School Nurse. I. Knowing the Content. Finding: THE GUIDELINE IS MET

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1 School Nurse I. Knowing the Content The professional education program provides evidence that candidates for School Nurse certification have a Bachelor of Science in Nursing (BSN) degree, current license as a Registered Nurse, and have demonstrated their knowledge of and competence in providing for the health care needs of children and youth (K-12) including: I.A. Providing information and services in school health related areas including: promotion of health education and health practices, assessment of community and school health needs, physical and mental health assessment of children and youth, development, management, and evaluation of the school health program, prevention, identification, and control of communicable diseases, counseling techniques, referral, and health care management of children and youth, case management of health needs of children and youth, competence in dealing with health related issues of diverse populations, child and adolescent development, educational psychology The self study provides evidence that ED 507: Instructional Psychology, ED 551: Introduction to special Education and ED 603 School Nurse Practicum meet the above criteria for this guideline. In ED 507: Instructional Psychology candidates gain the knowledge of theories related to learning and motivation. According to the self study, a developmental approach is utilized to understand difference in learning and behavior. In ED 603: School Nurse Practicum, candidates apply that content to practice based learning. One assignment requires the candidate to complete a developmental assessment for a teaching- learning project. The application of educational theory and motivation is applied in a health education session with students in the K-12 setting. The remainder of the criteria in this guideline is met through the ED603: School Nurse Practicum course. The school nurse instructor requires the candidates to critically review the present state of school nursing practice. Evidence-based practice is utilized to critically examine the research related to communicable diseases, dealing with health related issues in a diverse population and development/evaluation of a school health program. Examples from candidate s clinical practicum, as well as, case studies are used to assist them in applying evidence-based practice and standards of professional practice. This is often difficult given the balance that needs to be maintained between school mandates and National Association Standards of Practice for School Nurses. This is evidenced by course syllabi, student work, reflective journal, health needs assessment proposal, research paper, class presentations, student reports in class, class discussion, exam, individualized educational program (IEP)/individualized health plan (IHP), interviews and case studies.

2 I.B. Recognizing symptoms and consequences of safety and environmental factors including: child abuse, substance abuse, teenage pregnancy, violence, homelessness and poverty, emergency response and crisis intervention planning, safe and healthy school environment This guideline is met through ED 603: School Nurse Practicum course as evidenced in the course syllabus. Emergency response and disaster planning are taught by using the PDE s Safe Schools Crisis Response site and the PEMA Emergency guidelines, as well as, the Pennsylvania Association of School Nurses and Practitioners (PASNAP) crisis template. The candidates are urged to use the PDE web site to access School Emergency Operation Plans, Bullying Prevention, alternative education for disruptive youth and persistently dangerous schools. Class discussion provides application to practice through use of case studies. The evidence is noted in the self study, course syllabus, matrix for guidelines of school nurse, and interview with professor. I.C. Assessing, documenting and managing the health care needs of children and youth with disabilities in the least restrictive environment including: technological care, nutrition, medication, participation in multidisciplinary meetings, development of an individualized plan of health care The guideline is met through ED 551: Introduction to Special Education and ED 603 School Nurse Practicum content. In ED 551: Introduction to Special Education, candidates learn about ADA, IDEA and Section 504 requirements and the process in the public schools. The major classifications of handicapping conditions, the prevalence and etiology, and the development of an IEP for a specific child provide a foundation for the candidates in school health services. The course requires field experience in the special needs setting. This was evidenced by course syllabus, student work, student exams, and interview with current candidates and school nurse alumnus. In ED 603, the candidates apply the above content into a school nurse role and practice. Health problems commonly found in school age youth are used for students to develop Individualized Health Plans (IHP). Students are urged to attend multidisciplinary meetings during the clinical practicum in addition to the class discussion and reflective journals. The course syllabus, interviews, and candidate work validated the findings.

3 I.D. Regulatory, ethical and professional issues and responsibilities governing the provision of health care services in the schools including: Federal, state and local laws and regulations which impact children and youth, Pennsylvania State Professional Nurse Law, Pennsylvania school code and regulations, American Nursing Association/National Association of School Nurses code of ethics, privacy and confidentiality, child and parental rights WITH CONCERN The self study document stated that ED 506: School Law and Child Rights and ED 603: School Nurse Practicum courses met this guideline. The course syllabus for ED 506: School Law contained no course objectives. A weekly content list was provided. The content covered the framework of public education and the power of the state and local school boards. One week covered the public-private school controversy. The remainder of the course, eight weeks were evenly divided between rights of teachers and student rights. The topics covered included: academic freedom, corporal punishment, juvenile delinquency, suspensions, expulsions, search and seizure and preparation for court appearance. The student papers and exams were examined noting questions that were reflective of above topics and not relevant to regulatory, ethical and professional issues and responsibilities governing health care services in the school. This was validated during interviews when noted teachers should not do any health procedures on students including Epi Pens during a severe allergic reaction. The current candidates and school nurse alumnus also noted in the interviews that no Professional Nurse Law or Standards of Practice were addressed in this course. ED 603 addresses all of the above criteria for this guideline. Given the fact that a major liability issue exists with students taking a school law course in which legal issues in school health practice are not addressed. Although candidates took a school law course, all laws and regulations which impact the health care of students must be covered in this course. The content includes the State Nurse Practice Act as well as the National Association of School Nurses Professional Standards of Care. The resources and documentation for school nurses to educate school administrators that only certified school nurses have the legal right and educational background to provide and/or delegate school health services. Delegation, which causes many dilemmas for school nurses, is a major component of this content as seen in the syllabus and assignments. The evidence was validated by reflective journals, syllabus content, interviews and assignments.

