NURS 266 Nursing Roles in the School Setting

NURS 266 Nursing Roles in the School Setting

NURS 266 Nursing Roles in the School Setting

Nursing Roles in the School Setting

• They advocate for the children as policies are developed for the school community, such as nutritious school breakfasts and lunches or recess and physical education classes for all students. Because of their role in the education system, they are able to educate teachers and administrators about how health conditions affect student functioning and ways to integrate children with special healthcare needs into the school setting
• Children who have complex health conditions need school nurses to develop and coordinate the plan for their care during school
  • Increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury, violence, suicide, tobacco use and addiction, alcohol, or other drug use, unintended pregnancy, HIV/AIDS, and STIs, unhealthy dietary patterns, and inadequate physical activity
  • Increase the proportion of the nation’s public and private schools that require daily physical education for all students
  • Increase the proportion of public and private schools that require students to wear appropriate protective gear when engaged in school-sponsored physical activities
  • Increase the proportion of elementary, middle, and senior high schools that have a full-time registered school nurse-to-student ratio of at least 1:750

 

The nurse plans, develops, manages, and evaluates healthcare services to all children in the educational setting. Maintaining infection control, participating on teams to develop student individualized education plans and individualized health plans, updating health records, collecting data on services provided to students, consulting with health teachers about educational topics, investigating environmental safety hazards, developing emergency preparedness plan, and planning for crisis intervention and support services

• Partnering with the school physician consultant to discuss and update standing order for the care of children. These standing orders for the care of children. These standing orders usually address urgent and and emergency care potentially needed by students and the variety of student healthcare problems that may occur
• Working with the parent-teacher association and other community organizations to organize health fairs and injury prevention programs for students
• Communicating with the child’s primary healthcare provider or pediatric specialist about a child’s specific health condition that needs to be effectively managed in the school setting. Obtain the parent’s permission to request confidential client information. The school nurse has regular opportunities to monitor the child’s health status and to provide information that may help the primary healthcare providers with the child’s ongoing management
• Preparation For Emergencies
• Emergency Preparedness Plan
• Facilitating a Child’s Return to School

NURS 266 Nursing Roles in the School Setting

Nursing Roles In the Childcare Setting

• Many types of childcare arrangements exist, such as in-home care by a family member or nanny, a babysitter cooperative, a licensed childcare family home setting for up to five children, or a licensed childcare center for six or more children
• States establish minimum licensure requirements and guidelines for safe operation of childcare settings that address the staff qualifications, staff-to-child ratio, staff training requirements, safe food handling, safe health practices, and environmental safety
• Reducing Disease Transmission
  • Teach staff when and how to perform hand hygiene, manage a child’s secretions, sanitize toys and surfaces, and treat a child’s cuts and scrapes
  • Develop guidelines for diapering infants and toddlers to reduce disease transmission
  • Check each child’s health daily for signs of acute illness. Isolate and care for children who are ill until they return home
  • Monitor the immunization status of children and plan for the exclusion of unimmunized children and children with immune deficiencies and disorders when a vaccine-preventable disease occurs in a child attending the facility
  • Develop and follow guidelines for safe food preparation and handling

 

Health Promotion and Health Maintenance

Environmental Safety

Emergency Care Planning

 

Nursing Roles In the Home Healthcare Setting

• Nurses need a variety of skills, knowledge, and experience in pediatric assessment and acute care practice using various medical technologies. These skills enable nurses to provide direct care, teach the family and child self-care practices, and monitor the child’s progresses
• The ability to adapt, be creative, and be prepared to deal with the unexpected, such as equipment malfunctions
• An understanding of community resources, financing mechanisms, and multiagency collaboration; and good communication skills
• Knowledge of the community’s health resources to help families obtain services that match the child’s and family’s needs
• An understanding of the community’s cultural diversity and the cultural values of the families served
• Skill in collaborating with other healthcare team members

NURS 266 Nursing Roles in the School Setting

Nursing Considerations For the Child and Family With a Chronic Condition

Developmental Concerns For the Child With a Chronic Condition

(Newborns and Infants)

• Newborns and infants who are medically fragile are at risk for chronic conditions related to brain injury, oxygen deprivation, and respiratory problems
• Newborns cared for in the NICU are exposed to an environment of bright lights and high-pitched noises that can negatively affect their development
• Promote development and parent-infant bonding by encouraging the parents to spend time with the infant and engage in face-to-face interaction. When the newborn is stable, provide opportunities for parents to touch, soothe, and care for the infant
• Provide sensory stimuli such as mobiles, soft music, and different textures for the infant to touch

(Toddlers)

