School Health Occupational Health
School Health Occupational Health
Please read chapters 29 and 30 (PowerPoint attached) Once done answer the following questions;
1. Discuss how Healthy People 2020 can be used to shape the care given in a school health setting. Give at least one example.
2. Identify and discuss the eight components of a comprehensive school health program.
3. Identify and discuss the skills and competencies germane to occupational health nursing.
4. Describe and discuss a multidisciplinary approach for the resolution of occupational health issues.
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INSTRUCTIONS:
*Original papers (NO plagiarism)
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*A minimum of 800 words is required.
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Chapter_029.pptxChapter 29
School Health
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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. School Health Occupational Health
– Centers for Disease Control and Prevention (CDC, 2011)
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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.
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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%.
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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
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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
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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
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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
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Components of School Health Programs (Cont.)
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Figure 29-1
Health Education
CDC guidelines and priority areas:
Alcohol and drug use
Injury and violence (including suicide)
Tobacco use
Poor nutrition
Lack of physical activity
Sexual behavior that results in STDs or unwanted pregnancies
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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…
…comprehend concepts related to health promotion and disease prevention to enhance health.
…analyze the influence of family, peers, culture, media, technology, and other factors on health behaviors.
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National Health Education Standards (Cont.)
The student will demonstrate the ability to…
…access valid information, products, and services to enhance health.
…use interpersonal communication skills to enhance health and avoid or reduce health risks.
…use decision-making skills to enhance health.
…use goal-setting skills to enhance health.
…practice health-enhancing behaviors and avoid or reduce health risks.
…advocate for personal, family, and community health.
– CDC (2011)
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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.
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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.
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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
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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.
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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.
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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
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Other Educational Topics
Tattoos and body piercing
Making healthy decisions about body and sanitary conditions where procedures are performed
Dental health
Proper oral hygiene and regular dental check-ups
Relationship between high-sugar foods and dental caries
Physical education
Promotion of lifelong physical activity
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Health Services
Immunizations
All states now require proof of current immunization status or evidence of immunity before school entrance.
Health screenings
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
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Health Services (Cont.)
Emergency care
First aid, CPR, Emergency Care Plans (ECP)
Care of ill children
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
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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
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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. School Health Occupational Health
Responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated.
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Health Services (Cont.)
Nutritional concerns
Junk food and school vending machines
Skipping meals, especially breakfast
Unhealthy snacks
Identifying nutritional problems, counseling and making appropriate referrals
Eating disorders
Anorexia, bulimia, and binge eating
Obesity—fastest rising public health concern
Nutrition education programs
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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
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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
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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.” School Health Occupational Health
– NASN (2012)
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Healthy School Environment (Cont.)
Violence is a major public health problem because it threatens the health and well-being, 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
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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. School Health Occupational Health
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Health Promotion for School Staff
Health promotion programs at the work site produce beneficial results.
Positive effects on blood pressure control
Daily physical activity
Smoking cessation
Weight control
Improve morale
Reduce job stress and absenteeism
Heighten interest in teaching health-related topics to students
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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)
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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, full-time 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%
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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. School Health Occupational Health
– National Association of School Nurses (2000)
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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
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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. School Health Occupational Health
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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.
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Chapter_030.pptx
Chapter 30
Occupational Health
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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)
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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)
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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
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Figure 30-1 From Rogers B: Occupational health nursing expertise, AAOHN J 46:477-483, 1998. Copyright © Bonnie Rogers, 1998.
Occupational Health Nursing Knowledge Domains
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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
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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
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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
1942: American Association of Industrial Nurses formed
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Evolution of Occupational Health Nursing: Part 4
1951: AAIN voted to remain an independent, autonomous association, not merge with NLN
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
1999: AAOHN Foundation established and competencies in the specialty were delineated.
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Evolution of Occupational Health Nursing: Part 5
2003: Annual joint conference, the American Occupational Health Conference was abolished even though it was 60 years old
2005: AAOHN held its first separate occupational health nursing conference
21st Century: AAOHN continues to expand specialty borders, emphasizing the importance of occupational health concepts and population-based practice.
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Demographic Trends and Access Related to Occupational Health Care
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
Industry moving away from large facilities to smaller, service-based businesses
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Occupational Health Nursing Practice and Professionalism
Often the only on-site health care professional.
Collaborates with workers, employers, and other professionals.
Roles are diverse and complex.
Coordinates comprehensive, holistic services.
