As of May 2009, the Forward and Table of Contents, Chapters 1, 2, 3 and 7 have been revised. The chapters were re-formatted into stand alone modules and updated with the most current information on each topic. Revisions started in 2009 for modules 4 through 6 and the remaining modules will follow. In the meantime, the science and protocols in the current chapters are still appropriate.
To access the information in this guide:
Click on the title of the module or chapter where the topic of interest is located. Then, navigate through the text until you locate the page where the information appears. Module/chapter titles are underlined.
FOREWORD iv
ACKNOWLEDGMENTS v
PREFACE vii
WHO SHOULD USE THIS Guide vii
WHAT THIS GUIDE INCLUDES viii
TABLE OF CONTENTS ix
History of School Health 3
History of School Health Activities in Texas 3
Describing the Components of a School Health Program 4
Assumptions for School Health Services 6
The Health Needs of School-Aged Children 6
The Health Status of Children in Texas Schools 9
Types of Health Services Available in Texas 9
Health Services for Special Needs Children 11
The Legal Environment for School Health Services 13
Conclusions and Recommendations from Report of the School Health Task Force 16
Developing a Program 17
Planning 18
Infrastructure 19
Infrastructure at the State Level 21
Infrastructure at the District or Community Level 22
Infrastructure at the School Level 25
Needs Assessment 25
Identification of a Model 26
Financing a School Health Program 27
Federal Funding 27
Fiscal Issues in Texas 28
Collaboration Within the School System 31
Collaborative Partnerships Outside the School 32
Evaluation 33
References 36
School Nursing Practice/Standards of Care 3
Standards of Practice 3
Standards of Professional Performance 4
Establishing a School Health Team 5
Position Descriptions/Roles/Relationships 5
Relationship with School-Based Health Centers 13
Communicating With Parents 16
Culturally Effective Care 17
Communication – Practical Advice 18
School Health Resources 18
References 25
Consent to Health Services 3
Access to Student Records 5
Access by Parents 5
Access by Certain School Staff 6
School Entrance Physical Examination Requirements 6
Requirements for Enrollment 6
Immunizations 7
Population-Based Screening Programs: State Mandated 7
Annual Report 7
Vision Screening 9
Hearing Screening 11
Spinal Screening 15
Acanthosis Nigricans Screening 21
Dyslexia Screening 21
Population-Based Screening Programs: Best Practice 23
Height and Weight 23
Body Mass Index 24
Blood Pressure 26
Oral Health and Dental Screening 27
EPSDT/Medicaid/Texas Health Steps 28
Speech and Language 30
Fine and Gross Motor Screening 36
Evaluation of Normal Development 37
Exhibits 39
CDC Growth Chart (77 kb) 39
Girls Stature-for-age & Weight-for-age percentiles (546 kb) 40
Boys Stature-for-age & Weight-for-age percentiles (539 kb) 41
References 45
Immunization Requirements 113
Background Information 113
Ask the Experts: General Vaccine Questions, VISs, Thimerosal 120
Minimum Requirements 129
Texas Vaccines For Children Program 131
Exemptions 132
Serologic Confirmation of Immunity 132
Medical Contraindications 133
Exemptions for Religious Conflicts 133
Exemptions for Service in Armed Forces 134
Authorization/Consent 134
Liability 134
Procedure 135
Adverse Events Reporting 135
Documentation 136
School Records 136
Acceptable Documents of Immunizations 136
Vaccine Registry 137
Relevant Exhibits 138
Vaccine Information Statements 150
Chicken Pox (Spanish) (1.1 mb) 150
Chicken Pox (English) (724 kb)153
Diphtheria, tetanus & pertussis (Spanish) (1.2 mb) 156
Diphtheria, tetanus & pertussis (English) (757 kb) 159
Hepatitis A (Spanish) (828 kb) 162
Hepatitis A (English) (765 kb) 165
Hepatitis B (Spanish) (876 kb) 168
Hepatitis B (English) (795 kb) 171
Haemophilus Influenzae Type B (Hib) (Spanish) (827 kb) 174
Haemophilus Influenzae Type B (Hib) (English) (1.2 mb) 177
Measles, Mumps & Rubella (Spanish) (951 kb) 180
Measles, Mumps & Rubella (English) (790 kb) 183
Pneumococcal Conjugate (Spanish) (797 kb) 186
Pneumococcal Conjugate (English) (743 kb) 189
Polio (Spanish) (949 kb) 192
Polio (English) (821 kb) 195
Tetanus and Diphtheria (Spanish) (794 kb) 198
Tetanus and Diphtheria (English) (691 kb) 201
Guidelines for Administering Medications in Schools 207
Overview 207
Texas Education Code Provisions 207
Liability 209
Nursing Practice Considerations 210
Relationship with Other Healthcare Providers 211
Guidelines for Administering Medications 211
Procedures for Administering Medications 216
