Victorian Guidelines

Transcription

1 Victorian Guidelines Secondary School Nursing Program

2 Victorian Secondary School Nursing Program Guidelines

3 Published by Rural and Regional Health and Aged Care Division Victorian Government Department of Human Services Melbourne Victoria May 2002 Copyright State of Victoria, Department of Human Services, 2002 This publication is copyright. No part may be reproduced by any process except in accordance with the provisions of the Copyright Act ( ) Acknowledgements Valuable contributions have been made to the development of the Secondary School Nursing Program Guidelines by the following organisations and their staff: Association of School Councils in Victoria Australian Drug Foundation Australian Education Union Australian Nursing Federation Centre for Adolescent Health Centre for Multicultural Youth Issues Community Child Health Nursing RMIT Department of Education and Training, in particular the Divisions of Student Well Being, Privacy, Legal, Health Physical Education and Sport, School Community Links and Networks and Occupational Health and Safety Department of Education and Training Regional Secondary School Nursing Contacts Department of Human Services, in particular the areas of Primary and Community Health, Mental Health, Nurse Policy, Legal, Privacy, Occupational Health and Safety, Human Resources, Community Care, Child Protection and Juvenile Justice, and Portfolio Services Department of Human Services Regional Nurse Managers Nurses Board of Victoria Office for Youth Parents Victoria Principals of five rural and five metropolitan Victorian secondary schools involved in the Secondary School Nursing Program Secondary school nurses Student welfare coordinators VicHealth Victorian Association of Secondary School Principals Victorian School Campus Nurse Group ii

4 Contents Acknowledgements i SECTION 1: Introduction Purpose Background of the SSN Implementation of the Program Program Goals Program Partnerships Program Context SECTION 2: Roles for Key Stakeholders Overview Role of the Nurse Statewide Level Regional Level Within Schools Accountability SECTION 3: Governing Structures Structures for Nurses Structures for Schools General Structures SECTION 4: Practice Guidelines Defining Terms Primary Prevention and Health Promotion Early Intervention Intervention Infrastructure SECTION 5: Program Delivery Planning Evaluation SECTION 6: References SECTION 7: Appendices Appendix One Risk and Protective Factors Appendix Two What is a Registered Nurse Appendix Three Accountability Flow Chart for Nurses Appendix Four Information Privacy: A Brief Guide Appendix Five Consent and Confidentiality Flow Chart Appendix Six Annual Action Plan Appendix Seven Health Promotion Strategy: Program Plan iii

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6 Section 1: Introduction 1.1 Purpose The purpose of the Secondary School Nursing (SSN) program guidelines is multifaceted. The guidelines aim to achieve a shared understanding amongst school staff, students, caregivers or guardians and other stakeholders of the role of the nurse, to provide a clear framework to support nurses in the implementation of their role and to articulate clearly the structure and direction of the secondary school nursing program. The guidelines also aim to provide a consistent approach to the practise of nurses in schools. It is expected that the guidelines will provide a basis for the development of local decisions that directly reflect the policies, procedures and needs of individual schools. 1.2 Background The SSN program is a policy initiative of the Victorian Government to reduce risks to young people and promote better health in the school community. The policy resulted in the introduction of a program that focuses on primary health care, primary prevention and early intervention in the secondary school system. The program complements the Primary School Nursing Program, which provides vision screening and a targeted hearing test for primary school students in their first year of school and additional support as required to students throughout their primary school years. Before implementation, research was conducted into established models of secondary school nursing practices that exist within Australia and overseas. Current initiatives of the Department of Education and Training that address the health and wellbeing of students were also used to inform the Victorian model of secondary school nursing. The model found to most similarly reflect the objectives of the proposed Victorian program was the Queensland School Based Youth Health Nurse program. This model was consequently used as a framework for the development of the Victorian Secondary School Nursing Program. A statewide reference group representatives of relevant professional organisations, peak health, youth and cultural bodies, health promotion and adolescent health specialists and school nurses was convened to oversee a consultation process and inform the program s implementation of the program. 1.3 Program Implementation The program was implemented in two stages. The first stage began in 1999, by identifying 40 schools that rated highest using the Department of Education and Training Special Learning Needs Index. The first 20 nurses were employed and located across the schools; each worked with two schools. The second stage of implementation built on the experiences of the first stage and sought to address issues through a comprehensive consultation process involving secondary school staff, school councils, students, providers of health and support services, regional Department of Education and Training and Department of Human Services staff. 1

7 The first stage included the development of criteria to be used to select additional schools that met the program goal of placing nurses in areas of greatest health need and socioeconomic disadvantage. Criteria included socioeconomic and health factors and also considered rurality. The combination of data used to determine the 100 eligible schools included: The Special Learning Needs Index (SLN), based on information collected annually from schools. This index includes the occupation of caregivers or guardians, family status, Aboriginality, ethnicity, the number of students receiving the Education Maintenance Allowance or Youth Allowance and the number of transitory students. The Burden of Disease study, which is a detailed analysis of estimated years of life lost due to morbidity and mortality. There is a rating for each Victorian Local Government Area. The Survey of Risk and Protective Factors, conducted in 1999 by the Centre for Adolescent Health to explore young people s personal resilience. The Adolescent Health and Well-Being study was a stratified, school-based survey of a random sample of secondary schools including Government, Catholic and Independent schools. The sample included 150 metropolitan and 50 nonmetropolitan schools providing a population of 12,816 year 7, 9 and 11 students, of which 8,984 students participated with a 70 per cent response rate. Rurality and Isolation which takes into consideration the impacts of living in remote rural regions, including the health risks associated with isolation and the limited access to health services. This resulted in 50 per cent of nurses being allocated to rural schools. Using these criteria, recommendations for the selection of schools was made by the Departments of Human Services and Education and Training to the Minister for Health, who is responsible for endorsing schools involved in the program. During 2001 the second stage of the program was fully implemented, with 100 effective full time (EFT) nursing positions being provided to approximately 200 selected Government secondary schools throughout Victoria. Nurses employed in the program undergo a Police Check and are required to hold a current registration with the Nurses Board of Victoria. Nurses are registered as, or are eligible for registration as, a Division 1 Nurse, with demonstrated competence in the areas of health promotion, community health, adolescent health, mental health, sexual health, drugs and alcohol, primary health care, public health, chronic conditions and emergency clinical practice. 2

