Basic Water Systems
An adequate and safe water supply is of prime importance for every school. The best source is a safe municipal supply. In the absence of a municipal supply, it will be necessary for the school to develop its own pressurized water supply. For schools located in areas where pressurized water supplies are not possible, alternate means of supplying water will be considered on an individual basis.
Water Systems Serving a School:
Water supplies must meet the physical, chemical and biological requirements set forth in the current accepted state and/or federal potable water quality standards.
*Note: The Water Sampling Program does not apply to schools which use water systems serving villages, cities, or a rural water district, as these systems are presently involved in a water sampling program.
These samples are to be submitted to the State Department of Health Laboratory or any other laboratory approved by the Department.
Detailed information relating to proper water system construction is available from the Nebraska State Department of Health, Division of Drinking Water and Environmental Sanitation upon request.
Dispensing of Drinking Water
Where water under pressure is available, the number of water fountains provided shall be based on the ratio of one unit for every 90 students. At least one fountain should be located on each floor. There should be one or more drinking fountains in the school lunchroom, shops, and locker-dressing rooms. In schools where a pressure system is not possible, the dispensing of water will be considered on an individual basis. The use of a common drinking container is prohibited.
SEWAGE DISPOSAL SYSTEMS
Wherever possible, the school shall be connected to the municipal sewage collection system. If this is not feasible, then an alternate form of sewage treatment must be determined. However, regardless of the methods of disposal, sewage shall be disposed of in a manner which will protect the health of the general public and members of the immediate school community.
This requires that wastes be disposed of as follows:
Detailed information relating to the proper design, operation and maintenance of privies, septic systems and stabilization ponds is available from the Nebraska State Department of Environmental Quality upon request .
TOILET FACILITY
Each school shall be provided with at least one toilet room for boys and one toilet room for girls. Flush-type toilets, chemical toilets, earth-pit toilets or any other approved type of toilet facility will meet this requirement provided all flush-type toilets shall have sufficient pressurized water supply to properly operate such a toilet.
Facilities shall be conveniently located and provided on the ratio of one toilet for every 35 girls. The same ratio shall apply for boys except where urinals are provided at a ratio of one to every 30, one toilet for every 90 boys is adequate.
Provisions shall be made for adequate ventilation of the restroom area. The floors, walls, and ceiling of the restroom facility shall be of such construction as to allow proper cleaning of the area. Lighting of the area shall be such as to enable adequate cleaning and disinfection of the facility on at least a daily basis when in use.
HANDWASHING FACILITIES
Running water shall be provided for handwashing facilities. Handwashing facilities located in the restroom area, served by running water, shall be provided at the ratio of one lavatory for every 50 students. Both hot and cold water dispensed through a mixing tap -- or better still, tempered water -- should be made available. In all cases, the temperature of the hot water supplied to shower and handwashing facilities shall not exceed 120°(Fahrenheit). Soap and an approved method for drying hands shall be provided.
Provisions for handwashing facilities in schools not equipped with running water will be considered on an individual basis provided school with flush-type toilets shall provide hand-washing facilities in the restroom areas.
SOLID WASTE DISPOSAL
The outside storage of solid waste shall be accomplished with the use of an adequate number of containers which shall be cleaned as necessitated to eliminate odors and to prevent the container from serving as a breeding area for flies and other insects.
The refuse shall be disposed of at least weekly or more frequently if necessitated during the summer months in an approved manner.
FOOD SERVICE
The degree of food service which a school provides to the student(s) is optional.
However, those food services that are provided and used in relation to the school's food program (to include facilities, equipment, etc. ), must conform to the applicable portion of the then current standards and specifications approved by the Federal Food and Drug Administration or its successor association.
Copies of the food standards are available from the Nebraska Slate Department of Health, Division of Drinking Water and Environmental Sanitation, upon request.
SWIMMING POOL
The design and construction of swimming pools must be approved by the Department of Health before they are constructed or put into operation.
The Department of Health is charged with the responsibility of surveillance of school swimming pools, conducting training sessions for swimming pool operators leading to operator certification, and issuing and revoking permits to operate pools.
