Health care is provided in different settings. The role of a nurse in these settings is indispensable, as will be discussed in this paper. The school health community setting is very vital. This is not to negate the importance of the other settings. However, the fact that this setting deals with the health of the children warrants a special focus. This is because children have been considered very important to the future of the nation, and as such, their health. This paper delves into the role of the school nurse. In vetting this role, the paper will justify the importance of the school health as a community setting, overview its history, interpret community and national statistics, examine the ethical implications of care in this setting and the cultural issues that define care.
As a community setting, school health is an approach aimed at providing health services in schools. This approach uses school nurses as the primary healthcare providers. The oversight body for the school nurses is the National Association of School Nurses. This organization makes recommendations with regards to the requirements for service delivery. For instance, the organization recommends a nurse to student ratio of one nurse for every 750 students. The organization also recommends one nurse in 225 student attending mainstreamed special education programs and one school nurse in 125 students with severe chronic illnesses or those who are developmentally disadvantaged. However, the 60,000 registered school nurses are inadequate to meet these recommendations. Nonetheless, the program still offers indispensable services to the children of America, thereby helping improve their health (Nies & McEwen, 2013).
Importance of School Health
Today’s school going children are faced by diverse health related challenges. They include behaviors and risks that predispose them to life threatening diseases later in life. Tobacco use, irresponsible sexual behavior, poor nutrition, alcohol and substance abuse, reckless driving, inadequate physical activity violence and suicide are some of the behaviors and risks that predispose school going children to these problems. It is difficult to reach this population outside the school setting. This is partly because a significant number of these children are not covered by insurance programs.
More precisely, the Children’s Defense Fund (2008), reports that one in every nine children is not insured. This makes it difficult to reach them at the health facilities in their communities. The fact that over 50 million children in the United States attend various schools every day offers an apt opportunity for health providers to mitigate the risks and behaviors and risks discussed above. This is by offering both preventive and curative health services in this community setting. This justifies the importance of the school setting as an avenue for community health nurses to reach school going children.
History of the School Health
The early forms of school health can be traced back to 1850 in the Shattuck Report that proposed the importance of health education in preventing diseases. This opened the way for school administrators and public health officials. Increased impetus was seen in the 1860s during the Small Pox outbreak in New York City. The school setting was used effectively for widespread prevention programs. It is precisely around this time that the elements of the current school health system began. For instance the success of the vaccination programs in New York City paved way for school inspections to rid classrooms of health hazards and minimize the spread of disease. Isolation of students with infectious diseases also started at this time (Nies & McEwen, 2013).
Understandably, New York City pioneered the hiring of nurses to inspect schools and offer screening services for children, educate families on health matters and carry follow-up treatment. The input of nurses also helped establish the school health. For instance, Lillian Wald demonstrated how a school nurse could reduce the rates of absenteeism by half. This lead to the hiring of school nurses in schools across many cities across the country. Since then, school health has been adopted in schools across the country. the program has also been remodeled from what it was initially with nurses assuming more responsibilities in line with the increasing health needs. The history of this program shows the responsiveness of the public health system and the indispensable role of a community health nurse in the provision of health (Nies & McEwen, 2013).
Community and National Statistics on School Health
As espoused earlier, over 50 million American children attend school every day (NCES, 2008). Regrettably, 16% of these children suffer from chronic emotional, physical and other problems. There was a 60% increase in the number of children with health impairments resulting from chronic and acute problems (Bloom, 2009). Many states have student-based health centers. The Health Resources and Services Administration reports over two thousand school-based health centers throughout the country. This compares favorably to the 139 centers in New York City. These centers serve over three hundred and thirty three schools from the five boroughs in the city. One of the pressing statistics at the national level, and consequently translating to the community level is the number of registered school nurses versus the student population. This affects the case loads and by extension the quality of health offered, especially in the backdrop of increase prevalence of chronic diseases (New York City Department of Education, n.d.).
One of the ethical implications in school health is the conflict between maintaining confidentiality and mandated reporting. The two issues have implications for the health of the child. In its code of ethics, the Nursing Association of School Nurses (2010) outlines the professional responsibilities of a school nurse. Among them is maintaining confidentiality. However, state laws at times specify indications for mandated reporting. It is important for school nurses to not only understand this, but also to zealously implement these provisions. This requirement also has implications on client care and professional responsibilities of the school nurse in line with the code of ethics of the Nursing Association of School Nurses (2010). There are other emergent ethical issues include supervision and delegation to health assistants, professional conflicts, the pressure to work in other settings and the Do Not Resuscitate Policy. The resolution of these ethical stances has an implication on the health of the students and the professional career of the school nurses.
The current student population is very diverse in its composition. This diversity brings about cultural issues that school nurses have to maneuver. For instance, poverty is one such issue. Many students do not have insurance coverage, making the school setting the primary avenue through which they receive primary health care. Another cultural issue presents through one of the components of a school nurse’s job. Through health education, school nurses handle various topics that affect the health and well being of the students. Some of these issues challenge cultural norms and taboos. For instance, a school nurse is required to report incidents of violence. However, this might challenge norms and taboos in cultures where this issue is prevalent. The issue of immigrants also poses cultural challenges for the school nurse. Some of the immigrant cultures might be different, especially for ethnic minorities. A school nurse is required to exercise discretion, flexibility and professionalism when dealing with divergent cultures (Nies & McEwen, 2013).
Importance of the Nurses Role
The school nurse’s role is very important. At the primary prevention level, the school nurse is involved in immunizations, nutrition education, health education and safety. These elements are important because the touch on the well being of the students. These elements help provide a healthy foundation for the growth and development of the children. At the secondary level, the school nurse’s role involves screening for health concerns such as scoliosis and obesity, identification of risks, case finding treatment and home visits. This is important because in addition to prevention, this role entails early detection and treatment of health concerns, thereby enhancing the health of the students. At the tertiary level, the school nurse’s role involves making referrals when behavioral problems or substance abuse is indicated and preventing complications and the development of adverse effects. Under this role, the school nurse works in conjunction with the broader community to enhance the health of the students (Nies & McEwen, 2013).
Bloom B., & Cohen R.A. (2009). Summary health statistics for U.S. children: National Health Interview Survey, 2007. National Center for Health Statistics, Vital Health Stat 10 (239)
National Center for Educational Statistics (NCES). (2008). Digest of Education Statistics, 2007. Retrieved from http://nces.ed.gov/programs/digest/d07/
New York City Department of Education (n.d.). School-based health centers. Retrieved from> http://schools.nyc.gov/Offices/Health/SBHC/SBHC.htm
Nies, M. & McEwen, M. (2013). Community/Public health nursing: Promoting the health of populations. St. Louis. Elsevier Saunders.