8 1.4 Program Goals The aim of the Secondary School Nursing Program is to reduce risk to young people and promote better health in the wider community. Specific goals are to: Play a key role in reducing negative health outcomes and risk taking behaviours among young people, including drug and alcohol misuse, tobacco smoking, eating disorders, obesity, depression, suicide and injuries. Focus on prevention of ill health and problem behaviours, by ensuring coordination between the school and community-based health and support services. Support the school community in addressing contemporary health and social issues facing young people and their families. Place nurses in areas of greatest health need and socioeconomic disadvantage. Provide appropriate primary health care through professional clinical nursing, including assessment, care, referral and support. Establish collaborative working relationships between primary and secondary school nurses, to assist young people in dealing with any difficulties in their transition from primary to secondary school. 1.5 Program Partnerships It is important that the program is able to be responsive and knowledgeable about the multiple factors that contribute towards the health and wellbeing of young people. The implementation of the program and its ongoing quality therefore relies on a partnership approach that involves a number of initiatives between the two Departments. Centrally, the SSN program has liaised with various Department of Human Services Divisions, to ensure consistency of policy direction and planning initiatives. The program areas involved include Community Health, Mental Health, Privacy, Community Care, Drug Policy Unit, Child Protection Unit and Public Health. The aim of this integrated approach is to support the same approach at a local level and to ensure that the SSN program operates as part of the service system Links to Department of Education The partnership between the Department of Education and Training and the Department of Human Services is integral to the success and quality of the SSN program. The Departments have worked together to identify eligible schools for the program, discuss the logistics of introducing the nurse into schools, and develop an orientation program for the nurses. Department of Education and Training policy emphasises that student welfare is the responsibility of all staff working in a whole school context and acknowledges that students are better prepared for learning when they are healthy, safe and happy. The Framework for Student Support Services in Victorian Government Schools Teacher Resource provides guidance for schools in how to strengthen student welfare and curriculum support. 3

9 The Framework fundamental to the implementation of the SSN program in school communities is underpinned by four major concepts: Four Levels of Activity: Primary prevention that builds a sense of belonging and promotes wellbeing across the school. Early intervention that strengthens coping skills and reduces risk for students. Intervention that provides access to support and treatment. Restoring wellbeing by providing an appropriate response to extraordinary traumas, emergencies and tragedies that may occur. Continuity of Care. Partnerships between Schools and the Community. Accountability. The major emphasis of the framework is on prevention, with the goal of providing population-based strategies as well as targeted programs to provide young people with skills and strategies to enhance their resilience. Resilience refers to the capacity to cope with extreme and stressful life situations. The Department of Education and Training Framework for Student Support Services Teacher Resource 1 states: encouraging resilience is a teaching and learning strategy 2. Research indicates that certain social experiences and arrangements foster resilience in children and young people; others reduce resilience. To promote an ongoing status of health and wellbeing, health promotion programs and activities developed by nurses should be based on objectives that address risk factors and enhance protective factors (see Appendix 1 for a list of risk and protective factors) Links to Primary School Nursing The SSN program is part of a comprehensive school nursing program. Both primary and secondary school nurses work together to provide students with relevant health information, tools to access additional resources and a continuity of support for students during the transition from primary to secondary school. The Primary School Nursing Program offers a free service to all Victorian primary schools and English Language Centre schools. The Department of Human Services employs registered nurses to: Visit primary schools and conduct a health assessment in a student s first year of school. Provide advice, information and if appropriate, referral to other services. Be involved in health promotion aimed at maintaining and improving the health and wellbeing of children and their families. Provide support to families and school communities by providing information and education on issues relation to school aged children. 1 Department of Education, Employment and Training Framework for Student Support Services in Victorian Government Schools Teacher Resource (p 14), State of Victoria Hawkins, J. and Catalano R., 1993, Communities that Care: Risk and Protective Focused Prevention Using the Social Development Strategy, Developmental Research and Programs Incorporated. 4

