Standard 4

Preparation to Promote Student Health and Wellness

The program prepares candidates to integrate health and wellness concepts in the educational setting to allow students to be in school, healthy, and ready to learn.

The program prepares candidates to integrate health and wellness concepts in the educational setting to allow students to be in school, healthy, and ready to learn. Candidates are knowledgeable about primary (disease prevention and health promotion), secondary (health screening, emergency, and acute care) and tertiary (rehabilitative or palliative care) levels of health care intervention as these relate to students and their families.  In order for students to be optimally ready to learn, the program ensures that the candidate understands and can effectively apply the critical concepts of health and wellness within the school setting.  These include, but are not limited to:  

• promoting school safety, including disaster preparedness;
• delivering first aid and emergency care
• identifying and accessing local community and public health resources;
• addressing public health issues in the community that may affect schools;
• addressing student, family and community mental health and wellness;
• promoting nutrition and fitness;
• addressing specialized healthcare needs of students, including special education students;
• understanding child and adolescent growth and development;
• promoting staff wellness;
• addressing issues of community and family violence and substance abuse;
• addressing acute and chronic diseases or conditions within the student population

Criterion 1: Candidates recognize the need to integrate health and wellness concepts in the educational setting in the area of health education and health promotion in order to bring about positive behavioral changes among school age children and adolescents, as well as role models in faculty and staff.

Once candidates enter the core school nurse courses (NURS 184, 185, 186, & 187) they demonstrate knowledge of NASN standards of nursing practice and are able to apply the Nursing Process in the school setting in meeting the healthcare needs of individual school age children and in development of various screening and health education programs to maximize health and wellness through health promotion and health education (Standard 5b). Candidates also quote relevant sections of the CA Education Code that relate to school nursing practice. Candidates research imperatives for health education, including Healthy People 2010 goals, which include focus areas with goals and selected school-related objectives which they can use as a guide in developing realistic health education offerings. Candidates also define the responsibility for health promotion and health education needs to be a collaborative effort and is best accomplished through partnering with teachers and/or through participating in the development of coordinated school health programs that involve a joint effort with teachers, families, and community. In preparing candidates as health educators, candidates are required to take NURS 137, Teaching Perspectives for the Healthcare Client, in which they gain insight into learning theories, lesson planning, and curriculum development. In NURS 184, Introduction to School Nursing, candidates are expected to familiarize themselves with a conceptual model, the constructionist approach (Danielson & McGreal, 2002), for effectively teaching of school age children and adolescents in the school setting which they can use in developing a health lesson plan to teach in NURS 186, School Nurse Practicum I (elementary) or NURS 187, School Nurse Practicum II (secondary). In NURS 185, candidates gain insight into the Group Process and the art of facilitating a small group, which they can then use in facilitating small group discussion on an adolescent health issues at the secondary level in NURS 187, School Nurse Practicum II. Candidates follow guidelines for grade/age appropriate health education and learner readiness found in the CDE (2003) Health Framework for California Public Schools: Kindergarten through Grade Twelve and CDE (2010) California Health Education Content Standards: Kindergarten through Grade twelve in developing relevant and appropriate health curriculum and teaching plans.

With regard to faculty and staff health promotion, through Healthy People 2010 candidates research the essential components of a comprehensive worksite health promotion program, i.e., health education that focuses on skill development and lifestyle behavior changes in addition to information dissemination and awareness building, preferably tailored to employees’ interest and needs, supportive social and physical environments, integration into the organization’s structure, screening programs, etc. In didactic coursework candidates learn about the importance of including faculty and staff in health education and health promotion programs, recognizing the health adults are role models for youth, and that healthy teachers mean continuity of education for students and fewer sick days for employees. Candidates incorporate the Coordinated School Health Program Model which outlines a nine-step process for developing a school-site health promotion program in meeting the needs on a campus. Candidates must only use evidence-based resources such as the CDC School Health Policies and Programs Study for specific recommendations for school staff health promotion (CDC, 2001) and the purpose of the CDC School Health Index that related to school site self-assessment in order to plan health promotion programs and address other health related needs in the school community. (See NURS 184, Introduction to School Nursing, weeks 7 and 10).

