2GSHRM Chapter1

School Health Services and School Nursing Practice
School Nursing Practice NASN/GASN School Nursing Standards NASN Core Roles RN Decision Tree DHR School Services Poster School Health Clinic Management Duties and Responsibilities of the School Nurse Suggested School Clinic Procedures Recommended School Health Clinic Supplies Tips for Setting Up the Health Clinic Suggested Questions for the Parents of a New Student PeachCare for Kids Referral Information Childrens Intervention School Services (CISS )/Fee for Services (FFS) and Administrative Claiming for Education (ACE) Communicating with Families Collaboration with All School Employees School Health Index School Health Records Condentiality Documentation Special Education Abbreviations Commonly Used in Schools Basic Information on Government Health Insurance Sample Forms School Health Clinic Information Card Clinic Activity-Daily Log Health Notes Monthly School Health Services Activity Report Report of Clinic Visit to Parent School Health Clinic or Faculty Referral to School Social Services Accident/Incident Reports (2 samples) Student Chronic Health Concerns List Unlicensed School Health Personnel Skills Checklist School Health Clinic Parent Informational Letter 15 15 16 17 18 20 20 21 22 23 24 24 25 26 27 28 28 31 32 33 35
Chapter 1
Childrens Healthcare of Atlanta, Inc.
13
Required Health Certicates Immunization Requirements/Certicate More Resources Denitions Ear, Eye and Dental Examination Requirements/Certicate
63 63 66 70 71 75 76 83 84 86 87 89 90
Healthy School Environment Child Abuse Prevention, Recognition and Reporting GASN Advocacy for School Nurses in Georgia HeLP Legal Services Cultural Diversity Impact on Student Health in Schools Working with an Interpreter Georgias Diversity: Working with Diverse Populations More Cultural Diversity Resources
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School Health Services and School Nursing Practice

School Nursing Practice
School nursing practice is evolving as society changes and different health problems emerge, and the school nurse is taking on an ever-larger role in modeling and monitoring healthy behaviors of students and staff. The school nurse can contribute to overall educational goals by taking a leadership role in planning and promoting interventions that will directly impact the health and safety of the entire school community. The denition of school nursing adopted by the Board of the National Association of School Nurses in 1999 is: 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. The standards of school nursing care outlined by the National Association of School Nurses and endorsed by the Georgia Association of School Nurses form the basis for this practice. 1. C linical Knowledge: The school nurse uses a distinct clinical knowledge base for decision-making and systematic problem-solving and consistently evaluates the quality and effectiveness of the care provided. 2. N ursing Practice: The school nurse evaluates nursing practice in relation to professional nursing standards and relevant statutes, regulations and policies. 3. P rofessional Development: The school nurse identies, delineates and claries the nursing role, promotes quality of care, pursues continued professional enhancement and demonstrates professional conduct. This can be done by accessing such resources as GASN (Georgia Association of School Nurses) and NASN (National Association of School Nurses) Web sites that include current issues/information, conferences and CEU opportunities. 4. Ethics: The school nurses decisions and actions on behalf of students are determined in an ethical manner. 5. C ollaboration within the School System: The school nurse collaborates with other school professionals, parents and caregivers to meet the health, developmental and educational needs of students. 6. C ollaboration with Community Health Systems: The school nurse collaborates with members of the community in the delivery of health and social services and utilizes knowledge of community health systems and resources as a school-community liaison. 7. Research: The school nurse promotes use of research ndings in school nursing practice. 8. R esource Utilization: The school nurse considers factors related to safety, effectiveness and cost when planning and delivering care. 9. Communication: The school nurse uses effective written, verbal and non-verbal communication skills. 10. P rogram Management: The school nurse establishes and maintains a comprehensive school health program within the work setting. 11. H ealth Education: The school nurse assists students, families, the school staff and community to achieve optimal levels of wellness through appropriately designed and delivered health education.
Chapter 1
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The registered professional nurse (RN) practicing in the school setting usually has many different but overlapping roles: the generalist clinician, the primary care provider, the case manager, the health educator and the health counselor. School nurses meet the needs of the school-age population by providing a myriad of services (see graphic on page 19) including: assisting students to develop problem-solving skills, coping skills, anger and conict management skills and a positive self-image; providing ongoing assessment, intervention and follow-up for physical and mental health issues; advocating for students with health conditions that may warrant accommodations in the educational setting or process; providing education and resources for school staff on recognizing signs and symptoms of potential health problems and how to model positive health behaviors; becoming an active member of curriculum committees, student support teams and crisis intervention teams; becoming a resource for medical information for the school staff and referral information for families, as well as a liaison with the healthcare community; providing monitoring and evaluation of treatment plans and collaboration with families and healthcare providers to optimize treatment.
NASN identies these roles in further detail as the Seven Core Roles, which the school nurse needs to fulll in order to foster child and adolescent health and educational success as of 2007. Refer to NASN Web site www.nasn.org for more details on these roles. The school nurse: 1. provides direct care of students and staff. 2. provides leadership for the provision of health services. 3. provides screening and referrals for health concerns. 4. promotes a healthy school environment. 5. promotes health. 6. serves in a leadership role for health policies and programs. 7. is a liaison between school personnel, family, healthcare professionals and the community. The school nurse closely collaborates with school administrators, teachers and paraprofessionals, coaches and athletic trainers and other members of the school health team such as school physicians, psychologists, occupational therapists, physical therapists, audiologists, speech language pathologists and nutritionists. The nationally recommended ratio of students to school nurses in a general education program is 750:1.This number is accepted by the National Association of School Nurses, the American Academy of Pediatrics and the U.S. Surgeon General. A registered professional nurse should oversee the school health program, be responsible for assessment of the health status of students and plan the health services to be delivered in the school setting. Licensed practical nurses (LPNs) practice on a technical level, work in a team relationship with the RN and, under the Georgia Nurse Practice Act, must be supervised by a professional registered nurse or physician. The use of unlicensed school health personnel (paraprofessionals, clinic aides or monitors, school secretaries) to provide student health services in the school setting should be carefully considered to ensure student safety. State statutes exist that dene the roles and responsibilities of
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licensed health professionals in Georgia. When unlicensed school health personnel are designated to carry out health services in the school, minimum standards should be set, such as ensuring that the designated person has: a high school diploma or equivalent; current certication in CPR and rst aid (renewed every two years); and on-the-job training in condentiality of health records, documentation, precautions, infection control and routine clinic activities.
Key factors for effective and competent use of unlicensed school health personnel are role denition, adequacy of training and appropriate delegation and supervision. School and district administration should develop clear, written job descriptions and then ensure adequate training and competency to perform identied tasks. Assistive personnel should not be required to make clinical assessments or nursing judgments or to implement nursing tasks requiring licensure. There should be written protocols for handling specic student health issues including emergencies, with directions for particular signs and symptoms that should be reported to the school nurse, parent or principal. It is important that the following issues are considered when using assistive personnel in schools:
Unlicensed School Health Personnel

Georgia Nurse Practice Act, including but not limited to scope of practice and to licensure, delegation and supervisory responsibilities of RNs in relationship to LPNs and to other unlicensed personnel; scope and standards of school nursing practice; school district job descriptions that are legally appropriate to the level of preparation, expectations and experience of the assistive personnel; local, state or NASN stafng guidelines that consider various safe stafng mixes in relation to the health needs of the student population; the level of specialized nursing care needed for the students of the specic school.
The optimal use of unlicensed school health personnel is to extend the delivery of health services rather than to substitute for a professional healthcare provider in the school. According to the NASN, the use of unlicensed school health personnel may be appropriate to supplement the professional school nursing services in certain situations, but they should never supplant school nurses nor be permitted to practice nursing without a license. (Adapted from The National Association of School Nurses Position Statement, Using Assistive Personnel in School Health Services Programs, 2002.) Under the Georgia Nurse Practice Act, registered nurses may not delegate nursing activities to unlicensed personnel. (Refer to www.sos.state.ga.us/plb/rn/forms.htm for the text of the Georgia Nurse Practice Act) Nurses working with unlicensed school health personnel can gain better understanding of how to identify appropriate tasks and role denition from the decision tree, an algorithm available at www.sos.state.ga.us/plb/rn/decision_tree.htm and designed by a task force at the Georgia Board of Nursing. A copy of the decision tree is included on the next page.
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R N A s s i g n m e n t D e c i s i o n Tr e e : A s s i g n m e n t t o U n l i c e n s e d Assistive Personnel (UAP) by the Georgia Board of Nursing Assistive Personnel (UAP) by the Georgia Board of Nursing
RN Assignment Decision Tree: Assignment to Unlicensed
No Do NOT Assign
Is the care and activity to be performed based upon orders or directions of a licensed physician, licensed dentist, licensed podiatrist or person licensed to practice nursing as a registered professional nurse?
Yes
Yes Do NOT Assign Does performance of the task require licensure in another health care profession?
No
Yes Do NOT Assign Does the task require the knowledge and skills of a person practicing nursing as a registered professional nurse?
Unsure
Yes Do NOT Assign
No May assign
Does the clients health status and situation involve complex observations or critical decisions that require the knowledge and skills of a professional nurse?
No
No Do NOT Assign Can the task be safely performed according to exact, unchanging directions?
Yes
No Do NOT Assign Are the results of the task reasonably predictable?
Yes
No Do NOT Assign Has the RN verified that the UAP has the knowledge and skills necessary to accept the assignment?
Yes
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May Assign
Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta & Georgia Association of School Nurses 2004 Georgia School Health Resource ManualChapter 1 School Health Services and School Nursing Practice
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reviewed 2009tk
Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta & Georgia Association of School Nurses 19 Childrens Healthcare of Atlanta, Inc. 2004 Georgia School Health Resource ManualChapter 1 School Health Services and School Nursing Practice
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School Health Clinic Management

General Guidelines for Clinic Personnel
This information is provided to assist with areas of concern which confront school health personnel in the daily operation of the school health clinic. If a question or situation arises that is not addressed by general guidelines or local policies or procedures, remember the school principal always has the ultimate responsibility for the health and well-being of the student during school hours and school-sponsored activities. Nurses and other school health personnel should work within the guidelines established by school board policy, local school procedures and the principal. The Georgia School Health Resource Manual can be used as a resource in writing district and school policies, procedures and guidelines. The forms and letters (except state forms) are for school personnel to download and customize, or you can just use them for ideas and create your own. In this newer manual edition CD you will nd 12 chapters, followed by a forms chapter. The forms are formatted in such a way that you can alter them to meet your individual school health clinic needs. (i.e. add your schools logo.)
Duties and Responsibilities of the School Nurse (This list may be used and modied for your stafng model as needed.)
1. M aintain condentiality by respecting the privacy of students in the clinic, during telephone conversations and when handling their health records. 2. Provide appropriate health services and demonstrate care and concern for students. Notify principal and parents of any need for further care. Contact parents regarding student health issues whenever necessary. 3. Coordinate communicable disease control in the school. Report concerns to the principal and the public health department as necessary. Assist with immunization surveillance as requested. 4. Maintain a current list of students with ongoing health concerns and develop Individual Health Plans and emergency plans as needed for each. Keep the principal apprised of any situations that develop with these students. 5. Communicate pertinent student health information in a timely and condential manner to appropriate persons (principal/designee and/or other necessary school staff), with parent permission. 6. Maintain documentation of clinic records accurately and completely. 7. Develop effective working relationships with school personnel and parents/guardians. 8. Administer student medications in accordance with school system guidelines, the Georgia Nurse Practice Act (including rules and regulations of the Georgia Board of Nursing) and professional nursing judgment. 9. Provide special healthcare procedures and treatments to students, as prescribed. 10. Coordinate mandated school screenings and ensure necessary follow-up care. 11. Maintain an orderly health clinic. Maintain and restock supplies, per school policy. 12. Maintain current certication in basic rst aid and CPR. Maintain up-to-date knowledge of school health procedures through district training and continuing education. 13. Promote a healthy and safe environment within the school. 14. Provide employee wellness education and services to school staff. 15. Provide or assist with classroom health education as requested. 16. Participate on school committees as appropriate, providing health input on individual students or for the general student population (i.e. Crisis Team, SST/IEP, etc.). 17. Complete monthly report of school health activities, per local policy. Assist with an annual school health report to the local school board as requested.
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Suggested School Clinic Procedures

Accept students into the clinic as they walk in or with referral slip from teacher. Record name of child and time on daily log or using computerized system. Ensuring condentiality, listen to childs complaint and take a focused health history. Check the clinic health information card for that student to ensure you know the health history, allergies, etc. A ssess the child, taking vital signs as needed, and give care according to clinical judgment, local guidelines and policies and the Georgia School Health Resource Manual. 6. C ontact parent and/or consult with school nurse supervisor or administration, as necessary. A direct or dedicated telephone line in the clinic will facilitate this. 7. Release child from clinic per local school policies and procedures: a. to return to the classroom, or b. to the parent/guardian or other person designated by the parent. 8. S tudents coming in for daily medications should be kept in an orderly line, so that clinic personnel may concentrate on one at a time, document each child appropriately and avoid potential for medication errors. 9. Complete daily log with requested information including tallies for monthly report. 10. Record any pertinent information/observations in the childs health card/record. 11. C linic personnel should plan a regular lunch break per local policy, perhaps after the bulk of the daily medications. A consistent schedule will help teachers know when to avoid sending students with non-urgent problems. 12. I f the school nurse is responsible for more than one building or multiple schools, a cell phone/ pager can be provided, so the nurse can be reached in an emergency. 1. 2. 3. 4. 5.
School Nurses and Clinic Personnel Should Not:

