NURSE’S STATION Which Will It Be - Action or Reaction? Nancy Parker, RN, BS
Individuals, as well as public and private groups, education and health associations, have all expressed concern that the full potential impact of school health programs has not been realized or utilized on behalf of all children in school. Those with concern in this area have attempted to develop school health programs that are: (1) responsive to the health needs of students; (2) relevant to the child’s ability to profit from the educational experiences; and (3) stimulants for positive health concepts and health behaviors. Some have succeeded in attaining this comprehensive goal; others have begun; many others have not. Just as the 1970s have been the years of health awareness, the 1980s will be the years of innovations and vital activities in school health services. School nursing must become an action program rather than a reaction program. For years, school nurses have known the importance of adequate immunizations. Yet a largescale, mandated immunization search effort because of the increasingly alarming rates of preventable communicable diseases is only now being done. This is clearly a reaction program that will consume millions of nursing hours and could have been avoided had school nurses established an immunization monitoring system years ago. We need to learn from this effort and apply its principles to other areas of school nursing. Ninety percent of a school nurse’s caseload involves dealing with healthy developing students. This is a captive group to whom we can assure their continuing in a normal health-developing pattern through the use of increased periodic screening and check points at selected intervals. Expanded screening programs for identifiable and treatable maladies that not only interfere with learning but also the fullest enjoyment of life will need to be implemented, especially for children at risk. In APRIL 1979
selected areas, some children are provided growth and developmental screenings at school entrance and never again throughout their school years. Programs must be initiated to ensure every child has subsequent periodic screenings as well, for these have fairly high predictive ability. Other schools have screening programs for spinal deformities but fail to “see” the children at the same time in relation to gait, internal tibia1 relation, posture or foot deformities. Screening for dental defects and malocclusions are almost unheard of. It is time that these were coordinated to make the best use of nursing time and to provide a more comprehensive picture of children’s health status. Screening programs can be the most cost effective way to detect early and impending health problems. School nurses will not be able to continue the luxury of a one-to-one based “come and get it” health care system much longer. School nurses need to devise an innovative school health services plan for all children within an active case-finding system instead of the crisisoriented and episodic care which is not only inconsistent but also less than effective. Such programs would offer participatory health care and education to each student and stimulate self care and prevention of future health problems. Child health assurance must be the focus of school nursing efforts. We must shift the emphasis of reporting our findings from the numbers of defects uncovered to the numbers of normally developing children and to the numbers who received care and are remediated. This will not always be easy to do because of the strong orientation of education and health professionals to illness and the episodic care model. But we need to try to educate school personnel to the advantages of wellness. The cost of treating preventable illnesses and defects is THE JOURNAL OF SCHOOL HEALTH
much too high. And in these days of accountability, teachers need the assurance of healthy children in their classrooms who are free to learn. With the increase in the numbers of children requiring individual education plans (IEPs), school nurses must assume the responsibility for knowing and presenting pertinent health information for any and all students as it relates to the learning process, as well as nursing care plans for those who have identified health needs. Only when extensive and comprehensive health screening programs are implemented will the school nurse have the adequate sequential health and developmental indices available to benefit the child’s learning process and plan. To implement an overall systematic approach to health and developmental screening programs, school nurses will need to look critically at themselves and identify their new roles in health planning and promotion and in providing health care for all students in the school setting. Many will need to discard their illness orientation and traditional methods of health care. Some will take advantage of seminars, conferences and continuing education to update their nursing knowledge and sharpen their skills of observation, organization, and health systems management. These will be the school nurses who will be able to provide health services to the largest numbers of children while schools are suffering through the cost containment crisis. But these will also be the school nurses who are employed when the education dollars are more available following the “storm” and when the health dollars begin to flow to education for prevention programs of
the 1980s. Michigan has recently passed a law providing a funded minimum basic health services program to every child K-12,public and parochial. Cost-effective principles demand that the plan for implementation of a task of this magnitude will include extensive use of the screening processes. It will be the wise school nurse who has assumed the responsibility for her preparation in nursing observation skill and school health program management. It will also be the wise school nurse who communicates with her legislators to ensure the continuance and expansion of this minimum health service program on the basis of health program evaluations. In the past, the school nurse has been presented with many opportunities to help students attain and maintain good health status and good health habits through their school-age years. The opportunities for the future are even greater. The school is the one institution outside the home where children are regularly and readily assessible for 12 years, where meaningful evaluative and preventive services can be provided, where a complete picture of a child’s health or developmental problem can be ascertained, and where health behaviors can be taught. School nurses can wait no longer to change from the crisis-oriented, “come and get it” health care to active case-finding and preventive care. It is time to cease reacting to fragmented episodic health concerns and begin to develop a positive program for the prevention of those concerns. Adjust your priorities. Create a program that permeates education. Tell about it - ACT!
SUMMER 1979 WORKSHOPS AT THE OHIO STATE UNIVERSITY The School Health Curriculum Project The Primary Grades Curriculum Project
The Division of Health Education at The Ohio State University will offer school personnel the opportunity to receive training in grades four through seven of the School Health Curriculum Project and grades kindergarten through three of the Primary Grades Curriculum Project. Three hours of graduate, undergraduate or continuing education credit will be granted for each workshop. Further information can be obtained by contacting Dr. Phil Heit, Division of Health Education, The Ohio State University, 1760 Neil Avenue, Columbus, Ohio, 43210,(614)422-8707.
THE JOURNAL OF SCHOOL HEALTH