Swimming pools must comply with the rules and regulations and operational procedures as described in the "Rules and Regulations" embodied in the Nebraska Swimming Pool Act of 1969 as amended, copies of which are available from the State Department of Health.
For further information, contact the Nebraska State Department of Health, Division of Drinking Water and Environmental Sanitation.
Guidebook for Student Assistance Programs (1991)
Marquette: Eastern Upper Peninsula Substance Abuse Services
1500 W Washington St.
Marquette, MI 49856
Phone: 313-467-1399
Handbook for Public Playground Safety
US Consumer Product Safety Commission
Washington DC 20207
Journal of School Health
American School Health Association,
Dec. 1987, Vol 57, No. 10, pp 426-431
Play It Safe: A Guide to Playground Safety
American Academy of Orthopedic Surgeons
P.O. Box 738
Park Ridge, IL 60066
Tips for Improving School Climate
American Association Of School Administrators
1801 N. Moore St.
Arlington, VA 22209-9988
Phone: 703-528-0700
Wayne County School Health Manual (1993)
Wayne County Health Department
30712 Michigan Avenue
Westland, MI 48185
(313) 467-3300
II. SCHOOL ADMINISTRATOR - SCHOOL HEALTH EQUIPMENT & SUPPLIES
Equipment and Supplies for a School Health Services Program Health Room
| Clock with second hand Computer Desk and Chairs Filing Cabinet with drawer to be locked Nursing Reference Books Otoscope Puretone audiometer Aluminum folding stretcher or evacuation chair Antiseptic soap Ace bandages Band-aides Bandages with non-stick pads Basin for soaking Box or Cabinet with lock for prescription medications and medical supplies Cots (low, flat, with washable surfaces) Cotton balls in container Cotton-tipped Applicators in container Dental Floss Disinfecting Solution for thermometers Ear Speculums Emergency medication kits for allergic reactions Emesis basin Flashlight Folding Screen for privacy (or curtains) Forceps Gauze Pads in assorted sizes Gooseneck Floor Lamp Sphygmomanometer with X-Large Adult and Pediatric cuffs Heating Pad Ice Packs | Kleenex Measuring device to measure height (stadiometer) Paper Cups and dispenser Pillows with disposable covers Paper Towels Refrigerator Roller Gauze in several widths Safety Pins Sanitary Napkins (individually wrapped) Scissors (bandage; cuticle; and all-purpose) Splints (Yucca Board or plastic) Sterile petroleum jelly Storage Cabinet for Health Room supplies Tape (assorted widths) Non-mercury thermometers Tongue Blades in container Triangular Bandages Wastebasket with cover and Disposable Garbage Bags Nebulizers Epi pen Blood Borne Pathogens containers Sharps container Albuterol Vinyl gloves Stethoscope Telephone with access to an outside line Tympanometer (or access to) Vision testing equipment (wall charts and/or vision testing machine) |
Some local policies and procedures of which the school's health services Administrator should be knowledgeable are:
Comprehensive School Health Program
School Health Services
Healthy Environment
Health Promotion (Staff and Community)
Parent/Community (School Health Advisory Committee)
Guidance Counseling
School Food Service
Physical Education
Health Instruction (Curriculum)
Program Management
Personnel Policies of Local School Districts
Criteria for employment (job specifications)
Employee health examinations
Food service health policies
In-service obligations and opportunities
Policies regarding benefits, leave of absences
Student Policies
Prevention and control of communicable disease
Care of illness and injury
Emergency transportation of ill or injured students
Special Education needs -- role of school nurse -- policy regarding "Do Not Resuscitate" Orders
Physical education and sports examinations, excuses, adaptations, protective equipment
Injury prevention, legal liability
Environmental Policies
Sanitation codes and inspection
School safety and physical facilities
Playground safety
Bus Safety
Fire prevention and protection
Community emergency and disaster plans -- school district role
Hazards in the workplace
Infection control (universal precautions; blood-borne pathogens)
General Policies
District structure
Transportation