School Health Services - School Nurses

The school nurse serves as the health service expert, providing health care to students/staff and implementing interventions that address both actual and potential health and safety conditions.

The school nurse collaborates with the school administrator to promote the health and academic success of students and serves as the liaison between the school, community, and health care systems. This collaborative effort creates opportunities to build capacity for self-care, resilience, and learning.

The school nurse’s responsibilities include:

• Providing leadership in promoting personal and environmental health and safety by managing communicable diseases

• Monitoring immunizations

• Providing consultation and health-related education to students and staff to promote school health and academic success

• Providing quality health care and intervening with actual and potential health problems through health screenings, health assessments and nursing interventions,

• Developing healthcare and emergency care plans to enable students to safely and fully participate in school

• Providing case management services to direct care for students with chronic health conditions, to ensure their safety, and to increase their access to the educational program

• Collaborating with school and community-based resources to reduce health-related barriers to student learning, to improve access to healthcare, and to develop school-community partnerships to support academic achievement and student success.

The Pacific East has positively impacted School Health Services (School Nursing Program) as evidenced by:

• Creating consistency across the district with regards to:

  • Documents used

  • Policies and procedures followed

  • Professional Development related to school health services

  • Increased staffing so that each school now has at least one full-time school nurse (RN)

• Supporting and monitoring influenza vaccination compliance, leading to rates above 90% in our schools by mid-January.

• Assisting with supplies provided not only by each school’s budget, but also by local medical treatment facilities per agreement, DoDEA Headquarters, and the Pacific East District.

• Providing training to relevant school staff in the areas of first aid, CPR, AED, Concussion, Epi-Pen usage and recognition of Anaphylactic Shock; signs, symptoms and responses related to diabetes and other medical conditions.

DoDEA Headquarters (HQ):

• HQ School Nurse ISS stressed the importance of privacy regarding students with head lice The best way to protect confidentiality is to include lice warnings at the beginning of the year and during breaks where sleepovers might occur.

• Schoology trainings were provided for School Nurses:

  • Military Reintegration Module was developed by Penn State for DoDEA: This series, Supporting Military-Connected Students, is a collection of trainings related to supporting students and families experiencing geographic transitions, parental absence, parental injury and death, and other military-connected challenges. These trainings summarize research related to military-connected students, provide opportunities to practice developing skills, and include take-home resources to help school personnel apply the content from each training. These training sessions are available at no cost.

  • SEAS developed by Penn State was provided. This series, Suicide Prevention, is a collection of 42 mini-trainings, each focusing on a specific skill that will help school personnel prepare for,

screen for, identify, and respond to suicidality in students. These trainings summarize research about student suicide, provide opportunities to practice developing skills, and include take-home resources to help school personnel apply the content from each training.

• Administrative Instruction (AI) 6055.01, DoDEA Safety Program (: This Issuance addresses the practices and procedures to be followed in the Department of Defense Education Activity (DoDEA) facilities to maintain a safe environment for employees, students and visitors. This Issuance creates new policy and clarifies existing laws or already established policy and describes the steps to accomplish specific actions in accordance with the references.

• 2.8. SCHOOL NURSE. The school nurse's responsibilities are delineated in the DoDEA Regulation 2942.01 and DoDEA Regulation 2720.1 in regards to emergency and health care.

• Accident Injury Reporting System: All AIRs involving employees, students, visitors and contractors occurring on DoDEA premises or associated with a DoDEA-sponsored activity are to be reported through the online AIR reporting system when they meet the following requirements

• Revised Medical Forms

  • H-10-3 Social/Family/Medical History (revised 2017)

• Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, US Department of Labor, Office of Worker’s Compensation Programs (18 OCT 2018)

• Memorandum: Expectations for Late-Release/Early-Return Days for 2019 (10 JAN 2019)

• School Nurse Performance Elements (29 APR 2020)

