2020 School Health Conference Q/A February 19, 2020 Staffing and - - PowerPoint PPT Presentation

2020 School Health Conference Q/A

February 19, 2020

Staffing and Nurse Roles in the Schools

• Telehealth is great but let’s think bigger. Let’s utilize our Advanced Practice

Nurses in our school districts. Any thoughts on that? How would that look? Can Children’s Hospital help make that a reality in Virginia?

• I will not be able to attend this meeting however my burning issue is that

even with all of this information, without a bonafide nurse, a real nurse, an RN preferably, the students would not have the care that they would need in the event of any of the above mentioned conditions or occurrences. We need to get RNs in the schools to make this work. Let’s get that done before we ask someone who is labeled as a "school nurse" and is not, to do any kind of assessment. I appreciate your training but first things first. Let’s get trained nurses in the schools and make it a requirement.

School physician and School nurse

• Recommendations from the AAP Council on School Health is for every

school system have a school physician and that each school have registered professional school nurse. “Promoting the presence of a qualified school nurse in every school and a school physician in every district fosters the close interdependent relationship between health and education. Academic achievement, improved attendance, and better graduation rates can be a direct result

• f a coordinated team effort among the medical, family, and

educational homes all recognizing that good health and strong education cannot be separated.”

From School Health: Policy and Practice, 7th edition

School School Nur Nurse‐Ke Key Ro Roles

• Clinicians/care coordination
• Leaders
• Advocates
• Health Promoters
• Educators
• Policy Makers
• Community Liaisons

From School Health: Policy and Practice, 7th edition

Role of the School Nurse

• Facilitate normal development and positive student response to

interventions

• Providing leadership in promoting student health and safety, including

healthy environment

• Provide quality health care and with actual and potential health problems
• Use clinical judgement in providing case management, self‐advocacy, and

learning

• Actively collaborate with others to build student and family capacity for

adaption, self‐services

https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNpositionstatementsFullView/tabid/462/ArticleID/87/Role‐of‐the‐School‐Nurse‐Revised‐2011

https://www.nasn.org/nasn/advocacy/professional‐practice‐ documents/position‐statements/ps‐role

Role of the School Nurse

• School nurses lead in the development of policies, programs, and procedures for the provision of school health

services at an individual or district level, relying on student‐centered, evidence‐based practice and performance data to inform care

• the school nurse leads in delivery of care that preserves and protects student and family autonomy, dignity,

privacy, and other rights sensitive to diversity in the school setting

• As an advocate for the individual student, the school nurse provides skills and education that encourage self‐

empowerment, problem solving, effective communication, and collaboration with others

• At the policy development and implementation level, school nurses provide system‐level leadership and act as

change agents, promoting education and healthcare reform.

• School nurses employ cultural competency in delivering effective care in culturally diverse communities
• The school nurse strives to promote health equity, assisting students and families in connecting with

healthcare services, financial resources, shelter, food, and health promotion.

• School nurses are members of two divergent communities (educational and medical/nursing), and as such are

able to communicate fluently and actively collaborate with practitioners from both fields (Wolfe, 2013). As a case manager, the school nurse coordinates student health care between the medical home, family, and school.

• School nurses deliver quality health care and nursing intervention for actual and potential health problems.
• Continuous quality improvement is the nursing process in action: assessment, identification of the issue,

development of a plan of action, implementation of the plan, and evaluation of the outcome.

https://www.nasn.org/nasn/advocacy/professional‐practice‐documents/position‐statements/ps‐role

Infectious diseases (eg, outbreak control) Public health (eg, risk assessment and management, resources) Immunizations (eg, school requirements and medical contraindications) Medical‐legal issues State and district school and public health laws, regulations, and policies IDEA, Section 504, and ADA FERPA and HIPAA and how they intersect in the school setting Adolescent health (eg, brain development and reproductive health)

Critical Knowledge Base for School Physicians

ADA, Americans With Disabilities Act; FERPA, Family Education Rights and Privacy Act; HIPAA, Health Insurance Portability and Accountability Act; IDEA, Individuals With Disabilities Act. ↵a Unless there is a separate team physician