• Chronic illness can interfere with the achievement of autonomy and development of self-control. Some parents are overprotective and may do simple tasks they feel the child is incapable of accomplishing, rather than encouraging the child to try to do things independently. The child can lose independence and lack opportunities to meet developmental tasks
• Nurses can promote development of toddlers with chronic conditions by offering the child choices when possible, such as which color gown to wear or which food to eat first
• Help parents recognize the toddler’s capabilities, and allow the child to take the time to practice and learn a skill. Identify the next most appropriate developmental tasks for the child to learn and give the parents some strategies they can use to offer learning opportunities

(Preschooler)

• Preschool children recognize the association between body parts and problems associated with the chronic condition. The preschooler engages in magical thinking during this stage, and the child may believe that his or her thoughts or behaviors caused the condition. The child may also think the condition is a form of punishment
• Hospitalization or implementation of a treatment plan, such as a new med, may interfere with the preschool-age child’s developing independence
• Nurses can promote development by explaining the purpose of treatments and procedures in terms the preschooler can understand, and by emphasizing that treatments and procedures are not punishment for any wrongdoing
• Look for ways to use play so the child can learn an aspect of self-care, perform an activity, and feel a sense of accomplishment. Encourage social interactions with other children when possible. Give positive feedback to the child for appropriate efforts and successes

(School-Age Children)

• Early school-age children have an increased understanding of their condition and are capable of participating in certain aspects of monitoring and care. Older school-age children begin to understand about managing their condition and the long-term needs associated with their condition. They can assume more responsibility for their care such as serum glucose monitoring, intermittent self-catheterization, or monitoring the condition of skin under braces
• Some children with chronic conditions have learning difficulties and other limitations that interfere with education and social competence. The child needs to gain social skills, interact with peers, master new information, learn to cope with stress, and acquire skills that lead to self-sufficiency in order to develop a sense of industry
• The school-age child senses that he or she is different from peers and may feel left out, especially if functional limitations affect his or her ability to participate in extracurricular activities. It is important that children with chronic health conditions be allowed to participate in extracurricular activities as much as their condition allows and their physician approves
• Nurses can promote development of school-age children by encouraging their interaction with children in the same age group. When possible, this should occur with children who have the same type of chronic condition. Link the child to a peer support group to promote social interaction and to help the child recognize that others also have the same condition. When the child has an extended absence from school because of the chronic condition, encourage contact from school peers and friends through cards and computer messages, as well as the completion of school assignments
• Begin to identify aspects of the child’s care that the child can learn to assume under the parents’ supervision. Inform families of the benefit of special camps for children with the same condition (when available) to promote recreation, social interaction, and learning skills of self-care

NURS 266 Nursing Roles in the School Setting

(Adolescents)

• Numerous challenges regarding rapid changes in growth and sexual maturation, ongoing development of identity and body image. Cognitive development and abstract thinking skills are achieved at this age allowing the adolescent to develop an understanding of short term and long term consequences of the condition.
• They become more aware of differences between self and peers and some may be unable to cope with the recognizable differences between themselves and healthy peers; they may withdraw from social activities and relationships. Others may engage in risky behavior (drugs, sex, alcohol, foods that interfere with condition) that may be harmful just to be accepted by peers
• Nursing actions to promote development- client education to help them learn about the chronic condition, care needed, and problem solving or specific skills for integrating care management into daily life
• Encourage them to build safety net of friends who know enough about the condition to assist if a problem occurs such as seizure or asthma episode
• Discuss sex maturation and importance of protected sexual activity and discourage risky behaviors
• Provide them an opportunity to express concerns regarding self-management, vocational planning, and future independent living

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Care Coordination

 

• Care coordination is the process of planning and integrating health care services among providers in an effort to achieve and promote good health in the child. Care coordination in a medical home facilitates transition from a pediatric healthcare provider to an adult healthcare provider. A case manager, often a nurse or social worker, may be given responsibility to help the family with care coordination

NURS 266 Nursing Roles in the School Setting

Home Care

• The numerous benefits of home care include the promotion of health, well-being, and development of the child, decreased financial costs to health insurance companies and the healthcare system, and a sense of satisfaction to families when they are able to care for their child at home
• Management of the condition involves technologic support, meds, and treatment regimens. Many families must decide whether both spouses will continue to work or if one parent will stay home to care for the child. Moving the child who is chronically ill, or a technology-assisted child, to the home setting is a life-changing decision for the family and it must be done with collaboration between the family and the healthcare team
• Caregiver burden: the unrelenting pressure and anxiety related to providing daily care to a child with disabilities while meeting other family obligations
• Respite Care: is an important support service that involves caring for the child with a chronic condition while the parents take a short break away from the daily care. May be provided by extended family, friends, or an agency, and may take place in the home or an area outside of the home. Example: skilled nursing facility or the home so the family can have a weekend away
• Assist the family in identifying respite care that meets the individual family’s needs from the services available in the community. Because many respite services charge for their assistance, the family may require help in identifying respite waiver subsidies available to them
• Emergency Preparedness: Battery packs for power outage, or during a disaster