Introduction

A school is an institution designed for the teaching of

students (or "pupils") under the supervision of teachers. Most
countries have systems of formal education, which is
commonly compulsory. According to some, it is our second
home since we spend most of our day at school, attending
classes, doing projects, or just simply hanging out with our
friends. Since good health is wealth, it is important for a certain
school to focus, not only in academic affairs, but to the well-
being of each child as well. So why is there School Nursing?
How is it important in the lives of students from pre-school to
college?
School nursing focuses exclusively on the students and staff
of a public or private school or school district. This type of
nursing career allows you to support not just the physical well
being of children, but also their academic success and life-long
achievement. School nurses enjoy predictable hours and are in
great demand, particularly if they have what it takes to work
with special needs students. School nurses do much more than
simply intervene when students exhibit actual or potential
health problems. Being a School Nurse let you proactively
encourage healthy mental and physical development or assess
and monitor the immunization status of each student. Also
provide screening and referral for health conditions. Being a
school nurse also collaborate with faculty, parents and students
on health and safety awareness programs, play a leadership
 role in ensuring a healthy school environment, provide case
management services, serving as a liaison between school
personnel, family, community and health providers
Today's students have more diverse and complex health
problems, as well as problems caused by immigration,
homelessness, divorce, remarriage, poverty, substance abuse
and violence. School nursing plays a critical role in coordinating
school responses to all these issues.

BSN 4-E Day 1 (February 24, 2011)

Activities of the Day
 Assembly Time
 Nurse’s Prayer
 Checking of attendance
 Gathering of clearances
 Courtesy call with the Principal
 Enumerate the requirements for the exposure and the day of
submission
 Pre-Test
 Break
 Research abstract sharing
 Ward Class
 Lunch Break
 End of Duty (Dismissal)
Day 2 (Holiday, February 25

Day 3 (February 26, 2011)

Activities of the Day

 Assembly Time
 Nurse’s Prayer
 Checking of
attendance
 Post Test
 Break
 Ethico-legal
sharing
 Lunch Break
 Ward Class
 End of Duty
(Dismissal)

Health assessment is
an important tool used by school nurses in their assessment role.
This provides accurate and reliable data that can help school
nurses establish their role to students in advancing students’ well-
being, academic success, and lifelong achievements. It tries to
facilitate positive student responses to normal human
development; promote health and safety in the school and
environment. It is also vital in determining students’ actual and
potential health problems.
 In a developing country, like the Philippines, health service is
unreachable especially to the indigent citizens of the country. In
line with this perceived problem, the Department of Health
collaborates together with the Department of Education to help
eradicate problems in our health system specifically to
elementary grade pupils. They come up with a program that could
render health services to these individuals and this is school
nursing.

In school nursing, health assessment is done thoroughly

because of the above mentioned reasons. This has been
conducted nationwide through the efforts of the two sectors of
the government. It is now very common to school grade children
to have a health care professional assess them every now and
then.

Nurses on the other hand have this important job to assess

these groups of persons. Their findings and observations are
very important in addressing the health needs of the students.

The early detection of health problems is a great help to

prevent further complications that is more likely to occur if this is
left untreated. We, therefore, recommend monthly assessment of
the physical as well as dental health status of the pupils so that
we could promote and inculcate awareness even in their young
minds. School nurses are bound to assess and cater the health
needs of the students but at the end of the day, it is still within
the hands of the parents to follow up and check their children’s
health seeking beh aviors for in order for this program to make
through, all sectors should work hand in hand- the school
authorities, students, parents as well as the rest of the health
care team.
 Determinants of the intention
of elementary school nurses to adopt a
redefined role in health promotion at school

Guylaine Chabot1 Gaston Godin2 and Marie-Pierre Gagnon

Background

The quest for greater efficiency in the provision of primary healthcare

services and the implementation of a "health-promoting school"
approach encourage the optimal redefinition of the role of school
nurses. School nurses are viewed as professionals who might be
significant actors in the promotion of youth health. The aim of this
study was to identify the determinants of the intention of elementary
school nurses to adopt a new health-promotion role as a strategic
option for the health-promoting school.

Methods

This study was based on an extended version of the theory of planned

behaviour (TPB). A total of 251 respondents (response rate of 70%)
from 42 school health programs across the Province of Québec
completed a mail survey regarding their intention to adopt the
proposed health-promotion role. Multiple hierarchical linear
regression analyses were performed to assess the relationship
between key independent variables and intention. A discriminant
analysis of the beliefs was performed to identify the main targets of
action.

Results

A total of 73% of respondents expressed a positive intention to accept

to play the proposed role. The main predictors were perceived
behavioural control (β = 0.36), moral norm (β = 0.27), attitude (β =
0.24), and subjective norm (β = 0.21) (ps < .0001), explaining 83% of
the variance. The underlying beliefs distinguishing nurses who had a
high intention from those who had a low intention referred to their
feelings of being valued, their capacity to overcome the nursing
shortage, the approval of the school nurses' community and parents
of the students, their leadership skills, and their gaining of a better
understanding of school needs.