• Nursing Delegation in the School Setting by NASN (20 JUN 2019)

• K-12th Grade health Assessment (revised 2019)

• Medical Forms also available in Aspen were placed in the shared google drive (11 FEB 2019):

  • 5 SHSM H-3-2 Medication During the School Day

  • 6 SHSM H-3-6 Allergic Reaction Information Request

  • 7 SHSM H-3-7 Anaphylactic Reaction Student Information

• Accident Injury Reporting (AIR)

  • Accident Injury Reporting (AIR). Shared the fillable pdf for submitting AIRs (14 FEB 2019)

  • H-7 DODEA Accident/Injury Report (AIRS) DRAFT (14 FEB 2019)

  • AIR Matrix/Flowchart (14 FEB 2019)

  • To AIR or not to AIR (14 FEB 2019)

• Aspen Teacher Tip Sheet - Medical Alert Information (14 FEB 2019)

• Quarterly Professional Development included training related to (15 FEB 2019)

  • Concussions and Traumatic Brain Injuries (the following documents are in this folder)

    • Heads Up Concussion Action Plan

    • Report to Congress- Traumatic Brain Injury (TBI)

    • Report to Congress - The Management of Traumatic Brain Injury (TBI)

    • Report to Congress - Highlights Key Policy Strategies

    • Help Improve Outcomes in Children After TBI

    • A Parent’s Guide to Returning Your Child to School After a Concussion

    • Schools - Help Children Return to School After a TBI

    • Head Injury Protocol

    • Graduate Return to School -Sports Concussion Institute

    • Families - Help Your Child Be Successful at School After TBI

    • ACE Concussion Evaluation

    • ACE Concussion Care Plan

    • Concussion Signs and Symptoms Checklist

    • Patient Activity Guidance After Concussion

DoDEA Pacific Region:

• The Pacific Region Office provided “Families with Urgent/Acute Medical Needs (Medical Evacuation) Guidelines for School Administrator

• New School-Year Email: Aspen Alerts and Conditions (29 AUG 2918)

  • Medical Alerts for Teachers: The rule of thumb is Alerts are to be noted in laymen's terms and not include a diagnosis or medication information.

  • Teacher Tip Sheet - steps teachers can use to find and print their own medical alerts.

  • 2-1 Health Data Entry

  • Link with Aspen Training Sheets and self-paced videos

• Encouraged school nurses to participate in the OSHNA Asia Conference 2019. R2d2: Resiliency, Readiness, Diversity, Determination, Usmc Camp Foster, Okinawa, Japan (28 MAR 2019)

  • Travel, Transportation, & Base Access

  • Agenda

  • Cost of attendance and description and price of lodging

  • OSHNA Membership Information

  • Draft Principal letter created by OSHNA

• Email: RE: Curious about Emergency Medical Health Plans (25 APR 2019).

  • H-14-5 Emergency Action Plan, revised 2016

  • IEP 504 IHP and EAP School Plans (ADA) Sources: NASN and NCID OAS/DSS 04/12/12

• DoDEA districts did not have registered nurses as ISS supporting school nurses, so occasionally, a lead nurse in the district or region provided additional support. This is a welcome email to a new school nurse with a few key points of information This same email and documents has been sent to new school nurses each year (19 FEB 2019)

  • DoDEA Health Services Guide 6-07

  • https://www.dodea.edu/studentservices/health/index.cfm for great resources

  • Aspen Guidance for School Nurses- tip-sheets and self-paced videos on how to document nursing services in Aspen

  • Aspen Link

  • Link to Accident Injury Report (AIR)

  • Link to National Association of School Nurses (NASN)

  • Link to Overseas School Health Nurses Association (OSHNA)

  • Orientation Checklist

  • Monthly Checklist Orientation

  • Email: Re: Medical Alert Question: (4 SEP 2020)

  • Email: Aspen COVID19 Reporting Options (16 SEP 2020) COVID-19 - Aspen Documentation Office Visits and Dispositions in Health Spot.

