Strengthening the Student-School Nurse Partnership for Students with Asthma and Other Environmentally Triggered Conditions
"The school nurse is the child's advocate and a key communicator when dealing with past or potential environmental exposure." National Association of School Nurses (NASN), ISSUE BRIEF: School Health Nursing Services Role In Health Care, Environmental Concerns In The School Setting, (2004).
I. Nursing Diagnosis
II. Student and School Goals/Outcomes
III. Nursing Interventions: Health Security and Health Protection Checklist
IV. Improving the School's "Environmental IQ" Action Plan
I. Nursing Diagnosis
Other Health Impaired: 34 Code of Federal Regulation 300.7(c)(9): Having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that--(i) Is due to chronic or acute health problems... and (ii) Adversely affects a child's educational performance.
Bobby Goodchild, is at risk for impaired health and disrupted education (breathing difficulty, allergic reactions, and impaired cognitive and behavioral functioning) when exposed to irritants, allergens, air contaminants, aerosols, inhalants and other pollutants and sources of inflammation.
Bobby Goodchild is at risk for impaired health and disrupted education (increased absences, acquired educational deficits, impaired performance, and acute and cumulative loss of educational opportunity) when exposed to stimuli that cause illness and altered cognitive functioning.
Bobby Goodchild is at risk for feelings of powerlessness, anxiety, alienation and disconnectedness, and school aversion and school phobia when his personal safety needs are not respected and essential support and protection are inadequate and unreliable.
Bobby Goodchild is at risk for impaired health and disrupted education unless there is a strong partnership among parents, education and health professionals and other school staff to establish the necessary environmental safeguards and health management services.
II. Student Goals/Outcomes/Indicators of Plan Effectiveness
Bobby Goodchild participates in all educational, extra-curricular and social activities with peers with no adverse acute or long-term impact on his health, educational performance, or behavior.
The staff takes precautions and implements prescribed guidelines to protect Bobby Goodchild's health, behavior, and performance from unhealthy products, conditions and activities.
There is good communication and an effective partnership of parents, students, education and health professionals, facility operations, purchasing and maintenance staff, and the school community. The partnership institutionalizes environmental safeguards based on standards that protect and optimize the health, safety, attendance and academic achievement of all students but especially those with health impairments and environmentally-triggered conditions.
The whole school is safe, accessible and usable for all members of the community.
School environmental safety teams and staff/students continuously audit, monitor and improve school conditions, operations and activities to enhance environmental quality.
Everyone in the school community works to protect safe access and participation for all members of the community in all school areas and activities.
Comprehensive environmental safeguards are part of the Comprehensive School Health Program, School Wellness Policy, employee occupational health protection and student health education, safety and security.
III. Nursing Interventions: Health Protection Checklist
Gail Goodnurse, RN develops and maintains a comprehensive individualized health plan (IHP) for Bobby Goodchild that defines environmental safeguards and health management as recommended and prescribed by Bobby's physician(s).
Prior to Bobby's school entry, Gail Goodnurse. RN and Bobby's parents and teachers tour all classrooms and school areas to audit conditions, supplies, materials, and activities to identify conditions, products and activities that would put Bobby at risk for impaired health and educational disruption.
Gail Goodnurse, RN implements immediate risk reduction steps to protect Bobby from unsafe conditions, products or activities such as removing any product from the school/activity/classroom that does not comply with standards for Bobby's health and safety; notifying all staff to immediately remove and safely dispose of the same or similar products; defining criteria for preferred materials and products; and prohibiting or restricting occupancy until corrections are made.
Bobby's IHP includes staff guidelines for ongoing environmental monitoring and improvement in all school areas and activities and for immediate action when Bobby has breathing difficulties, allergic reactions, or changes in appearance, health status, alertness, stamina, concentration, attention, and behavior.
Bobby's IHP action plan (or Section 504 Plan) defines the responsibilities of teachers and support staff when conditions, products or activities put Bobby at risk, such as extreme weather or poor air quality.
Bobby's IHP restricts or prohibits occupancy of areas where conditions are unsafe and/or unhealthy. The IHP identifies alternative safe areas for relocating Bobby's classes and activities to provide Bobby with full access to his educational program with peers (or provides equivalent educational opportunity in an alternative setting until corrections and effective precautions achieve protective safety standards for Bobby.)
Gail Goodnurse, RN provides universal education* to the school community on environmental and occupational health practices, facility safety standards and health guidelines that enable them to recognize unsafe products, conditions, or activities, to eliminate hazards, and to modify activities.
*The syllabus includes: routes of exposure; exposure hazards; adverse health effects of allergens, irritants, inhalants and toxic chemicals; how to read MSDS/labels, how to recognize sources of irritants and neurotoxicants, criteria for selecting safe products and their safe use; how to recognize change in health or behavior in students; appropriate responses to changes in student health or behavior; sanitation, hygiene, infection control and blood borne pathogens, food safety, and how to report unsafe conditions or activities.
IV. Improving the School's "Environmental IQ' Action Plan
Gail Goodnurse, RN establish health-based standards for occupancy that reflect the true risk profile of the student (and teacher) population such as students with asthma and other environmentally-triggered conditions.
Gail Goodnurse, RN logs health complaints and student and staff disrupted and missed days. She reviews time, location and symptoms patterns for indicators of environmental problems. She monitors compliance with health, hygiene and safety standards by using student/staff feedback about unhealthy facility conditions and unsafe activities.
Gail Goodnurse, RN rigorously implements and enforces health-based occupancy standards. She prohibits or restricts occupancy of rooms and other areas until conditions meet health-based occupancy standards.
Gail Goodnurse, RN is part of the school environmental safety team that ensures that
[ ] HVAC inspections and maintenance are conducted regularly;
[ ] Building maintenance staff are qualified to operate and maintain the HVAC system;
[ ] Specialized exhaust ventilation is used for equipment such as kilns and copy machines and high risk areas and activities such as voc-tech shops, labs, photography, science and art;
[ ] Occupancy rates, energy conservation practices, and air-exchange rates are reviewed to assess their impact on employee and student health;
[ ] Repair, sanitation and maintenance practices are timely and effective;
[ ] Purchasing criteria and policies are updated to reduce or eliminate asthma aggravators, allergenic, irritant, and toxic products for housekeeping, pest control, furnishings, repair, maintenance, and educational and extra-curricular activities; and
[ ] Benefits of the improvements in school environment and staff practices are publicized.
The world endures solely by virtue of the breath of school children. (Talmud)