Conclusions

Results suggest that leadership is a skill that should be addressed to

increase the ability of school nurses to assume the proposed role.
Findings also indicate that public health administrators need to
ensure adequate nurse staffing in the schools in order to increase the
proportion of nurses willing to play such a role and avoid burnout
among these human resources.

Bibliography
Chabot, G. et al. Determinants of the intention of the elementary
school nurses to adopt a redefined role in health promotion at
school. Published last November 26, 2010 from
http://www.implementationscience.com/content/5/1/93/abstrac
t. Retrieved last February 23, 2011.

REACTION AND RECOMMENDATIONS

School nurses play a very important role in terms of

promoting health among schools and especially to the
youth. Since behavioral control, beliefs and attitude affect
their intention to adopt a redefined role in health
promotion at school they should have also the knowledge
and skills to be more competent in their profession.
Leadership and management skills as well as
knowledge should be emphasizing in every nurse because
these increase the ability of school nurses to assume the
proposed role.
Assessing the youth, giving interventions and
providing health teachings are just basic but these are
very important in this area since school nurses are dealing
with the youth. Giving microteaching and IEC materials for
the youth could help them to have an awareness
regarding health tips especially proper nutrition, exercise
and their health status. I also recommend that additional
nurses or adequate staffing to increase proportion of
nurses willing to play on the role.
 School Nursing Services Use in an Urban Public
School System

Elisabeth Schainker, MD; Mary Jane O’Brien, PNP; Debra

Fox, MSN; Howard Bauchner, MD

Objective To describe the quantity and type of school

health services provided by nurses in Boston Public
Schools.

Setting In 2001, the 63 024 students enrolled

predominantly belonged to minority groups (48% black,
28% Hispanic, and 9% Asian) and were eligible for a free
or reduced-price lunch (71%).

Main Outcome Measure: Analysis of the 2001-2002

Boston Public Schools Health Services database.

Results A total of 63 024 students generated 721 291

individual encounters with 93.5 full-time equivalent school
nurses, including episodic care (57.8%), medication
administration (31.5%), procedures (6.2%), and screening
(5.1%). A total of 2420 students had an individual health
care plan for the administration of medications and
procedures during the school day. Students with individual
health care plans averaged 117.9 encounters per year
with school nurses, and students without averaged 7.2
encounters per year. Outcomes of encounters included
school dismissal (3.0%); verbal communication with
parents (10.6%), school staff (3.9%), and community
agencies or health care providers (1.1%); and referral to a
primary care provider (4.6%) or emergency services
(<0.1%).

Conclusions Some school-age children receive a large

amount of health care from school nurses in Boston Public
Schools. We estimate that these children are 8 times more
likely to see a school nurse than a pediatric health care
provider. These school nurses were involved in the care of
children with mental health and chronic health care needs.
Despite the extensive amount of care, little is known
about the efficacy of the care provided or the effect of
these services on health care use.
Conclusion

This article shows that the e school nurse has a

central management role in the implementation of the
school health services program for all children and youth
in the school. School nurses function as a member and
often the coordinator of the school health services team.
The school nurse has a unique role in the provision of
school health services for children with special health
needs, including children with chronic illnesses and
disabilities of various degrees of severity. She/he
develops this plan with the student, parents or guardians.

In the Philippine setting, this happens simply

because of financial constraints experienced by most
Filipinos which are most likely caused by poverty. Since
the DOH provides free consultation in schools with the aid
of school nurses, parents would prefer to bring their
children in school clinics rather than in private physicians.

Recommendation

Continued strong partnership among school nurses,

pediatricians, and other school health care personnel
should be implemented. These partners should work
together closely to promote the health of children and
youth by facilitating the development of a comprehensive
school health program, ensuring a medical home for each
child, and integrating health, education, and social
services for children at the community level.

Bibliography
Schainker, Elisabeth , et. Al., “School Nursing Services:
Use in an Urban Public School System”
http://archpedi.ama-
assn.org/cgi/content/abstract/159/1/83, 2005

Energy Drinks: A New Health

Hazard for Adolescents

Nicole Pennington, Elizabeth Delaney,

MSN, RNC MSN, RN, ARNP
Molly Johnson, MSN, Mary Beth
RN, PNP Blankenship, MSN,
RN, ARNP

Abstract

A new hazard for adolescents is the negative health

effects of energy drink consumption. Adolescents
are consuming these types of drinks at an alarming
amount and rate. Specific effects that have been
reported by adolescents include jitteriness,
nervousness, dizziness, the inability to focus,
difficulty concentrating, gastrointestinal upset, and
 insomnia. Health care providers report that they
have seen the following effects from the
consumption of energy drinks: dehydration,
accelerated heart rates, anxiety, seizures, acute
mania, and strokes. This article is a comprehensive
literature review on the health effects of energy
drinks. Findings from this article indicate the need
for educational intervention to inform adolescents of
the consequences of consuming these popular
drinks. School nurses are in a unique position to
teach adolescents about the side effects and
possible health issues that can occur when energy
drinks are consumed.