Criterion 2: Candidates are knowledgeable about primary (disease prevention and health promotion), secondary (health screening, emergency, and acute care) and tertiary (rehabilitative or palliative care) levels of health care intervention as these relate to students and their families:

While candidates are registered nurses who are aware of the levels of prevention and care, this subject matter is covered throughout the core school nurse courses and specifically addressed in NURS 184, Introduction to School Nursing, in Wk 4 as it relates to the role of the school nurse.

Primary prevention (promoting health and preventing disease among school age children and adolescents susceptible to disease with no known pathology) is covered in seminar courses for examples, in NURS 184 (elementary seminar), candidates learn about coordinated school health programs related to health promotion and disease prevention (Wk 2); prevention through immunization requirements and other programs (Wk 5); health promotion and the role of the school nurse as health educator (Wk 10). In NURS 185 (secondary seminar), candidates relate primary prevention to coordinated school health programs at the secondary level (Wk 2); adolescent preventive services and health promotion (Wk 3); the school nurse as health educator at the secondary level, The Group Process, and facilitating small groups on topics related to prevention (Wk 4); adolescent fitness (Wk 5); health promotion and education related to substance abuse prevention (Wk 6); health promotion and education related to sexually transmitted disease prevention (Wk 7); health education as it related to healthy teen pregnancy (Wk 8); and mental health issues (Wk 9). In Practicum courses (NURS 186 and NURS 187), candidates strengthen their ability as health educators in the school setting, in health promotion through counseling with individual children and adolescents, facilitating discussion with small groups on various health related topics, through presentations to faculty, staff, and community groups, and through presenting health lessons in the classroom. Candidate competency in these areas is determined by qualified school nurse preceptors and clinical instructors.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists - E1 through E19 and S1 through S18 for candidate competencies and skills in the area of Primary Prevention.

Secondary prevention (detecting disease in early stages in order to reverse or decrease the severity of the disease outcome, which includes persons who may not exhibit clinical signs) is addressed throughout the core school nurse coursework. Candidates demonstrate understanding the importance of screening to detect health related problems that may impact learning, they also understand the importance of health teaching and health promotion as it relates to helping school age children, adolescents, and families adapt and care for adjustments, such as corrective tools and equipment, that may be necessary following referral and evaluation. In prerequisites to core school nurse courses candidates are required to take Audiometry for School Nurses (3U), Health Assessment for School Nurses (3U), Introduction to Counseling (3U), as well as Vision and Scoliosis Screening in the School Setting (1U) or equivalent coursework approved by the program coordinator prior to entering core school nurse courses. These prerequisite courses give candidates the necessary tools needed to screen, interview, and assess those who may have unsuspected health conditions and those with suspected health conditions that impact the child’s or adolescent’s ability to learn. In core school nurse courses candidates learn about the various sections of the California Education Codes that relate to mandated screening requirements and guidelines, i.e. vision, hearing and scoliosis. Screening programs, as well as planning strategies and tools for conducting classroom/school wide screening, are addressed in different aspects of the core school nurse courses. For example in seminar courses are as follows: NURS 184, Introduction to School Nursing (elementary) – Role of the school nurse in Child Health and Disability programs (Wk 5); screening programs related to BMI (body mass index), nutritional needs, normal growth and development, identifying barriers to learning through assessment (Wk 6); use of the School Health Index in schools, cultural/ethnic backgrounds and tendency toward related health issues, health concerns among migrant and homeless, dental screening programs (Wk 7). Examples in NURS 185, School Nurse Seminar (secondary), School nurse responsibility as it relates to understanding adolescent growth and development, helping teachers deal with stress (Wk 1); understanding adolescent behavioral issues (Wk 2); adolescent preventive services (Wk 3); nutrition and weight control among adolescents, female athlete health issues (WK 5); adolescent addiction and substance abuse identification and intervention (Wk 6); counseling and referral for suspected sexually transmitted diseases (Wk 7); pregnancy counseling, referral, and follow-up (Wk 8); assessment and counseling related to various suspected mental health disorders, anxiety, self mutilation (Wk 9); counseling and referral for suspected depression, threat of suicide (Wk 10); use of school bases health clinics for screening and treatment of adolescent (Wk 11).  In Practicum courses (NURS 186 and NURS 187), candidates participate in screening and assessment individual school age children and adolescents, as well as to participate in various screening teams where they gain insight into screening techniques and develop their case findings and assessment skills. This includes, but is not limited to screening school age adolescents for vision, hearing, scoliosis, dental problems, BMI, nutrition, as well as communicable diseases, acute and chronic health problems, mental health issues and various other conditions that have the potential to limit a student’s ability to learn. Candidate competency in these areas is determined by qualified school nurse preceptors and clinical instructors.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists - E1 through E19 and S1 through S18 for candidate competencies and skills in the area of Secondary Prevention.