Errors and Omissions in Medication Administration and Recording 222
Special Topic: Medication Administration off of School Grounds (Field Trip/Event) 227
Special Topic: Herbal and Dietary Supplements 231
Special Topic: Use of Emergency Medication in Schools 233
Emergency Injectable Epinephrine in the School Setting 233
Special Topic: Psychotropic Medications in Schools 235
Antidepressants 236
Antianxiety Medications 237
Mood Stabilizers 237
Stimulants 238
Special Topic: Medication for Diabetes (Type 1 and 2) in Schools 240
Oxygen Administration in Schools 244
Relevant Exhibits 251
Skills Checklist for Medication Administration (415 kb) 251
Sample Parental Consent/Provider Authorization 252
Letter to Parent Advising of Texas Medication Law (w/Nurse) 253
Letter to Parent Advising of Texas Medication Law (w/oNurse) 254
Refusal to Administer Medication Letter (to Parents) 255
Administrative Regulation for Administration of Medications at School 256
Parental Permission to Administer Prescription
or Non-Prescription Meds 258
Sample Provider Authorization Form (17 kb) 259
Sample Medication Log 260
Sample Incident / Error Reporting Form 262
Sample Medication Administration Plan 263
Sample Wall Poster “5 Rights of Medication Administration” 264
Sample Product Insert - Epipen 265
Sample Insulin Pump 266
Additional Resources 267
Counseling, Psychological and Social Services 271
Overview 271
The Counselor 272
The Psychologist 274
The Nurse 277
The Teacher 278
Mental Health in Schools 280
New Roles for School Nurses 281
Screening: A Note of Caution 284
Interviewing: Exploring the Problem with Student/Family 289
Understand the Nature and Scope of Problems 290
Psychosocial Guidance and Support 293
Psychosocial Counseling 294
Mental, Emotional and Behavior Disorders in Children and Adolescents 296
Mental, Emotional and Behavior Problems 297
Counseling, Psychological and Social Services: Special Populations 300
Children with Special Health Care Needs 300
“At risk” Youth/Suicide 301
Eating Disorders 303
Substance Abuse 307
Family Crisis/Divorce 309
Homosexuality/Alternative Sexual Orientation 309
Violent Relationships 310
School Violence 312
NASN Position Statement: Role of the School Nurse in Violence Prevention 313
Legislation 314
Primary Prevention: Principles of Prevention and Early Warning Signs 315
Conflict Resolution 319
Relevant Exhibits 322
Special Education: Children with Special Health Care Needs 3
Individuals with Disabilities Education Act 3
Section 504 4
Americans with Disabilities Act 6
Related Services 6
Scope of Related Services 6
Individualized Education Program 7
Timeline for Major Legislation Related to Children with Special Health Care Needs in
School Based Settings 7
The Role of the School in the Individualized Health Care Plan Process 8
The Role of the School Nurse in the Individualized Health Care Plan Process 10
Children with Disabilities 12
Eligibility 12
Types of Disabilities 13
The School’s Role 16
The Educational Environment: Inclusion 18
Children Requiring Special Health Care Procedures 19
Procedures Performed in School Settings 20
Steps for Procedures Performed in Schools 21
Learning Disabilities 22
Role of the School and the Nurse in the Assessment of learning Disabilities 26
Learning Disability and the Law 32
Increased Services, Equal Opportunity 33
Public Agency Support 33
Children with Chronic Illnesses 34
Allergies 34
Asthma 37
Diabetes 42
Seizure Disorders 45
References 52
Communicable Diseases 445
NASN Position Statement: Infectious Disease 445
Universal Precautions 446
Overview 446
Handwashing 447
Ways to Avoid Contact with Body Fluids 448
Disposal of Infectious Waste 448
Accidental Exposure 450
Reportable Conditions 451
Reportable Disease Table 453
Selected Communicable Diseases 456
Impetigo 456
Hepatitis A 457
Influenza 458
Meningitis 459
Varicella (Chicken Pox) 461
Tuberculosis 463
Pediculosis 465
Tinea Capitis (Ringworm of the Scalp) 467
Exclusion from School 467
Relevant Tables and Exhibits 470
Dermatology: Common Childhood Diseases Associated with Rashes (21 kb) 470
Hepatitis Chart (17 kb) 473
Communicable Disease Chart for Schools and Child-care Centers (1.4 mb) 475
References (29 kb) 481
TB Addendum
Emergency Procedures 485
The Law 486
The School's Role 488
Step One: Emergency Prevention and Risk Reduction 488
Step Two: Emergency Readiness 490
Step Three: Communication 496
Emergency Procedures: Allergic Reaction 497
The School's Role 498
Common Types of Allergic Reactions and Strategies to Reduce Allergic Responses 502
Emergency Procedures: Heat-Related Illnesses 509
