V. The School Nurse's Unique Role

The basic continuum of care is provided under the direction of the School Nurse.

To provide and maintain this continuum of care, the School Nurse first creates a safe and healthful environment at each school site by the following:

• universal precautions are instituted
• emergency care guidelines are established (all staff should be trained in first aid, and a minimum of three should be certified in CPR)
• medication policies are developed and locked storage provided (see Section II).
• immunization status must be verified and students excluded until compliance is achieved (see Section VII).
• routine procedures for caring for ill or injured students are developed and carefully documented
• Individualized Health Plans (IHPs) and/or Individualized Education Plans (IEPs) are developed for students with special health needs

(Portions of this section were adapted from Chapter 7, by Diane Alansworth, and reprinted with permission, from The Comprehensive School Health Challenge, ©1994, ETR Associates, Santa Cruz, CA. For information about this document and other related materials, call 1-800-321-4407.)

The School Nurse and The CONTINUUM of CARE

Secondly, to provide and foster this continuum of care, the School Nurse assesses the health status of each student with the goal of early detection of health problems, referral for diagnosis and treatment, and appropriate modification of the educational environment to accommodate students whose disabilities are not amenable to remediation.

The School Nurse maintains this continuum of care by:

• establishing and safeguarding an individual health record for each student (see "The Student Health Record" later in this section).
• developing a system of documentation which meets standards of practice while complying with the Federal Privacy Act and Code of Ethics for Nurses to protect the student's right to privileged health information
• providing data collection for ongoing evaluation of the school health services program, as well as surveillance of student health status for state health planning purposes
• obtaining appropriate and periodic health histories
• maintaining current knowledge of community resources and their referral criteria
• reviewing the student's sports physicals and mandatory physical exams at entry level, seventh grade, and upon transfer from another state
• conducting screening programs, referral and follow-up
• conducting system specific nursing physical assessments when students request care at the health office
• adhering to state laws, regulations and rules, district and local policies relating to mandatory reporting of child abuse
• becoming familiar with the Federal and state legislation, rules and regulations relating to students with disabilities
• continuously monitoring the health status of students with special health care needs via health care plans
• delegating special care procedures to qualified staff only as permitted by the nurse practice act (Nursing 71-1, 132.04 to 71-1, 132.53)

The School Nurse and Health Promotion and Education for Students ... Staff ... School Community

The School Nurse must be dedicated to health promotion for students, staff and school community. Efforts should be directed toward implementing Nebraska's comprehensive, sequential K-12 (kindergarten through 12th-grade) health curriculum. School nurses may provide valuable resources, serve as guest lecturers and curriculum advisors.

Health education must occur at multiple "teachable moments" for individual students, parents, and staff All screening activities conducted by the School Nurse should include appropriate educational materials for students and their families.

Staff education relative to an individual student's health problems are based on a "need-to-know"; however, the School Nurse should conduct full staff, in-service training on health concerns common to all students. For example, the School Nurse should see to it that all school staff members are trained in recognizing rashes, pediculosis, seizures, diabetic reactions, asthma symptoms, and child abuse.

Parent and community health education can be facilitated via the school newsletter and parent meetings. Wellness activities developed for site use by staff and parents should be encouraged. Students, families, and staff should be taught to be wise consumers of health care -- including how and when to use the appropriate health care resource.

Expanded Health Service Programs

Expanded health promotion includes an interdisciplinary task force to address health hazard appraisal, fitness screening, developmental evaluation and nutritional history.

Health and safety instruction, use of the cafeteria as a nutritional learning laboratory, and environmental monitoring are thus added to the traditional health services program.

Expanded services might also include participation of part-time mental health providers in developing a Student Assistance Team to assist teachers in the recognition and referral of students with significant behavioral and emotional problems.

Comprehensive Health Service Programs

Comprehensive health service programs are models wherein primary physical and mental health care is provided in school-based or school-linked health centers or clinics.

Licensed nurse practitioners or physician assistants and licensed mental health professionals staff these centers with community medical providers available for referral, and during periods when school is not in session.

The Nebraska Health and Human Services is committed to fostering these models where factors exist which interfere with students' ability to find accessible, acceptable, affordable, quality health care.

Such factors might include students who:

• are identified "at-risk",
• have no medical-hospital insurance,
• are on free or reduced lunch,
• are living in single parent families,
• have both parents employed outside the home.

Creating interagency partnerships offers the best opportunity to secure funding for these models. School-community support and local control is fundamental to their success.