4 Recommendation: The recommendation is for the deletions of ED 506: School Law from the school nurse certification requirements and additional credits to be added to ED 603: School Nurse Practicum to address all of the criteria for this guideline. Currently the course (ED 603) is taught as an independent study and the theory is approximately two hours weekly. Candidates need to have adequate time for this content to be addressed and time to expand discussion as related to the legal issues during the practicum experiences. Continued use of delegation assignment and case studies to provide experiential learning are needed in this content area. The school nurse professor utilizes Legal Issues in School Health Services by Schwab and Gelfman to supplement content as noted by interview. Response: II. Performances The professional education program provides evidence that each School Nurse certification candidates are assessed and demonstrate competence in the above content areas during a minimum of 100 hours participation in early field experiences and a required practicum. The early field experiences and practicum must be in diverse settings and educational levels while under the supervision of a certified school nurse. In ED 603: School Nurse Practicum, the candidate is required to complete 15 days in school health services of a school district. The candidates must divide the time between primary and secondary levels and meet clinical objectives. The candidates select a school with approval of the school nurse professor. The clinical practice is completed under the supervision of a certified school nurse. The certified school nurse completes a clinical evaluation which is based on the clinical objectives for the school nurse professor. There is evidence of communication between the certified school nurses and the school nurse professor. Visits by the school nurse professor are made to each of the school sites. These clinical experiences are compiled in a reflective journal which applies the content of the course to the clinical setting. Clinical issues are discussed in class. The evidence to validate this guideline includes: clinical evaluation tool, course syllabus, student work- reflective journals and interviews. There was no evidence of a verification of clinical experience form.

5 III. Professionalism The professional education program provides evidence that each School Nurse certification candidate demonstrates knowledge of and competencies in promoting professionalism in school and community settings including: III.A. Professional journals, organizations and other sources of professional development The candidates gain a good understanding of their professional organization, National Association of School Nurses (NASN) by reviewing Professional Standards of Care, issues in brief and position statements. Many of the required readings for class discussion are from the Journal of School Nursing or Journal of School Health. Various assignments required these journals, NASN and PASNAP web site documentation and use of Centers for Disease Control (CDC) information. An extraordinary example of role modeling professionalism is the school nurse professor. She is a member of the PASNAP Board of Directors, chairs the annual state conference and presents regularly in state and national events. The opportunity to share this experience with school nurse candidates is extraordinarily pivotal in promoting the development of professionalism. The evidence for this guideline was verified in the course syllabus, assignments, student work, interviews, faculty vitae and class discussions. During interviews, candidates and school nurse alumnus indicated that they have joined PASNAP and attended local school nurse meetings. Commendation: The school nurse professor is to be commended for the enormous amount of time and energy that she contributes to school nursing on a state-wide level. She is a strong role model in professionalism. III.B. Integrity and ethical behavior, professional conduct as stated in Pennsylvania s Code of Professional Practice and Conduct for Educators; and local, state, and federal laws and regulations This guideline is only met through ED 603: School Nurse Practicum. The students examine the Pennsylvania s Code of Professional Practice and Conduct for Educators by comparing it to the American Nurses Association Code of Ethics in which the school candidates will be bound to for practice. State and local laws/regulations are discussed in the classroom. This is evidenced by the course syllabus, assignments and reflective journals. III.C. Collaboration with other professionals

6 The content for this guideline is clearly evident in ED 551: Introduction to Special Education and ED 603: School Nurse Practicum. Both courses require the candidate to learn how to collaborate and provide experience in the school setting through field experience and clinical practicum. Assignments in ED 603 promote collaboration between the school nurse candidate and faculty/staff in the school setting while completing the health needs assessment. The school nurse professor teaches methods for collaboration in the classroom and the school nurse preceptor observes and guides the candidate in the school setting. The evidence to verify the content is found in course syllabi, assignments, student work, clinical evaluation, reflective journals and interviews. III.D. Effective communication with parent/guardians, other agencies and the community at large to support learning by all students The evidence for this guideline is ED 603: School Nurse Practicum. Issues related to effective communication within the school setting are discussed. Candidate reflective journals demonstrate the experience in the school environment. The development of IHPs and the health needs assessment assignment provide candidates the opportunity to gain experience in this area. Clinical situations from the school setting are discussed in class with school nurse professor able to provide guidance for effective communication techniques. The evidence is validated by the course syllabus, reflective journals, student work, interviews and the clinical evaluation tool. Program Strengths: The School Nurse professor is to be commended for her advocacy and dedication to the school nurse candidates. During interviews her commitment to assist them in obtaining the best clinical experiences and challenge them to critically review the status quo of school health practice were noted. Interviews also indicated how she has a wealth of knowledge and experience. She serves as a strong role model for candidates to learn to become proactive and a leader in health within the school and community. The candidates are taught to use evidence -based knowledge to apply in the practice of school nursing, to question the best way to practice based on the research. She is a strong proponent for school nurses to educate school faculty and administration on evidence-based practice that promotes the health of school age youth. A second strength is the ED 551: Introduction to Special Education course. From interviews and review of student work, it becomes quite evident that school nurse candidates are well received in that course. Content and issues relevant to school nursing are addressed. The field experiences and assignments also strengthen the content. The professor for this course was also seen as a strength as evidenced by their knowledge of disabilities and modeling of the advocate role. This was noted through interviews.

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