Aug 22 2011
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Back to School: Health Concerns 2011 and How School Nurses Can Help

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The start of the new school year has health professionals gearing up for emerging health issues schools are now facing, such as cyber-bullying. Thousands of school nurses play an important role, both in addressing individual health needs and on changes that can make schools healthier environments. NewPublicHealth spoke with Carolyn Duff, R.N., president of the National Association of School Nurses, and Thomas G. DeWitt, M.D., F.A.A.P., Director, Division of General and Community Pediatrics at the Cincinnati Children's Hospital Medical Center about issues for the upcoming school year, and the role of school nurses to help.

NewPublicHealth: What role do school nurses have in helping to shape school policy to improve the health of children?

Carolyn Duff: School nurses work at all levels to help shape school policies that promote and protect the health of students. School nurses are watchdogs, always looking to make changes, for example, in procedures or infrastructure at the building level to protect student health. Examples are advocacy for changes to playground equipment to make playgrounds more age-appropriate; and participation in the development of school wellness committees to infuse health education into all curricula.

At the district level, school nurses keep administrators informed of changes in laws that regulate nursing and school health services and assist in creating policy that comply with regulations.

At the community level, nurses are instrumental in advocating for changes related to school safety such as addition of crossing guards at busy intersections and leading walk-to-school programs to increase physical activity, reduce traffic congestion around schools, improve air quality, and teach safe walking behaviors.

NPH: What are examples in communities where school nurses have made a difference at the school and community level?

Carolyn Duff: I can immediately think of two examples; one is the impact school nurses make in the management of students with life-long health conditions; and the other is partnerships developed and maintained by school nurses to increase access to care for students.

Students with life-long health conditions, such as diabetes and asthma, are different from other students in only one way, and that is that they need health care and services at school in order to remain seated in the classroom learning just like their classmates. Their conditions, if managed well, will not impact their reaching for the same levels of achievement that their classmates can expect. Health management is key, and school nurses [can be] the difference between being in school as often as their peers and having many absences due to illness and/or the need for routine specialized treatments.

As for partnerships, a full-time school nurse in a school means that there is someone there with whom health care community partners can work to further their missions. School nurses participate in partnerships to gain access to health care for students who are un- or underinsured. In my own county, there are partnerships that provide free dental, vision and episodic care and actually transport children to and from appointments during the school day. There are partnerships that connect pregnant and parenting students to nurses that help manage pregnancies to ensure delivery of healthy babies and then mentor the new young mothers at home to support development of parenting skills and to encourage and support them as they finish school and graduate. Other partnerships connect students to primary care and involve parents in the process, educating them to access the health care system appropriately and independently.

NPH: What is the scope of a school nurse’s interaction with a health department during a school year?

Carolyn Duff: There’s a lot of interface with the health department, for education programs geared more toward immunization, infectious disease and chronic diseases. And school nurses all across the country work with health departments to provide immunization clinics for students and to do surveillance for infectious diseases, and chronic diseases.

NewPublicHealth: What new concerns are uppermost in your mind as the school year begins?

Carolyn Duff: Prescription drug abuse is increasing in schools, as is use of cell phones and texting, sometimes inappropriately. Where school nurses are involved is with parent education and interacting with parents when the school nurses perceive that a student is involved in concerning behaviors. And our association has many resources online for school nurses to use to give parents information about the risk behaviors that their children may be involved in. Prescription drug abuse, of course, is something where parents are really key because students get the medications most often right from their own homes. Right from the beginning of the school year, school nurses get involved with parent education programs to keep parents up-to-date with resources.

NPH: Dr. DeWitt, what other issues should we look out for this school year?

Dr. DeWitt: Bullying is a major concern a lot of parents have, and traditionally I think the thinking was about the bully on the bus. But now the issue of bullying through media is another concern. It’s more anonymous in some ways than bullying on the bus where you actually have physical contact. Bullying through the media can be a posting on Facebook or over a Twitter account that then other people can pick up, so there’s kind of a viral spread that can happen to it, and then it’s very difficult to try and reverse that and break that chain. So, that’s where we’re suggesting that parents make their children aware that this can happen and to let parents know right away if that’s happening so that parents can work with school authorities to get it stopped.

NPH: Some states have reported an increase in accidents because kids are listening to music while walking and don’t see vehicles or don’t pay attention to traffic lights or crosswalks. What would a parent do to help prevent those sorts of accidents?

Dr. DeWitt: Setting some limits is important in addition to reminding kids about school bus safety — they may be listening through ear buds on the bus, but those have to come out before the child gets off and don’t get put back in until the child is in a safe place to listen, not while walking from the bus stop to home, or while walking home from school. Don’t put the ear buds back in until the child is in a secure spot and doesn't have the possibility of getting hit by a car or even stumbling.

Tags: Pediatrics, Public and Community Health, Q&A, School Health