10 1.6 Program Context Two key models of health service delivery underpin the SSN program and are used by nurses to guide their work in schools Social Model of Health The social model of health is a framework that considers health in line with the World Health Organisation s definition: health is a complete state of physical, mental and social wellbeing, not merely the absence of disease or infirmity. This definition of health highlights the importance of understanding health and disease within the personal, social and cultural context specific to the person or community whose health is being considered. It is not possible to decide how best to support the improvement of health without understanding this context. 3 A social model of health is a conceptual framework for thinking about health. Within this framework, improvements in health and wellbeing are achieved by directing efforts towards addressing the social and environmental determinants of health, in tandem with biological and medical factors. Using the social model of health framework provides a common basis for the interface between health and education. Both nurses and school staff acknowledge that students bring with them from their home and community a wide range of strengths and weaknesses that will impact upon their wellbeing and their potential to learn. This is highlighted in a quote documented in the Evaluation of the School Focused Youth Service and taken from the International Commission on Education for the Twenty-first Century: the problems of the social environment can no longer be left behind at the school gates: poverty, hunger, violence and drugs enter classrooms with the children, whereas in the not so distant past they were kept outside with the unschooled Health Promotion Health promotion is the process of enabling people to increase control over and improve their health. To reach a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and realise aspirations, satisfy needs and change or cope with their environment 5. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing. 6 3 Aged Community and Mental Health and Public Health, Primary Care Partnerships Draft Health Promotion Guidelines December 2000 (p 15), Victoria Government Department of Human Services, Melbourne Victoria, November Success Works, Evaluation of the School Focused Youth Service Summary, Education Victoria and Department of Human Services, March World Health Organisation 1986, The Ottawa Charter for Health Promotion, Geneva 6 Aged Community and Mental Health and Mental Health, Primary Care Partnerships Draft Health Promotion Guidelines December 2000, Victorian Government Department of Human Services, Melbourne Victoria, November

11 The purpose of the SSN program and the role of the nurse aims to ensure that current health promotion initiatives in schools are not stifled, but further enhanced, by the nurse s appointment at the school. Health promotion is the foundation for the work of the nurses within the school. In some schools, this will mean that they are able to build on initiatives such as: Work initiated through the Health Promoting Schools Project. The role of health educators who are involved in health promotion activities and are permanent staff members or visitors to the school. Existing connections with community health promotion agencies. The health promotion focus within the curriculum. Health promotion strategies and programs will be adapted to the local needs. The most effective health promotion requires a set of mixed interventions that reflect the social, cultural and economic status of the local community. A single health issue cannot be addressed completely through one single strategy; a multi-pronged approach is more effective. For example: A school and the nurse agree that drug and alcohol misuse is an issue. They develop strategies to address this issue, involving: A student forum with experts from the drug and alcohol field. Forum followed by some small group discussions with students and teachers. Information posters and brochures offered to students and their caregivers. Students work with the nurse and drama teacher to depict drug and alcohol issues for young people in a play. Combining strategies in this way will reinforce messages and affect individual and organisational change. Nurses have the capacity to develop a combination of interventions, which may include strategies under all or some of the following areas of their work: Primary prevention and health promotion Early intervention Intervention Restoring wellbeing. Health promotion strategies implemented by school nurses will operate as a catalyst for change in school policy and/or procedure, in the attitudes of the school community, in the behaviour of individual students and in the access provided by local health agencies to young people and their health needs. 6

12 Section 2: Roles of Key Stakeholders PRINCIPLE: Clarity around the roles of each of the stakeholders is integral to the successful partnership required to have a positive impact on the health and wellbeing of students. 2.1 Overview The secondary school nurse is a member of the school welfare team. Most nurses work with two schools, usually within neighbouring locations. As a member of the welfare team, the nurse will require the support of the school and the Principal and will work within the school s charter. The roles of the various stakeholders involved in the SSN program will differ according to the: School structure. Specific needs of the school community. Delivery of services to students. School decision making processes. The following role statements provide an overall description of the relationship each stakeholder has with the nurse working in the school. Section 4 of the guidelines provides further detail on the roles and responsibilities of stakeholders, in relation to specific situations experienced on a day-to-day basis. 2.2 Role of the Nurse Over recent years Victorian Government schools have moved towards a selfmanaging approach that offers greater freedom and flexibility in the delivery of education and provision of resources. Schools are still guided by curriculum standards and statewide policy, but they have a greater capacity to meet the needs of their student and community population. Given the nurse and the school community will work together to achieve the goals of the program, the nurse s role will vary at a local level, according to the cultural and health needs of the specific school community. Many schools have done a lot of work in developing welfare and health promotion structures and programs for students, establishing referral processes with external agencies and building structures for community involvement. The nurse s role will strengthen the school s existing programs and processes, evaluate health promotion activities and health education, and inform the school of opportunities for additional welfare and health promotion processes. The nurse is employed by the Department of Human Services and is managed by the Regional Nurse Manager. The nurse is required to work within the protocol, policies, management structures and processes of the school and within the nurse s mandated legislative (see Section 3 and Appendix 4) and registration responsibilities (see Appendix 2). 7

13 The nurse is also expected to become familiar with the cultural diversity of students in the school, to ensure cultural sensitivity in the information they present, the activities they conduct and their involvement with students generally Target Group Although all students can access the nurse for health information or support, the focus of the program will be on students in the junior years of secondary school and students identified as being at risk of experiencing reduced resilience (as identified in above) or a reduced status of health and wellbeing Health Promotion One of the key roles of the nurse is health promotion and primary prevention. In response to needs and priorities identified by both the nurse and the school staff, the nurse, in collaboration with the appropriate school staff, will develop health promotion initiatives. For example: Health promotion activities linked to National and State health priorities such as Dental Health and Sunsmart Awareness campaigns. Health promotion programs on current issues of concern identified by the school and/or nurse, such as smoking, sexual health, drug use and mental health issues. Provide health education as part of a team teaching approach in a classroom setting and on an individual or small group basis. Provide in-service education to staff on current health issues affecting the school community. Conduct education / discussion forums for caregivers or guardians. Participate in health curricula development and in planning for school health promotion activities. Liaise with year level coordinators regarding appropriate curriculum framework and delivery that, for example, may be related to science or health and physical education Health Counselling Consultation The nurse will provide individual student support that is either initiated by the student, or through consultation with the school welfare team, or initiated by the nurse. These individual activities will involve discussions with students and can include: Identifying mental, social and emotional health as well as physical health issues that may require further investigation. Seeking secondary consultations from expert health professionals. Making appropriate referrals to local agencies. Assisting students to access health information and support. Supporting students to access health services within the community. Working with families to address students health and wellbeing issues. 8