1. 2. 3. 4. 5. perform any invasive procedures such as probing in the eyes, ears, nose, skin or throat. make a medical diagnosis; prescribe treatment or medication. apply any unauthorized topical creams, ointments or sprays. transport students unless approved by the principal. a dminister or assist students with prescription or non-prescription medications, without a signed medication authorization form.
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Recommended School Health Clinic Supplies

Permanent Equipment
Bed (2) (w/adjustable headrest) Chairs (4) Clock with second hand Desk with chair Bookcase or shelf Computer Bulletin board Locked medication cabinets File cabinet with lock Telephone Sink with hot and cold water Privacy screen Covered trashcan Rolling chair (less expensive than a wheelchair) Disposable mouth barrier for CPR (suggest one per CPR provider in the school) Toilet facility Biohazard (sharps) container Thermometer Thermometer covers if needed Flashlight Bandage scissors Tweezers Goose neck lamp (for head checks) Weight scale and stadiometer (measures height) Small refrigerator Soap dispensers Vision testing equipment Pure tone audiometer Sphygmomanometer with cuffs
Injury Care Supplies

Non-latex, hypoallergenic tape (assorted sizes) Band-aids, assorted sizes Pint-size baggies for ice, frozen sponge Non-sterile gauze (2x2 and 4x4) Sterile gauze (2x2 and 4x4) Normal saline eyewash Eye pads/dressing/shield Cotton-tipped applicators Cotton balls Tongue depressors Emesis basins Elastic bandages Dental wax and oss Rolled non-sterile gauze Cold packs (small and medium) Arm splints, slings Portable rst aid kit for eld trips Disposable diapers (may be used for compression)
General Supplies
Alcohol prep pads Blanket School-approved disinfectant Cleaning supplies, plastic bags Bed pillow, plastic cover Glucose gel (Cakemate icing can be used) Non-latex gloves (disposable) Sanitary pads Liquid soap, in dispenser Pediculosis sticks (optional) Heating pad (UL approved) Fingernail clippers, ring cutter Facial tissues Paper towels with dispenser Table paper for bed (disposable) 3 oz. paper cups Medicine cups General ofce supplies Hand lotion, Vaseline for chapped lips Cooler for ice (if no freezer) Magnifying glass
Do not use peroxide as a wound cleanser as it has been proven to be damaging to tissues. Simply use soap and water or normal saline to clean. If bleach is used as a disinfectant and is approved for use in your district, it should be diluted 1:10 with water and made up daily.
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Tips for Setting Up the Health Clinic

1. A n organized workspace will be critical to your success. You may not have control of how much space, furniture and equipment you have to work with, but you can still organize your space with some attention to the functions of your job. Some nurses have set up their ofces with multiple work stations, each with the supplies and resources needed for that task readily available (i.e. First Aid, Medication Administration, Phone, Paperwork and Referrals). 2. K eep your student clinic cards or les in order alphabetically and possibly by grade. These should be easily accessible, keeping condentiality in mind. You can use color-coded ags or dots to mark the cards of students with ongoing health concerns. Students who have specic instructions, treatments and emergency plans should have a separate duplicate le that can be transported with the portable emergency kit if needed. 3. M edication Authorization forms may be led together in a notebook with tabs for Daily, PRN and Aerosols (updated weekly as needed). Medications must be kept locked either in a mounted cabinet or a le cabinet. Limited access to that key is suggested. Some nurses keep the medications and authorization forms for one student in a le folder with sides stapled. These folders are labeled and alphabetized, and the drawers are separated by Daily, PRN and Aerosols. You may want to keep aerosols together in a container that can be put into the portable emergency kit for an evacuation. Of course, some medications require storage in a refrigerator. See Chapter 3 (Medication Administration) for more details. 4. R esources to have posted in the clinic include: Communicable Disease chart, list of staff currently certied in CPR/ rst aid or First Responder/AED, emergency numbers (including poison control), CPR poster and handwashing reminders. Also keep posted by the phone the schools phone number, fax number and address; valuable time can be lost if you have to search for these during an emergency. 5. A computer can be used to access student emergency contact information from the school database, to access the Internet for quick research and to maintain student health records with an adequate software program. 6. H ave a substitute clinic personnel folder (easily found) with important information and/or instructions; including some Clinic Dos and Donts. 7. U se a bulletin board in your health clinic or in the hall near your ofce for health education. Refer to Chapter 9 (Health Education: The School Nurse Role) for ideas and use your imagination! 8. C linic supplies and equipment can be obtained from school districts, partners in education, principals funds, and clinic showers sponsored by PTA and individual classes. The PTA may also be able to help you with a secondhand clothing closet, so that you can provide clean clothes for students who have accidents of various kinds during the day. Let people know what you need. It will take awhile for you to make your clinic just like you want it, but keep working at it. 9. Y ou may want to keep a phone logbook for easy reference. Many nurses have found that keeping a spiral notebook for notes written during the day can be invaluable when many things are happening at once. 10. H ave an Emergency Go (Evacuation) Bag or Emergency To-Go Cart supplied and ready. Check expirations dates routinely.
School Nurse Checklist for New Students

This checklist can be completed in an interview with the parent/legal guardian at the time of registration of the new student or by telephone, ideally within the rst week of the childs attendance. Take this time to briey explain the school health program in your school, your role as the school nurse and how you may be contacted.
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Suggested Questions for the Parents of a New Student

1. Does your child have asthma? Initiate discussion about asthma action plan. 2. Does your child have any allergies to foods, animals, insects, medications, latex or other substances? 3. W ill your child need to take any medications in school? If so, discuss and give copies of policies and needed forms for regular and prn meds. 4. D oes your child have any activity restrictions for PE or recess? 5. I s there anything that causes your child to miss school frequently? 6. D oes your child have any vision or hearing problems? Corrected? 7. A re there any other health problems that I, as the school nurse, need to know about (i.e. seizures, diabetes or other chronic health conditions which may affect your child during the school day or affect his ability to learn successfully)? The school nurse can advocate for your child in the school setting, if health problems affect or can be affected by the learning environment. 8. H ave you completed the emergency contact cards with all of the information I may need to reach you if necessary? 9. D oes your child have a healthcare provider for regular checkups and illnesses? If not, do you need referral information (PeachCare, Medicaid, local practitioners)? 10. I s your child current on immunizations? Offer information here, about needed 6th grade immunizations and tetanus/diphtheria boosters. 11. I s there anything else about your childs health that you would like to share with me? 12. D o I have your permission to share this information with your childs teacher, the principal or other school staff as needed? Discuss why this may be important and have parent sign permission for release of medical information. After this interview, nd a time to introduce yourself to the child and show him where the clinic or health room is. Add his name to your medical alert list, if necessary. Schedule him for screenings, if needed. PeachCare for Kids Referral Information (This information is current as of 2008. For the most current information about eligibility and covered benets, check www.peachcare.org or call 1-877-427-3224). There are at least 190,000 children in Georgia eligible for PeachCare. The eligibility requirements include: U.S. citizenship (and certain qualied legal residents, refugees or asylees), age up to the 19th birthday, uninsured, family income less than or equal to 235 percent of federal poverty level, which is $40,000 for a family of 3 and $48,000 for a family of 4. If the child is eligible for Medicaid, the PeachCare for Kids application will be forwarded to Medicaid. PeachCare for Kids health benets include: episodic healthcare for illness visits to a doctor preventive services for health check-ups and immunizations specialist care dental care vision care, including vision screenings and glasses hospitalization emergency room services prescription medications mental healthcare.
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Please note: Families are ineligible if their child has access to health insurance through the parents employment with the state of Georgia, even if the parent has not purchased the state coverage. Each child enrolled in the program will have a primary care provider who will coordinate the childs care. For children under six years of age, there is no premium charged to the family. For children 7-18 years of age, the premium is $10.00 to $35.00/child per month. For two or more children 7-18, the premium maximum is $70.00 for two or more children living in the same household. There are no co-payments or deductibles. Families generally must be uninsured for three months, unless the uninsured status was involuntary (parent loses job, etc.). The application can be made online, in English or Spanish, at www.peachcare.org, and callers may ask questions at 1-877-GaPeach.
Childrens Intervention School Services (CISS)/Fee for Service (FFS) and Administrative Claiming for Education (ACE)
Childrens Intervention School Services provide reimbursement for medically necessary health-related services that are received in schools and provided by or arranged by a school system for Medicaid-eligible students with an Individualized Education Plan (IEP). Students must be under the age of 21 years. These intervention services must be provided by a licensed practitioner and include audiology, nutrition, nursing, physical therapy, speech language pathology, occupational therapy, counseling, specialized transportation and targeted case management. In this program, the school system is the enrolled Medicaid provider and may employ or contract with health practitioners or clinics to provide the services. Covered nursing services include: skilled intermittent nursing care such as suctioning, dressing changes and catheterization administration of treatment regimens during the school day prescribed by the childs physician (medications must be administered by a registered nurse, licensed in Georgia.) assessment of the capabilities of the child, his family and other caretakers to carry out nursing care, medication administration or monitoring and specic physician-ordered treatments teaching self-care to the child and family or caretaker. Documentation of covered services must meet Medicaid requirements for legibility, completeness, chronological order of services rendered and appropriate signatures of providers. A state program also is available for Administrative Claiming for Education (ACE). The ACE program reimburses local education agencies quarterly for the administrative activities related to providing Medicaid outreach, eligibility intake, referral coordination and monitoring activities for all students. Examples of Medicaid administrative activities include: observing students for health-related issues referring students to health-related services for follow-up appointments developing programs and planning for the delivery of health services general administration relating to Medicaid referral and outreach activities. More information on both of these programs may be obtained from the Georgia Department of Community Health: Division of Medical Assistance, (www.dch.ga.gov) 404-657-9093
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Communicating with Families

Communication with families is an important component of school health services. Because of societal changes and work situations, parents may be difcult to contact. In some cases, the nurse will be communicating with grandparents, guardians, foster parents or social workers. Nurses will need to reach families to request further information, as well as to report screening results and health issues that come up during the school day. Sending a letter or form home with information about clinic visits will assist with keeping the lines of communication open (See Report of Clinic Visit to Parent sample letter in this chapter on page 45 or in Chapter 13 Forms and Letters section). The nurse should document and maintain a record of communication with parents. Helping parents understand, during registration and interviews with families new to the school, that the nurse is there to be an advocate for the child can help the nurse obtain good contact information and pave the way for good communications. Pediatrician Dr. T. Berry Brazeltons approach to working with parents promotes a positive attitude of enlisting parents as partners in the healthcare process. School nurses can be a part of the supportive network for families who may be undergoing stresses of all types as their children grow. Dr. Brazeltons Touchpoints Project was developed as an interdisciplinary, relational model to help healthcare providers create a supportive model of family interaction. This relationship is built on mutual respect, care and acknowledgement of parents care and concern for their children. The seven basic principles of Touchpoints practice for healthcare providers are: recognize what you bring to the interaction; look for opportunities to support mastery; use the behavior of the child as your language; value and understand the relationship between you and the parents; be willing to discuss matters that go beyond your traditional role; focus on the parent-child relationship; and value passion wherever you nd it. (Adapted from the Touchpoints Web site. For more information see: www.Touchpoints.org)
Collaboration with All School Employees

School nurses have a responsibility for monitoring and maintaining a healthy school environment in which students can learn. In order to accomplish this goal, collaboration with other school employees is a key ingredient of success. 1. T he principal is the leader of the school team. The principal should be made aware of any obstacles or problems that occur in the school health clinic, such as the following: if a child is seriously ill or injured if emergency services need to be called if there is a concern with communication with a parent/guardian if there is a pattern of illness, infection, injury or infestation if there is suspected child abuse or neglect if there is a concern about the safety or health of the school environment any time there is a situation with which the school nurse or clinic worker needs assistance. 2. T he school administrative staff can provide information on the students and families, class scheduling, building concerns, problems that may be occurring in other schools and community resources.
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3. T eachers can be your best observers. They will most likely be the rst ones to notice students physical symptoms, patterns of illness, health complaints and psychological changes. Special education teachers and paraprofessionals also have a wealth of knowledge and experience in dealing with students with special needs. 4. T he school social worker, guidance counselor, Student Support Team leader and other allied health professionals (speech therapist, etc.) can be your best allies in gathering information about children and families and available resources. District level personnel such as audiologists and school psychologists are also important contacts. 5. T he cafeteria staff can be helpful with snacks you may need for children, ice and observation of a childs eating patterns. The district level Nutrition Director can also provide assistance with students with special nutrition needs. 6. The custodial staff can help you with infection control issues, clean-up of spills and building safety issues. 7. The media center staff can help you with researching a health issue and nding resources for health education. 8. Interpreters are becoming more and more important as our population becomes more diversied. 9. The technical support staff at your school or district can help you with computer software needs and problems. 10. M any times you may be asked to help with a staff members health concern as well. You may be able to provide rst aid, assist with referrals, help with health education curriculum and ideas for bulletin boards, etc. 11. O ther school nurses and school nurse consultants can be resources for you when you have concerns and questions as well. The School Health Program Coordinator in the Division of Public Health (Ofce of Infant and Child Health Services) is also available for consultation with school nurses at 404-657-4143. 12. C hildrens Healthcare of Atlanta also has a 24-hour nurse advice line for questions about healthcare, a specic illness or injury or referral information. The number is 404-250-KIDS.
School Health Index