Emergency preparedness (eg, children with special health care needs) Environmental and occupational health (eg, indoor air quality) Health and learning (eg, medical, emotional, attentional, and learning problems that affect learning) Social services resources (eg, access to health insurance and assistance programs) A coordinated school health model (eg, health services, health education, healthy and safe environment, physical education and activity, nutrition services, counseling/psychology/social services, staff health promotion and family/community involvement) Sports medicine The value of physical education and physical activity at school Injury prevention Conditioning Disqualifying conditions Hydration The effects of climate extremes on athletes Concussion management Adaptive physical education

Mandated Services Physical exams (grade mandated, special education, work permits, sports participation) Oversight of return to sports (eg, concussion management programs) Active member on teams/committees (eg, special education, wellness, health education) Consultation Write standing nursing orders/protocols Athletic advisor/team physician Oversee health aspects of athletic programs and best practice standards Infectious diseases esp. for close contact sports Participation of athletes with serious medical conditions Adaptive physical education for acutely injured or chronically disabled youngsters Mixed gender competition Develop policies Contagious diseases/pandemics Restraint, suspension, expulsion Bullying Reproductive health Chronic school absenteeism Develop protocols Delivery of medications Seizure management Diabetes care

Roles for School Physicians

Anaphylaxis management Asthma education and management Assist in the management of specific medical emergencies or immediacies Participate at the building level in comprehensive, multidisciplinary teams and wellness councils Programmatic leadership Health program evaluation and quality improvement Health education Mental health promotion programs Nutrition and food services Physical activity and education Staff wellness Family and community education Liaison with primary care physicians regarding specific concerns Professional performance development Evaluation and collaborative oversight of nursing staff and other health service providers, including one‐on‐one nurses and door‐to‐door transportation Reviews of emergency care plans for children with life‐threatening conditions. Classroom observations of children with special needs Health education curriculum development Direct consultation with principals or the superintendent Medical‐legal issues Parent attorneys or advocates in accommodation disputes and hearings Building and playground health and safety Bloodborne pathogen incidents School closure related to illness or weather extremes, or infections that affect public health

Advanced Practice Nurses in Schools

• Yes it is possible and is happening in some dedicated

School‐Based Health Clinics

• Similar issues to physicians in schools
• Cost/Economics
• Liability
• Legal arrangements

Asthma Questions

• If a student comes to the clinic requesting his inhaler, and my assessment

shows everything normal/good, I still give the student a dose of his

• inhaler. Is this correct? Yes immediately but if this is happening

recurrently may need to check in with his clinician, consider use of peak flow meter to document

• Asthma inhalers ‐ Some kids parents want the child to take the inhaler

every day. I notice with some kids they have less visits to the ER when given every day. Is this safe for the kids body. Use of daily controller inhaler is safe and assists with keeping child in school, out of hospital, and

• ut of ER‐better quality of life

Asthma Questions

• What are your thoughts on a standing order for Oxygen administration or Albuterol

administration during a respiratory distress event? This is the second time in 5 years where I have personally called EMS to respond to a respiratory event and had the worst 20 minutes or more of response time. Standards of practice don’t often consider rural locations with longer EMS response times. This gets complicated

• quickly. Lots of variables. Recommend discussion with your school health advisory

group, administrator in charge, and local community physician, public health

• department. Explain the problem, see if there is a way to keep a portable oxygen

tank, oximetry at school. Set up parameters for use that include calling local EMS to assess, stabilize and transport student to the nearest appropriate medical facility

• n an emergency basis.
• What is the best strategy for getting parents to bring in their asthma medication for

their child. It is a constant struggle. Can physicians encourage this when the family is being seen in the asthma clinics? Yes, often good to keep a duplicate albuterol inhaler full time at school (and keep it at school). How have you solved this question? Might be worthwhile to communicate with the physician, let her/him know the problem and see if she/he would write for the duplicate inhaler

Asthma Action Plan

http://www.virginiaasthmacoalition.org/ virginia‐asthma‐action‐plan.html

Insulin Dependent Diabetes Mellitus

• Interested in Physician response to School Nurses following CGM

(continuous blood glucose monitor) apps while at school. It’s interesting to hear nursing perspectives and how resistant some are to following the data during school hours. Not sure of what the question is here. Lets talk briefly about diabetes in school.