Bibliography:
Pennington, N. et al. (2010, December). Energy Drinks: A
New Health Hazard for Adolescents.
The Journal of School Nursing. Retrieved February 23,
2011 from
http://jsn.sagepub.com/content/26/5/352.abstract

Dental screening in schools: the views of parents,

teachers, and school nurses
R G Watt

December 2010

Objectives:
 To obtain insight into the views of relevant 'stakeholders'
(parents, teachers and school nurses) in dental screening
in schools.

Methods:

Eight schools in Chester and Ellesmere Port in the UK

formed the setting of this study. A teacher from each
school participated in one-to-one interviews, and focus
groups for parents were carried out in each school. A
focus group for school nurses working in the locality was
also held. The same trained researcher undertook the
interviews and focus groups; all interviews and focus
groups were tape recorded, transcribed verbatim and
thematically analysed independently by two trained
individuals.

Results:

Teachers, school nurses and parents all perceived the

process of negative consent and the current dental
examination as acceptable. The follow up procedure for
identification of screened positive children was seen as
inadequate. There was a strong feeling within each group
that parents were ultimately responsible for their
children's oral health and that state institutions had a
limited role in ensuring children attended and received
dental treatment.

Conclusions:

All of the groups considered it was primarily the

responsibility of parents to take screened positive children
to see a dentist. The NHS has limited influence on this
process. This fact represents a significant challenge to
improving the effectiveness of school dental screening.
 Stunting and soil-transmitted-
helminth infections among school-age
pupils in rural areas of southern China
Yu Shang,1,2 Lin-Hua Tang
December 2010
Background

Stunting and soil-transmitted helminth (STH) infections

including ascariasis, trichuriasis and hookworm remain major
public health problems in school-age pupils in developing
countries. The objectives of this study were to determine the
prevalence of stunting for children and its association with
three major soil-transmitted helminths (STH) in rural areas of
southern China. The study also aims to determine risk factors
for stunting and to provide guidance on the prevention and
control of stunting and STH infections for future studies in this
field.

Results

A cross-sectional survey was carried out in the poor rural areas

in Guangxi Autonomous Regional and Hainan Province where
STH prevalence was higher between September and November
2009. Pupils were from 15 primary schools. All the school-age
pupils aged between 9 and 12 years old (mean age 11.2 ± 3.2
years), from grades three to six took part in this study. Study
contents include questionnaire surveys, physical examination
and laboratory methods (stool checking for eggs of three major
STH infections and haemoglobin determination was performed
for the anaemia test). Finally 1031 school-age pupils took part
in survey. The results showed that the overall prevalence of
stunting (HAZ < 2SD) was 25.6%, based on the WHO Child
Growth Standards (2007). Risk factors for stunting based on
logistic regression analyses were: (1) STH moderate-to-heavy
intensity infections (OR = 1.93;95%CI:1.19,3.11); (2) anaemia
(OR = 3.26;95%CI: 2.02,5.27); (3) education level of mother
(OR = 2.13; 95%CI: 1.39,3.25). The overall prevalence of major
STH infections was 36.7%, STH moderate-to-heavy intensity
infections was 16.7%. The overall prevalence of ascariasis,
trichuriasis, hookworm and co-infection were 18.5%, 11.2%,
14.7% and 9.1% respectively. The prevalence of anaemic
children (HB < 12 g/dl) was 13.1%.

Conclusion

The present study showed that stunting was highly prevalent

among the study population and STH infection is one of the
important risk factors for stunting, with moderate-to-heavy
intensity infections being the main predictor of stunting. Hence,
additional interventions measures such as to promote de-
worming treatment, to enhance health education and to
improve hygiene and sanitation in order to reduce stunting in
this population, are needed throughout the primary school age
group.

Hunger: Its Impact on Children’s Health and

Mental Health

Linda Weinreb, MD*, Cheryl Wehler, Jennifer

Perloff, MPA||, Richard Scott, PhD¶, David
Hosmer, PhD#, Linda Sagor, MD, Craig
Gundersen, PhD**
Objective. Hunger, with its adverse consequences for children,
continues to be an important national problem. Previous
studies that document the deleterious effects of hunger among
children cannot distinguish child from family hunger and do not
take into account some critical environmental, maternal, and
child variables that may influence child outcomes. This study
examines the independent contribution of child hunger on
children’s physical and mental health and academic
functioning, when controlling for a range of environmental,
maternal, and child factors that have also been associated with
poor outcomes among children.

