School nursing today: a search for new cheese.

The practice of school nursing must change with the times. School nurses must develop new leadership and collaborative skills to work within the interdisciplinary school and community teams that will be required to put changes in place. This article defines current trends and their implications for the search for the most efficient and appropriate school health services. It explores preparation and competencies for school nurses, legal and ethical concerns, and financing needed to provide adequate school health services. Many support systems exist today, and new ones are being developed to expand the range of health services provided in schools. The National Association of School Nurses encourages strategic planning for the new school health environment, and the Office of School Health at the University of Colorado provides extensive resources to help school nurses develop and put their plans in place.

Considering school health program screening services as a cost offset: a comparison of existing reimbursements in one state.

This paper reports results of an analysis of the approximate costs of Colorado school health program screening activities during the 1993/94 school year had they been conducted elsewhere in the public or private sectors. School nurses and health aides performed 1,161,779 screening procedures during the year, an average of 1.93 per child enrolled in school districts throughout the state. Charges for Current Procedures Terminology (CPT) codes, which correspond to school health program screening activities, were used to approximate market value. Conservative assumptions were made regarding provider skill and time requirements as well as student service utilization profiles. The general dimension of the contribution of school health screening activities was found to be impressive.

Functions of school nurses and health assistants in U.S. school health programs.

This paper reports results from a nationwide survey of a systematic random sample of school districts. Information obtained from 482 participating districts was used to contrast roles of nurses and health assistants in school health programs throughout the country. Most districts relied heavily on nursing personnel for technically involved clinical services, but often employed health assistants to administer medications and basic first aid. Litigation was somewhat more frequently filed regarding care provided by health assistants than care by nurses or classroom personnel. But in general, health assistants were performing satisfactorily, particularly in districts where registered nurses coordinated the services and activities of health program personnel. While use of health assistants increased the past three years, school nurses were not being displaced. Just 9% of districts had downsized their nursing staff during that period. Despite the modest expansion of nursing resources, nurses reportedly were underused in health education programs of most schools.

School nursing.

School nursing has been in a process of transition since its inception. This role evolution parallels the growing complexity of the health, education, and social needs of America's youth. The workplace within which school nurses practice is equally complicated because health and education administrators often hold differing philosophies of management, and school health programs are ill-defined. Fortunately, there is growing support for an integrated services approach and the development of school health systems with nurses joining an interdisciplinary team rather than continuing to function as "boundary dwellers." The roles of the school nurse as primary care provider, school health coordinator, case manager, and epidemiologist are emerging and replacing outdated nursing functions. As the role of the school nurse shifts and expands, it produces a cascade effect. The role of the school health assistant to aid the nurse surfaces as the next logical step in planning. Numerous model school health programs exist today. The emphasis, and rightfully so, is preventive in nature and should be targeted at the preparation of a new generation of health consumers who are more self-reliant than their predecessors. Unfortunately, all these programs are plagued with financing problems that could be alleviated with the right plan for health care reform, such as an expansion of maternal and child health funds (Title V) to health departments and the introduction of school nursing leadership into the DASH office at the Centers for Disease Control and Prevention, a health education unit largely run by health educators, to reallocate some of these resources to the clinical preventive services needed in schools to reduce health risk behaviors. Finally, total quality management is the next issue on the horizon for this nursing specialty; benchmarking would be the place to start. In summary, systems development in the school health field is now underway, and it will not be easy, but this sort of work never has been simply. It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders of those who would gain by the new ones.

School-linked family health centers in health care reform.

Many of our nation's children have little or no access to health care, a serious problem that threatens their health and well being. If we are to provide adequate, cost-effective, and accessible health care, fundamental reform of the nation's health care system must be undertaken.

Health promotion and disease prevention: secrets of success.

Successful health promotion programs impart knowledge, influence attitudes, and change behaviors. Essential program components are: needs assessment, organization, coalition-building, marketing, and location. Early intervention, family and peer involvement, individual attention, mentoring, repetition, and after-care are secrets of effective health promotion disease prevention programs.

Meeting the challenge of immunizing the nation's children.

Achieving fully immunized status in the nation's pediatric population remains an elusive goal. A new campaign is underway to improve immunization coverage, and the nation's schools are logical sites to implement these projects.

Health promotion: the new frontier.

In a country where many U.S. children live in poverty, do not share equally in health and access to health care, and are at risk for several adolescent problems, health promotion has become the new frontier in health care. The newer approaches to health promotion are discussed.

Health behavior surveys for youth.

In recent years, many health-related risk behavior surveys have been developed for youth. Three of these inventories - the Wellness Check Teen Health Risk Appraisal, the Adolescent Health Survey, and the Youth Risk Behavior Survey - are used widely, and pediatric nurses need to be familiar with them to enhance health promotion activities.

Report of a national survey of school nurse supervisors.

This is the first national survey of school nurse supervisors which obtained data on local school health programs. The results indicate the status of school health programming nearly a decade ago and may reflect the direction of the 1990s.

An update on student health fairs.

With a nationwide prevention campaign underway in the United States, the traditional student health fair has taken on additional credibility and relevance, and careful planning should be undertaken when conducting these fairs. An overview of a successful Denver, Colorado student health fair is outlined in this article.

Healthy People 2000.

Healthy People 2000 marks the continuation of a national public-private initiative whose aim is to improve the health status of Americans, reduce the risks of preventable death and disease, and improve health care services. This initiative is outlined here for Pediatric Nursing readers.