Insulin Dependent Diabetes in School

• Each student with diabetes is unique in his or her disease process, developmental and

intellectual abilities, and levels of assistance required for disease management.

• An individualized Diabetes Medical Management Plan (DMMP) is completed by the

healthcare provider and includes the medical orders to manage the student's diabetes needs during the school day and at school‐sponsored activities (Jackson et al., 2015).

• The school nurse develops an individualized healthcare plan (IHP) in partnership with

the student and his or her family, based on the medical orders in the DMMP and the nurse's assessment. (American Nurses Association/National Association of School Nurses [ANA/NASN], 2011).

• The IHP outlines the student's diabetes management strategies and personnel

needed to meet the student's health goals in school (National Diabetes Education Program [NDEP], 2016).

• The school nurse also prepares an emergency care plan (ECP), based on the DMMP

medical orders, that summarizes how to recognize and treat hypoglycemia and hyperglycemia and directs action to take in an emergency.

• Copies of the ECP should be distributed to all school personnel who have

responsibilities for the student during the school day and during school‐sponsored activities (NDEP, 2016).

http://main.diabetes.org/dorg/PDFs/living‐with‐diabetes/diabetes‐medical‐management.pdf

MRSA

• Please talk about MRSA and rates of infection with sports related activities.
• What is MRSA? Methicillin Resistant Staphylococcus aureus (“staph”) are bacteria

commonly carried on the skin or in the nose of healthy people. About 25‐30% of the U.S. population carries staph on their bodies at any time. MRSA is a kind of staph that is resistant to some kinds of antibiotics.

• MRSA infections are becoming more common in community settings, including schools

and among athletes. Since staph (including MRSA) are spread by direct contact (and on athletic teams), there are many opportunities for direct contact among athletes. Since 2002, school athletic teams in several states, have reported MRSA infections among wrestling, volleyball, and most frequently, football teams.

• Skin infections, including MRSA, are most commonly reported among athletes in sports

with a lot of physical contact. This includes wrestling, football, and rugby. However, MRSA infections have been reported among athletes in other sports such as soccer, basketball, field hockey, volleyball, rowing, martial arts, fencing, and baseball.

MRSA Signs and Symptoms

How can MRSA infection among school athletes be prevented?

• Practicing good hygiene is the best way to prevent getting and spreading MRSA infections and many
• ther infections. Encourage athletes to:
• Shower with soap and water as soon as possible after direct contact sports, and use a clean, dry towel
• Keep hands clean by washing them frequently with soap and warm water or use an alcohol‐based

hand sanitizer gel

• Keep cuts and scrapes clean and covered with a bandage until healed
• Avoid contact with other people’s wounds or bandages
• Not share towels (even on the sidelines at a game), soap, razors, or other personal care items
• Not share ointments or antibiotics
• Wash towels, uniforms, scrimmage shirts, and any other laundry in hot water and ordinary detergent,

and dry on the hottest cycle after each use. Inform parents of these precautions if laundry is sent home (laundry must be in an impervious container or plastic bag for transporting home).

• Avoid whirlpools or common hot tubs, especially when having open wounds, scrapes, or scratches
• Inform their coach or athletic trainer if they think they have a skin infection

Adrenal Insufficiency

• What is the expectation of Transportation staff for a student with

Adrenal insufficiency? Our local EMS does not have a protocol to administer So in an emergency their Protocol is fluids, monitor and transport.

• How can we expect a bus monitor or driver to be required to

administer this medication if needed when EMS will not?

Adrenal Insufficiency

• Adrenal insufficiency is defined by the impaired synthesis and release of

adrenocortical hormones

• An adrenal crisis usually comes on suddenly. The symptoms of an adrenal

crisis can include:

• Loss of appetite
• Vomiting
• Belly pain
• Weakness
• Fever
• Confusion
• Passing out

Adrenal Insufficiency

• Child needs to get to emergency facility for children
• Consider Orapred odt tablets in a situation where that cannot occur

rapidly (Consult with the health care team managing the condition)