Methods. With the use of standardized tools, comprehensive

demographic, psychosocial, and health data were collected in
Worcester, Massachusetts, from homeless and low-income
housed mothers and their children (180 preschool-aged
children and 228 school-aged children). Mothers and children
were part of a larger unmatched case-control study of
homelessness among female-headed households. Hunger was
measured by a set of 7 dichotomous items, each asking the
mother whether she has or her children have experienced a
particular aspect of hunger during the past year—1 concerns
food insecurity for the entire family, 2 concern adult hunger,
and 4 involve child hunger. The items, taken from the
Childhood Hunger Identification Project measure, are summed
to classify the family and divided into 3 categories: no hunger,
adult or moderate child hunger, or severe child hunger
(indicating multiple signs of child hunger). Outcome measures
included children’s chronic health condition count using
questions adapted from the National Health Interview Survey,
Child Health Supplement, and internalizing behavior problems
and anxiety/depression, measured by the Child Behavior
Checklist. Additional covariates included demographic variables
(ie, age, gender, ethnicity, housing status, number of moves,
family size, income), low birth weight, child life events (ie, care
and protection order, out of home placement, abuse, severe life
events count), developmental problems (ie, developmental
delay, learning disability, emotional problems), and mother’s
distress and psychiatric illness. Multivariate regression
analyses examined the effect of child hunger on physical and
mental health outcomes.

Results. The average family size for both preschoolers and

school-aged children was 3; about one third of both groups
were white and 40% Puerto Rican. The average income of
families was approximately $11 000. Among the school-aged
children, on average 10 years old, 50% experienced moderate
child hunger and 16% severe child hunger. Compared with
those with no hunger, school-aged children with severe hunger
were more likely to be homeless (56% vs 29%), have low birth
weights (23% vs 6%), and have more stressful life events (9 vs
6) when compared with those with no hunger. School-aged
children with severe hunger scores had parent-reported anxiety
scores that were more than double the scores for children with
no hunger and significantly higher chronic illness counts (3.4 vs
1.8) and internalizing behavior problems when compared with
children with no hunger. There was no relationship between
hunger and academic achievement.

Among preschool-aged children, who averaged 4 years of age,

51% experienced moderate child hunger and 8% severe child
hunger. For preschoolers, compared with children with no
hunger, severe hunger was associated with homelessness (75%
vs 48%), more traumatic life events (8.5 vs 6), low birth weight
(23% vs 6%), and higher levels of chronic illness and
internalizing behavior problems. Mothers of both preschoolers
and school-aged children who reported severe hunger were
more likely to have a lifetime diagnosis of posttraumatic stress
disorder.

For school-aged children, severe hunger was a significant

predictor of chronic illness after controlling for housing status,
mother’s distress, low birth weight, and child live events. For
preschoolers, moderate hunger was a significant predictor of
health conditions while controlling for potential explanatory
factors. For both preschoolers and school-aged children, severe
child hunger was associated with higher levels of internalizing
behavior problems. After controlling for housing status,
mother’s distress, and stressful life events, severe child hunger
was also associated with higher reported anxiety/depression
among school-aged children.

Conclusion. This study goes beyond previous research and

highlights the independent relationship between severe child
hunger and adverse physical health and mental health
outcomes among low-income children. Study findings
underscore the importance of clinical recognition of child
hunger and its outcomes, allowing for preventive interventions
and efforts to increase access to food-related resources for
families.
School nurses’ involvement, attitudes
and training needs for mental health
work: a UK-wide cross-sectional study
Mark Haddad1, Georgia S. Butler2, Andre Tylee3
published : 23 AUG 2010

Abstract
Aim.  The aim of this study was to identify school nurses’
views concerning the mental health aspects of their role,
training requirements and attitudes towards depression in
young people.
Background.  Mental health problems in children and
young people have high prevalence worldwide; in the
United Kingdom they affect nearly 12% of secondary
school pupils. School nurses have a wide-ranging role, and
identifying and managing mental health problems is an
important part of their work
Methods.  A cross-sectional study was conducted using a
postal questionnaire sent to a random sample of 700
school nurses throughout the United Kingdom in 2008.
Questions concerned involvement in mental health work
and training needs for this work. Attitudes were measured
using the Depression Attitude Questionnaire
Results.  Questionnaires were returned by 258 (37%)
nurses. Nearly half of respondents (46%) had not received
any postregistration training in mental health, yet 93%
agreed that this was an integral part of their job. Most
(55%) noted that involvement with young people’s
psychological problems occupied more than a quarter of
their work time. Staff attitudes were broadly similar to
those of other primary care professionals, and indicated a
rejection of stigmatizing views of depression and strong
acknowledgement of the role of the school nurse in
providing support.
Conclusion.  Working with young people who self-harm,
and recognizing and being better equipped to assist in
managing depression and anxiety are key topics for staff
development programmes.