14 2.2.4 Networking The nurse will be required to have knowledge of relevant points of referral for students and be aware of services, activities and events that are happening in the local area. The nurse will build on networks that have been developed by school staff and establish additional relevant networks to further facilitate links between the students, the school community and community-based agencies. As part of their role, the nurse will be expected to: Act as a resource and referral person in linking the school and students to appropriate community services. Facilitate joint planning and program delivery to meet identified school needs. Develop service and referral protocols with other primary health care services. Promote the secondary school nurse role at both the school and community level. Facilitate appropriate access for students to existing primary health care and community-based agencies. Develop joint programs. Represent school health needs in broader health planning, for example, community health plans and municipal public health plans. In many instances, school staff will already have developed networks with local services or positions that the nurse can become familiar with and build on. Local services may include: Child and Adolescent Mental Health Services Community Health Services Department of Human Services Health Promotion Officers Divisions of General Practice Drug and Alcohol Services Family Planning and Sexual Health Clinics Family Violence and Child Protection Services Maternal and Child Health Nurses Mental Health Promotion Officers Migrant Resource Centres Student Support Service Officers (Guidance officers, psychologists, social workers, speech therapists) Visiting Teachers (hearing, visual and physical) Women s Health Services Youth Specific Health Services. In addition, there are currently two State Government initiatives that provide useful points of contact for nurses: Primary Care Partnership School Focused Youth Service. These two initiatives bring together a diverse range of primary health providers, all working together to reduce duplication of services, develop evidence-based health promotion activities and improve service delivery. 9

15 Primary Care Partnership The Primary Care Partnership (PCP) is an initiative of the Department of Human Services. They are voluntary alliances of primary health care providers, usually covering two or three local government areas. PCPs aim to improve the health and wellbeing of their catchment s population by better coordination of planning and service delivery in response to identified needs. PCPs are responsible for producing Community Health Plans that have the capacity to inform the health needs of young people in the school localities. Each PCP makes their own decision about which service providers and other organisations participate in their alliance. However, the core group of agencies will typically include the following services: Community health. Primary health care services funded and delivered by local government. Home and Community Care (HACC), including District Nursing. General practitioners. Psychiatric disability support. Psychogeriatric Assessment and Treatment Teams. Aged care assessment. Women s health. Aboriginal community-controlled health services. Sexual assault. Dental health. Community drug treatment services. Local ethnospecific health services. Children s and Family services. Disability services. Maternal and Child Health services. School Focused Youth Service The School Focused Youth Service (SFYS) is a joint initiative between the Department of Human Services and the Department of Education and Training in partnership with the Association of Independent Schools of Victoria and the Catholic Education Office. The aim of the SFYS is to develop an integrated service response for young people who are at risk of developing behaviours that may make them vulnerable to self harm, suicide or attempted suicide, or who are displaying behaviours requiring further support and intervention. The objectives of the SFYS is to: Establish collaborative structures and mechanisms between schools and the relevant youth services and community services that support young people including welfare, health and mental health agencies. Provide linkages for agencies and schools that have a client base of young people and directly support young people. Improve linkages, cohesiveness and integration of service provision for young people displaying at risk behaviours who require support and attention. 10

16 Purchase services to meet gaps in the current service system, as identified at the local level First Aid Although the nurse s primary function is not that of first aid provider, schools will be able to utilise the expertise of the nurse in developing first aid policy and advising existing first aid providers when appropriate. Nurses will do this by working in partnership with the school staff responsible for first aid and care of student s health needs. Whilst nurses are able to provide updates on first aid information to teachers, their role does not extend to the delivery of first aid training for teachers Portfolios In some regions nurses may carry a portfolio responsibility for specific health issues. Portfolios represent areas of health in which nurses have a particular expertise or interest. Nurses will continue to maintain a broad knowledge of all areas of health care, however, this model can facilitate ways of creating efficiencies in workload. The portfolio model can provide a regional structure to encourage the sharing of knowledge and expertise and streamline dissemination of information and resources through individual nurses Core Knowledge and Skills Nurses employed in the SSN program will hold a current registration with the Nurses Board of Victoria. They will be registered, or eligible for registration, as a Division 1 nurse. Nurses are expected to maintain current knowledge and skills in core areas required of their role: Emergency clinical practice, including cardiac pulmonary resuscitation (CPR). Mental health. Health promotion. Adolescent health and development. Sexual health. Drugs and alcohol. Primary health care. Public health. Chronic conditions such as diabetes and asthma. Community health. See section for further information about professional development for nurses First Aid and Emergency Response Secondary school nurses must demonstrate that they have the required competencies with regard to the provision of first aid and emergency response, including CPR. Annual updates specifically designed for registered nurses in the following areas are considered mandatory: Cardiac Pulmonary Resuscitation (CPR) Asthma crisis. 11