Prevention 509
Temperature Overload 510
Hot Weather Emergencies 510
Emergency Procedures: Cardiac Arrest 514
Causes of Cardiac Death in Children and Adolescents 514
Risks for Sudden Cardiac Death in Schools 515
Treatment of Sudden Cardiac Arrest 515
The Law 518
Out-of-Hospital Do Not Resuscitate Orders 519
Legal Background 520
Honoring a DNR Order 521
DNR Order Record-Keeping 523
Secondary Prevention: Crisis Management and Responding to School Violence 523
The Emergency Response Plan 523
The Emergency Response Team 525
Intervention During a Crisis 526
The Role of the School Nurse 527
Other Resources for Critical Incident Response Plans 528
Relevant Exhibits 537
Emergency Categorization Chart (40 kb) 537
General Emergency Guidelines 538
Legal Discussion Regarding Standing Delegation Orders 539
Helpful Resources 541
Suggestions for School First Aid Supplies 544
Sample Universal Precautions Guidelines 545
Sample Emergency Care Plan (Allergy) (353 kb) 547
TDH Out-of-Hospital DNR Order Form and Instructions (962 kb) 549
Case Management 555
Child Abuse 558
Operational Definitions of Abuse 559
Reasons for Abuse and Neglect 559
Assessing for Signs of Abuse and Neglect 563
Referrals to Child Protective Services 577
Child Protective Services 577
Referrals to Other Health Care Providers 588
Primary Health Care Providers 589
Emotional 591
Nursing Liaison Services to Homebound Students 599
Home Visits 602
Refugee, Migrant and Immigrant Health 615
Refugees 615
Immigrants 615
Mexican/Hispanic and Latin American Immigrants 618
Cuban Refugees and Immigrants 621
Iraqi Refugees 621
Somali Refugees 622
Sudanese Refugees 624
Bosnian Refugees 625
Vietnamese Immigrants 626
Indian Immigrants 628
Migrants 630
Texas Essential Knowledge and Skills for Health Education 635
Safety and Injury Prevention 635
Substance Use and Abuse 642
School Prevention Programs 643
Alcohol Abuse 650
Drug Abuse 652
Tobacco Use 654
CDC Guidelines for Preventing Tobacco Use and Addiction 659
Abstinence-Based Education 667
What is Abstinence? 667
What is the Title V Abstinence Education Program? 668
Texas Essential Knowledge and Skills for Health Education: Abstinence-Based Education 668
Lifelong Healthy Eating 671
School Nutrition Services 671
CDC Guidelines: Promoting Lifelong Healthy Eating 673
Physical Education 681
CDC's Guidelines for School and Community Programs Promoting Lifelong Physical
Activity 681
How Much Physical Activity Do Young People Need? 682
How You Can Help 685
Skills to Target Each Year (Grade School, Middle School, High School) 687
CDC Guidelines for Promoting Lifelong Physical Activity 691
Preparticipation Physical Evaluation-Medical History 697
Physicals 699
Excerpt From AHA Medical/Scientific Statement: Cardiovascular Preparticipation Screening of Competitive Athletes 699
Prevention of Anabolic Steroid Use 703
Staff Wellness Programs 715
Relevant Exhibits 721
Adult Immunization Schedule (628 kb) 721
Helpful Resources (14 kb) 723
Wellness Disease Prevention Resources: Tobacco (599 kb) 726
Wellness Disease Prevention Resources: Violence (654 kb) 728
Wellness Disease Prevention Resources: Environmental Health (603 kb) 730
Wellness Disease Prevention Resources: Nutrition (761 kb) 732
Wellness Disease Prevention Resources: Substance Abuse (388 kb) 734
Wellness Disease Prevention Resources: Physical Activity (731 kb) 735
Wellness Disease Prevention Resources: Cancer (697 kb) 737
Wellness Disease Prevention Resources: Diabetes (751 kb) 739
Healthy School Environment 743
Indoor Air Quality 743
Asbestos 753
Mold 754
Tobacco 756
Pest Control in Schools 756
Lighting at School 766
Promoting Healthy Computer Use 767
Protective Eyewear in Schools 770
Animals in the Classroom 772
School Building Requirements 773
Safe Playgrounds 775
Resources for School Facility Construction and Renovation 781
Relevant Exhibit: EPA Tools for Schools Action Kit 787
IAQ Backgrounder (2.3 mb)787
Teacher's Classroom Checklist (2.4 mb) 793
Administrative Staff Checklist (1.3 mb) 801
Health Officer/School Nurse (935 kb) 805
Ventilation Checklist & Log (1 mb) 808
Explanatory Info for Ventilation Log Items (3.7 mb) 812
Building Maintenance Checklist (1.8 mb) 824
Food Service Checklist (857 kb) 830
Waste Management Checklist (426 kb) 833
Renovation and Repairs Checklist (3,108 kb) 835
Walkthrough Inspection Checklist (1,116 kb) 845
Parent and Community Involvement 853
Family and Community Involvement in Schools 853
School Health Advisory Committees 857
Parent Teacher Organizations 859
Community Regulatory Organizations 860
INDEX (14 kb) 1053