Reference:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-
2648.2010.05432.x/abstract

MOISES, MADYL ANDREA

BSN IV-E
 Key Issues in Philippine
Education

Imagine yourself a Filipino teacher. Imagine yourself a

teacher in a public school. Imagine yourself handling a
class of 60 to 70 students. Imagine yourself handling two
shifts of classes with 60 to 70 students.

Yes, it is a nightmare. And yes it happens in real life within

the public school system. It is a manifestation of the two
most prevalent problems in the educational system: lack
of classrooms and lack of teachers.

In fairness, most private school teachers, especially those

in small private schools, will admit that public school
mentors earn more than they do. But even with the
relatively higher wages, it does not seem to compensate
for the daily travails of public school teachers.

The ideal ratio of teacher to student is 1:25. The less

number of children handled by one mentor, the more
attention can be given to each individual, especially if
their learning competencies are not equal. With 25
students in a class, the teacher is likely to know each of
her students, not only by face but by name and how they
are actually performing in class.

But with 60 children in a classroom, it is a miracle how

teachers are able to stay sane every single day. They
hardly know their pupils, save for the excellent ones or
unfortunately, the notorious. She does not even bother to
remember them. How can she? Classrooms are cramped,
if there are any at all. Many classes are held in makeshift
rooms meaning a multi-purpose covered court with
partitions where 4 or 5 classes are merely separated by
thin plywood walls. With 60 kids north, east, south and
west, it's a wonder teachers can hear themselves over the
din.

Students are still divided into sections and they are

grouped into the level of their academic skills. Which
leaves those who are academically challenged lumped
together and their teacher to stretch her skills, patience,
resources and dedication to addressing the need of her
students.

Resources are another matter. Many public school

classrooms are equipped with the most basic of
equipment: a blackboard, chalk and eraser. Some are
fortunate to have visual aids, either donated or purchased
by the school. But many times, a teacher will not only
have to be creative, but will dig into her own pocket to
produce the kind of materials she needs and wants to
teach class.

It used to be that rolls of Manila paper were adequate to

write down the lesson for the day. But this can get to be
very expensive, especially if the lessons are long. And
with a class so huge, children are barely able to see small
handwriting from the back, so you need to write bigger,
and use more paper. Children always welcome additional
and unique visual aids, and woe to the teacher who has to
create them if she wants her subject or lesson to be more
interesting.

Which brings us to the budget for visual aids. It is non-

existent, except if you choose to shell out on your own.
Teachers still have to make ends meet. And often, their
pay is simply not enough to cover their needs, as well as
their families.

Bibliography:
Aarou,M. Key issues in Philippine Education. Published last
August 3,2010 from http://www.
squidoo.com/educ8#module10519600.Retrieved
last February 23, 2011.
REACTION AND RECOMMENDATIONS

The Philippine constitution has mandated the

government to allocate the highest proportion of its
budget to education but our country still has one of the
lowest budget allocations to education among ASEAN
countries. I have observed that the government has yet to
come up with a plan that will finally address these
problems.

Lack of classrooms, facilities, and teachers are the

tree main problems in terms of education. I recommend
that the government must focus on these problems and to
have construction and repair of classrooms around the
country. Also, to build an additional classrooms and
provide good ventilation for the pupils to have a good
environment during the class. Since almost public schools
has the ratio of 1 teacher is to >40 pupils, I recommend
that the ideal ratio of teacher to pupils which is 1:25
should be implemented in every school so that learning
process should be emphasize in every pupil. Lastly, I
recommend that the teachers’ salary scale should be
upgrade since they have been underpaid wherein there is
very little incentive for most of them to take up advanced
trainings

Education is very important. Thus education to

children is the hope of our mother land.
 In Fairfax malpractice case, family awarded $3
million

By Tom Jackman

Washington Post Staff Writer

Saturday, February 27, 2010

A Fairfax County jury has awarded nearly $3 million to the

family of a student who died after his esophagus tore
while he was swallowing a piece of steak, finding a school
nurse liable for disregarding child’s complaints.

Hector Alvarez, 12, first complained of chest pains and

trouble swallowing after he had eaten steak from the
school cafeteria. The piece of meat had gotten stuck in his
throat, attorney John J. Sellinger said, and "he later said it
felt like it went down the wrong way."
According to court records, Alvarez was only advised by
the School nurse to rest and increase fluid intake for it will
just go through. The complaints persisted for almost 3
weeks and the family decided to seek professional
medical assistance. It was found out later on that the
child’s esophagus was perforated. Operation was
immediately performed but the child died 10 days after
the operation. The family went after the school nurse for
negligence of duty. License was then withdrawn and the
school nurse was put into trial.
Implication:

Negligence

In general terms, negligence is "the failure to use ordinary

care" through either an act or omission. That is,
negligence occurs when:

• somebody does not exercise the amount of care

that a reasonably careful person would use under
the circumstances; or
• somebody does something that a reasonably careful
person would not do under the circumstances.