17 A current certificate in first aid is also considered mandatory; additional updates in first aid procedure may be undertaken at the nurse s discretion. Additional regular updates are recommended in mental health emergencies or crisis. This will ensure that secondary school nurses are able to advise the school on any changes to first aid and emergency procedures. Nurses will be responsible for ensuring they receive updates as mentioned above. See Section for further information about professional development for nurses. In line with the nurse s legislated duty of care, the nurse at the scene of an emergency will provide appropriate nursing care. 2.3 Statewide Level Role of Government Program Staff At a statewide level, the Department of Human Services and the Department of Education and Training work in partnership to implement the Secondary School Nursing Program. Department of Human Services The SSN program is located in Primary and Community Health, which is a unit of the Rural and Regional Health and Aged Care Services Division. At central office level, staff support the program through: The development of policy. Keeping the Minister for Health informed of the progress of the program and of any new developments. Providing comments on funded programs in response to questions from Ministers. Coordinating the statewide presentation of information. Resourcing regional staff. Managing the program budget. Ensuring key performance indicators are met. Development and implementation of program guidelines. Department of Education and Training The SSN program is located in the Student Welfare Unit, which is part of the Student Wellbeing Branch of the School and Community Development Division. The role of program staff within the Student Welfare Unit includes: Providing input to policy and program development. Liaison with Department of Human Services staff. Consultation with relevant Department staff to assure consistency and integration of other programs with the SSN program. Liaison with regional staff concerning implementation of the SSN program. Providing information to senior management of any new developments in the program. 12

18 2.4 Regional Level Role of Regional Nurse Manager The Regional Nurse Manager is employed by the Department of Human Services and is based at a regional office. This requires a comprehensive understanding of school nursing and adolescent health. The SSN program employs nurses under a classification of 4A, meaning they do not require clinical supervision. Therefore, although desirable, it is not mandatory for the Regional Nurse Manager to be a registered nurse. The Nurse Manager has line management responsibility for all nurses employed in their region. Their role in relation to the secondary school nurses falls under the following headings: Human Resources Manage human resource obligations, for example: performance management, travel reimbursement, leave applications. Ensure that debriefing mechanisms are accessible to nurses when required. Monitor workloads to ensure nurse health and wellbeing. Provide day-to-day support as required. Be responsible for the employment of SSNs within their region. Professional Development Coordinate relevant professional development for nurses. Provide opportunities for peer support and sharing of current information through regular regional meetings. Provide nurses with accessible, updated, current relevant health information and resources. Administration Ensure all Departmental equipment is maintained and work environments comply with occupational health and safety standards. Evaluation of the program, for example: school s commitment to program and nurses ability to carry out the role. Ensure the completion of Annual Action Plans. Coordinate the Regional Reference Group to ensure ongoing development of the role within the schools. Liaison Provide input to and feedback from statewide program meetings. Liaise with principals and student welfare teams in schools as required throughout the year for planning, support to nurses, support for development of processes within the school. Ensure nurses liaise with primary school nursing staff to ensure a team approach to child and adolescent health. Liaise with regional Department of Education and Training office to ensure a joint approach and support for the program. 13

19 The Regional Nurse Manager will also be responsible for dealing with performance issues, disciplinary procedures and industrial disputes (see Section Performance Management for details) Role of Regional Department of Education and Training Secondary School Nurse Contact Department of Education and Training Regional Directors have nominated a contact person for the program in each region. This person may hold different positions at different regional offices. The contact person responsible for the SSN program: Liaises with Department of Human Services Regional Nurse Managers on matters relevant to the SSN program. Promotes linkages between SSN program and Department of Education and Training regional initiatives. Improves linkages and communication between agencies and schools Role of Regional Communication and Consultation Regional discussions between key stakeholders encourage networking and resolution of regional issues. They are an excellent forum for discussing ongoing quality approaches to the activities of the nurse in secondary schools. A regional discussion can take the form of a Regional Reference Group, or Regional Nurse Managers can facilitate communication channels through visits to schools. It is expected that key stakeholders may include: Principals. Community health services. Student welfare team. Adolescent mental health services. Drug and alcohol services. School Focused Youth Service. Koori Education Development Officer. Nominated member of local Aboriginal Education Consultative Group. Regional Department of Education and Training staff. Regional Department of Human Services staff. The role of regional discussions is to: Provide ongoing monitoring and evaluation of the program at a regional level. Link to external regional planning processes and strategy development. Provide a forum to discuss further development of the program. Provide a forum to share experiences of good practice. 2.5 Within Schools The Principal The Principal of the school has a management and leadership function that requires the development of integrated strategies to maximise opportunities for all students within the school to receive a quality education. The Principal supports the work of the school council and is responsible for the day-to-day operation of the school. 14

20 The Principal has responsibility for ensuring that the nurse is aware of and works within the schools protocols, policies, processes and management structures. The Principal is fundamental to the success of the SSN program within the school. They contribute by: Supporting the aims and objectives of the SSN program, by ensuring that the nurse has the capacity to implement the program guidelines, and where necessary, working with the nurse to develop protocols that further enhance the program guidelines. Providing support to the nurse that will ensure that programs and services to students can occur with maximum efficiency and effectiveness. Providing regular reports to the school council to keep them informed of the nurse s activities. Ensuring that the whole school supports the nurse and the role of the nurse. The Principal also has a role in overseeing the successful orientation of new nurses and the integration of the SSN program into the school community. They need to ensure that: Students have access to the nurse, either individually or as part of structured events. The nurse is well-oriented to the systems and policies of the school. The nurse is aware of Department of Education and Training policies that will impact upon the role of the nurse within the school. The nurse is involved in relevant school initiatives. The nurse is acknowledged as a valuable contributor and an integral part of the school. There is direct involvement by relevant staff, including themselves, in the annual planning process to identify the direction for the work of the nurse. The nurse has access to basic office supplies. The nurse has a safe workplace. The school community, school council, caregivers or guardians, staff and students are aware of the role of the nurse and the benefits the role brings to the school. Reporting The nurse will provide reports to the Principal on a quarterly basis. These reports are informal and keep the Principal up-to-date with what the nurse is involved in and any consistent issues being raised by students. The Principal will be expected to forward the nurse s quarterly report to the school council for their information School Welfare Team The Framework for Student Support Services in Victorian Government Schools outlines current Department of Education and Training policy directions for provision of student welfare in schools. Within this framework, schools will be responsible for the development of appropriate welfare structures, to ensure the provision of a positive and supportive school environment and the delivery of coordinated and comprehensive services for students. 15