Tertiary prevention/intervention (includes ameliorating the course of disease, reducing disability, including rehabilitation involving persons with clinical manifestations of disease). Candidates define the purpose of tertiary prevention which is to interrupt the progression of a condition in order to decrease the amount of morbidity or complications that are possible. Candidates  demonstrate the importance of sound health teaching and health promotion, as well as case management of school age children and adolescents who have been identified as having chronic health conditions that significantly impact their lives and frequently their ability to reach optimal levels of ability to learn. Prerequisite to core school nurse courses prepare candidates to work effectively to help these children and adolescents. These courses are COUN 174 (or 200), Introduction to Counseling, in which the candidate gains insight into effective counseling techniques that aid the candidate in interviewing clients and families; SPED 120, Mainstreaming Exceptional Students, that gives the candidate insight into programs and rights of individuals with disabilities; and NURS 136, Health Appraisal, which gives candidates insight into appropriate health assessment techniques in determining deviations from the norm. In NURS 184, Introduction to School Nursing (seminar), subject matter related to tertiary prevention/intervention is addressed. For example: The role of the school nurse in caring for children and adolescents with chronic conditions such as asthma, attention deficit disorders, diabetes, seizure conditions, Cystic Fibrosis, severe allergies, Sickle Cell disease, and mental health issues are covered in Wks 8, 9, & 11; health teaching techniques in Wk 11; Individuals with disabilities in Wk 12; the IEP process, mainstreaming, and advocacy for children and families in Wk 13; and care of the medically fragile and those with special health care needs, and supervision and training of unlicensed personnel to care for children with special needs is covered in Wk 15. In practicum courses (NURS 186 and NURS 187), candidates participate in case management of students with complex health related issues; learn to develop individual health care plans and emergency action plans for those with special needs; participate in supporting, counseling, and teaching children, adolescents, and families about their health conditions and assist clients in taking responsibility for self care, offering students and families support and directing them to appropriate resources; as a member of the education team at school sites candidates participate in the planning process specific to the school nurse role in finding appropriate educational placement of students needing special education programs or 504 plans to accommodate their learning needs in the classroom.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E20 through E30 and S19 through S30 for candidate competencies and skills in the area of Tertiary Prevention/intervention.

Criterion 3: In order for students to be optimally ready to learn, the program ensures the candidate understands and can effectively apply the critical concepts of health and wellness within the school setting. These include, but are not limited to:

Promoting school safety, including disaster preparedness:
Candidates respond to a research question in NURS 184, Introduction to School Nursing, in week 5 requiring the candidate to discuss the role of the school nurse in evaluating playground safety at an elementary school and to include in their response what should be included in a playground injury prevention plan.  In week 7, one of the questions requires the candidate to discuss the role of the school nurse in participating in a school wide program to address individual safety relate to bullying. In NURS 185, School  Nurse Seminar, Week 11 is entirely devoted to school safety issues such as the role of the school nurse in promoting safety and involvement in school wide disaster planning, crisis intervention and post-vention, emergency action plans, collaboration in school safety, identifying gangs and gang related violence, hate motivated behavior and anger management. In practicum courses, students are expected to become familiar with the school wide emergency plans at the school sites at which they are assigned, understand the role of the school nurse in the event of a disaster or crisis incident, to participate in planning an emergency action plan if the opportunity arises, to be area of potential dangers in the neighborhood, to become familiar with signs of gang activity in their area, to be aware of threats to individual students such as bullying, and to be prepared for the role of the school nurse in a disaster, i.e. as first responder, triaging, counseling, etc. Candidates are knowledgeable about potential environmental health hazards such as mold, and playground safety issues.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E8, E9, E22, E30 and S6, S7, S30 for candidate competencies and skills in the area of school safety promotion and school wide disaster preparedness.