Reaction/Recommendation

Nurses should be aware of their duties especially

their purpose, which concerns the majority. As future
nurses, we may not know where we’ll be working after
passing the board exams. Some may work in the clinical
area, some on Rural Health Units. Always make sure that
we cater each complaint and perform referrals to
knowledgeable persons if we’re not sure or if our clients
need professional care of physicians. Where ever we may
work in the future, it is important that we always put in
mind our duties, how people trust nurses, and how many
lives depend on our hands.
 Ethics and the HPV Vaccine:
Considerations for School Nurses

Mary P. Bennett, RN, BSN

Abstract

School nurses are at the forefront of health care providers

for many families of junior high and high school students
and are used as primary sources of information and
guidance about recommended student vaccinations. In
the case of the relatively new vaccine for human
papillomavirus (HPV), school nurses must be both
knowledgeable about the infection itself and unbiased
when asked to give students and families information
about the vaccine. This article explores the development
and current status of HPV and the HPV vaccine and the
ethical principles of autonomy, utilitarianism, beneficence,
nonmaleficence, justice, and cultural and religious issues
as they relate to discussions with students and families
about HPV vaccinations. School nurses are advocates for
the health of students. Therefore, they must critically
evaluate the application of these ethical principles when
providing information and recommendations about the
HPV vaccination.

Bibliography:

Bennett, M. P. (2008, October). Ethics and the HPV

Vaccine: Considerations for School Nurses.
 The Journal of School Nursing. Retrieved February
23,2011 from http://jsn.sagepub.com/

content /24/5/275.abstract

Ethical Principles as a Guide in

Implementing Policies for the
Management of Food Allergies in
Schools

Jason Behrmann, MSc

Abstract

Food allergy in children is a growing public health problem

that carries a significant risk of anaphylaxis such that
schools and child care facilities have enacted emergency
preparedness policies for anaphylaxis and methods to
prevent the inadvertent consumption of allergens.
However, studies indicate that many facilities are poorly
prepared to handle the advent of anaphylaxis and policies
for the prevention of allergen exposure are missing
essential components. Furthermore, certain policies are
inappropriate because they are blatantly discriminatory.
This article aims to provide further guidance for school
health officials involved in creating food allergy policies.
By structuring policies around ethical principles of
confidentiality and anonymity, fairness, avoiding
stigmatization, and empowerment, policy makers gain
another method to support better policy making. The
main ethical principles discussed are adapted from key
values in the bioethics and public health ethics literatures
and will be framed within the specific context of food
allergy policies for schools.

Bibliography:

Behrmann, J. (2010, June). Ethical Principles as a Guide in

Implementing Policies for the

Management of Food Allergies in Schools. The Journal

of School Nursing. Retrieved

February 23,2011 from

http://jsn.sagepub.com/content/26/3/183.abstract

LEGAL ISSUES FOR SCHOOL NURSES:

An Interview with Nadine Schwab, RN, MPH, NCSN, FNASN
Ms. Schwab, a former Connecticut State Department of Education
Consultant for Health Services, is a well-known presenter, consultant
and author on clinical and legal issues in school health. She addresses
legal issues from a practice perspective and recommends that school
nurses develop a relationship with attorneys in their states who have
expertise in health and education law
SHA: To what types of liability are school nurses subject?

NCS: School nurses are subject to civil, administrative, and

criminal liability.. Most civil cases against school nurses are
related to questions of negligence and are settled out of court,
making it difficult to find written details. The finding of liability
in a civil case does not require proof of intent to do harm, but
rather, failure to meet the standard of care of another
reasonable school nurse in the same situation. Of cases
decided in court, frequent causes of liability include failures to
(1) perform an adequate assessment, (2)intervene effectively
in emergencies, (especially anaphylaxis and asthma), and (3)
document evidence of appropriate nursing care. Additional
causes of liability include failures to keep clinically up-to-date,
follow district policy, delegate safely, and communicate with
parents.

School nurses can be subject to administrative liability if

referred to their state's board of nursing for investigation of
possible failure to meet state practice standards. A finding of
liability can result in discipline, including temporary or
permanent loss of one's license to practice. Involvement in a
special education due process hearings on behalf of school
districts may be considered a type of administrative liability..
While it is the district, not the nurse, that is liable for a hearing
officer's finding that it did not carry out its legal responsibilities
to a student, the nurse's actions or recommendations to the
school team may contribute to the finding of school district
liability. The same concept applies to investigations by the
Office for Civil Rights, U.S. Department of Education.

Finally, school nurses can be subject to criminal investigation

for actions that are prohibited by law, such as theft of
controlled drugs or practicing medicine without a license. If
charges are brought and a nurse is found guilty, he or she is
generally sentenced by the court and may be required to pay a
fine or serve a jail sentence, or both.