The Centers for Disease Control and Prevention, Adolescent and School Health section, has developed the School Health Index, a self-assessment and planning tool for elementary and secondary schools that will enable the schools to: identify the strengths and weaknesses of their health, physical activity and nutrition policies and programs; develop an action plan for improving student health; involve teachers, parents, students and the community in improving school health services. The School Health Index is available at no cost and can be completed in approximately ve hours. Many of the improvements that a school may want to make after completing the index can be done with existing staff and resources. A small investment of time can pay big dividends in improving students well-being, readiness to learn and prospects for a healthy life. Go to www.cdc.gov/nccdphp/dash/SHI/index.htm to obtain a copy of The School Health Index. (Comprehensive school health program information adapted from CDC Web site: www.cdc.gov/nccdphp/dash/cshpdef.htm)
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School Health Records

Condentiality
A National Task Force on Condential Student Health Information met in 2000, representing national education, allied health and nursing associations. The Guidelines for Protecting Condential Student Health Information were published in 2000 by the American School Health Association, outlining the recommendations of the task force. The recommended guidelines include: 1. Distinguish student health information from other types of school records. 2. Extend to school health records the same protections granted medical records by federal and state laws. 3. Establish uniform standards for collecting and recording student health information. 4. Establish district policies and standard procedures for protecting condentiality during the creation, storage, transfer and destruction of student health records. 5. R equire written, informed consent from the parent and, when appropriate, the student, to release medical and psychiatric diagnoses to other school personnel. 6. L imit the disclosure of condential health information within the school to information necessary to benet students health or education. 7. E stablish policies and standard procedures for requesting needed health information from outside sources and for releasing condential health information, with parental consent, to outside agencies and individuals. 8. P rovide regular, periodic training for all new school staff, contracted service providers, substitute teachers, and school volunteers concerning the districts policies and procedures for protecting condentiality. (This publication is available at www.ashaweb.org, the website for American School Health Association. Just type into search box condentiality). A second Task Force in 2004 developed an additional tool to guide schools in development and implementation of policies for handling condential student health information. They published Protecting and Disclosing Student Health Information: How to Develop School District Policies and Procedures, providing a legal and ethical framework for such policies and including sample policy language. It also contains specic standards to assist school health and education in addressing issues that have arisen with the adoption of the Health Insurance Portability and Accountability Act (HIPAA) in 2004. Standard 1: Transparency: School districts make publicly available on an annual basis clear explanations of their policies, procedures and practices regarding the collection, use, storage, release and destruction of personally identiable student health information. Standard 2: Consent a. C onsent for Internal Sharing: School district ofcials obtain valid informed consent from parents, eligible students or qualied minor students for the collection and use of student health information internally within the school district except when such collection or use is expressly permitted without consent by state or federal law and when such permissible practices are based on ethical standards and made transparent to parents and students, as describe in Standard 1 above. If consent is required but not obtained, then a formal, authoritative and publicly accountable process must be used to authorize or justify a waiver of consent.
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b. C onsent for External Sharing: School district ofcials obtain valid informed consent from parents, eligible students or qualied minor students for the disclosure of student health information to and from healthcare providers and other agencies outside the school district with limited exceptions that are permitted by law, specied in policy and procedures and made transparent to parents and students as again mentioned in Standard 1.
Standard 3: Collection Limitation: School districts limit the collection of student health information to that information required for current need, or reasonably projected future needs, which are made explicit at the time consent is obtained. Standard 4: Parent and student access: Parents, eligible students and qualied minor students are allowed access to student health information in educational records. Standard 5: Information Use Limitation: School districts limit the sharing and use of student heath information to those legitimate educational purposes for which the information was obtained and to those purposes made explicit at the time consent was given. Standard 6: Data Quality: School ofcials ensure that student health information in educational records is accurate, complete and up to date as required for the purposes for which it is collected and used. Standard 7: Security: Districts protect student health information in education records from unauthorized access by using reasonable security measures. Standard 8: Accountability: All members of the school community including volunteers, consultants and business associates are accountable for adhering to strict standards of protecting student health information during collections, use, transfer, storage and destruction. ASHA (American School Health Association) offers technical assistance to answer questions in connection with these issues and these publications. In addition, ASHA has developed a training workshop which can be tailored to specic school districts and personnel for a fee. For further information, visit www.ashaweb.org to contact the Director of Research and Sponsored Programs. (This publication is available at www.ashaweb.org, the website of the American School Health Association) The discussion that follows is adapted from the National Association of School Nurses 2002 Issue Brief on Policy Standards for Student Health Records. The Family Education Rights and Privacy Act of 1974 (20 U.S.C. 1232g) (FERPA) and its regulations (34 CFR 99), and revisions by the U.S. Department of Education, set requirements for the protection and release of personally identiable student information, including student health information. This act applies to all education records in all public and private schools that receive any federal funding. FERPA provides a basic framework for protecting and disclosing student records, but leaves discretion to school districts for interpretation and implementation. FERPA also does not prescribe consequences for school employees for disclosures
29
of protected information. The Privacy Rule of the 1996 Health Insurance Portability and Accountability Act (HIPAA) sets higher national standards for the privacy of individually identiable health information and went into effect April 14, 2003, covering most healthcare providers and health plans. Schools that are covered under FERPA regulations are not covered under HIPAA, but private schools that do not receive federal funding and school-based health centers providing primary care may be covered under HIPAA. The healthcare providers and institutions that share health information with schools are bound by HIPAA regulations. To continue to share protected health information with schools, these providers may be concerned about ensuring the degree of privacy and security required of identiable health information. The National Association of School Nurses 2002 issue brief on this subject states: In other words, in order to conduct business involving the transmission of identiable student health information to or from an entity that is covered by HIPAA, school districts and school health professionals will likely be required to meet HIPAA standards. School nurses who understand the special protections afforded to personal health information are the most qualied school employees to coordinate and advocate for district health privacy standards. The task force guidelines listed above provide a template for district policies and procedures to be written or revised. The complete NASN issue brief can be obtained on the NASN Web site: www.nasn.org, where when you type in research window student record condentiality. You can read in detail both NASN briefs starting with The School Nurses Role in Education: Privacy Standards for Student Health Records (including FERPA and HIPAA rules) and then The School Nurses Role in Education: School Health Records. Student health information should be shared with other school personnel on a need to know basis to benet the health, safety and educational progress of the student, with parent/guardian permission. It will often be in the childs best interest for certain other school staff to be aware of medical information. The principal, classroom teachers and others should know about a child with a potentially life-threatening health condition or allergy. For instance, food service workers may need to know about a child with food allergies and classroom and PE teachers about a child with insect sting allergies or diabetes. In these cases, it is important to share the functional health problem rather than the actual medical diagnosis: how to recognize it, what to do if it happens and where emergency plans and equipment are located. Individualized health plans and emergency plans should be distributed to appropriate staff, instead of circulating a list of students with their medical conditions specied. However, always discuss sharing of health information with parents rst (who needs to know, what to share and what inservice teaching should be done) and obtain written permission from them, per school district policy. If a computerized record system is used, it should have safeguards such as protected personal passwords, overwrite protection and an adequate backup system. The Guidelines for Protecting Condential Student Health Information lists the following steps for protecting electronic health information: require individual authentication of users to access les; limit access to only a few individuals; establish audit trails of who accessed specic les; place the computer in a secure area; develop a disaster, back-up recovery plan; limit and protect remote access points;
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do not link with external electronic communications; and perform routine system assessment. An excellent and up-to-date resource for legal issues in school health is: Legal Issues in School Health Services: A Resource for School Administrators, School Attorneys, and School Nurses, Nadine Schwab and Mary Gelfman, ed., Northbranch, Minnesota: Sunrise River Press, 2001. (ISBN 0-9624814-5-9)
Documentation
Parents/guardians should complete a health form for every child at the beginning of the school year or upon registration, which includes: all emergency contact information (including cell phones and pagers) pertinent health history primary care provider/insurance information all medications taken allergies persons to whom child may be released signed permission to release medical information or contact the primary care provider (PCP). Ideally, this form (or a copy or computer version) should be available in the school health clinic, led under student name alphabetically and by grade. It should be updated annually, especially for emergency contact and health history information. Some schools put space on the back of the form to record specic student health information as it occurs, such as clinic visits, immunizations given and screening reports. Some schools have incorporated this information onto a health folder, which can then be led and used to hold other pertinent health information for this child. The childs school health record includes: Immunization Certicate (form 3231) and supporting documents including GRITS (Georgia Registry of Immunization Transactions and Services) records Vision, Hearing and Dental form (form 3300) medication authorization forms correspondence from physicians and parents treatment authorization forms results from school screenings, referral letters sent clinic visit reports, nurses notes student accident forms any other documentation related to the childs health in school. Some schools may choose to keep all information in one record in the ofce, but keeping health information led separately in the health clinic is better for logistics and condentiality. Wherever this information is kept, it must be locked and accessible only to authorized persons to maintain condentiality. Orders for medications and treatments should be written and signed per local district policy. Acceptance of verbal or faxed orders should be addressed in school policy. Two people should always listen to a telephone verbal order from a healthcare provider and both should sign the order. Verbal orders, if taken, should always be followed by an order in writing within a specied time period,
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usually 48-72 hours. Personal health information that is faxed should come in and be sent out with a cover sheet, clearly marking the information as condential. Standards of documentation for the school health record are similar to any other nursing documentation. All written materials should be accurate, objective, concise, complete, timely and well-organized. Entries should be legible, in ink, with each entry timed and dated. Subjective student data should be recorded in the students own words. Assessment data should include signicant ndings, both positive and negative. Nursing actions should be documented completely; personal judgments and opinions should be omitted. An accepted method of error correction is one single line drawn through the entry, the word error and the nurses signature written above it. Avoid late entries; however, if necessary, make the entry with the correct date and time and mark as late entry.
Special Education Abbreviations Commonly Used in Schools

AB ADA ADD ADHD APE BD CST DFCS DHHS DHR DOE EBD EIP ESY FAPE FERPA HI HIPPA HB IDEA IEP IHP LD Adaptive Behavior Americans with Disabilities Act Attention Decit Disorder Attention Decit Hyperactivity Disorder Adaptive Physical Education Behavior Disorder Child Study Team Department of Family and Child Services Department of Health and Human Services Department of Human Resources Department of Education Emotional Behavior Disorders Early Intervention Program Extended School Year Free and Appropriate Public Education Family Educational Rights and Privacy Act of 1974 Hearing Impaired Health Insurance Portability and Accountability Act Home Bound Individuals with Disabilities Education Act Individualized Education Plan Individualized Health Plan Learning Disabilities Local Education Agency or Limited English Prociency LRE Least Restrictive Environment MiID Mild Intellectual Disability MoID Moderate Intellectual Disability OCR Ofce for Civil Rights OHI Other Health Impaired OSEP Ofce of Special Education Programs Para Paraprofessional Physical Disability PD Physically Impaired PI Profoundly Intellectual Disability PID Rehabilitation Services RS SDD Signicantly Developmentally Delayed SEA State Education Agency SED Serious Emotional Disturbances Speech Impaired or Sensory Integration SI Signicantly or Severe Intellectual Disability SID SLD Specic Learning Disabilities SST Student Study Team Traumatic Brain Injury TBI Visual Impaired VI A Civil Rights Law 504 LEA
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Basic Information on Government Health Insurance