Delivering first aid and emergency care:
A requirement for all candidates entering the program is a current First Aid and CPR certificate which needs to be kept current throughout the program. Prior to entering core school nurse courses, candidates must also take NURS 136, Health Appraisal with gives them the skills necessary to assess various health concerns and complaints. In seminar courses (NURS 186 and NURS 187) first aid and emergency care is addressed; in NURS 184, Introduction to School Nursing, Wk 8, a weekly question requires the candidate to outline the assessment and first aid steps in managing various injuries and other types of complaints. In NURS 185, School Nurse Seminar, Wk 5, questions relate to the role of the school nurse in managing common sports injuries and emergency first aid. In practicum courses at the elementary and secondary levels (NURS 186 and NURS 187), candidates spend time working under the direct supervision of a qualified school nurse at a school site assessing student complaints of illness or injury who come into the health office, those injured on the playground or in P.E., and those who require emergency care in the classroom, i.e., seizures.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists - E20, E21, E22, E23 and S19, S29 for candidate competencies and skills in delivering first aid and emergency care to students, faculty and staff at the elementary and secondary levels.

Identifying and accessing local community and public health resources:
Community health coursework is required as a prerequisite to entering the program. It is the strong belief of program faculty that the school nurse must have a global understanding for community health issues and knowledge of relevant resources in the community in order to meet the needs of the school age children, adolescents, and families they serve. Most candidates enter the program having completed a BSN program that includes community health coursework leading to a PHN. Candidates entering the program having completed a bachelor’s degree in another field are required to complete community health coursework, both didactic and field experience, at the university. Though a PHN is not required, importance is placed on the need for candidates to know and understand community health needs, issues, and resources. California State University, Fresno offers community health coursework through the RN to BSN program, NURS 141, Concepts in community Health (3U), and NURS 141L, Practicum in Community Health Nursing (3U) in which application of primary, secondary, and tertiary prevention in the community with individuals, families, and groups is addressed. The importance of community involvement is stressed in core school nurse courses. In NURS 184, Introduction to School Nursing, community outreach is covered in the following areas: Coordinated school health programs which includes community outreach (Wk 2); community collaboration (Wk 7). In NURS 185, School Nurse Seminar, community outreach is covered in the following areas: Coordinated school health programs, adolescent and family involvement (Wk 2); disease prevention for adolescents through coordinated programs (Wk 3); accessing community resources as they relate to primary, secondary, and tertiary prevention and intervention regarding adolescent involvement with substance abuse, unsafe sexual behavior and sexually transmitted diseases, pregnancy, and mental health issues (Wks 6, 7, 8, and 9); school based clinics, community partnerships (Wk 12). In both practicum courses, NURS 186 and NURS 187 (elementary and secondary respectively), candidates are required to spend 8 to 10 hours each semester becoming acquainted with community resources relevant to each of these educational levels through actually visiting community agencies and programs and being involved in other community activities such as participating in community health fairs or planning a health fair where agencies are invited to a school site.

See Sec. 3 (p. 396): NURS 186 Preceptor Syllabus checklists – E6 and S4 for candidate competency in identifying and accessing local community and public health resources.  

Addressing public health issues in the community that may affect schools:
Program faculty realizes that the school nurse cannot remain isolated in the school building without knowledge of what is taking place in the community. As noted above, Community health coursework is required as a prerequisite to entering the program. Candidates incorporate a global understanding for community health issues and knowledge of relevant resources in the community in order to meet the needs of the school age children, adolescents, and families they serve. Most candidates enter the program having completed a BSN program that includes community health coursework leading to a PHN. Candidates entering the program having completed a bachelor’s degree in another field are required to complete community health coursework, both didactic and field experience, at the university. Though a PHN is not required, importance is placed on the need for candidates to know and understand community health needs, issues, and resources. California State University, Fresno offers community health coursework through the RN to BSN program, NURS 141, Concepts in community Health (3U), and NURS 141L, Practicum in Community Health Nursing (3U) in which application of primary, secondary, and tertiary prevention in the community with individuals, families, and groups is addressed. In practicum courses (NURS 186 and NURS 187) candidates spend 8-10 hours visiting and becoming acquainted with community resources and gaining insight into health issues in the community; they also spend 10-12 hours each semester during their practicum experiences attending community meetings where health issues are discussed, i.e., school nurse meetings and conferences, meeting for health care providers put on by local health departments, and community forums addressing health issues. Candidates participate in community screening programs, i.e. tuberculosis case follow-up, meningitis, flu, etc. that may occur during their practicum experience. Working under the supervision of a qualified school nurse preceptor, candidates gain insight into steps that are necessary to prepare the school community to meet the challenges of public health threats such as the HINI flu, i.e. notification if school community and families, health education (effective hand washing techniques and coughing techniques) in and outside of the classroom, use of other recommended precautions, establishment of guidelines for exclusion and readmission to school, and staying informed themselves through communication with the local public health department and CDE advisories.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E6, E9 and S4, S7 for candidate competency in addressing public health issues in the community that may affect schools.  

