Occupational Health and Healthy People 2020 Questions

Chapter 29 School Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. School Health The healthy development of children and adolescents is influenced by many societal institutions. After the family, the school is the primary institution responsible for the development of young people in the United States. – Centers for Disease Control and Prevention (CDC, 2011) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Academic Success     It is impossible to achieve success in school without maximizing the health of the students. Poor academic performance is strongly correlated with uninsured status of youth; acquisition of health insurance leads to an increase in school performance. Health problems lead to increase in absenteeism. The school nurse has a unique opportunity to make a positive impact on the nation’s youth. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 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%. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 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 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 History of School Health (Cont.)       1960s: First NP programs with inclusion of primary care services in schools 1975: Education for the Handicapped Act 1976: First National School Conference 1986: Drug-Free Schools and Community Act 1994: Above act expanded to include violence prevention measures 1990s: CDC Division of Adolescent and School Health formed Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 History of School Health (Cont.)   1990s: School-based health centers 2001: No Child Left Behind Act ➢  Safe and Drug Free Schools and Communities focused on prevention of school violence and illegal use of alcohol, tobacco, and drugs 2010: Patient Protection and Affordable Care Act (ACA) ➢ Awarded funds to 278 school-based health centers to create new sites and expand services ➢ Expansion of services in medically underserved areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Components of School Health Programs      Health education Physical education Health services Nutrition services Counseling, psychological, and social services    Healthy school environment Health promotion for staff Family and community involvement Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Components of School Health Programs (Cont.) Figure 29-1 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Health Education  CDC guidelines and priority areas: ➢ Alcohol and drug use ➢ Injury and violence (including suicide) ➢ Tobacco use ➢ Poor nutrition ➢ Lack of physical activity ➢ Occupational Health and Healthy People 2020 Questions

Sexual behavior that results in STDs or unwanted pregnancies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 National Health Education Standards    Established to promote positive health behaviors for students in all grades. Gives students, families, and communities a framework for development of health education programs in schools. The students will… 1.…comprehend concepts related to health promotion and disease prevention to enhance health. 2.…analyze the influence of family, peers, culture, media, technology, and other factors on health behaviors. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 National Health Education Standards (Cont.)  The student will demonstrate the ability to… 3.…access valid information, products, and services to enhance health. 4.…use interpersonal communication skills to enhance health and avoid or reduce health risks. 5.…use decision-making skills to enhance health. 6.…use goal-setting skills to enhance health. 7.…practice health-enhancing behaviors and avoid or reduce health risks. 8.…advocate for personal, family, and community health. – CDC (2011) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Youth Risk Behavior Survey  Conducted by the CDC every 2 years among selected high school students in the U.S. ➢  http://www.cdc.gov/HealthyYouth/yrbs/index.htm Reports provide valuable information that can help improve health education programs in schools. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Youth Risk Behavior Survey (Cont.)  Purposes of YRBS (CDC, 2007): ➢ ➢ ➢ ➢ ➢ ➢ Determine the prevalence and age of initiation of health risk behaviors. Asses whether health risk behaviors increase, decrease, or remain the same over time. Examine the co-occurrence of health risk behaviors. Provide comparable data among subpopulations of youth. Provide comparable national, state, territorial, tribal, and local data. Monitor progress toward achieving the Healthy People 2020 objectives and other program indicators. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Injury Prevention  Should be taught early and be age appropriate ➢ ➢ ➢ ➢ ➢  Bicycle safety and helmets Proper use of backpacks Schoolyard and playground safety Motor vehicle safety for adolescents Sports safety • Equipment • Hydration and frequent rest periods • Stretching, warm-up, and cool-down activities • Pool safety Related school policies, recommendations, data collection on injuries, and staff training Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Tobacco Use  Tobacco ➢ Smoking is the single leading preventable cause of death in the United States. ➢ An estimated 80% of adults who use tobacco began before the age of 18 years. ➢ Adolescents who use smokeless tobacco are more likely to become cigarette smokers. ➢ Adolescents targeted by tobacco advertising. ➢ Teach adolescents the negative consequences associated with tobacco. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 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 and abused drug among children and adolescents is alcohol.  Illicit drugs ➢ ➢ The most commonly used illicit drug among youth in the United States is marijuana. Use of illegal anabolic steroids has decreased, but remains a concern. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Sex Education   Teens are becoming sexually active at earlier ages, and, despite recent declines, pregnancy rates continue to be high. Sex education in the school setting is a controversial topic. ➢ ➢ 21 states mandate sex education be taught No research concludes that sex education in the schools increases sexual activity Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Other Educational Topics  Tattoos and body piercing ➢  Dental health ➢ ➢  Making healthy decisions about body and sanitary conditions where procedures are performed Proper oral hygiene and regular dental check-ups Relationship between high-sugar foods and dental caries Physical education ➢ Promotion of lifelong physical activity Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Health Services  Immunizations ➢  Health screenings ➢ ➢ ➢ ➢ Occupational Health and Healthy People 2020 Questions