Medicaid Is a state insurance program for some low-income individuals and their families and they must meet certain qualifying criteria including income level. It pays directly to their healthcare provider(s) for services rendered. Please refer to http://www.cms.hhs.gov/MedicaidGenInfo/downloads/MedicaidATAGLANCE2005.pdf where you can get more details on Medicaid. PeachCare for KidsOverview Created by Congress and partnered by states, this health insurance program provides health care for uninsured children in the United States. It provides states the opportunity to create their own programs called SCHIP (State Childrens Health Insurance Program). In Georgia it is called PeachCare for Kids. PeachCare for Kids is a comprehensive health care program for uninsured Georgian children with benets that include primary, preventive, specialist, dental and vision care. Certain eligibility requirements must be met in order to qualify and documentation submitted to prove eligibility. Family income must be at or below 235 percent of the federal poverty level (about $49,800 for a family of four). Income is veried annually as part of the renewal process. Please refer to the following resources for more information as needed: www.peachcare.org www.schip-info.org http://dch.georgia.gov/vgn/images/portal/cit_1210/35/2/70650182PeachCare.12.2008.FINAL.pdf
Sample Forms
Several sample forms are found on the following pages. If you need any of these forms, feel free to use them as is or modify them to meet your individual needs and policies, add your school logo or letterhead, etc. You can access these forms in Chapter 13 to revise them to t your individual clinic needs. You also may just use these for ideas and create your own forms. If you have any types of forms that are not included here, please refer to Chapter 13 (Forms and letter). If you have a form not found here and have one that you nd especially useful, please let us know, so it may be added in the next manual revision. Forms also found in Spanish are noted by (Sp) and can be located in Chapter 13-Forms and Letters as well.
School Health Clinic Information Card (Sp) Clinic Activity-Daily Log Health Notes Monthly School Health Services Activity Report Report of Clinic Visit to Parent (Sp) School Health Clinic or Faculty Referral to School Social Services Report of Accident (2 samples) Student Chronic Health Concerns List Unlicensed School Health Personnel Skills Checklist School Health Clinic Parent Informational Letter (Sp) Report to Schools for PostHospitalization and/or Out Patient Care)
Ch1-1a and Ch1-1b Ch1-2 Ch 1-3 Ch1-4 Ch1-5a and Ch1-5b Ch 1-6 Ch1-7a and Ch1-7b Ch1-8 Ch1-9 Ch1-10a and Ch1-10b Ch1-11
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SCHOOL HEALTH CLINIC INFORMATION CARD
(School Year: 20___ to 20___)
School: ________________________________ Grade: ________ Teacher/HR: _________________________ Name: ________________________________ Sex: M F D.O.B. _________________________
Address: _______________________________ Phone: ____________ (H) ____________ (C) ___________ (W) HEALTH HISTORY (Answer Yes or No, and give information as needed.) Allergies (Specify) ________________________ Diabetes ___________________________ Asthma ________________________ Physical Disabilities ______________________ ADHD/ADD ________________________ Sickle Cell ______________________________ Cancer ________________________ Seizure Disorder _________________________ Other physical or mental health issues which may be a concern at school: (continue (continue on on back back as as needed) needed) __________________________________________________________________________________________ __________________________________________________________________________________________ _____ Does your child require special seating in the classroom? Specify: ______________________________ _____ Does your child have any condition that would limit physical education activities? List: ______________ _____ Does your child take any prescribed medications routinely? List: ________________________________ _____ Does your child take any non-prescription medications? List: ________________________________ _____ Did your child receive any immunizations this past year? List type, date: _________________________ _____ Date of last tetanus shot? List name(s) of school-age siblings: 1. _______________________________________ Grade/School: ____________________________________ 2. _______________________________________ Grade/School: ____________________________________ 3. _______________________________________ Grade/School: ____________________________________ --------------------------------------------------------------------------------------------------------------------------------------EMERGENCY CONTACT INFORMATION Father/Guardian ______________________________
Name
Phone (H) _____________ (C) ____________ Phone (W) _____________ Pgr ____________
Mother/Guardian _____________________________
Name
Phone (H) _____________ (C) ____________ Phone (W) _____________ Pgr ____________
If parents cannot be reached, list two nearby persons who will assume care of your child. Name ________________________________ Relationship __________________ Phone ______________ Name ________________________________ Relationship __________________ Phone ______________ Childs Healthcare Provider ____________________________________________Phone ______________ I give permission to give my child medicine for fever or headache, like Tylenol or Advil (or generic equivalent) according to label instructions after contacting me (Parent/Guardian) by phone. Yes _____ No _____ I give permission to contact my childs healthcare provider for further medical information. Yes _____ No _____ I also understand that in the event of an emergency and I can not be reached that the school will have my child transported to the hospital via the EMS/911 service to receive appropriate treatment. Parent Signature ______________________________________ Date ________________________________
Rev.2009tk
Ch1-1a
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36
TARJETA DE INFORMACIN DE LA CLNICA DE LA ESCUELA (Ao escolar: 20__ al 20__) Escuela: ___________________________ Grado: ____ Profesor/Saln de clase:_________________________ Nombre: ___________________________ Sexo:
(Trabajo)
Fecha de nacimiento: __________________
Direccin: __________________________Tel. #: ________ (Vivienda) ____________ (Cel.) ________________
HISTORIA CLNICA (Conteste S o No, y d la informacin segn sea necesario.) Alergias (especifique) ________________________ Diabetes _______________________________________ Asma _____________________________________ Discapacidades fsicas ____________________________ Trastorno por dficit de atencin e hiperactividad (ADHD) /Trastorno por dficit de atencin (ADD) _________________________________________________________________________________________ Anemia drepanoctica______________________________ Cncer ________________________ Trastorno convulsivo______________________________ Otras afecciones de salud fsica o mental que puedan ser preocupacin en la escuela: (contine en la parte posterior, segn sea necesario) __________________________________________________________________________________________ __________________________________________________________________________________________ _____ Requiere su nio asiento especial en el saln de clase? Especifique: _____________________________ _____ Tiene su nio alguna afeccin mdica que lo limite para hacer educacin fsica? Especifique: ___________________ _____ Toma su nio regularmente algn medicamento recetado? Especifique: __________________________ _____ Toma su nio algn medicamento de venta sin receta? Especifique: _____________________________ _____ Recibi su nio alguna vacuna este ltimo ao? Especifique el tipo y la fecha: ____________________ _____ Fecha en que recibi la ltima vacuna contra el ttano? Escriba los nombres de los hermanos en edad escolar: 1. ______________________________________ Escuela/Grado: ____________________________________ 2. ______________________________________ Escuela/Grado: ____________________________________ 3. ______________________________________ Escuela/Grado: ____________________________________ --------------------------------------------------------------------------------------------------------------------------------------INFORMACIN DE CONTACTO EN CASO DE EMERGENCIA Padre/Representante legal _____________________ Telfono (Vivienda) _____________ (Cel.) ____________ Nombre Telfono (Trabajo) ______________ Pager ____________ Madre/Representante legal ____________________ Telfono (Vivienda) _____________ (Cel.) ____________ Nombre Telfono (Trabajo) ____________ (Cel.)______________ Si no se puede contactar a los padres, dnos el nombre de dos personas cercanas que asumirn el cuidado del nio Nombre_______________________________ Parentesco __________________ Telfono ____________ Nombre _______________________________Parentesco __________________ Telfono____________
Rev.2009tk
Ch1-1b
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Proveedor de atencin mdica del nio ___________________________________Telfono ___________ Doy permiso para que se le d a mi nio un medicamento para la ebre o el dolor de cabeza, tal como Tylenol o Advil (o su marca genrica equivalente), siguiendo las instrucciones de la etiqueta, y despus de que se me comunique por telfono (padre/representante legal) S _____ No _____ Doy permiso para que se comunique con el proveedor de atencin mdica de mi nio para obtener informacin mdica adicional. S _____ No _____ Tambin entiendo que, en caso de una emergencia, y no se puede comunicar conmigo, la escuela har que mi nio sea transportado al hospital a travs del servicio 911/EMS (# 911/Servicios Mdicos de Emergencia) para recibir un tratamiento adecuado. Firma de uno de los padres ______________________________________ Fecha __________________
El personal de la clnica de la escuela tiene mi permiso para comunicarse con el proveedor de atencin mdica de mi nio para obtener informacin mdica adicional. S _____ No _____ En caso de una enfermedad/lesin seria, la escuela llamar por telfono al (911) para comunicarse con los Servicios Mdicos de Emergencia (Emergency Medical Services, segn su nombre en ingls) para pedir transporte inmediato al hospital ms cercano. S _____ No _____. Si su respuesta es S, uno de los padres/representante legal, autoriza al personal de urgencias del hospital, para transportar y dar tratamiento a mi nio _______________________________.
N ombre
Proveedor de atencin mdica del nio ___________________________________Telfono ___________
Firma de uno de los padres ___________________________________ Fecha __________________________
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Ch1-1b Rev. 2009tk
Clinic ActivityDaily Log
Clinic ActivityDaily Log
Ch1-2 Rev.2009tk
School:
Complaint Treatment Temp Parent Called (Y/N)
Date:
Clinic Personnel:
Class or Home (C/H),
Home Time Room/ In Grade
Time Out
Name
Absentee Calls
39
Illnesses Inj/1st Aid Sent Home Accid. Rpts
911 Activated Parent Consults Staff Consults Daily Meds
PRN Medications Immunization Cks Hearing/Vision Screens Head Cks/Lice Cases
Referrals Employee Visits Student Health Counseling SST, IEP meetings
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H e a l t hNotes Notes Health
School Name Student Name Teacher

Date Vital Signs
School Year DOB Grade Physician
Page
of
Health Notes (Sign after each entry.)
reviewed 2009tk Ch 1-3 Rev.2009tk
Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta & Georgia Association of School Nurses 41 Childrens Healthcare Atlanta, Inc. 2004 Georgia School Health Resource ManualChapter 1 School Health of Services and School Nursing Practice
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Monthly S c h o oHealth l H e a l tServices h S e r v i c Activity es Activ ity Report Monthly School Report
School:
Activity: # Week 1
Clinic staff completing report:School Year: 2 Month:

Week 2 Week 3 Week 4 Week 5
to 2
Total
1. Illness visits 2. Injury visits 3. % Back to class 4. Accident/Incident Reports 5. 911 activated 6. Parent consults 7. Staff consults 8. Daily meds 9. PRN meds 10. Immunization checks 11. Hearing screen 12. Vision screen 13. Head checks 14. Head Lice cases 15. Referrals 16. Employee visits 17. Student Health counseling 18. SST, IEP meetings 19. Absentee calls 20. Scoliosis screen 21. Classes taught 22. Supervisor visit, nursing mtg. 23. Attended inservice; committee mtg. 24. Other (Ht./Wgt. Screen, ect.)
Unusual Occurrences (not listed above):
Other activities (not listed above):

Communicable Illnesses: Unusual occurrences:
Communicable illnesses: Safety Issues: Safety issues: Signature:

Signature:
Ch1-4 Rev.2009tk
Other Concerns: Title:

Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta of & Georgia Association 43 Childrens Healthcare Atlanta, Inc. of School Nurses 2004 Georgia School Health Resource ManualChapter 1 School Health Services and School Nursing Practice
44
Report of Student Clinic Visit to Parent

School: Student Name: Your child was seen in the clinic today for: Teacher: Date:
We noticed the following:
First aid or treatment given:
o Your child returned to class and reported no further problems. o We attempted to call you at phone #: Please help us assist your child further by doing the following: o Continue to observe at home. o Watch for signs of infection (pain, swelling, redness, heat). o Recommend healthcare provider follow-up for further recommendations or treatment. o Return to school when fever free for 24 hours. o T o prevent possible spread of infection in the school, we will need a note from your healthcare provider before your child returns to school. o Other: Please feel free to call the school if you have any further questions or concerns relating to this visit. I can be reached at: (Phone #) Time:
Sincerely,
(Reported by)
Title:
Ch1-5a Rev.2009tk
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Informe para los padres de la visita del estudiante a la clnica

Escuela: Estudiante: En la clnica se examin a su nio hoy debido a: Profesor: Fecha:
Notamos lo siguiente:
Primeros auxilios o tratamiento dado:
o Su nio regres a la clase y no report problemas adicionales. o Tratamos de llamarlo al: Por favor aydenos a darle asistencia adicional a su nio, haciendo lo siguiente: o Contine observndolo en casa. o Observe si tiene seales de infeccin (dolor, hinchazn, enrojecimiento, se siente caliente). o Se recomienda cita de control con el proveedor de atencin mdica para instrucciones adicionales o tratamiento. o Regrese a la escuela 24 horas despus de que le pase la ebre o P ara prevenir la posible diseminacin de la infeccin en la escuela, necesitamos que traiga una nota del proveedor de atencin mdica antes de regresar a la escuela. o Otro: Por favor sintase con toda libertad de llamar a la escuela, si tiene ms preguntas o preocupaciones sobre esta visita. Puede llamarme al telfono #
Atentamente, Ttulo: (Informe presentado por)
Ch1-5b Rev.2009tk
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48
CC. Principle Rev.2009tk
Schoo l H e a l tClinic h Clini c o r F a c u lReferral t y R e f e rto ral t o S c hSocial o o l S oServices cial Services School Health or Faculty School
Student Name: Date: DOB (Age) / / School: ( ) Teacher:
Student ID: Grade:
Mother/Guardian
Mothers Home Phone( Mothers Work Phone( Mothers Cell/Pager( ) )
Father/Guardian
Fathers Home Phone( Fathers Work Phone( Fathers Cell/Pager( )
) )
Street Address: City: Emergency Contact Name: CHECK ALL THAT APPLY Attendance: As of Number of Excused Number Unexcused Number of Tardies / / Abuse Services Academic Services Discipline Services Special Education Emergency phone(
Apt: Zip Code: )
Homeless Pregnancy Verification of Residence Family/Health/Personal/Social Services
Problem Seen By Referring Person And Attempts Made By School To Remedy:
Referred by
Title
Social Worker Signature
Date
Ch 1-6 Rev.2009tk
Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta & Georgia Association of School Nurses 49 Healthcare ofServices Atlanta, Inc. Nursing Practice 2004 Georgia School Health Resource Childrens ManualChapter 1 School Health and School
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Report of Accident/Incident (please print clearly)