Practice guided by AAOHN’s Standards of Occupational and Environmental Health Nursing Practice and Code of Ethics (2012).
Empowered, well-trained, usually educated at the baccalaureate level.
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The Occupational Health Nurse
Practice guided by an ethical framework.
Encourages and enables individuals to make informed decisions about health care concerns.
Is a worker advocate; upholds professional standards and codes.
Responsible to and compensated by management; must practice within a framework of company policies and guidelines.
Fosters equitable and high-quality health care services and safe, healthy work environments.
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Occupational Health and Prevention Strategies
Prevention of exposure to potential hazards
Biological-infectious hazards
Chemical hazards
Enviromechanical hazards
Physical hazards
Psychosocial hazards
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Primary Prevention Strategies
Health promotion
Facilitates lifestyle changes
Enhances awareness
Increases motivation
Builds skills
Creates environments that supports positive health practices
One-on-one interaction is an important strategy for evaluating risk reduction behavior for individuals
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Primary Prevention Strategies (Cont.)
Disease prevention
Recognize health risks, diseases, or environmental hazards
“Seize the moment” with every employee encounter
Use aggregate-focused intervention strategies
“Walk-throughs” on a regular basis
Recognize potential and existing hazards
Maintain communications with safety and industrial hygiene resources to prevent illness and injury from occurring. School Health Occupational Health
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Primary Prevention Strategies (Cont.)
Overall health promotion
Health fairs, on-site fitness center, etc.
Nonoccupational programs
Cardiovascular health, cancer awareness, personal safety, immunization, prenatal and postpartum health, accident prevention, retirement health, stress management, and relaxation techniques
Emergency response, CPR, first aid and CPR, right-to-know training, immunization programs for international business travelers, back injury prevention with proper lifting and ergonomics
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Primary Prevention Strategies (Cont.)
Women’s health and safety issues
Maternal-child health, reproductive health, breast cancer early detection, stress management, work-home balance, etc.
Racial and ethnic minority groups
Basic health concerns for this population and the illnesses traditionally associated with these groups or workers
Programs must be culturally and linguistically appropriate
Veterans special health needs
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Secondary Prevention Strategies
Aimed at early diagnosis, early treatment interventions, and attempts to limit disability.
Focus is on identification of health needs, health problems, and employees at risk.
Conduct assessments and provide treatment and referrals
Health screenings at worksite with relative ease, minimal cost
Pre-placement evaluations for baseline medical and occupational health history, and a targeted physical assessment and medical tests (ADA compliance). School Health Occupational Health
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Secondary Prevention Strategies (Cont.)
Focus (Cont.)
Periodic assessments to document any health changes
Annual and biannual
Specific protocols for exposure to substances or irritants (e.g., lead, asbestos, noise, chemicals)
Job transfer evaluations
Document any changes in health while working in a specific area or with a specific process
Comply with OSHA regulations or NIOSH recommendations
Assessment of commonly occurring health conditions
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Tertiary Prevention Strategies
Rehabilitation and restoration of the worker to an optimal level of functioning
Avoiding disability syndrome
Case management for the disabled employee’s successful return to work
Negotiation of workplace accommodations appropriate to the employee’s health limitations
Counseling and support for workers returning to work
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Skills and Competences of Nurses
Competent
Confident, has mastery of skills, ability to cope with specific situations, stresses consistency of practice rather than individual differences
Proficient
Increased ability to perceive situations as a whole based on past experiences, predict the events to expect, able to alter protocols when needed
Expert
Extensive experience, broad knowledge base, able to grasp situation quickly and initiate appropriate action; a sense of salience grounded in practice guiding actions and priorities
– Benner (1984)
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Skills and Competencies of the Occupational Health Nurse
Skills and competencies
Clinical and primary care
Case management
Workforce, workplace, and environmental issues
Legal and ethical responsibilities
Management and administration
Health promotion and disease prevention
Occupational and environmental health and safety education
Research
Professionalism
Nursing Code of Ethics
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Federal Legislation and Occupational Health
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. School Health Occupational Health
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Legal Issues in Occupational Health
The occupational health nurse is professionally primarily accountable to workers and worker populations and to the employer, the profession, and self. (AAOHN, 2012)
Liability and legal issues relate to…
The employee-nurse relationship
The employment capacity of the occupational health nurse
Any acts of negligence
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Multidisciplinary Teamwork
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Figure 30-2