GUIDELINES FOR THE NURSE IN THE SCHOOL SETTING

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 Guidelines for the Nurse in the School Setting  (1,258K)

The Illinois Emergency Medical Services for Children (EMSC) program recognizes the unique field of school nursing and the multiple roles that the nurse in the school environment is called upon to perform. The intent of this manual is to provide nurses working in the school setting with a set of emergency care guidelines that can be utilized during the delivery of care to the ill or injured student. In addition, other resources are contained in this manual which school nurses may find useful to reference or integrate into their current practice. The EMSC School Nurse Task Force has worked to ensure that the information presented in this document is accurate and in accordance with professional standards in effect at the time of publication. It is hoped that this document becomes a valuable addition to the resources already available within the arena of school nursing practice.

It is important to note that there exist variations in school settings, services and access to resources and personnel. These differences can impact upon delivery of care. Therefore the protocols contained in this manual should be regarded as guidelines and not as dictating an exclusive course of treatment. In addition, these protocols should not serve as a substitute for the professional advice of a physician and should not be construed as excluding other acceptable methods of treatment. It is recommended that care must always be based upon the student’s clinical presentation and on authorized policies.

Because schools provide services to students throughout the childhood and adolescent years, it is important when utilizing this resource manual to remain cognizant of pediatric developmental stages as well as "age appropriate" services and information. A baseline understanding of pediatric developmental characteristics and a general knowledge of appropriate approaches in the assessment and management of the varied age groups will be beneficial. The assessment and treatment approach when dealing with an injured or ill kindergartner is quite different from that of a high-school student, especially when considering participation of the child in the decision making process, provision of educational information and level of parental involvement.

In addition, children with special needs or chronic conditions are seen in increasing numbers in the school system. This population can present with physical disabilities, mental disabilities and/or chronic illnesses that may require technological support. Special needs children may require frequent emergency care interventions. When caring for the special needs child, "age appropriate" guidelines should be utilized as well as the following reminders:

• Concentrate on the child's abilities, not disabilities. Focusing on what the child is able to do promotes self-esteem and a positive self-image.

• Communicate with the child in a manner appropriate to his or her ability. Presence of a physical disability does not mean that the child is also cognitively impaired.

• Meet with the care giver and obtain a careful history. Their assistance in interpreting behaviors and responses can provide a better understanding of the child's needs.

• Develop an individual health care plan for these students.

• Become familiar with respiratory emergency adjuncts and interventions since the most common emergency encountered with these children is respiratory related.

Development of a plan identifying appropriate follow-up after emergency incidents is essential. Communication between the school nurse, the teacher and the parent/care giver assists in maintaining awareness of student progress, identifies any new or additional care needs and reinforces any restrictions or limitations that may have been placed on their activities at school.

Many emergencies are avoided daily in the schools because school nurses have established individual health care plans for students with special health needs and have educated parents and staff members in prevention and early intervention techniques. The school nurse has a key role not only in the provision of emergency care to students but also in the development of prevention strategies. School nurses can work collaboratively with administrators, staff, medical advisors, local EMS and health care providers and parents to establish a comprehensive emergency care program in schools that results in the reduction of morbidity and mortality in students. School policies, protocols, individual health plans, communication, documentation, data collection and follow-up are all part of a comprehensive prevention program.