Injured Person Information: Name: Address: School: o Visitor o Employee Age: Grade: Phone #s: Date of Accident:
(Month Day Year)
o Student Sex: o Male Teacher: o Female
Time of Accident:
(Hr. Min. AM or PM)
Location
Type of Injury
Body Part Injured

R R L L B B
o Classroom or Auditorium o Abrasion o Head o Cafeteria o Bite o Eye o Corridor o Blister o Ear o Commons Area o Bruise o Mouth o Stairs (inside) o Burn o Teeth o Bathroom o Cut/Laceration o Neck o Showers or dressing room o Poisoning o Chest o Parking area o Puncture o Shoulder o Driveway o Scratch o Arm o Shops o Sprain o Elbow o Labs o Tooth Damage o Wrist o Homemaking o Other: ___________ o Hand o Playground o Abdomen o Street, Highway Possible Injury: o Hip o Athletic Field o Concussion o Leg o Other: ________________ o Dislocation o Knee o Fracture or Break o Ankle o Internal Injury o Foot o Strain or Sprain o Toe(s)
R R R R R
L L L L L
B B B B B
R L B R L B R L B R L B R L B R/L: ____________ Other: ___________
Degree of Injury
o o o o
Accident / Incident Description (include cause):
Non-disabling Temporary (lost time from school) Permanent disability Death Who gave First Aid, if any?
Witness(es):
Describe aid given: o Yes o No MD notied: o Yes o No MD name: Parent(s) notied? o Yes o No MD phone: Principal notied? o Parent o EMS/Hospital o Back to class Accompanied by: Released to:
Report Prepared by: Title: Date: # Days Lost From School: (Continue on back of page as needed)
Ch1-7a Created 2009tk
51
Body Diagram (Anterior/Posterior)

Body Diagram (Anterior/Posterior) Right Left Left Right
52
Cc: Principal
Created2009tk
Student Accident Report to Parent

School: Student Name: Your child was seen in the clinic today for: Teacher: Date:
We noticed the following:
First aid or treatment given:
o Your child returned to class and reported no further problems. o We attempted to call you at phone #: Please help us assist your child further by doing the following: o Continue to observe at home. o Watch for signs of infection (pain, swelling, redness, heat). o Recommend healthcare provider follow-up for further recommendations or treatment. o Other:
Please feel free to call the school if you have any further questions or concerns relating to this visit. I can be reached at: (Phone #)
Sincerely,
(Reported by)
Title:
Ch1-7b
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Student Chronic Health Concerns List

Name of Chronic Health Concern ADD/ADHD Autism/Asperger's Syndrome Allergies: Food (peanut, milk, etc.) Environmental and Seasonal Bee or Insect Stings/ # Epinephrine Pens Anxiety/ Depression Arthritic conditions or Bone Disorders Asthma / # with Inhalers Cancer Cerebral Palsy Cystic Fibrosis Diabetes / Hypoglycemia Down's Syndrome G.I. disorders (Crohn's, Reux, etc.) Hearing or Visual disturbances Heart condition or Bleeding disorder Lupus Mental Health concern (Bipolar, EBD, Compulsion disorder, etc. Migraines Muscular Dystrophy / Spina Bida Nosebleeds Scoliosis Seizure disorders Sickle Cell Anemia Thyroid disorders Tourette's Syndrome Other: Other: Other: # Meds administered Daily # Meds administered PRN (as needed) Please ll out the chart using the School Health Clinic Information Card. Turn this form in to your Supervisor and Principal by the end of the rst month of school.
Ch1-8 Created: 2009tk
Number of Students with this Concern
55
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Unlicensed School Health Personnel Skills Checklist

This for bec adapted unlicensed personnel are in school U may nli e n sfor e use d ifS choo l He aemployed lth P e r shealth o n clinic nel Skills Checklist
This form may be adapted for use if unlicensed personnel are employed in school health School District: Name: School:
Routine Completion of Certied First Aid or First Responder Course (repeat every two years) Current CPR Certication (every two years) Adheres to standard precautions and infection control techniques Verbalizes understanding of job description and chain of command within the school setting Knows when to call for assistance/consult with schoolnurse Maintains student condentiality Communicates effectively with students, staff, parentsand school nurse Knows school emergency plans and procedures Demonstrates ability to triage students Assesses vital signs, using proper technique Uses rst aid measures appropriately Demonstrates proper medication storage and recordkeeping Maintains up-to-date clinic/emergency cards Documents appropriately (daily log, incident reports,medication forms, etc.) Maintains organized and clean health clinic area Submits requested paperwork and monthly reports,completed and in a timely manner Completes the Chronic Health Concerns list for student population Recognizes signs of child abuse and knows appropriate reporting procedures Uses appropriate resources for referrals Attends inservices provided by school district
School Nurse: Year:

Skills Date SN N/A
Code: S= Satisfactory N=Needs further education/practice

N/A=Not applicable
N/A=Not applicable
Ch1-9 Rev. 2009tk
57 Childrens Healthcare of Atlanta, Inc. Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta & Georgia Association of School Nurses 2004 Georgia School Health Resource ManualChapter 1 School Health Services and School Nursing Practice
This form may be adapted for use if Health unlicensed personnel are employed in school Checklist health Unlicensed School Personnel Skills
This for may be adapted for use if unlicensed personnel are employed in school health clinic
Unlicensed School Health Personnel Skills Checklist

Special Skills for Emergency Situations Demonstrates ability to recognize signs and symptoms of respiratory distress/asthma exacerbation and begins appropriate intervention Knows how to properly deliver nebulizer treatments and assist with inhaled medications Demonstrates ability to recognize the signs and symptoms of hypo- and hyperglycemia and begins appropriate intervention Demonstrates ability to recognize signs and symptoms of a seizure and begins appropriate intervention Demonstrates ability to recognize signs and symptoms of a severe allergic reaction and begins appropriate intervention Special Skills for Screening Knows role in screening of students, as appropriate Vision Hearing Scoliosis Height and Weight Date Date
N/A=Not applicable
S N N/A
N/A
Comments:
Issues/ skills to work on:
Signatures: School Employee Principal
School Nurse Date
44
Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta & Georgia Association of School Nurses 2004 Georgia School Health Resource ManualChapter 1 School Health Services and School Nursing Practice 58 Childrens Healthcare of Atlanta, Inc.
School Health Clinic Parent Informational Letter

Dear Parent/Guardian:
School Year 20__-20__
Date:
We need your assistance and cooperation in preparing for the possibility that your child might need to take medication, become ill or have an accident during school hours. We hope this letter will explain our procedures.
Emergency Information
Emergency contact information should be updated annually by sending the information to the school or calling the school ofce. When you receive a Student Health Form, please update it and return it to the school within ve days. Current, accurate information will enable us to contact you whenever there is a need. If any information changes during the school year, contact the school immediately.
Prescription/Non-Prescription Medication
Medication time schedules should be set so that, when possible, medicine is taken at home rather than at school. However, if medication must be taken at school, the following procedures apply. 1. M edication Authorization Form The parent/legal guardian must complete an authorization and instruction form titled Parent/Guardian Authorization to Give Medication at School. For prescription medication, your healthcare provider must also sign the form. A copy of this form is on the back of this letter. You can make copies yourself or request additional forms from the school. The completed form has to accompany the medication, so be sure to take this form to your healthcare provider whenever your child is ill. 2. T he medicine, in the original container (along with authorization form), must be taken to the school ofce/clinic for central storage. The parent/guardian should take the medication to school; if this is not possible, however, your child should be instructed to take the medication and the authorization form directly to the school ofce/clinic. Under no circumstances should medication be shown or shared with other students. 3. A t the designated time, the student will go to the ofce/clinic to take the medication. Assistance/supervision will be given in accordance with the instructions on the authorization form. Medication is a parental responsibility; school employees will not assume any liability for supervising or assisting in the administration of medication. 4. U nused medication should be retrieved from the school ofce/clinic within one week after medication is discontinued; otherwise the school will dispose of the medication.
Student Illness/Injury
Sick students who are contagious must not be sent to school. When a student becomes ill at school, the parent must arrange for the student to be taken home. By working together, we can strive to ensure the health and well being of every student so that he/she can benet from the educational program. Principal
Ch1-10a Rev. 2009tk
School Clinic Personnel

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Carta informativa de la enfermera escolar para los padres Ao escolar 20

Apreciados padres/representante legal: Fecha:
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Necesitamos su ayuda y cooperacin en preparacin para la eventualidad de que su nio llegare a necesitar algn medicamento, se enfermara o tuviera un accidente durante el horario escolar. Esperamos que esta carta les explique nuestros procedimientos.
Informacin de emergencia
La informacin de los contactos en caso de emergencia debe actualizarse anualmente, envindola a la escuela o llamando a la ocina. Cuando reciba el Formulario Salud del Estudiante (Student Health Form), por favor actualcelo y devulvalo a la escuela en los cinco das siguientes. Esta informacin, actualizada y exacta, nos permitir comunicarnos con usted cada vez que sea necesario. Si en algn momento durante el ao escolar esta informacin cambia, comunquese inmediatamente con la escuela.
Medicamentos recetados/medicamentos de venta sin receta

El horario para tomar los medicamentos debe programarse de tal manera que, de ser posible, se tomen en casa en lugar de hacerlo en la escuela. Sin embargo, si deben tomarse en la escuela, se aplican los siguientes procedimientos. 1. Forma para Autorizacin de Medicamentos Los padres/representante legal deben llenar una forma de autorizacin e instruccin titulada Autorizacin de los padres/representante legal para administrar medicamentos en la escuela (Paren/Guardian Authorization to Give Medication at School). En el caso de medicamentos de venta con receta, su mdico tambin debe rmar dicha forma. Al reverso de esta carta, usted encontrar una copia de dicha forma. Usted le puede sacar copias o solicitar formas adicionales en la escuela. La forma, debidamente llena, debe entregarse junto con el medicamento; as que asegrese de llevarle esta forma al proveedor de atencin mdica, cuando su nio se enferme. 2. E l medicamento en su envase original (junto con la forma de autorizacin), debe entregarse en la enfermera/ ocina de la escuela para su almacenamiento central. Los padres/representante legal deben llevar personalmente el medicamento a la escuela; sin embargo, si esto no es posible, debe instruir a su nio para que lleve el medicamento y la forma de autorizacin directamente a la enfermera/ocina de la escuela. Bajo ninguna circunstancia se debe mostrar el medicamento a otros estudiantes o compartirlo. 3. A la hora designada, el estudiante ir a la enfermera/ocina a tomarse el medicamento. Se dar asistencia/supervisin, siguiendo las instrucciones que aparecen en la forma de autorizacin. El medicamento es responsabilidad de los padres; los empleados de la escuela no asumen ninguna responsabilidad por supervisar o asistir en la administracin del mismo. 4. E l medicamento no utilizado se debe retirar de la enfermera/ocina de la escuela, dentro de la semana siguiente de haberse suspendido su administracin; de otro modo la escuela lo desechar.
Ch1-10b
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Enfermedad/lesin de un estudiante
Los estudiantes con enfermedades contagiosas no deben ir a la escuela. Cuando un estudiante se enferme en la escuela, los padres deben hacer los arreglos necesarios para llevarlo a casa. Trabajando juntos, trataremos de garantizar la salud y el bienestar de cada estudiante para que l/ella pueda beneciarse de los programas educativos.
Director
Personal de enfermera
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Required Health Certicates

Required health certicates for school include:
Form 3231 Certicate of Immunization Form 3300 Certicate of Eye, Ear, Dental Exam
Georgia Immunization Requirements