SHA: Parents may have different expectations of what school

nurses can and should do. How can nurses minimize conflicts
with parents?
NCS: The keys to minimizing conflicts with parents are focusing
on students' needs and family priorities, collaboration, and
communication. When one is sued for negligence, usually a
series of things have gone wrong, particularly communications.
Developing a sound working relationship with parents,
beginning with their priorities and preferences, is key. Building
trust requires deliberate actions to promote joint planning and
problem solving, open discussion of recommendations and
concerns, and parental notification of changes in student health
status and district procedures. It is critical to communicate
disagreement without conveying "disapproval" of a parent's
position, and to document all communications. Explaining (in
lay terms) the scientific basis of specific recommendations,
including potential benefits to student learning, and addressing
both pros and cons of differing positions advances
understanding and collaborative approaches.

SHA: Medications at school raise legal concerns: what practices

and products should be allowed, who can dispense them, and
who decides about giving medications - the physician, RN,
parent or principal?

NCS: In general, the answers vary according to the state laws

where the school nurse practices. It is critical to know and
understand the relevance of various state laws and regulations
that apply to medication administration in schools, including
the nurse, pharmacy, and medical practice acts, regulations
related to controlled drugs, applicable education laws, and
declaratory rulings or guidelines of state agencies and boards.

It is also important to use legally correct terms. For example,

physicians and advanced practice nurses can prescribe,
dispense and administer medications, pharmacists can
dispense medications, and nurses can administer (but not
dispense) them. Because nurses cannot dispense medications,
packaging for administration on field trips is a challenging
issue.

Medication administration at school should primarily be

considered a support service provided when a student requires
it in order to access an appropriate education. Therefore, in
most instances, this support or "related" service should be
incorporated into a student's Section 504 accommodation plan
or individualized education program (IEP). An exception might
be when a drug is medically necessary for an acute
problem(e.g., an antibiotic required during school hours for
infection).

Medication administration and related issues are generally

governed by state law and regulations . As a practical matter,
when parents ask school staff to administer medication to their
children, the situation is not legally the same as when parents
administer medications themselves. Even in states where
school nurses do not have the legal responsibility to direct
medication administration, they have an ethical responsibility
to students (their clients) to speak out against unsafe practices
and to try to establish standards for safe medication
administration in their school district.

School district policy and procedures that support safe

medication administration practices are essential. For example,
in the DeBord case (1997), the court found for the school
district in a dispute regarding the school nurse's refusal to
administer a dose of Ritalin that would have exceeded the total
daily dosage recommended in the Physician's Desk Reference.
Critical to the court's finding was the school district's policy
supporting the nurse's review of all medication orders prior to
administration to insure compliance with safety standards.
Because the policy applied to all students, the court did not find
discrimination on the basis of the student's disability, as
alleged. In addition, the district had tried to accommodate the
medication order by suggesting alternate accommodations
(e.g., allowing a parent to administer the dose or dismissing the
student early).

SHA: Should students be allowed to carry emergency asthma

inhalers or staff trained to use Epi-pens?

NCS: Whether students can self administer asthma inhalers,

and whether or not teachers can administer epinephrine to
students, are matters of state law. From a practice perspective,
students with chronic conditions need to learn self-care skills,
including self-administration of medication, in order to develop
into competent adults. Immediate access to medication may
also be critical for disease management and lifesaving
purposes. Self-administration includes keeping the medication
on one's person. School nurses should support policies that
promote safe self-administration of medication, including
epinephrine (Epi-Pens) for students at high risk of anaphylaxis.
If students are unable to self-administer epinephrine, it should
be immediately available for rapid administration by properly
trained staff.
SHA: What about non-prescription or herbal products parents
ask schools to give?

NCS: Even if state law allows school nurses or other staff to

give non-prescription, over-the-counter medications (OTCs)
without a doctor's order, e.g., acetaminophen for fever or
headache, the school nurse has a duty to students to use
medication only when it is indicated from a medical perspective
and to assure safety. Our book suggests that, in most
instances, using OTC medications is not in the best interests of
students, nor in keeping with best pediatric practice standards.
Teaching students other strategies for managing common
health complaints is fundamental to quality practice.

The in-school administration of herbal and naturopathic

substances is also a complex issue, addressed differently by
individual states. Regardless, health professionals should not
administer to minors substances for which there are no
established safety parameters. As with other medication issues,
school districts need written policies that support current
standards and safe practices. School nurses and medical
advisors must communicate the relationship of these standards
and practices to student health and learning.

SHA: Sometimes a nurse or principal feels threatened or so

fearful of liability that he or she is paralyzed into inaction. How
do you analyze options in light of"theoretical" liability?

NCS: One can be liable for damages caused by one's failure to

act (when one should have acted), as well as by taking an
action (when one shouldn't have acted). Therefore, inaction is
not protection against liability. To minimize liability, analyze the
situation, determine what standards of care apply, obtain
consultation and all other relevant information, and then
determine the best course of action (or inaction).