    • COVID-19 - Aspen Documenting Office Visits and Dispositions outlines how to properly document COVID19 symptoms in Aspen.

  • Email: Influenza Reporting and Entering Waivers in Aspen - Save for Future Reference (3 NOV 2020)

    • Aspen: Entering Exception Waivers with step-by-step visuals (3 NOV 2020)

    • 2016 Immunization Exemption Updates and Changes (also sent in previous years)

    • DoDEA Form 04 SHSM H-2-2 Immunization Exemption Request (also sent previously)

    • Influenza 2019

  • Email about the Influenza Series in Aspen (10 NOV 2020).

  • Email about Professional Growth Plans (PGP): (3 APR 2021)

• Email - Essential Oils are being classified as a medication (3 SEP 2019)

• It was determined that very few of the health forms went through the DoD official approval process:

  • DD 2870 from December 2003 is our only official release of information/HIPPA form (16 JAN 2020)

  • Hold Harmless letter was removed from Aspen, but if we need something to use, this one has the Japanese translation included. (3 MAR 2020)

  • Revised Health Forms:

  • H-10-1 Health Assessment (revised 2019)

• Email: Cover your sneeze/cough and handwashing videos (29 OCT 2019)

  • Handwashing

  • Handwashing with singing - younger students

  • The sneeze - a favorite - grades 2 and up

  • Why Don’t We Do It in Our Sleeves? - older students

• Example Procedures for Safe Administration of Daily Medications In the Absence of a Registered Nurse Reference: 2942.0, Appendices 3.1,3.2,3.3 and 13.1: These policies are to ensure the safe and consistent administration of medication to members of the student body. Includes Medication In-service and form for Trainee and Registered School Nurse to sign. (shared 17 APR 2020)

• (17 APR 2020)

• Follett Aspen, Aspen Health Management Training Guide Participant Edition, copyrighted- only provided to DoDEA school nurses (14 MAY 2020)

• Aspen Position Types, Roles and Rights, Exceptions (21 MAY 2020)

Pacific East District:

• School nurses developed Staff presentations about head lice and DoDEA schools’ expected responses

  • The Facts of Lice

  • Head lice PPT, Professional Development Spring 2022

• Email: One school nurse’s procedure for EpiPen training including Parent Letter (8 FEB 2019)

• Provided Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger United States 2019 (11 FEB 2019)

• School Nurses helped develop fillable pdf for Review of Social Family Medical Health Form for the use of school nurses in the district. Here is one email to school nurses with identifying information removed Here is the Word Version (19 FEB 2019)

• Email: Funding for CPR Classes and purchasing procedures- the process sees to change a little each year (16 APR 2019)

• Withdrawals, End, and Beginning of School-Year Procedures (10 MAY 2019)

• School Nursing Monthly Checklist (8 OCT 2019)

• Email regarding New Student Immunization Requirements, Documents, and due dates for the influenza vaccine with a grace period during winter break (8 NOV 2019)

  • H-2-4 Disenrollment Notice

  • H-2-3 Immunization Due

  • DoDEA Form 04 SHSM H-2-2 Immunization Exemption Request (Provided only by School Nurse, so explanation of possible school removal can be explained)

  • DoDEA Immunization Requirements SY 2019-2020

  • Email from one school nurse who responded to all with an example of a pre-typed email sent along with the immunization requirement form (8 NOV 2019)

• School Nurse Sub Binder Table of Contents

• School nurses helped to create a list of questions for USFJ representatives to answer for local Medical Treatment Facilities (MTF) about COVID-19 school nurse expectations.