The State of Georgia requires up-to-date or completed immunizations for school attendance. For the current immunization requirements, please visit the Immunization Section web site at www.health.state.ga.us/programs/ immunization/. Prevention of the occurrence of childhood vaccine-preventable diseases requires vigilance by healthcare providers, school and childcare personnel and parents. All students entering school (through 19 years of age) must be immunized according to the rules and regulations established by the Georgia Department of Human Resources (DHR). Georgia requirements are based on the schedule recommended by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). In addition to the immunizations that are required for entering schools, there are other immunizations that are 'recommended' for each child to receive. Each year, the Recommended Immunization Schedule by the ACIP is updated and includes all recommended immunizations. Each state then determines which of those recommended vaccines will be required for entry into schools. Therefore, it is still important to encourage children and parents to receive the 'recommended but not required' vaccines. Be sure to annually review and print the immunization schedules for children, teens and adults by visiting www.cdc.gov/vaccines/recs/schedules/default.htm.
Most children will complete the immunization schedule they need to enter school when they are between four and six years of age. At this time, the childs healthcare provider will complete the Certicate of Immunization, Form 3231, which must be returned to the school by the parent/guardian at the time of registration or entrance to school. Under state regulations, a school may grant a one-time 30-day waiver, to allow a student to attend school while appointments are being made to complete immunizations. If the childs record does not meet the requirements, the healthcare provider will complete the Form 3231 with an expiration date marking when the next required immunization in the schedule is due. Such children may attend school, but parents are responsible for keeping up with the schedule until the series is complete. A new certicate should be obtained and submitted to the school within 30 days of the expiration date. Using a tickler le is the best way to keep track of students who have certicates with expiration dates. The Form 3258, entitled Immunization Guidelines for Child Care Facility Operators and School Personnel" (see More Resources section below) provides detailed instructions on managing a tickler le. Note: It is not necessary to replace the older DHR Form 3032 or previous versions of the 3231 for students already attending Georgia schools. For entrance into sixth grade, a currently enrolled child must have the following immunizations documented on Form 3231, Rev. 3/07. (If the student has an older version of the 3231 but it veries the following information, the newer 3231 is not required.) total of two doses of varicella (chicken pox) vaccine on or after the rst birthday, administered at least 28 days apart; date of positive serology; a healthcare providers documentation of disease based on the parents description of disease history; or a healthcare provider-documented year of diagnosis. The second dose is a new requirement effective 7-1-07.
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total of two doses of measles-containing vaccine administered on or after the rst birthday and at least 28 days apart (or date of positive serology). total of two doses of mumps-containing vaccine administered on or after the rst birthday and at least 28 days apart (or date of positive serology). The second dose is a new requirement effective 7-1-07.
There are two exceptions that apply to the immunization requirements for school attendance. If a familys religious beliefs do not allow immunizations, the parent/guardian must submit a signed and notarized letter to that effect. This letter must be kept on le in lieu of a certicate and does not expire. In the case of a medical exemption to some or all of the required immunizations, the healthcare provider will complete a Form 3231, checking the appropriate boxes. This certicate must be reviewed and reissued annually. In the event of an outbreak of a vaccine-preventable disease for which the child has not been immunized, it is the schools responsibility to exclude that child from school for the entire period of the outbreak.
The required immunizations for Georgia are:

diphtheria tetanus pertussis poliomyelitis measles mumps rubella (German measles) haemophilus inuenza type B (HIB) (not required on or after 5th birthday) hepatitis B varicella (chicken pox) Pneumococcal (not required on or after 5th birthday) Hepatitis A
Schools Responsibilities Regarding the Immunization Program

1. Know and enforce immunization requirements as outlined in the Policy Guide 3231 REQ. 2. Review the certicates for validity, prior to accepting. Form 3231 must be: legible completed with dates of immunizations (M/D/Y) listed marked with either Date of Expiration or Complete for School Attendance, not both signed or stamped by a Georgia physician or public health clinic or issued from GRITS physician or clinic address noted marked with date of issue original or photocopy 3. O nly a date of positive serology or medical exemption is acceptable in lieu of a vaccination date for hepatitis B, hepatitis A, measles, mumps, rubella or varicella. Physicians diagnosis or history of disease applies to varicella only. All medical exemptions must be reviewed annually and a new certicate issued.
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4. D evelop a system for immunization certicate management. Keep certicate les current. Notify parents before a certicate expires to give them time to obtain the needed services. If 30 days or more have passed after a certicate has expired, the child should not be attending school. 5. Have certicates available for inspection and audit by health ofcials. 6. W hen a child leaves or transfers to another facility, the Certicate of Immunization or religious exemption statement should be given to the parent/guardian or sent to the new facility. This should include the moves from elementary to middle to high school as well. 7. R eport the occurrence of any cluster of cases of a disease listed on the notiable disease list. See Chapter 4 Communicable Diseases and Infection Control, page 223. 8. Use and teach handwashing as an effective way to decrease the spread of bacteria and viruses. 9. Utilize and teach standard precautions to all staff. See Chapter 4 Communicable Diseases and Infection Control, page 218. To help you inform parents about Georgia's immunization requirements, request copies of the Georgia Immunization Program brochure,Give Em Your Best Shot (Form 3193), to distribute in your ofce. A Spanish translation, Hay que Vacunarlos, is also available (Form 3194). For this and any other questions, you may call the Georgia Immunization Program at 404-657-3158 . The Vaccines for Children Program (VFC) is coordinated by the Georgia Immunization Program and provides free vaccines to public and private healthcare providers for children who are Medicaid- or PeachCare-enrolled, American Indian/Alaska Native, uninsured and insured but whose vaccines are not covered by insurance. (Providers may charge an administration fee.) Schools can assist parents by providing them with information about state requirements, local health departments and other resources for immunizations at registration and when new students enroll. It is helpful to healthcare providers and parents to let them know that the earlier they go to complete their immunizations or obtain the certicates, the easier it will be. In some cases, health departments may work with schools to provide some immunizations at school, such as the sixth grade-required immunizations. The Georgia Registry of Immunization Transactions and Services (GRITS) project was mandated by the legislature (OCGA 32-12-3.1) in 1996. Among other functions, the registry is used to assist public health ofcials in assessing and improving the immunization status of the community, and by providers to access up-to-date immunization records of Georgians. The registry database allows enrolled healthcare providers to print the required immunization certicates. In addition, most school health nurses have been trained to locate and view student records in the system. If the child is Complete for School, a 3231 can be printed. If he/she is not up-to-date, the school can print an Immunizations Needed report to give to the parents so they can have their child immunized and obtain an up-to-date 3231.
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More Resources:
Immunization Guidelines for Childcare Facility Operators and School Personnel www.health.state.ga.us/pdfs/prevention/immunization/requirements.pdf Policy Guide 3231REQ can be found under School and Daycare Requirements at: http://www.health.state.ga.us/programs/immunization/parent.asp Give Em Your Best Shot and Hay que Vacunarlos Brochures for Parents: http://www.health.state.ga.us/programs/immunization/parent.asp Immunization Section, Division of Public Health at the Georgia Department of Human Resources www.health.state.ga.us/programs/immunization/ Recommended Immunization Schedules for persons aged 0-18 yearsUnited States, 2008. MMWR Weekly 57(1), 11 Jan. 2008; http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm American Academy of Pediatrics; School Health Policy and Procedure 6th edition. Elkgrove Village, Il, 2004 ISBN: 1-58110-094-9 www.nursing.advanceweb.com and then type in the search box your immunization or infectious illness question. www.nasn.org/default.aspx?tabid=258 for the Tools for Schools: Pertussis and in Hep A, a free toolkit for schools that includes a fact sheet , parent letter, poster and more. Visit www.choa.org/buildingbridges and click on the various tip sheets provided: About Your Childs Vaccinations; Flu Alert: Prevention and Treatment; Hepatitis A; Know the Facts about Meningitis
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Rev. 03/2007
The General Recommendations 2006 can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/ rr5515a1.htm and are scheduled for an extensive revision in 2009. The General Recommendations will then be revised every three years thereafter. 67 Childrens Healthcare of Atlanta, Inc.
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290-5-4-.01 Denitions
Unless a different meaning is required by the context, the following terms as used in these rules shall have the meaning hereinafter respectively ascribed to same: (a) Immunization means the presumptive presence in the body of an immunized person of sufcient protective antibodies or of cellular immunity, as a result of previous infection or introduction of specic antigenic agents, or a presumptive state of being so conditioned by previous experience with a particular disease so as to provide an immediate and protective response upon exposure to specic infectious agents of that disease; (b) Local Board of Health means any county, city or District Board of Health supported entirely or in part by the Department through the allocation of public funds or other support; (c) Physician means a practitioner of the healing arts licensed in accord with O.C.G.A. or the equivalent laws of the practitioners jurisdiction if outside Georgia; (d) Physical Disability means any physical condition or physiological idiosyncrasy which might in the opinion of a physician cause a specic immunization to endanger the life or health of the recipient; (e) Health Authority means the Department of Human Resources or a local Board of Health in Georgia or the corresponding agencies in other states or nations; (f) Epidemic means an outbreak, or rise in incidence rate, or spread of incidence of a contagious or infectious disease so as to constitute a clear and present risk of infection to the public at large or to congregated groups thereof; (g) Facility means any public or private day center or nursery intended for the care, supervision, or instruction of children; (h) School means any public or private educational program or institution instructing children at any level or levels, kindergarten through twelfth grade, or children of ages ve through nineteen if grade divisions are not used; (i) Afdavit means a written statement made under oath before an authorized magistrate or ofcer which certies that the required immunization conicts with religious beliefs of the parent or guardian. (j) New Entrant means any child entering any school or facility in Georgia for the rst time or entering after having been absent from a Georgia school or facility for more than twelve (12) months or one (1) school year. Note: For list of reportable diseases go to Chapter 4, Communicable Diseases and Infection Control, page 223. Or go to Web site: http://health.state.ga.us/pdfs/epi/notiable/notiableposter.05.pdf for the most up to date list of reportable diseases in Georgia.
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Required Health Certicates
Ear, Eye and Dental Examination Requirements

All children beginning school in Georgia for the rst time must have a vision, hearing and dental examination (completion of Form 3300). The students parent/guardian must furnish the school system with this certicate issued by: private practitioner, licensed in Georgia (vision, hearing, dental) dentist or dental hygienist, licensed in Georgia (dental) Georgia health department personnel (all).
This certicate acknowledges that the child has been examined in these three areas and states the results of these examinations. This policy does not apply if the parent or legal guardian of the child objects to it on the grounds that such examination conicts with their religious beliefs. In this case the parent/guardian must furnish the school ofcials with a notarized letter stating this exemption. This document must remain on le at the school in lieu of the certicate.
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73 Childrens Healthcare of Atlanta, Inc. Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta & Georgia Association of School Nurses 2004 Georgia School Health Resource ManualChapter 1 School Health Services and School Nursing Practice
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74 Childrens Healthcare of Atlanta, Inc. Childrens Healthcare of Atlanta & Georgia Association of School Nurses of Human Resources, Division of Public Health, Georgia Department 2004 Georgia School Health Resource ManualChapter 1 School Health Services and School Nursing Practice
Healthy School Environment

Maintaining a healthy school environment involves creating a safe work and study area and a healthy atmosphere that is physically, emotionally and psychologically supportive. Optimum indoor air quality, elimination of safety hazards and adequate lighting are important factors to be considered in achieving this goal. Approximately 20 percent of the U.S. populationnearly 55 million people--spend their days inside elementary and secondary schools. In 2007, indoor air quality (IAQ) was reported to be unsatisfactory in about one in four public schools in the United States, while ventilation was again reported as unsatisfactory in about one quarter of the public schools, according to the National Center for Education Statistics of the Department of Education. (From the brochure IAQ Tools for Schools available at www.epa.gov/iaq/schools) This indicates the need for increased involvement of the school nurse in educating "educators" to the implications this can have on a student's health and subsequent learning abilities. Exposure to air pollution is a health concern for everyone, especially those with asthma and other chronic respiratory conditions. In the school setting, outdoor air pollution and high levels of ozone are problematic when physical education, sports activities, eld days and eld trips are held outside. Indoor air quality can be even more of a concern with construction of tightly sealed buildings; reduced ventilation rates to save energy; use of synthetic materials in construction, furnishings and carpets; and chemicals in consumer products. Some of the consequences of poor air quality in schools are: increased long- and short-term health problems for students and staff spread of airborne infectious diseases degraded student learning environment, affecting comfort and attendance reduced productivity of teachers and staff due to discomfort, sickness and absenteeism deterioration of the school building and equipment.
The National Association of School Nurses (NASN), in a 2002 position paper, stated that the school nurse is in a unique position to work with administration, maintenance personnel and other health professionals in detecting, monitoring and eliminating sources of indoor air contaminants, as well as proactively educating students, staff and parents on indoor air quality issues. The Environmental Protection Agency (EPA) has developed the Indoor Air Quality (IAQ) Tools for Schools Action Kit, which will guide school staff in how to improve the air quality environment in the school. This kit is recommended by the National Safety Council, the American Lung Association, the National Education Association and the National Parent Teacher Association. Checklists included in the kit allow staff to pinpoint areas of concern and potential solutions. Through simple, low cost measures, schools can: reduce IAQ-related health risks and triggers for asthma identify sources of mold improve comfort and performance levels avoid costly repairs avoid negative publicity and loss of parent and community trust avoid liability problems.
The IAQ Tools For Schools Kit, brochure and other materials are available from the IAQ Info Clearinghouse at 1-800-438-4318.
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Child Abuse Prevention, Recognition and Reporting