21 To facilitate this, schools determine a structure, such as a school welfare team, that is established to deliver: A coordinated whole school approach to student welfare within the school. Identification of student needs and development of appropriate welfare and curriculum policy. The development of statements that describe the delivery of student welfare, including referral protocols and the supporting role of school staff. The development of networks and protocols with community agencies and service providers, to ensure the continuity of care through the provision of a full range of services for young people at risk. As a member of the school welfare team, the nurse will work to complement and strengthen the team s activities and can play a key role in facilitating the above outcomes. Within the school welfare team, the nurse s role is to: Identify existing welfare and health promotion processes, protocols and practices, to enable the nurse to work within current structures and enhance the role of the school welfare team. Work collaboratively with other members of the team, particularly the Student Welfare Coordinator, on issues surrounding the health and wellbeing of students in the school. Keep abreast of and inform the school welfare team of community-based contacts that are additional to those identified by the school, and that could further support the school welfare team in regard to secondary consultations and referrals. Attend regular team meetings to maintain communication links with others in the team. Liaise with staff associated with student welfare in primary schools and/or with primary school nurses, to support the transition of students from primary school to secondary school, especially those that the primary school nurse or welfare staff have had contact with and are identified as having special needs or at risk. In some schools the regional Student Support Services Officer (SSSO) is a member of the school welfare team. SSSOs can provide assistance to schools in planning and providing support to students, their families and teachers Student Welfare Coordinator The Department of Education and Training has made funds available for a staff member to be responsible for the welfare of students. Schools can allocate these funds in various ways, either: Employing a full time Student Welfare Coordinator. Allocating responsibility to Year Level Coordinators. Allocating responsibility to the Assistant Principal. The nominated staff member who fulfils the welfare role provides a central coordination point, initiating and strengthening the full range of services to 16

22 support the wellbeing of all students. The Student Welfare Coordinator (or equivalent) and the nurse work together as team colleagues. The role of the Student Welfare Coordinator or nominated welfare staff may include: Working with the nurse in the development and implementation of initiatives that affect the health and wellbeing of the school community. Providing orientation for the nurse in understanding the systems of the school and the structure of the school welfare team. Providing the nurse with information about established networks and contacts in the local area. Informing the nurse of the school s referral protocols with relevant internal and external services, including protective service protocols. Participating, if requested by the nurse or Regional Nurse Manager, in performance assessments for the nurse. Providing input to the Annual Action Plan and evaluation processes associated with the work of the nurse. Jointly discussing potential professional development opportunities for school staff that will impact upon the health and wellbeing of students Students and Caregivers or Guardians Students and caregivers or guardians have various roles within a school environment. They are members of school councils, parent associations, student representative committees or other organising committees that are focused on specific activities or events. Integrating the views and ideas of students and caregivers or guardians into discussion about the role and direction of the school nurse provides an important perspective from the recipients of the service. The primary role of students and caregivers or guardians in relation to the school nurse may include participating in opportunities to provide input into: The role of the nurse and the service offered. The annual planning processes, by participating in surveys or discussions with the nurse School Council The school council is an elected group of caregivers or guardians, community members and staff representatives who are responsible for the management of the school. Their general roles and responsibilities include: Determining the general educational policy, goals and priorities of the school within the framework of the school charter and statewide guidelines. Developing the school charter. Monitoring and evaluating the performance of the school. Reporting annually to the school community and Department of Education and Training. Approving and monitoring the school budget. Making recommendations to the Education Secretary on the appointment of the school Principal. Entering contracts consistent with the school charter. Developing a student code of conduct. 17

23 Employing non-teaching staff and casual relief teachers. General oversight of the buildings and grounds, facilitating the provision of cleaning and sanitation services. Stimulating interest in the school. In relation to the school nurse, the school council has a role in: Providing input to the nurse s annual planning processes. Ensuring that the nurse is aware of the school charter, policies and priorities and how they link with her role. Providing input to protocol development where appropriate. Developing and endorsing health education policy. Endorsing health education curriculum development processes. Approving health education curriculum. Endorsing school health and wellbeing initiatives, including the distribution of health pamphlets. 2.6 Accountability Employment of the Secondary School Nurse The employment of the secondary school nurse is the responsibility of the regional office of the Department of Human Services. Nurses will be required to undergo a Police Check prior to employment. A standard position description that contains a selection criteria based on core competencies is used to employ all nurses. Regional offices of the Department of Human Services identify the selection process to best suit their needs. It is recommended that a Principal or nominated staff member from the schools involved (if schools have been selected), or a nominated representative from a school in the area is involved with the Regional Nurse Manager on the selection panel. In some instances, regional Department of Education and Training staff will also be involved in the selection process. Nurses are required to perform their duties in accordance with the duties and responsibilities of a State Registered Nurse Division 1 (see Appendix 2 for details of nurse registration). Registered nurses are required to demonstrate competence, which they must maintain to keep their registration (renewed annually). Nurses will present Regional Nurse Managers with renewed registration certificates The Nurse Accountable to Department of Human Services Nurses are accountable to the Department as their employer (through the Regional Nurse Manager) and have a responsibility to adhere to all policies and processes, including the policy relating to duty of care. The Duty of Care Policy requires all staff to take reasonable care of a person. Department staff must take reasonable care to avoid causing injury to people in the delivery of its services. 18