Addresses student, family and community mental health and wellness:
Candidates who enter the program have a background of understanding for mental health and wellness issues. These were addressed in undergraduate nursing programs through sociology and psychology courses, psychiatric affiliation, and in their community health nursing experiences. In the program, candidates learn about the value of coordinated school health programs, use of the School Health Index, and value of surveys in determining health education needs in the school community. As a prerequisite to practicum courses (NURS 186 and NURS 187) candidates are required to take an introduction to counseling course, COUN 174 or COUN 200, which prepares them to use effective counseling techniques and interviewing techniques with both students and families in discussing student and family concerns. Mental health and wellness addressed in NURS 184, Introduction to School Nursing, examples: Employee job satisfaction, Wk 4; identifying barriers to healthy lifestyle for children (Wk 6); helping students and families cope with stress (Wk 7); anxiety disorders and behavioral issues (Wk 11); acting out behaviors, school phobia, children of dysfunctional families (Wk 12); supporting parents of special needs children (Wk 13). In NURS 185, School Nurse Seminar, examples: Adolescent behavior and impact on health and learning, teacher stress (Wk 1); coordinated school health programs and adolescent health issues (Wk 2); adolescent preventive services, health education, school nurse as health educator (Wk 3, 4); adolescent activity and fitness (Wk 5); health promotion and education as it relates to substance abuse, unsafe sexual activity, pregnancy (Wks 6, 7, 8); psychiatric disorders, behavioral and emotional issues, depression and suicide, stress and self injury, eating disorders, date rape, hate motivated behavior and anger management, role of the school nurse in counseling and psychosocial interviews (Wks 9, 10, 11). Under the supervision of a qualified school nurse preceptor in practicum courses (NURS 186 and NURS 187), candidates have the opportunity to interview and teach school age children, adolescents, and families regarding a variety of health related issues. At the secondary level, candidates practice health promotion and to teach, interview and counsel adolescents working through personal crises in their lives, i.e. substance abuse issues, suspected sexually transmitted diseases, pregnancy, emotional issues, depression, and possible threatened suicide.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E4, E5, E11, E12, E18, E31, E34, and S2, S3, S10, S11, S13, S15, S21-26, S31, 232 for candidate competency in addressing student, family and community mental health and wellness issues.  

Promoting nutrition and fitness:
In core school nurse courses, candidates study the importance of growth and development and age appropriate nutritional needs and physical fitness needs of school age children and adolescents, as well as the additional nutritional needs of athletes. In NURS 184, Introduction to School Nursing, subject matter is addressed: The school nurse role in keeping children with food allergies safe at school through educating and working with teacher, families, and students (Wk 5); assessment of growth and development of the school age child, calculating body mass index, promoting a healthy lifestyle among school age children (Wk 6); promoting healthy eating in school, assessing school nutrition services (Wk 7); intervention in the cycle of childhood obesity (Wk 9). In NURS 185, School nurse seminar, examples where subject matter is addressed: The role of the school nurse in understanding adolescent growth and development (Wk 1); adolescent physical activities and fitness, nutritional needs of the young athlete; and identification, counseling, and referral of students with eating disorders (Wk 9). In practicum courses (NURS 186 and NURS 187) candidates perform health assessments on school age students and adolescents during their clinical experience with a qualified school nurse preceptor. In NURS 186, candidates are asked to complete a case study on a school age child which includes a nutritional assessment, giving the candidates the opportunity to do some teaching and health promotion with the family. Candidates frequently choose nutrition as a topic to teach as a lesson in the classroom at the elementary level or individually with students with special needs such as students with diabetes, and/or facilitating discussion among small groups at the secondary level, i.e. pregnant teens, athletes, others.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E13, E31, and S11, S22, S24 for candidate competency in promoting nutrition and fitness among school age children and adolescents.

