Community/Public Health Nursing:

Promoting the Health of Populations

5th Edition

Mary A. Nies
and
Melanie McEwen

Copyright © 2019, 2011, 2007, 2001, 1997,

1993 by Saunders, an imprint of Elsevier Inc.
 School Health
Chapter 29
Christina N. DesOrmeaux
OUTLINE
• History of School Health
• School Health Services
• Health Education
• Physical Education
• Health Services
• Nutrition
• Counselling, Psychological, and Social Services
• Healthy School Environment
• Health Promotion for School Staff
• Family and Community Involvement

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OUTLINE
• School Nursing Practice

• School-Based Health Centers

• Future Issues Affecting the School Nurse

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OBJECTIVES
• At the end of this lecture, the student will be able to do
the following:

1. Discuss how Healthy People 2020 can be used to shape the

care given in a school health setting.
2. Identify and discuss the eight components of a
comprehensive school health program.
3. Recognize the major stressors that can negatively affect
an adolescent’s mental and physical health.
4. Identify common health concerns of school-age children
and associated health interventions.

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OBJECTIVES
5. Explore the various roles of the nurse in
the school setting.
6. Be familiar with the standards according to
which school nurses practice.
7. Cite several resources available to the
school nurse.

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School Health
• Schools could do more than perhaps any other
single institution in society to help young people,
and the adults they will become, to live healthier,
longer, more satisfying, and more productive lives.
– Carnegie Council on Adolescent Development,
CDC (2006)

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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%.

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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

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History of School Health (cont’d)
• 1960s: First NP programs with inclusion of primary
care services in schools
• 1986: Drug-Free Schools and Community Act
• 1994: Above Act expanded to include violence
• 1990s: CDC Division of Adolescent and School
Health formed
• 1990s: School-based health centers

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Comprehensive School
Health Programs
• Healthy school • Health education
environment • Physical education
• Health promotion • Health services
for staff
• Nutrition services
• Family and
community • Counseling,
involvement psychological, and
social services

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The eight components of school health
programs.

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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
• Youth Risk Behavior Survey
• Conducted by the CDC every two years among selected
high school students in the U.S.
• http://www.cdc.gov/HealthyYouth/yrbs/index.htm
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Youth Risk Behavior Survey
• Determine the prevalence and age of initiation of health-
risk behaviors.
• Focus the national and relevant agencies on specific health-
risk behaviors of young people.
• Assess whether health-risk behaviors increase, decrease, or
remain the same over time.
• Provide comparable national, state, and local data.
• Monitor progress toward achieving the Healthy People
objectives and the National Education goals.
– CDC (2007)

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Injury Prevention
• Bicycle safety and helmets
• Proper use of backpacks
• Schoolyard and playground safety
• Sports safety
• Equipment
• Stretching and preparation
• Health problems related to physical activity
• Promote positive health outcomes
• Related school policies

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Tobacco Use
• Tobacco
• Smoking is the single leading preventable cause of death
in the United States.
• An estimated 90% of adults who use tobacco began
before the age of 19 years.
• Adolescents who use smokeless tobacco are likely to
become cigarette smokers.
• Adolescents targeted by tobacco advertising.
• Teach adolescents the negative consequences
associated with tobacco.

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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 drug among children and
adolescents is alcohol.
• Drugs
• Use of illegal steroids has increased.
• The most commonly used illicit drug among youth is
marijuana.

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Sex Education
• Human sexuality
• *Pregnancy prevention
• STDs
• HIV/AIDS prevention
• *Gender identity/sexual orientation
*Controversial topics. Not taught in some schools.

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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

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 Preventive Health Services
• Immunizations
• All states now require proof of current immunization status
or evidence of immunity before school entrance.
• Health screenings
• Height, weight, vision, and hearing screenings
• Scoliosis or postural screening
• High blood pressure screening
• EPSDT: early and periodic screening, diagnosis, and
treatment

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Health Services
• Emergency care
• First aid, CPR, etc.
• Care of ill children
• Management of acute and chronic health conditions
• Medication administration
• Children with special health needs
• Individuals with Disabilities Education Act of 1990
• Delegation of tasks
• Nurse is responsible but each state’s nurse practice act
stipulates what can be delegated

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Children With Special Health
Needs

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Student Records
• Records should include:
• Immunization status
• Pertinent health concerns
• Results of screenings and examinations
• Health history
• Individualized plans of care
• Family Educational Rights and Privacy Act (FERPA)
• Health Insurance Portability and Accountability Act
of 1996 (HIPAA)

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Nutrition
• Addressing nutritional concerns
• Junk food and school vending machines
• Skipping meals, especially breakfast
• Unhealthy snacks
• Identifying nutritional problems, counseling and
making appropriate referrals
• Eating disorders
• Obesity
• Nutrition education programs

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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
• Suicide ideation
• Eating disorders
• Under / over achievement

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Healthy School Environment
• All students and staff have an inherent right to
learn and work in a school environment that is
health and that school nurses “have the expertise
and responsibility to promote a health physical
environment for all members of the school
community.”
– NASN (2005)

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Healthy School Environment
(cont.)
• Violence
• Identify 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
• Terrorism
• Develop an emergency management plan

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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
• Reduce absenteeism

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Family and Community
Involvement
• The school nurse is a resource to the community;
performs many roles:
• Educator
• Volunteer
• Consultant
• Advocate
• Family Risk Index

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School Nursing Practice
• Education in specific areas needed:
• Growth and development
• Public health
• Mental health nursing
• Case management
• Program management
• Family theory
• Leadership
• Cultural sensitivity
• Bachelor’s degree or higher recommended

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 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)

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Roles of the School Nurse
• Supervise others • Care provider
• Practice independently • Student advocate
• Delegate cares • Educator
• Conduct research • Community liaison
• Case manager

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School-Based Health Centers
• An interdisciplinary team approach
• Nurse practitioners
• Social workers
• Psychologists
• Physicians
• Provide services on site
• Operated by one or more local agencies
• Health departments, hospitals, or medical schools
• Works in collaboration with, but does not take the
place of the school nurse

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Summary

• Components of a comprehensive school health

program have been clearly identified and discussed.
Many of the Healthy People 2020 objectives
specifically relate to issues that can be addressed in
the school setting. The role of the school nurse has
changed dramatically since its inception and
continues to evolve to meet the demands of
school-age children, their parents, and the
communities in which they live.

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Summary

• School nurses continue to reduce the number of

days and the frequency with which students miss
school related to illness.
• They have become child advocates, counselors,
health promoters and collaborators, educators,
researchers, and resources in both the school and
the community.

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