24 Accountable to School At the same time nurses are required to work within the policies and frameworks of the school/s and broader Department of Education and Training policies, as long as they do not contradict Department of Human Services policy or the nurses legislative responsibility. Where relevant existing school policy and processes are in place, the nurse and Principal will work together to identify how they impact on the role of the nurse. If necessary, additional processes can be established to support the nurse in providing a service to students, within the legislative and ethical boundaries that apply. Accountable to Public Nurses are also accountable through their registration to the public. Nurses have a responsibility to the individual, society and the profession to provide safe, competent nursing care, which is responsive to individual, group and community needs. All nurses are personally accountable for their practice in whichever setting the practice occurs, however they cannot be held responsible for factors outside of their control which may affect the practice setting or the care provided The School Accountability to the Nurse Eligible schools that have agreed to participate in the SSN program have invited the nurse into the school as a member of the school welfare team. The school is responsible for providing a safe working environment for the nurse. This will include ensuring that every effort is made to foster student access to the nurse and to support the nurse in their role of improving the health and wellbeing of students, for the purpose of maintaining their capacity to learn. The school also has a responsibility to participate in the development of the SSN program s annual action planning process and to support the achievement of objectives identified as priorities for the year Reporting The nurse will be required to establish regular reporting mechanisms on the programs and services that have been provided. The reports will include: Evaluation of programs. Details of planned events. Consistent health issues arising for young people. Positive outcomes. Reports will be provided to: The Regional Nurse Manager on a monthly basis, The Principal on a quarterly basis. These reports can be verbal or printed and will keep the Principal up-to-date with what the nurse is involved in and any issues consistently raised by students. The Principal will be expected to forward a quarterly report to the school council for their information. 7 Australian Nursing Council, ANCI Code of Professional Conduct for Nurses in Australia, ANCI July

25 2.6.6 Conflict Staff Conflict In the event that there is a conflict between a school employed staff member and the nurse, the grievance procedures developed to resolve internal staff conflict in the school will apply. Organisational Conflict Conflict with the SSN program may occur due to: A contradiction or conflict between Department of Education and Training and/or Department of Human Services policies and the expectations of the nurse. A contradiction or conflict between school and/or Department of Human Services policies and the expectations of the nurse. If organisational conflict does arise, the nurse will alert the Principal to the issue and together they will attempt to develop local resolutions. The nurse can receive further support from the Regional Nurse Manager if local discussion is not successful. A discussion organised and facilitated by the Regional Nurse Manager should involve the Principal, the Department of Education and Training regional staff and the nurse. The purpose of this discussion is to propose strategies to address and resolve the contradiction or conflict. If every effort is made to resolve the situation, but it is not possible to provide a supportive work environment for the nurse or school staff, alternative strategies to relocate the nurse will be implemented. 20

26 Section 3: Governing Structures PRINCIPLE: All stakeholders involved in the SSN program will operate within the boundaries of relevant legislation and ethics developed to protect young people at risk and the functions of the nurse. 3.1 Structures for Nurses Listed below are the documents that provide legislative and ethical boundaries for nurses to operate within whilst working in a school environment Code of Professional Conduct for Nurses in Australia July 1995 (reprinted November 1999) Purpose Inform the profession of the minimum standards for professional conduct Inform the public of the minimum standards for professional conduct; and Provide appropriate bodies with a basis for decisions regarding standards of professional conduct. Relevance Nurses have a responsibility to individuals, society and the profession to provide safe, competent nursing care that is responsive to individual, group and community needs. The Code of Professional Conduct for Nurses in Australia is a set of national minimum standards for accountable professional nursing conduct. Further information Australian Nursing Council P.O. Box 873 Dickson ACT [email protected] Phone: Code of Ethics for Nurses in Australia July 1993 (reprinted February 2000) Purpose Identify the fundamental moral commitments of the profession. Provide nurses with a basis for professional and self reflection and a guide to ethical practice. Indicate to the community the values which nurses hold. Relevance The code of ethics provides a framework that nurses are expected to work within. The code allows an individual nurse to refuse involvement in procedures that contradict personal moral beliefs, however not to the detriment of a person if there is any possibility of danger to their life or welfare. Further Information Australian Nursing Council P.O. Box 873 Dickson ACT [email protected] Phone:

27 3.1.3 Nurses Act 1993 Purpose The main purposes of this Act are: To protect the public by providing for the registration of nurses and the investigation into the professional conduct and fitness to practice of registered nurses; and To establish the Nurses Board of Victoria and the Nurses Board Fund of Victoria; and To repeal the Nurses Act 1958; and To provide for other related matters. Relevance Nurses in the SSN program must be registered under this Act as a Division 1 Nurse. Further Information Nurses Board of Victoria Phone: Duty Of Care Policy This policy applies to all Department employees and agencies providing services for the Department, whether or not they work in direct contact with clients. Employees must comply with the law of negligence in all aspects of their work. Relevance Describes negligence and the boundaries of care that need to be applied by nurses when carrying out their daily activities. Further Information Department of Human Services regional offices or Intranet Industrial Structures Nurses employed in the Secondary School Nursing Program are covered by a Federal Award relating to Public Servants and a Memorandum of Understanding entered into between the relevant parties. These documents are currently under negotiation and will be revised shortly. Further Information Australian Nurses Federation Phone: Structures for Schools The following two documents provide the legislative basis on which the school makes decisions relating to operation. The Principal and school council are responsible for ensuring that the boundaries generated by these documents are applied across the school. 22