Addressing specialized healthcare needs of students, including special ed. students:
Throughout the core school nurse coursework candidates study the care of students with special needs, including those in special education programs and the medically fragile. The care of students with special needs is addressed in seminar courses and candidates are exposed to caring for these students in the school setting in practicum courses at the elementary and secondary levels.  Candidates demonstrate that an important school nurse function is to develop healthcare plans for individual school age children with special needs in regular education and in special education programs, and for families with a child in an early intervention program. These include Individualized Health Care Plans, i.e. for students with diabetes, Sickle Cell Disease, Cystic Fibrosis, etc.; Individualized Family Service Plans related to early childhood; 504 Plans for students who need special accommodations or nursing services in a regular classroom; and Emergency Action Plans for students with conditions that can become life threatening. Candidates also define the role of the school nurse as a member of the IEP (Individualized Education Program) team. Candidates understand that the plan must be specific to the client or family and must be developmentally, culturally, and environmentally appropriate, seeking to safeguard the student and promote health and prevent disease. To prepare candidates to understand the laws and basic issues relevant to students placed in special education in the least restrictive environment, candidates are required to take SPED 120, Mainstreaming the Special Needs Child (3U), (or Psych 168) as a prerequisite to core school nurse courses. Candidates learn about the law that authorizes special education, federal Public Law 94-142 of 1975, now known as IDEA (the Individual with Disabilities Education Act). In NURS 184, Introduction to School Nursing, specialized healthcare needs of students, including those in special education programs are addresses: Care of students with chronic health problems, development of Individual Healthcare Plans and Emergency Action Plans (Wks 8 & 9); Special education, the IEP Process, interdisciplinary collaboration, role of the SEPA (Special Education Local Planning Area); IFSPs (Individual Family Service Plan), special programs/placement (Wks 13 & 14); medically fragile students, developing special healthcare plans, supervision and training  unlicensed assistive personnel to assist in caring for students with special needs; infection control in the medically fragile population, understanding and advocating for parents of children with disabilities (Wk 15). In NURS 185, School Nurse Seminar, special education at the secondary level is addresses (Wk 1). Candidates also spend time shadowing three other members of the education team to gain insight into their roles and how they work with students and families, and how they interact as a member of the education team. In NURS 186, School Nurse Practicum I, candidates learn first-hand about the role of the school nurse as a member of the IEP team. Candidates gain insight into the IEP process through completing a required case study, on a school age child of a different cultural other than their own, who has been referred for evaluation for possible placement in a special education program. Candidates participate in the entire process beginning with the Developmental History, the school nurse assessment of the child, participation in the initial Student Study Team meeting, and ending with the placement of the student into the appropriate program. Candidates spend quality time in their practicum experience developing care plans for students with special needs and gaining first-hand experience in caring for the medically fragile. In practicum courses candidates are also encouraged to actually spend time observing in special education classrooms to gain insight into teacher-student interaction and classroom issues. In NURS 187, School Nurse Practicum II, candidates have the opportunity work with adolescent with special needs either through developing care plans, emergency action plans and/or participating in the IEP process. At the secondary level, candidates also  must use demonstrate their counseling and assessment skills in meeting the healthcare needs of student who are suspected of substance addiction, have pregnancy related issues, and various other conditions of a physical or mental health nature, i.e. eating disorders, depression, such as eating have become addicted to substances.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E20, E27, E22, E24, E25, E27, E28, and S9, S10, S22, S23, S24, S27, S29 for candidate competency in addressing specialized healthcare needs of students, including special education students.