Recognition of Child Abuse
Child maltreatment is a public health issue that is costly in lives, direct and indirect services and the short- and long-term physical and emotional injuries that children sustain. In Georgia, a child is reported as abused or neglected every six minutes. Young children and children with developmental, physical or behavioral disabilities are more likely to be victims of child abuse. Many prevention programs that reduce risk factors and strengthen protective factors are available in Georgia.
Program Target Audience Sponsoring Organization Description Body safety and violence prevention education for children Personal safety and violence prevention curricula Good-Touch/Bad-Touch Children in pre-K 6th grade Generally school-based; created by Childhelp Talking about Touching; Children in pre-K 8th grade School-based; created by Second Step Committee for Children
Need to Talk? Teenagers Prevent Child Abuse Georgia Distribution of HELPLINE cards in schools First Steps New parents Prevent Child Abuse Georgia Support, information and referrals; phone-based after initial face-to-face visit Healthy Families Georgia New parents Prevent Child Abuse Georgia Long-term voluntary home visitation for more vulner able families of newborns HELPLINE Parents and other caregivers Prevent Child Abuse Georgia Toll-free, condential source of support, information and referrals Stop it Now! Adults Prevent Child Abuse Georgia Public health campaign on adult responsibility for preventing child sexual abuse
Stewards of Children Adults; staff of youth-serving Darkness to Light & Georgia Training program on adult organizations Center for Child Advocacy responsibility for preventing child sexual abuse
Educators and school personnel can help in these prevention efforts by providing:
Education and assistance for students

Provide training on life skills such as communication, problem-solving, coping, personal safety and parenting. Use teaching styles that promote assertiveness, decision-making skills, positive peer relations and self-esteem. Make sure students know where they can go to get help or talk to a trusted adult.
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Support and modeling for parents

Offer after-school care or programs for children of working parents or parents who need respite from childcare responsibilities. Invite parents to get involved in school activities where they can observe positive models for interactions with children. Provide referrals to families facing domestic violence, drug and alcohol abuse or unemployment, as well as those with food, housing, mental health or healthcare needs. Have clear and consistent codes of conduct. Send positive feedback to parents about their children. Set realistic goals and celebrate small successes.
Training for school staff and organizational change

Require all staff to participate in training on child abuse and neglect and encourage them to reach out to students at risk. Ensure that school is a safe place; have policies that prohibit corporal punishment on campus. Develop child protection policies such as those that eliminate one-adult/one-child interactions at school. Make school facilities available for parenting support meetings and workshops. Use school resources (e.g., newsletters, bulletin boards, newspapers) to broadcast prevention messages. Form partnerships with law enforcement, social services and other community organizations that deal with child abuse Support advocacy efforts at the community, state and federal level for more funding for prevention programs.
Recognition of Child Abuse Types of Abuse

Physical abuse is non-accidental physical injury or death inicted upon a child by a parent or a caretaker to a child under age 18. In Georgia, physical forms of discipline may be used by a parent as long as there is no physical injury to the child. Neglect is the failure of the parent or caretaker to see that the child is adequately supervised, fed, clothed, housed or provided medical care.
Cruelty to children is willfully depriving a child of necessary sustenance or causing cruel or excessive physical or mental
pain. This includes allowing a child to witness family violence battery. Sexual abuse means a person's employing, using, persuading, inducing, enticing or coercing any minor who is not that person's spouse to engage in any sexual act. Sexual exploitation means conduct by a child's parent or caretaker that allows, permits, encourages or requires that child to engage in prostitution or sexually explicit visual or print material.
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Emotional abuse is a repeated pattern of caregiver behavior or extreme incident(s) that harm a childs self-worth or emotional well-being or convey to children that they are worthless, awed, unloved, unwanted, endangered or only of value in meeting another's needs. Munchausen by Proxy Syndrome is a form of child abuse in which a parent or caretaker presents a child for medical attention with symptoms that may have been fabricated or directly created by the parent or caretaker, and which subjects the child to unnecessary or potentially harmful medical procedures. The parent or caretaker may display considerable medical knowledge and may have worked in a healthcare setting. Risk Factors in Parents and Caregivers Lacks understanding of child development and has expectations that are inconsistent/inappropriate for the childs age Was abused as a child Approves of and uses physical punishment as a discipline technique Is a young parent, a single parent or is socially isolated from the community Has physical or mental health problems or misuses alcohol or drugs Lives in area with high unemployment, poverty or crime
Indicators of Abuse and Neglect Any of the following traits should raise the suspicion of abuse or neglect, but it should be recognized that there can be reasonable explanations for these. It is the responsibility of Department of Family and Child Services (DFACS) in the state of Georgia workers and their supervisors to make these determinations.
Signs of Physical Abuse

Consider the possibility of physical abuse when the child: has unexplained burns, bites, bruises, broken bones or black eyes. has fading bruises or other marks noticeable after an absence from school. seems frightened of parent(s) and protests or cries when it is time to go home. shrinks at the approach of adults. reports injury by a parent or another adult caregiver.
Consider the possibility of physical abuse when the parent or other adult caregiver: offers conicting, unconvincing or no explanation for the child's injury. describes the child as "evil," or in some other very negative way. uses harsh physical discipline with the child. has a history of abuse as a child.
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Signs of Neglect
Consider the possibility of neglect when the child: is frequently absent from school. begs or steals food or money. lacks needed medical or dental care, immunizations or glasses. is consistently dirty and has severe body odor. lacks sufcient clothing for the weather. abuses alcohol or other drugs. states that there is no one at home to provide care.
Consider the possibility of neglect when the parent or other adult caregiver: appears to be indifferent to the child. seems apathetic or depressed. behaves irrationally or in a bizarre manner. is abusing alcohol or other drugs.
Signs of Sexual Abuse

Consider the possibility of sexual abuse when the child: has difculty walking or sitting. suddenly refuses to change for gym or to participate in physical activities. reports nightmares or bedwetting. experiences a sudden change in appetite. demonstrates bizarre, sophisticated or unusual sexual knowledge or behavior. becomes pregnant or contracts a venereal disease, particularly if under age 14. runs away. reports sexual abuse by a parent or another adult caregiver.
Consider the possibility of sexual abuse when the parent or other adult caregiver: is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex. is secretive and isolated. is jealous or controlling with family members.
Signs of Emotional Maltreatment

Consider the possibility of emotional maltreatment when the child: shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity or aggression. i s either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example).
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is delayed in physical or emotional development. has attempted suicide. reports a lack of attachment to the parent.
Consider the possibility of emotional maltreatment when the parent or other adult caregiver: constantly blames, belittles, or berates the child. is unconcerned about the child and refuses to consider offers of help for the child's problems. overtly rejects the child.
Reporting of Child Abuse Georgia Laws

Section 19-7-5 of the Ofcial Code of Georgia mandates that certain professionals, including registered nurses, licensed practical nurses, school teachers, school administrators, school guidance counselors, social workers and school psychologists make a report when they have reasonable cause to suspect that a child has been abused. Reporters do not have to be sure that maltreatment has occurred; a reasonable suspicion is sufcient. All reports are condential. The knowing and willful (intentional) failure to make a report is a crime. The law provides immunity from criminal or civil liability for reporting abuse and/or neglect when the report is made in good faith. If a child is in immediate danger, the police should be called right away. In all other cases, an oral report, followed by a report in writing, should be made as soon as possible to the Division of Family and Children Services (DFCS) in the county where the child lives. Some schools may designate a particular staff member to receive notications of suspected abuse and to make a report to DFCS on behalf of the school. Response time ranges from within 24 hours to ve days, depending on the nature of the allegation, the age of the child and the severity of the allegations. If the person who makes the report wants to know what DFCS did, he or she can call the department and nd out whether the maltreatment was conrmed. (Adapted from the brochure Protecting Children from the Division of Family and Children Services, Georgia Department of Human Resources.) Per section 16-5-7 of the Ofcial Code of Georgia, a person commits the offense of cruelty to children when the primary aggressor in a family violence battery has knowledge that a child under the age of 18 is present and sees or hears the act. Children in homes where domestic violence is present are at much higher risk for emotional or physical abuse. Emotional problems that develop in these children can include aggression, depression, anxiety, fear, guilt, self-blame, low self-esteem, post-traumatic stress disorder and the belief that violence is a normal behavior.
Supporting Children
It is important to support as well as report. The attitude of school personnel can make a difference in the progress a family makes once a report of abuse or neglect is made. A school nurse who is supportive and available to the family throughout the investigation, treatment and rehabilitation process not only protects the child but helps the family maintain dignity and move forward.
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When you suspect abuse:

1. Act on your suspicions. 2. Call a helpline if you have questions. Prevent Child Abuse Georgia Helpline, 800-CHILDREN Childhelp National Child Abuse Hotline, 800-4-A-CHILD
3. Determine the childs immediate needs (e.g., safety, medical attention). 4. Talk to the childs non-offending parent, and do what you can to connect him or her to needed services, including a child advocacy center. To nd a child advocacy center near you, contact The National Childrens Alliance at www.nca-online.org or 800-239-9950.
5. Report according to school policy and your responsibility as a mandated reporter within 24 hours. 6. Follow up with any other school staff who do reporting within 24 hours.
When a child discloses abuse:

1. Talk to the child in a private place. 2. Remain calm. Be careful not to overreact. Make sure the child knows that it is okay to talk with you about these things. 3. Let the child know you believe and will support him or her. 4. Listen carefully, and encourage the child to talk. Ask openended questions, such as What happened next? Avoid leading questions about details. 5. Reassure the child that it is not his or her faultWhen things like this happen to children, it is never the childs fault. 6. Thank the child for telling you and praise the childs courage. 7. Assure the child that you want to do everything you can to protect him or her.
When the abused child returns to the classroom;

1. Create a supportive and safe environment for the child. 2. Make sure the child feels like he or she is valued and accepted as part of the classroom and school. 3. Provide structure with consistent routines, clear instructions and predictable behavior. 4. Talk to the child one-on-one. Acknowledge the situation, but do not dwell on it. 5. B uild the childs self-worth and sense of identity with praise and friendly nonverbal communication like smiles. Tell the child what you like about him or her and what makes him or her special and unique. 6. C ollaborate and communicate with Department of Family and Children Services (DFACS), law enforcement, foster parents and others. Meet with your schools child protection or crisis team to plan how to best protect and help the child. Coordinate any support services that the child may need.
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Online Resources for Educators, Parents and Caregivers:

American Professional Society on the Abuse of Children www.apsac.org The Bureau for At-Risk Youth www.at-risk.com Centers for Disease Control and Prevention National Center for Injury Prevention and Control http://www.cdc.gov/injury Child Welfare Information Gateway www.childwelfare.gov Childrens Advocacy Centers of Georgia www.cacga.org Childrens Defense Fund/ Parent Resource Network www.childrensdefense.org Childrens Healthcare of Atlanta Child Protection Center www.choa.org/childprotection Childrens Safety Network www.childrenssafetynetwork.org Childrens Television Workshop Online http://parenting-ed.org/parent-links.asp Darkness to Light www.darkness2light.org Georgia Division of Family & Childrens Services http://dfcs.dhr.georgia.gov National Center for Missing and Exploited Children www.missingkids.com ; 1-800-THE LOST Prevent Child Abuse America www.preventchildabuse.org Prevent Child Abuse Georgia, www.preventchildabusega.org ; 1-800-CHILDREN Stop It Now! www.stopitnow.org
References
C. Crosson-Tower (2003), The Role of Educators in Preventing and Responding to Child Abuse and Neglect, U.S. Department of Health and Human Services, http://www.childwelfare.gov/pubs/usermanuals/educator/educator.pdf Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, http://www.cdc.gov/injury/ Child Welfare Information Gateway - http://www.childwelfare.gov Darkness to Light (2006), 7 Steps to protecting our children. Georgia Division of Family and Children Services Statistical Information - http://www.dfcsdata.dhr.state.ga.us/ Sandau-Christopher, Debra (1988), The School's Role in the Prevention/Intervention of Child Abuse and Neglect. A Manual for School Personnel. Colorado Department of Education, http://eric.ed.gov/ERICWebPortal/custom/portlets/ recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED313648&ERICExtSearch_ SearchType_0=no&accno=ED313648; then click on "Eric Full Text" link on left. State of Georgia, (2007). Ofcial code of Georgia.
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GASN Advocacy for School Nurses in Georgia