• Inventory of specific items were requested across the district (14 APR 2020)

• Email: First Aid/CPR/AED purchasing procedures They seem to change each year (16 APR 2019)

• DoDEA Equipment and Material Return/Pickup including medications (29 APR 2020)

• Created Google Shared Drive for school nurses to actively collaborate with one another such as:

  • First Aid/CPR/AED training lists

  • Health teaching resources

  • COVID-19 updates

  • Meeting minutes

• Created this Expectations Memo for administrators and staff to learn more about this program (AUG 2020)

• Email: One complex’s email about First Aid/CPR/AED training (10 AUG 2020)

• Back to School Immunization Update Reminder example (17 AUG 2020)

• Accident Injury Reports (AIR) moved to Service Now- Links to instructions (27 AUG 2020)

• Email showing collaboration with local medical treatment center to provide videos for students at the start of the school-year including placing them on school websites and social media (20 AUG 2020)

  • Preschool-1st Grade:

    • Handwashing: Children's National Hospital: Handwashing heroes. Gives information about coronavirus and the associated symptoms, reminds children to stay at home if they have symptoms, instructs all the instances in which we should wash our hands

(45 sec)

• Mask Wear: Shandy Clinic: Explained to Kids: Why are we wearing masks (2 min: 1 sec)

• Social Distancing: Jack Hartmann Kids Music: Greet Someone Without Touching/Greet from 6 feet. Song that shows alternate ways to greet your friends: wave, mile, peace sign, air hug, air fist pump. (2 min, 21 sec)

• Elementary/Middle School:

  • Handwashing: Children’s Hospital Los Angeles: Proper Hand washing techniques (1:27)

  • Mask Wear: World Health Organization: How to wear a fabric mask safely (2:10)

  • Social Distancing: Kid Explorer: Social Distancing explained by kids! Provides 6 tips presented by kids ages 7-11: wash hands often, cough in your elbow, don’t touch your face, stay 3 feet away from people (note: must explain this is updated to 6 feet), get outdoors, use social media to connect with others (3:16)

• High School:

  • Hand Washing: Hamilton Health Sciences: Proper handwashing! What gets left on your hands when you don’t wash properly. Shows how to wash hands properly and shows a science experience of how much bacteria remains on your hands when you don’t wash your hands appropriately. (4:46)

  • Mask Wear: World Health Organization: How to wear a fabric mask safely. (2:10)

  • Social Distancing: CBC Kids News: What is social distancing? (1:23)

• One Complex’s Discussion with Public Health (4 SEP 2020)

  • http://https//www.journals.elsevier.com/eclinicalmedicine - review summarizing the clinical presentation of COVID 19 in 7780 Peds patients around the world

  • Detailed guidelines for ROM Handbook

• Delegation of school nurse diabetic care to non registered nurses was disseminated (4 SEP 2020)

  • DoDEA Office of School Nurse. Guidelines for Safe Administration of Daily medications in the Absence of the School Nurse Refer to form Medication In-service H.3.10

  • What School Personnel Should Know About the Student with Diabetes from School Health Services Guide: Diabetes Information for School Personnel (MAY 2014)

  • Nurse Delegation in the School Setting NASN Position Statement

  • Guidelines for Personnel Working in the School Health Office Who Are Not Registered Nurses

  • Weekly Diabetes Blood Sugar Chart

  • Nutrient Analysis of Menu Items EXAMPLE

  • Type 1 Diabetes Classroom Presentation

  • Hypoglycemia (Low Blood Glucose) and Hyperglycemia (High Blood Glucose) Causes, Onset, and Symptoms by Rhoda Rogers, RN, BSN, CDE, Sunrise Community Health Center, Greely Colorado, 1999 copyright by Novo Nordisk Pharmaceuticals Inc.