Understanding child and adolescent growth and development:
Candidates enter the program with a background of understanding for growth and development obtained from their basic under graduate nursing programs. Candidates in core school nurse courses understand growth and development and, in practicum course (NURS 186 and NURS 187) incorporate guidelines for growth and development when assessing client health status; and in planning and development age/grade level appropriate health education materials, lesson plans, and classroom teaching which needs to be based on student readiness to learn. Candidates also gain insight into the nutritional needs of children and adolescents based on age and level of activity. Sources used by candidates in the program that gives them the necessary insight into growth and development and nutritional needs  for age and level of physical activity are the required course readings: Selekman (2006) School Nursing: A Comprehensive Text, chapter 16, Growth and Development: Preschool through Adolescence; California Department of Education (2003) Health Framework for California Public Schools; Kindergarten through Grade Twelve; California Department of Education (2010) Health Education Content Standards for California Public Schools: Kindergarten through Grade Twelve; and recommended text practicum courses, Lewis, K. D. & Bear, B. J (2008) Manual of School Health (3rd Ed.), as well as other reference materials. In seminar courses, growth and development is addressed in NURS 184, Introduction to School Nursing, assessment of growth and development and body mass index (Wk 6); and in NURS 185, School Nurse Seminar, adolescent growth and development (Wk 1).

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E2, E5, and S1, S3 for candidate competency in understanding child and adolescent growth and development as it relates to the health care and health education needs of school age children and adolescents.

Promoting staff wellness:
Candidates define that “health promotion of staff” is one of the eight components of a Coordinated School Health Program and that the school nurse has a responsibility for promoting a healthy lifestyle among this population. Candidates understand that this means creating an interest among staff member for the purpose of encouraging them to take personal responsibility for their well-being through taking advantage of opportunities that the school nurse may provide such as health assessments, i.e. screening; health education offerings and fitness activities based on staff interest. Candidates learn that investment in the health of employees benefits both the employees and employers (Partnership for Prevention, 2001). Candidates learn that staff wellness results in improved health behavior and health status, reduced healthcare costs, and lower employee absenteeism as well as higher productivity and moral (Allegrante, 1998).  It is also believed that attention to employee health in the school setting further leads to a greater commitment of the employee to the school’s health program and increases numbers of healthy role models for school age children and adults.  In NURS 184, Introduction to School Nursing, health promotion of staff is addressed in the following: Coordinated school health programs (Wk 2); Cal-Osha guidelines and role of the school nurse in in-services school faculty/staff on safety measure related to blood borne pathogens, benefits of worksite health promotion program, school nurse development of surveys to determine health education and health promotion needs of students and staff, evaluation of survey data in determining programs (Wk 10). In NURS 185, School Nurse Seminar, health promotion of staff is addressed in the following: Coordinated school health programs at the secondary level (Wk 2); and bringing health fairs to campus (Wk 3). In practicum course (NURS 186 and NURS 187) candidates, under the supervision of a qualified school nurse preceptor, have opportunities to participate in health promotion among staff. This may include a screening program, i.e. taking blood pressures, administering PPD (TB) skin tests, presenting at a faculty meeting on current health concerns, i.e. HINI flu precautions, assisting in the development of a survey regarding staff interest in a health education offering or physical activity, or taking on a project such as a school health fair for students and staff.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E12, E13, and S11, S15 for candidate competency in promoting staff wellness.

Addressing issues of community and family violence:
In seminar courses candidates define the impact of violence on the school community and its effect of student learning; the early warning signs of danger and behavioral precursors; signs of gang activity and bullying; child abuse and neglect; gender harassment and abuse; date violence; and other various threats to campus security, i.e., intruders. Candidates also research school site safety plans that address prevention through partnering with law enforcement and other community groups and agencies, corporation among members of the school community, school site security measures; conflict resolution; and the role of the school nurse. In NURS 184, Introduction to School Nursing, following are examples where subject matter is addressed: Identifying bullies and the victims, bullying prevention and the role of the school (Wk 7); Child abuse and neglect, identification and responsibility for reporting and role of the school nurse. In NURS 185, School Nurse Seminar, following are examples where subject matter is addressed: Bullying recognition and prevention at the secondary level, sexual harassment (Wk 10); safe schools and the role of the school nurse, disaster prevention, intervention, and post-vention, school wide emergency action plans, collaboration in keeping schools safe, gangs and violence, hate motivated behavior, racial and ethnic issue, anger management. In NURS 186 and NURS 187, practicum courses, candidates have the opportunity to experience first-hand the concerns associated with community and family violence.