Executive Summary
Approximately 1.5 million children are school-age in Georgia, but at least 13 percent of those are without healthcare insurance coverage. 161,000 could be covered by SCHIP (School Children Health Insurance Program) Reauthorization Act of 2007 which in Georgia is known as PeachCare for Kids. Approximately 30 percent of these Georgian children have chronic health conditions (i.e. asthma, diabetes, cancer, life-threatening food allergies and epilepsy) affecting their ability to learn. As many as 5 million doses of prescription medication are given annually at school including asthma medications, psychotropic controlled substances, antibiotics, seizure medications, insulin and emergency injections for severe allergic reactions. Approximately 15 million annual visits to the ofce or school health room take place for illness, medication and injury in Georgia. Some children injured at school may be inadequately assessed and treated due to lack of a medically trained professional on site. At least 30 percent of school-age children have developed risk factors for heart disease and diabetes, which could be modied by focused health education from an onsite school nurse. Since the school nurse program was funded in Georgia, under HB 1187, the majority of schools in Georgia have a licensed school nurse on site during at least part of the school day. Healthy People 2010 includes the practice of school nurses in their strategy for addressing preventable threats to childrens health. The American Academy of Pediatrics recommends use of school nurses, not paraprofessionals, to deliver day-to-day nursing services and health counseling to children in schools. The accepted national consensus on the best ratio of regular education students to school nurse is 750:1, Georgia has 1:1,197, in a 2006 survey of school districts. One thousand three hundred and fty one (1,351) nurses are employed by Georgia schools, totaling 922 RNs and 429 LPNs. Georgia ranked 44 out of 50 states on the overall child wellbeing index for 2006. A correlation exists between lower ratios of students to school nurses and a states higher ranking on child well-being. The school nurse provides the professional expertise to identify, assess, and monitor student health needs, with an emphasis on prevention of disease and injury and promotion of positive health by health services, health counseling and health education. Promoting this initiative could be perhaps the single most important thing the Georgia Legislature could do to improve the health of Georgias children statewide.
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Georgia has no mandates or requirements for school nursing, Georgia DOE does not have a state school nurse consultant, and $30 million in the State Georgia DOE budget is the only funding for school nurses in the state. This funding is allocated in Georgia to each school district. Each district receives $20,000 plus $18.89 per FTE. School districts must embellish on this limited funding with local resources to provide needed full-time school nursing in every school. Georgia prison systems require a nurse to administer medication in prisons; should we require less for our children?
HeLP Legal Services

HeLP Law Partnership (HeLP) provides free legal services to low income children and their families. They must be at or below 200 percent of the Federal Poverty Level. HeLp clinics are community legal service clinics made up by a team of lawyers and healthcare providers from Georgia State University College of Law, The Atlanta Legal Aid Society and Childrens HealthCare of Atlanta. HeLP can assist with legal issues such as family law, benets, education, housing, employment and other topics. For more information visit their website at www.choa.org/default.aspx?id=5120, call a Childrens social worker or call 404-785-2005
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Cultural Diversity Impact on Student Health in the Schools

As the school system has grown and more students from other cultures attend public schools, school staff members need to understand more about these cultures. A students culture can be dened as the set of values, beliefs and social practices that is practiced in his home country and family. Culture can be considered an experiential comfort zone for children, shared through generations, which guides their thinking, social relationships and the behaviors of daily life.Having some understanding of a students cultural beliefs and practices can help guide your assessments, and keep you from forming opinions and making judgements that would hinder the communication process and your ability to help the student. Always remember that cultural variations in ways of thinking exist, and stereotypes should never be applied.Many of these students may have experienced a war or other very traumatic event, which affects their approach to new situations and people. Other school personnel may have acquired knowledge of different cultures and should share this knowledge with everyone involved with these students. Language barriers are often a problem, especially in communicating with parents. Some resources are listed at the end of this section. There are some common denominators to keep in mind when working with any non-English speaking families and children: Families who have immigrated to this country range from college-educated professionals (who may be working here in much lower-paying jobs here) to the very poor and uneducated seeking opportunities for their families or relief from war and persecution. Do not assume that afrmative head shakes mean that patients or clients have understood you. People who are not fully familiar with English often nod their head afrmatively or smile at what they think are appropriate moments even though they do not fully understand what is being said. This is particularly true if the person has fear and/or respect for authority. Providing written educational materials in their native language, even if available, may still not bridge the gap if illiteracy is a problem. Appropriate verbal translation should always be the goal.Video presentations in the native language are often more effective than written materials. Ask patients or clients to repeat what they have been told in their own words or demonstrate their understanding of what has been said. This practice is a good idea with any teaching, but it is particularly important if you are not certain that the patient or client has understood what has been said. Remember that one usually learns to understand another language before being able to speak it. Sometimes patients or clients may understand you, even though they have difculty communicating their understanding to you. To work more effectively with non-English speaking individuals, be exceptionally aware of one's own culture, and always try as hard as you can to understand different world views and their inuence on the health practices of the family.
Cultural Assessment and General Health Evaluation: Areas for Consideration

Where was the student born? How long has he lived in this country? (Do not question citizenship status, as this may lead to miscommunication.) What kinds of health and education facilities does the student and family have experience with? (i.e. may have had limited school attendance or access to healthcare, or may have come from a socialized medicine system where healthcare is free and easy to access.)
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What is the students ethnic identity? Who are the students major support people? (i.e. family, friends; refugee families may have an American support family) Can any of those people help with language barriers? How can they be reached? Who is the family spokesperson? (helpful when you have to contact the family with concerns) What are the primary and secondary languages of the family, and what is their speaking and reading ability in English? What is the non-verbal communication style? Eye contact, space and touch practices may be very different. Are the familys religious practices of major importance in daily life? (i.e. are there activity or dietary restrictions?) What are the health and illness beliefs and practices of the family? What diseases and disorders are endemic to the country of origin? What are the customs and beliefs concerning major life events?
Working with an Interpreter

Attempting to communicate with a family who does not speak English can be a very frustrating situation. Learning how to make the most of using an interpreter can help the process tremendously. The following are some tips for working with interpreters: Whenever possible, help the interpreter prepare and understand what needs to be done ahead of time. Let the interpreter know exactly what you want to cover and any details about the situation before approaching the family. A few minutes of preparation may save a lot of time in the long run. Talk to the family, not the interpreter. Say,Juan should take this medicine two times a day, rather than Tell Mrs. Gomez that Juan should take this medicine two times a day. Certied medical interpretation is preferred. Interpreters who have no professional background may not understand or interpret correctly, no matter how good their language skills are. Speak slowly and clearly. Avoid jargon. Use short sentences and be concise. Pause every few sentences so the interpreter can translate your information. If youve spoken more than 30 seconds, its time to stop and let the interpreter express the information. Give the family and the interpreter a break. Thirty minutes per session is long enough for anyones attention span and concentration. The interpreters timing may not match yours. It often takes longer to say in another language what youve said in English. Avoid interrupting the interpreter. Let him complete his sentence or phrase before asking a question or adding more information. Express the information in two or three different ways if needed. Sometimes there is not only a language barrier but a cultural one as well that may interfere with understanding. Use an interpreter even when you have materials written down in another language. Just because something is translated into Spanish does not mean the family can read or understand it.Have the interpreter verify understanding frequently and clarify information as needed. Often children learn English before their parents do and are expected to interpret. Since these children can interpret conversations differently than adults, and can be inuenced by their understanding of the expectations of parents and school staff, they should not be used as interpreters unless there is no other alternative.
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Translation Resources
AT&T has a Language Line which can be set up by contract, and interpreters of almost any language are available for translation by telephone with families. There is also translation software and online free translation services for written materials and web pages. Some of the current online and software resources are: InteractiveTran at www.tranexp.com/win/InteractiveTran.htm Software to translate into 37 languages w ww.wordtoword.com/free.html Online translation service and dictionaries for 180 languages http://world.altavista.com Babel Fish online translation of up to 150 words of text or web page from English to 8 languages http://translation2.paralink.com Online translation: English to 4 languages www.freetranslation.com Online translation: English to 3 languages Search www.google.com for online translation for new services.
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Georgias Diversity: Working with Diverse Populations

Refugee, Immigrant and Migrant Health Refugees
http://bearspace.baylor.edu/Charles_Kemp/www/refugees.htm; http://www.globalhealth.gov/refugee/index.html; http://www.refugeehealth.com/links.htm A refugee is dened by the United Nations as a person forced to ee his or her country of origin due to persecution or fear of persecution because of religious, political or other beliefs. Refugees enter this country with documents, having been awarded refugee status by the Immigration and Naturalization Service (INS).Many refugee children have experienced trauma and loss, and have been exposed to political violence and poor living conditions in refugee camps before coming here. Although some children are more resilient than others, many such children and their families may experience Post Traumatic Stress Disorder (PTSD). These families also often have been deprived of adequate food and medical care. Healthcare providers may nd they must begin with the basics: assessing for immunization status, congenital and long-term health problems. Malnutrition is another common problem in this group. When malnourishment has been severe before the age of three, children may experience permanent physical and intellectual decits. Refugee resettlement programs offer health and social services, English as a Second Language (ESOL) classes, employment services, etc.
Immigrants
An immigrant is dened as a person who is a citizen of one country but decides to become a resident of another country. Immigrant families may come into this country legally through the immigration program implemented by the Immigration Naturalization Service (INS) or illegally by crossing national borders without the proper visa. Healthcare programs available for refugees often are not available for immigrants, and undocumented immigrants are at even greater risk, with no access to health insurance. School nurses should research and be aware of local health services available for undocumented immigrants in case referrals are needed.
Migrants
No universally accepted denitions exist for migrant or seasonal farm workers. According to the Ofce of Migrant Health, a migrant farm worker is an individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months and who establishes for the purpose of each employment a temporary abode.An estimated three million migrant and seasonal farm workers and their dependents work in the United States. Many migrant families experience crowded and unsanitary living conditions and maintain a stressful lifestyle with little consistency and frequent moves. They may be exposed to pesticides, fertilizers and other toxic substances. However, while such families may have signicant health problems, their access to healthcare is limited and fragmented. The care of migrant children in school is also often complicated by lack of written health and education records, lack of immunizations, inconsistent follow-up and language and cultural barriers. In areas where refugees or migrant workers are living, school nurses should be familiar with available community resources for this population.
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Cultural Diversity References

Other References on Cultural Diversity include:
Refugee Health: http://bearspace.baylor.edu/Charles_Kemp/www/refugees.htm The EthnoMed site contains on formation about cultural beliefs, medical issues and other related issues pertinent to the health care of recent immigrants to Seattle or the US, many of whom are refugees eeing war-torn parts of the world, Web site: www.ethnomed.org School Health Cultural Zone offers a collection of resources about the inuence of culture on the foundations of health illness. It also provides recommendations for intercultural communication competence that will help school nurses and educators deal with the expanding cultural diversity of todays school population. www.brigantine.atlnet.org/nurse/SCHOOL_Health_Culture_ZONE/index.html
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2GSHRM Chapter1

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School Health Services and School Nursing Practice

Childrens Healthcare of Atlanta, Inc.

Childrens Healthcare of Atlanta, Inc.

School Health Services and School Nursing Practice

Childrens Healthcare of Atlanta, Inc.

Childrens Healthcare of Atlanta, Inc.

Unlicensed School Health Personnel

Childrens Healthcare of Atlanta, Inc.

RN Assignment Decision Tree: Assignment to Unlicensed

Childrens Healthcare of Atlanta, Inc.

School Health Clinic Management

Childrens Healthcare of Atlanta, Inc.

Suggested School Clinic Procedures

School Nurses and Clinic Personnel Should Not:

Childrens Healthcare of Atlanta, Inc.

Recommended School Health Clinic Supplies

Injury Care Supplies

Childrens Healthcare of Atlanta, Inc.

Tips for Setting Up the Health Clinic

School Nurse Checklist for New Students

Childrens Healthcare of Atlanta, Inc.

Suggested Questions for the Parents of a New Student

Childrens Healthcare of Atlanta, Inc.

Childrens Healthcare of Atlanta, Inc.

Communicating with Families

Collaboration with All School Employees

Childrens Healthcare of Atlanta, Inc.

School Health Index

Childrens Healthcare of Atlanta, Inc.

School Health Records

Childrens Healthcare of Atlanta, Inc.

Childrens Healthcare of Atlanta, Inc.

Childrens Healthcare of Atlanta, Inc.

Childrens Healthcare of Atlanta, Inc.

Special Education Abbreviations Commonly Used in Schools

Childrens Healthcare of Atlanta, Inc.

Basic Information on Government Health Insurance

Childrens Healthcare of Atlanta, Inc.

Childrens Healthcare of Atlanta, Inc.

SCHOOL HEALTH CLINIC INFORMATION CARD

(School Year: 20___ to 20___)

Childrens Healthcare of Atlanta, Inc.

Childrens Healthcare of Atlanta, Inc.

Fecha de nacimiento: __________________

Direccin: __________________________Tel. #: ________ (Vivienda) ____________ (Cel.) ________________

Childrens Healthcare of Atlanta, Inc.

Proveedor de atencin mdica del nio ___________________________________Telfono ___________

Firma de uno de los padres ___________________________________ Fecha __________________________

Childrens Healthcare of Atlanta, Inc.

Ch1-1b Rev. 2009tk

Clinic ActivityDaily Log

Clinic ActivityDaily Log

Home Time Room/ In Grade

Childrens Healthcare of Atlanta, Inc.

Illnesses Inj/1st Aid Sent Home Accid. Rpts

911 Activated Parent Consults Staff Consults Daily Meds

PRN Medications Immunization Cks Hearing/Vision Screens Head Cks/Lice Cases

Referrals Employee Visits Student Health Counseling SST, IEP meetings

Childrens Healthcare of Atlanta, Inc.

H e a l t hNotes Notes Health

School Name Student Name Teacher

School Year DOB Grade Physician

(School Year: 20_ to 20_)

Direccin: __________Tel. #: (Vivienda) (Cel.)

Proveedor de atencin mdica del nio _________________________Telfono _

Firma de uno de los padres _________ Fecha

R L B R L B R L B R L B R L B R/L: __ Other: _

School Year 20-20