School-based health centers National Association of School Nurses

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%. Lina Rogers – 1st School Nurse in US (1902)
– Hired to work for the New York City Health Department, provided a variety of services for children, including lunches and recreational activities
– Retired in 1914, when she married Dr. William Struthers, wrote “The School Nurse”, published in 1917. 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 1960s First NP programs with inclusion of primary care services in schools 1986 Drug-Free Schools and Community Act 1994 Community Act expanded to include violence 1990s – CDC Division of Adolescent and School Health formed
– School-based health centers National Association of School Nurses (NASN) provides general guidelines/support for all school nurses Standards of professional practice assessment, diagnosis, outcomes identification, planning, implementation, and evaluation Professional performance standards quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, leadership, and program management American Academy of Pediatrics (AAP) guideline – Ensure that children get the health care they need, including emergency care in the school
– Ensure that the nurse keeps track of the state-required vaccinations that children have received
– Ensure that the nurse carries out the required screening of the children based on state law
– Ensure that children with health problems are able to learn in the classroom NASN and AAP recommends that Registered nurses who also have a bachelor’s degree in nursing and special certification in school nursing No general laws regarding the educational background of school nurses Some states require RNs, but LPNs work in some schools; only about half of all U.S. states require some form of additional study for school nurse specialty certification Controversies in school nursing (Examples) – Providing birth control education in the school
– Giving birth control to students in the school Ethics in school nursing – Nurse must keep personal beliefs out of the discussion
– If a nurse cannot work with a situation because of beliefs, another school nurse should be called for help or student should be referred to other health providers who can give the care the student needs Parish nurses nurses who respond to health and wellness needs of populations of faith communities and are partners with the church in fulfilling the mission of health ministry CIRCLE Model of Spiritual Care C aring
I ntuition
R espect for religious beliefs and practices
C aution
L istening
E motional Support Occupational Health Nursing The specialty practice that focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment … Betty Moulder 1888: hired by a group of coal mining companies. Ada Mayo Stewart 1893: “first industrial nurse” Anna B. Duncan 1897: visited sick employees at home 1899 Nursing service established for employees at worksite 1912 Workers’ compensation legislation passed 1915 Basis for Industrial Nurses Organization formed 1916 Factory Nurses Conference organized 1917 First educational course for industrial nurses offered at Boston University’s College of Business Administration World War I Nurses lost jobs as considered nonessential World War II Increased number of women in workforce 1942 Health conservation of the “industrial army” was the most urgent civilian need during the war 1938-1943 Number of occupational health nurses increased by 10,000 1942 American Association of Industrial Nurses formed 1953 Industrial Nurses Journal formed (now AAOHN Journal) 1977 AAIN became American Association of Occupational Health Nurses (AAOHN) 1989 AAOHN developed first research agenda 1993 Office of Occupational Health Nursing established by OSHA Industrial transformations in the 21st century – Changing workforce demographics
– Rising health care costs
– Diversity of health care systems with the integration of managed care
– Influence of the world economy
– Shift in production from goods to services
– Proliferation of advanced technologies Occupational Safety and Health Act – OSHA (1970) Employers must “furnish a place of employment free from recognized hazards that are causing or likely to cause death or serious physical harm to employees.” Workers’ Compensation Acts (state based) Provide income replacement and health care for employees who sustain a work-related injury or death. Americans with Disabilities Act – ADA (1990) Employers must make “reasonable accommodations” to enhance opportunities for individuals with disabilities; prohibits discrimination on the basis of disability. 19th century – Ladies’ charitable organizations provided care to the sick in their own homes by hiring nurses
– Henry Street Settlement House Early 1900s Metropolitan Life Insurance Company included home care as a benefit to policyholders 1965 Home care as a benefit for Medicare enrollees Home Care – Includes disease prevention, health promotion, and episodic illness-related services provided to people in their places of residence
– Is an approach to care provided in people’s homes because theory or research suggests this is the optimum location for certain health and nursing services Family caregiving includes assisting clients to meet their basic needs and providing direct care such as personal hygiene, meal preparation, medication administration, and necessary treatments Working in the Client’s Home The home environment lacks many resources typically found in institutions, so it is essential that nurses have good organizational skills, be able to adapt to different settings, and demonstrate interpersonal savvy for working with the diverse needs of people in their homes Lillian Wald – The Henry Street Settlement served the sick and the poor and sponsored welfare, civic and social work, and visiting nursing
– Nurses lived in the settlement to better identify the needs of the families served.
– Began home visit program for the Metropolitan Life Insurance Co policy holders Population-focused home care directed toward the needs of specific groups of people, including those with high-risk health needs such as mental health problems, cardiovascular disease, or diabetes; families with infants or young children; or older adults Transitional care in the home designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another Home-based primary care – emphasis is delivering primary care in the homes of people for whom it is difficult to come to a primary care clinic, community center, or physician’s office because of functional or other health problems
– House call programs are an example: NP’s or MD’s provide primary care for clients who have difficulty visiting an office due to health problems. May also be interdisciplinary team Five general types of Home Care Nursing based on administrative and organizational structures – Official
– Private and
– voluntary
– Combination
– Hospital based
– Proprietary Hospice palliative care of the very ill and dying; focuses on reducing distress from physical, emotional, and spiritual symptoms Direct care the actual physical aspects of nursing care – anything requiring physical contact and face-to-face interaction:
– Performing a physical assessment on the client
– Changing a dressing on a wound
– Giving medication by injection
– Inserting an indwelling catheter
– Providing intravenous therapy
– Teaching clients/family how to perform a task Indirect care activities a nurse does on behalf of client to improve or coordinate care:
– Consulting with other nurses and health providers in a multidisciplinary approach to care
– Organizing and participating in client care team conferences
– Advocating for clients with the health care system and insurers
– Supervising home health aides
– Obtaining results of diagnostic tests
– Documenting care Hospice – Historically, the word Hospice referred to a place of refuge for travelers.
– Originating in 19th century England
– Hospice movement gained momentum in the US in the 1970’s – Dr. Elisabeth Kubler-Ross – work on death & dying
– 1982 – Medicare reimbursement
– Hospice care model – institutional, home care or both
– Services offered: home care services, volunteers, chaplain support, respite care, financial help (medicines & equipment), bereavement support for the family Hospice Primary Goal maintain the client’s dignity and comfort.