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2008/2009 School Nurse Needs Assessment. Office of Healthy Schools WVDE. Coordinated School Health Program/Model. Definition of School Nursing:
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2008/2009School Nurse Needs Assessment Office of Healthy Schools WVDE
Definition of School Nursing: "School nursing is a specialized practice of professional nursing that advances the well being, academic success, and life-long 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."
Staffing • Recommended Ratio by NASN: • 1:750 for regular education students • 1:225 for students requiring daily school nursing services and interventions • 1:125 for students with complex health care needs • WV Code §18-5-22: • 1:1500 for students in grades K-7 • SB 53 • 1:1500 for students in grades Pre-K-12 in 18 counties receiving funding (funding decreases 20% per year from 2008 until zero since approval of new School Funding Formula)
Hancock 4 Brooke 6 4.67 6.50 Ohio 5 8 8 6 8 3 3 1 8 1 6 7 3 1 1 2 3 1 1 3 1 2 1 4 1 3 3 5 1 1 5.22 14 3 1 2 2 6 2 2 7.25 9 1 19.50 33 3 2 5 7 5 Marshall Morgan Wetzel Berkeley Mineral Tyler Hampshire Pleasants Monongalia Jefferson Marion Preston Wood Grant 8 Ritchie Taylor Harrison Wirt Hardy ridge Dodd Barbour Tucker Jackson Calhoun Lewis Roane Gilmer Upshur Pendleton Randolph Mason Braxton ` Putnam Webster 3 Clay Kanawha Cabell Pocahontas Nicholas 4 Lincoln 2 Wayne Fayette Boone Greenbrier Raleigh Logan Mingo Wyoming Summers Monroe 1 Mercer McDowell 2008/2009 WEST VIRGINIA Distribution of School Nurses and School Based Health Centers 6 2 2 5 1 Number of Certified School Nurses provided through Education # 3 School-Based Health Centers serving one or more schools # The Regional Education Service Agency (RESA)
Number of School Nurses according to the 2008/09 School Nurse Needs Assessment
WV State Board of Education School Health Policies • Policy 2422.7, Standards for Basic and Specialized Health Care Proceduresplus accompanying BSHCP Manual (Care Plans and management of all specialized health procedures by certified school nurse) • Policy 2422.8, Medication Administration (Prescribed and OTC) • Policy 2423, Communicable Disease (Immunizations, education and protocol regarding communicable diseases)
Screening Services • Immunizations • Hearing • Vision • Growth & Development • Height/Weight • Blood Pressure • Other Conditions
Incorporating collaborative efforts with Community and Local Health Care Providers through parent approved sharing of health information HealthCheck includes: • Comprehensive health and developmental history • Comprehensive physical examination • Age appropriate immunizations • Labs as recommended from well child visit • Developmental screening including speech and language • Vision and hearing screening • Dental screening
Case Management The certified school nurse’s role includes major responsibility for students with medical or other health problems. School nurses delegate, train, monitor and supervise school personnel performing health care procedures. The school nurse reviews provider orders, ensures medication dosage levels are accurate, monitors side-effects, assesses daily health and chronic disease status of students, documents, communicates with community medical providers and educates students, parents, staff and the community in health promotion. These actions do not describe the complete role of the school nurse but enable us to see the complexity especially when dealing with extremely high student ratios along with 15-20% needing specialized health care.
Nursing/Health Care Procedures Children needing management of chronic health care conditions attend WV schools daily. Several students require school nursing services in combination with home visits to support and sustain their school attendance.
Specialized Health Care Procedures Specialized health care procedures range from administration of an oral medication to inhalation therapy, blood glucose monitoring and suctioning for students who need tracheotomy care. In some cases, more than one procedure is provided for an individual student.
School nurses are facing a crisis regarding how medications administered to students at school are going to be done legally and safely. Emergency medications require higher skill levels and less delegation, at times. The ability to monitor for side effects and low/high dosage levels are skilled assessments needing a certified school nurse. Medication
Epilepsy/Seizures Epilepsy affects about 2.7 million Americans, results in an estimated annual cost of $15.5 billion in medical costs and lost or reduced earnings and production. People of all ages are affected, but particularly the very young and elderly. About 10% of Americans will experience a seizure sometime during their lifetime and about 3% will have had a diagnosis of epilepsy by age 80. (CDC, 2006)
Attention Deficit Hyperactivity Disorder (ADHD) • Most commonly diagnosed childhood behavior disorder • Affects 3 to 5 percent of school-aged children • Core symptoms = lack of attention & concentration and a high level of activity/distractibility/impulsivity
Diabetes Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes is a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are two major types of diabetes:
Diabetes Type 1 - A disease in which the body does not produce any insulin, most often occurring in children and young adults. People with Type 1 diabetes must take insulin injections daily to stay alive. Type 1 diabetes accounts for 5 to 10 percent of diabetes. The administration of insulin CANNOT be delegate to WV school personnel due to its complexity. A potential error in the administration of insulin can lead to severe complications or even the DEATH of a student.
Diabetes Type 2 - A metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. It is the most common form of the disease. Type 2 diabetes accounts for 90 to 95 percent of diabetes. Type 2 diabetes is nearing epidemic proportions, due to an increased number of older Americans, and a greater prevalence of obesity and sedentary lifestyles.
Asthma • The most common serious childhood disease • Is the most common cause of missed school days • Cause of more than 3 million physicians visits in U.S. yearly • Over 13,000 reported cases in WV schools last year
Conclusion The number of students with chronic health conditions require schools to provide even more complex health care, necessitates a careful look at the numbers of nurses who provide daily care to our WV public school students. The health services provided by certified school nurses in WV are essential, not only to the health, safety and educational progress of students, but also to the academic mission and school climate of schools.
Rebecca King Coordinator rjking@access.k12.wv.us 304-558-8830 Office of Healthy Schools Website http://wvde.state.wv.us/osshp/main/