Regarding community violence: Candidates spending time at school sites become aware of the potential dangers in the community and threats to schools. Working with a school nurse preceptor and other members of the education team, candidates begin to identify signs of gang activity and other potential threats to individuals and the school community. Candidates have the opportunity to see how schools and partners in the community work together in a multidisciplinary effort to carry out a school-wide safety plan. Most importantly, candidates learn that the school nurse is a key person in the school community, one who is knowledgeable of the physical and emotional needs of the students and who is known and trusted by parents and staff, that he/she is the only health professional at the school site and, therefore, needs to be involved in the planning, implementing, and in the execution of the disaster plan, particularly in the area of crisis response and as a first responder to the public health crisis.

With regard to family violence: In practicum courses (NURS 186 and NURS 187) working under the supervision of a qualified school nurse preceptor, candidates use their assessment skills in identifying signs and symptoms of child abuse and neglect and to exercise their judgment in appropriate reporting. At the secondary level, candidates also have knowledge of the existence of date violence and sexual abuse reporting guidelines and are prepared, with preceptor supervision, to counsel and refer these victims to the appropriate community resources and file appropriate reports.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E8, E15, and S6, S16 for candidate competency in addressing issues related to community and/or family violence.

Addressing substance abuse:
Candidates research substance abuse in core school nurse course relevant to the secondary level (middle school and high school). Nursing 185, School Nurse Seminar (secondary level), week 6 is devoted to the role of the school nurse as it relates to substance abuse prevention and intervention among pre-adolescents and adolescents. This includes various types of street drugs and addiction, alcohol abuse, smoking and other inhalants, ergogenic substances used by athletes, factors leading to substance abuse, assessment and recognition of substance abuse, health education programs, health promotion and prevention, cessation programs, and Ed code references to health promotion and education in the area of substance abuse. In practicum courses, particularly at the secondary level, candidates may assess, interview, counsel, and refer students who are suspected of substance abuse. Candidates also gain insight the role of the school nurse with regard to reporting responsibilities, i.e., school administrator and law enforcement involvement. In the secondary level practicum, candidates visit community agencies and programs that treat adolescent substance abuse.

See Sec. 3 (p. 401): NURS 187 Preceptor Syllabus checklist – S17 for candidate competency in addressing substance abuse in the pre-adolescent and adolescent population.

Addressing acute and chronic diseases or conditions within the student population:
The candidate’s nursing background has prepared them with insight into various acute and chronic health conditions. Candidates demonstrate a clear understanding for the Nursing Process (assessment, diagnosis, outcomes identification, planning, implementation, and evaluation) with regard to problem solving and meeting the healthcare needs of school age children and adolescent. Prior to entering core school nurse course, candidates are required to have a current First Aid certificate and to have taken NURS 136, Health Assessment (or its equivalent), which provides them the knowledge background and skills necessary to properly assess the various health complaints related to acute and chronic health condition that students present with on arriving in the school health office. In NURS 184, Introduction to School Nursing, examples of subject matter addressed: Assessment as it relates to secondary and tertiary prevention and intervention (Wk 4); keeping children with allergies safe in the school setting (Wk 5); acute complaints, i.e., “stomachache,” chest pain, complaints of “not feeling well”; chronic health conditions, i.e., asthma, diabetes I, seizure conditions, Sickle Cell disease, Allergic Rhinitis, encoprisis, food allergies, Cystic Fibrosis, health issues resulting from obesity, attention deficit disorder, etc. (Wks 6 and 7). In NURS 185, School Nurse Seminar, examples of acute and chronic health conditions at the secondary level: Substance abuse issue, suspected sexually transmitted diseases, pregnancy related problems, anxiety and stress related self injury, eating disorders (Wks 6-9); and use of school based clinics (Wk 12).  In practicum courses, under the supervision of a qualified school nurse preceptor, candidates assess students with acute and chronic health conditions who are seen in the health office, develop Individual Healthcare Plans on those with chronic health conditions, and Emergency Action Plans for those with conditions that could result in an emergency. Candidates use their counseling skills in helping these students, as well as the opportunity to teach and instruct the student regarding their condition and about self care and personal responsibility. Candidates case manage, i.e., assist families in obtaining appropriate care, and to partner with care providers in the community and agencies in meeting the healthcare needs of these students. Further, candidates strengthen their understanding for confidentiality as it relate to HIPAA and FERPA laws in sharing information on a need to know basis.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E2, E4, E 20 through E25, E27, E29, and S19, S20, S22 through S29 for candidate competency in addressing acute and chronic disease or conditions within the school population.

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