• Email: Links for Bloodborne Pathogens, EpiPen and diabetes trainings at the beginning of the year (4 SEP 2020)

  • Bloodborne Pathogens

  • How to use an EpiPen

  • Diabetes: Causes, types and treatment

  • Epinephrine - Food Allergy and Anaphylaxis Training

• Nurse on Wheels: Example of one nurse’s attempt to prevent contamination during first check with a student (8 SEP 2020)

• Example Parent Letter- Your student has been sent home from school with the following symptoms (15 SEP 2020)

• Example Parent Letter- when school nurse is out

• Email: FYI 504 Chairs, SST Chairs, Mental Health Teams [including school nurses]: Non-Nurse Records in the Health Record. School nurses were reminded that sensitive documentation such as 504 plan minutes, diagnoses, threat screening summaries and reentry plans would be stored in the student health record per AI 2500.14 and this Privacy Act Cover Sheet would be attached with a binder clip to this non-nurse information in the back of the file(9 OCT 2020)

• CDC Immunization Translations Link (11 OCT 2020)

• Shared one memo to Parents regarding the influenza vaccine requirement along with helpful information (14 OCT 2020)

• Shared Back to School Family Checklist developed by NASN (19 OCT 2020)

• Chicken Pox - Parent Letter from May 24, 2017 was shared (20 OC 2020)

• Information about Influenza Vaccines (10 NOV 2020)

  • The Flu: A Guide for Parents by the Center for Disease Control (CDC)

  • A Strong Defense Against Flu: Get Vaccinated! By the CDC

  • Developed by the CDC

  • Vaccination Screening Questionnaire Used by one clinic,

  • Vaccine Consent Form in one location

  • Immunization Requirements 2020-2021 School-Year

  • One example of When, Where, Who, What

• Another example of ShotEx Schedule (when they would be providing immunizations. School nurses attempt to include information like this with any reminders about immunization requirements (1 DEC 2020)

• Email documenting that Hand-Foot-Mouth Disease (HFMD) information from three years prior was shared (1 DEC 2020)

  • WHO Emerging Disease Surveillance HFMD biweekly (3 SEP 2017)

  • 2017 Air Force List of Reportable Medical Events

  • Hand Foot and Mouth Disease page 1, page 2, page 3, page 4

  • This Parent letter about HFMD was not mentioned in the email but was in our shared files (17 SEP 2017)

  • This Department of the Navy: Hand, Foot and Mouth Disease Recommendations for Public Release was also in the shared drive (1 DEC 2020)

• Email about the required steps for setting up First Aid/CPR/AED training in the schools (22 JAN 2021)

  • SF 182

  • New GPC

• Information about Meningococcal ACWY Vaccine (Pediatric) (5 FEB 2021)

• DoDEA Regulations that mention First Aid/CPR/AED and who should be trained- due to funding for the course and paying for subs, only those required will be funded (31 MAR 2021)

  • DoDEA Regulation 2720.1 school nurses, physical education teachers, coaches, administrators, all assistant principals, and other designated staff who coordinate emergency care when school nurse is unavailable

  • DoDEA Manual 2942.0 DoDEA School Health Services Guide Although school nurses may not be designated to provide direct services in every case, they are responsible for completing health assessments, participating in decisions about the student’s health and safety needs in school, recommending appropriate accommodations to the school team, developing plans, providing consultation to other 19 team members, and, when necessary, training an unlicensed employee and supervising health-related services done by that employee.

  • Far East Programs Procedural Guide (FEPPG) SY 19-20 3.3 The DoDEA PAC Region district superintendents submit funding requirements for district FEAP, IAP, and JROTC activities’ support in accordance with the ZBB process, including funding for travel, per diem, transportation, extra-duty assignment compensation, coach certification classes, cardiopulmonary resuscitation (CPR) and first aid training, equipment, referees, and logistical support. 5.16.2 Required coach courses: Red Cross CPR, First Aid, and AED - Pac East Funded - complete every two years after the NFHS First Aid, Health & safety Course Completed

• Milk or dairy allergy or intolerance parent letter requesting medical documentation and understanding that alternatives will be made available - One school shared this letter (9 APR 2021)

• Reminder- School Nursing Monthly Checklist including end and beginning of year expectations (8 OCT 2019)