One of the most important "standards of care" against which a

school nurse can be measured in a court case, in addition to
the nurse practice act and job description, is the Standards of
Professional School Nursing Practice (National Association of
School Nurses, 1998). These standards help guide school
nurses to make decisions that are in the best interests of
students. It is always safer, in terms of preventing liability, to
make decisions that are focused on the needs of students,
rather than on one's own interests, such as job security or
colleague acceptance.

SHA: Many RNs have multiple schools with others (LVN, aide,
clerk, secretary, volunteer) assigned to see students. Who is
liable for errors? Even with training and spot-checks, how can
an RN protect students and his/her license?

NCS: School nurses responsible for multiple schools or large

student populations need job descriptions that reflect their
responsibilities more as consultants than direct care providers.
One's job description is often used as a "standard of care"
against which a nurse's action or inaction is measured in a civil
suit. It might reflect responsibilities related to advising the
district on health and safety issues, drafting policies and
procedures regarding school health services, consulting to
school personnel, participating on the special education team,
and so forth. It should not reflect responsibility for day-to-day
direct care services to all students. The nurse's administrative
and legal responsibilities related to other personnel who
provide direct services should also be clear in the job
description - and achievable.

School nurses can be liable for errors made in advising the

district, consulting to other staff, setting priorities for their own
practice, making professional judgments, and directing others,
as well as for staying long-term in a situation that remains
unsafe for students. School nurses are generally not liable for
errors made by others, unless they contribute to those errors
by deliberate actions (or inactions), such as unsafe delegation
under pressure from an administrator, or inadequate training or
supervision of someone to whom they delegate a nursing
activity.

One strategy is to advocate for a school health advisory council

or "healthy school" team that includes other school personnel,
parents and community health professionals. Such a group can
advise district leaders on high priority health issues, including
staffing needs and options, and support recommendations for
improvements during budget deliberations. Collaboration with
others not only supports improved services for students, it also
builds legal protection.
Reference:
http://www.schoolnurse.com/med_info/legalissues.html

Medication Management Problems

Reported by Subscribers to a School
Nurse Listserv
Thomas J. Reutzel, PhD

Given the potentially serious consequences of suboptimum

medication management practices in elementary and
secondary schools and the fact that this topic has been subject
to little empirical inquiry, the purpose of this study was to
obtain a preliminary understanding of the types of medication
management problems that school nurses face, as well as the
strategies they use to solve those problems. An analysis of
messages related to medication management that appeared on
the SCHLRN-L listserv (a 1,400-member discussion group for
schools nurses) was performed. All messages sent to the
listserv during a 5-month period were monitored. Any
discussion thread that began during this time period and
addressed the management of medications was selected for
possible inclusion in the study. The result was a group of 71
threads. The listserv participants described a wide array of
medication management problems and suggested numerous
strategies for solving them. This study shows that serious
medication management problems exist in schools and that
school nurses make use of various strategies or “tricks of the
trade” to handle these problems. This research highlights the
need for a contribution from the pharmacy profession in this
important and neglected area of drug therapy.

Reference:
http://jsn.sagepub.com/content/17/3/131.short
 Age, as they say, is never an assurance to one’s health
status. If you’re too young, you’re health is too fragile, while
when you’re old, you’re prone to many degenerative
diseases. Amidst this irony, it is still good to think that there
have been many programmes about health awareness and
health assessment and rehabilitation measures that have
risen out of the concern and initiative of certain people.

Being exposed to A. Mirasol Memorial School taught us

nursing student’s different stuffs we could use in our future career.
Doing physical assessment to the elementary students, gave us
an opportunity to practice our skills and learn to master these
skills. It has been a greater ground of learning for all of us student
nurses of the University of San Agustin, College of Nursing. Even
though, we we’re not able to handle all the grade levels, the
knowledge that we gained is already enough to be taken for
granted.

After our school nursing exposure, we had identified

problems like poor personal hygiene among the students which
affects their health and school performance. With this problem,
we recommend to have a microteaching to all the students
regarding proper hygiene such as bathing, brushing of teeth,
trimming of nails, and proper way of hand washing. Teachers
and parents or guardians of these students may also be
informed regarding this problem and they will also be educated
on how to teach, train, and monitor their children if they follow
the instructions given to them.

Another problem identified is that there is no

school nurse assigned to this school but only a clinic
teacher. Since the clinic teacher is the primary
healthcare provider in school, they must possess some
of the traits of a healthcare provider. We recommend
that a clinic teacher assigned must be knowledgeable
enough to assess the condition of the child and knows
the appropriate and best interventions to be given.
Clinic teachers must also be knowledgeable enough on
what interventions may be given to a certain case
because not all interventions are applicable to all
situations. Clinic teacher must attend a seminar or
training on how to perform vital signs taking such as
blood pressure monitoring, as well as wound dressing
and other interventions in emergency cases. Clinic
teacher should always be available on the said area so
that all the concerns of the students may be addressed
to her and that proper referrals may be done in
emergency situations.