 All states now require proof of current immunization status or evidence of immunity before school entrance. Vision is required in most states Hearing screenings Scoliosis or postural screening High blood pressure screening EPSDT: Early and Periodic Screening, Diagnosis, and Treatment created by Medicaid Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Health Services (Cont.)  Emergency care ➢  Care of ill children ➢   First aid, CPR, Emergency Care Plans (ECP) Management of acute and chronic health conditions Medication administration Children with special health needs ➢ ➢ Public Law 99-142 (1976) gave all children the right to public education in the least restrictive environment possible regardless of mental or physical disabilities Individuals with Disabilities Education Act of 1990 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Health Services (Cont.)  Student Health Records should include: ➢ ➢ ➢ ➢   Immunization status Pertinent history Results of screenings and examinations IHPs (Individualized Health Care Plan) Family Educational Rights and Privacy Act (FERPA)—strong privacy protection act of education and health records Health Insurance Portability and Accountability Act of 1996 (HIPAA)—confidentiality of personal health information Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Health Services (Cont.)  Delegation of tasks by the school nurse ➢ ➢ Not all schools have a nurse; a nurse may be assigned to multiple schools. Nurse is responsible, but each state’s nurse practice act stipulates what can be delegated. • Nurse must provide appropriate education, written procedures, and ongoing supervision and evaluation of the caregivers for tasks delegated to others. ➢ Responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Health Services (Cont.)  Nutritional concerns ➢ ➢ ➢   Identifying nutritional problems, counseling and making appropriate referrals Eating disorders ➢   Junk food and school vending machines Skipping meals, especially breakfast Unhealthy snacks Anorexia, bulimia, and binge eating Obesity—fastest rising public health concern Nutrition education programs Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Female Athlete Triad  A syndrome consisting of… ➢ ➢ ➢   eating disorders, amenorrhea, and osteoporosis. A complex problem with psychological and physiological factors. Can result in menstrual irregularities, premature osteoporosis, and decreased bone mineral density; if taken to the extreme, it can become life threatening – Data from Nemours Foundation: Female Athlete Triad (2010) www.KidsHealth.org/teen/food_fitness/sports/triad.html Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 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 ➢ Suicidal ideation ➢ Eating disorders ➢ Under- or over-achievement Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Healthy School Environment “All students and staff have an inherent right to learn and work in a healthy school environment, and that the school nurse can assess the school environment for risk factors, advocate for the school community, to address environmental pollution issues, and educate the community to the impacts of environmental issues and exposures.” – NASN (2012) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Healthy School Environment (Cont.)  Violence is a major public health problem because it threatens the health and wellbeing, both physical and psychological, of many children and adolescents. ➢ ➢ Be aware of 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 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Healthy School Environment (Cont.)  Terrorism ➢ ➢ ➢ Every school is expected to have an emergency management plan. Many states mandate plans for potential threat of terrorist attack or natural or man-made disaster. Nurse is a potential first responder and should be an active participant in planning and policy development. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Health Promotion for School Staff  Health promotion programs at the work site produce beneficial results. ➢ Positive effects on blood pressure control ➢ Occupational Health and Healthy People 2020 Questions

Daily physical activity ➢ Smoking cessation ➢ Weight control ➢ Improve morale ➢ Reduce job stress and absenteeism ➢ Heighten interest in teaching health-related topics to students Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Family and Community Involvement  The school nurse is a resource to the community; performs many roles: ➢ Educator ➢ Resource/leadership role ➢ Consultant ➢ Advocate  Students who have parental support are more successful, experience less emotional distress, eat healthier, and are more actively engaged in learning (see Family Risk Index) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 Family Risk Index (Annie E. Casey Foundation, 2002) Children living in families with four or more of the following characteristics are considered “high risk” … ➢ ➢ ➢ ➢ ➢ ➢  Child is not living with two parents Household head is a high school dropout Family income is below the poverty line Child is living with parent(s) who does not have steady, fulltime employment Family is receiving welfare benefits Child does not have health insurance Percentage of children living in “high-risk” families, based on the definition above, is 10% Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 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) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 School Nursing Practice  Education needed by school nurse: ➢ Growth and development ➢ Public health ➢ Mental health nursing ➢ Case management ➢ Program management ➢ Family theory ➢ Leadership ➢ Cultural sensitivity  Bachelor’s degree or higher recommended Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Roles of the School Nurse      Care provider Student advocate Educator Community liaison Case manager    Delegate cares and supervise others Practice independently as a member of an interdisciplinary team Conduct research Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 School-Based Health Centers   One of best ways to offer comprehensive health care to children and adolescents. An interdisciplinary team approach ➢ ➢ ➢ ➢   Nurse practitioners Social workers Psychologists Physicians Provide services on site Works in collaboration with, but does not take the place of the school nurse. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Chapter 30 Occupational Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 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 … – American Association of Occupational Health Nurses (2012) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Occupational Health Nursing … … includes the prevention of adverse health effects from occupational and environmental hazards. … provides for and delivers occupational and environmental health and safety programs and services to clients. … is an autonomous specialty, and nurses make independent nursing judgments in providing health care services. – American Association of Occupational Health Nurses (2004) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Occupational Health Nursing … (Cont.) … has a multidisciplinary base: ➢ Nursing science ➢ Medical science ➢ Occupational health sciences ➢ Epidemiology ➢ Business and economic theories, concepts, and principles ➢ Social and behavioral sciences ➢ Environmental health ➢ Legal and ethical issues Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Occupational Health Nursing Knowledge Domains Figure 30-1 From Rogers B: Occupational health nursing expertise, AAOHN J 46:477-483, 1998. Copyright © Bonnie Rogers, 1998. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Evolution of Occupational Health Nursing: Part 1      1888: Betty Moulder hired by a group of coal mining companies 1895: Ada Mayo Stewart was “first industrial nurse” 1897: Anna B. Duncan visited sick employees at home 1899: Nursing service established for employees at worksite 1912: Workers’ compensation legislation passed; cost-effectiveness of providing health care to employees was achieving increased recognition Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Evolution of Occupational Health Nursing: Part 2      1913: A registry of industrial nurses initiated 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 Great Depression: Nurses lost jobs because industrial nursing was considered nonessential Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Evolution of Occupational Health Nursing: Part 3      World War I: Government demanded health services for workers at factories and shipyards holding defense contracts 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 …