28 3.2.1 Education Act 1958 The Education Act provides for the administration of primary and secondary education in Victoria and compels the attendance at school of children aged between six and fifteen years. Relevance The Act establishes the framework for the State schools in which the nurses are based. There is no provision in the Act for the provision of health (or welfare) services to students. The Act provides for the establishment of a school council for each school with powers set out in the Act, Regulations and the Constituting Order of the school council. School councils are also subject to Ministerial orders and directions. Further Information Useful information about practical legal and administrative requirements in school can be found in the Victorian Government Schools Reference Guide, which summarises legal and administrative requirements for State schools School Charter The school charter is an understanding between the school council and the Director of School Education. It describes how a school combines local and system requirements to deliver quality education to the local community. The charter also provides a basis for internal and external reviews because it is the schools key accountability document. School charters operate for three years and contain a school profile, the goals of the school, planning for improvement, curriculum, budget and accountability plans, codes of practice, a student code of conduct and an agreement to implement the charter. Further Information Victorian Government Schools Reference Guide section General Structures There are six additional legislative documents that apply to all staff working within the school and it is expected that the obligations under all of the following documents are operating within the school environment Health Records Act 2001 Purpose The purpose of this Act is to promote fair and responsible handling of health information by: Protecting the privacy of an individual's health information that is held in the public and private sectors; Providing individuals with a right of access to their health information; and Providing an accessible framework for the resolution of complaints regarding the handling of health information. 23

29 Relevance for Nurses The Health Records Act (HRA) applies to personal information handled by a nurse when providing a service related to a student s health. The HRA applies to all identifying information handled by health, disability and aged care providers in relation to their services. Relevance for Schools Although schools are non-health service providers, they collect and hold information such as the health status, medical and treatment details about staff and students which is covered by the HRA. The Act applies to all identifying information about the health and disability of an individual. Further Information Department of Human Services Central Office School Nursing Program Adviser Phone: (03) Information Privacy Act 2000 Purpose The main purposes of this Act are: To establish a regime for the responsible collection and handling of personal information in the Victorian public sector; To provide individuals with rights of access to information about them held by organisations, including information held by contracted service providers; To provide individuals with the right to require an organisation to correct information about them held by the organisation, including information held by contracted service providers; To provide remedies for interferences with the information privacy of an individual; and To provide for the appointment of a Privacy Commissioner. Relevance to Nurses The Information Privacy Act will not generally apply to information handled by school nurses, who are covered by the Health Records Act. Relevance to Schools The Information Privacy Act applies to all non-health personal (identifying or potentially identifying) information held by all Victorian Government schools. It applies standards to protect the privacy of such information, which is similar in character to the privacy principles set out in the Health Records Act. All school staff will need to be aware of the broad principles in the Information Privacy Act. Further Information Web site of the Victorian Privacy Commissioner Department of Human Services Central Office School Nursing Program Adviser Phone: (03)

30 3.3.3 Children and Young Persons Act 1989 Purpose To establish The Children Court of Victoria as a specialist court dealing with matters relating to children and young persons; and To provide for the protection of children and young persons; and To make provision in relation to children and young persons who have been charged with, or who have been found guilty of, offences; and To amend and consolidate for the purposes of the new Court the law relating to the jurisdiction and procedure of childrens courts. Relevance This Legislation mandates reporting of child abuse by teachers or nurses to the Department of Human Services when they form a belief whilst carrying out the duties of their office, on reasonable grounds, that a child is in need of protection from physical injury that results from abuse, neglect or sexual abuse. Further Information Department of Human Services Safe From Harm Professional Development Kit Department of Education and Training/ Department of Human Services Protecting Children Protocol Victorian Government Schools Reference Guide section 4.6 Student Care and Supervision Occupational Health and Safety Act 1985 Purpose The objects of this Act are: To secure the health, safety and welfare of persons at work; To protect persons at work against risks to health or safety To assist in securing safe and healthy work environments; to eliminate, at the source, risks to the health, safety and welfare of persons at work; To provide for the involvement of employees and employers and associations representing employees and employers in the formulation and implementation of health and safety standards. The legislation requires employers to provide a safe and healthy work environment and an employee to take reasonable care for their own health and safety and the safety of anyone else who may be affected by their acts or omissions at the workplace, cooperate with their employer with respect to any actions taken by the employer to comply with any requirement imposed by the Occupational Health and Safety Act. Relevance Department of Human Services as the employer is responsible for the Occupational Health and Safety of nurses, however schools are responsible for ensuring that the health and safety of nurses visiting or working in their school is not at risk. 25

31 Further Information Department of Human Services Organisational Health Located in each of the nine regions Victorian WorkCover Authority Ph: (03) Department of Education and Training Occupational Health and Safety Consultant Noel Arnold and Associates Ph: (03) Racial Discrimination Act, Disability Discrimination Act, Sex Discrimination Act Purpose There are two forms of discrimination; Direct Discrimination which occurs when a person is treated less fairly than another person because of their sex, marital status, pregnancy, race, colour, descent, national or ethnic origin, or disability. Indirect Discrimination when a requirement that is the same for everyone has an unfair effect on some people because of their sex, marital status, pregnancy, race, colour, descent, national or ethnic origin or disability, for example if an activity is provided in a venue with stairs, students with a disability may be prevented from attending. Relevance When providing a service or planning an activity, access for all students is integral to ensuring that discrimination, direct or indirect, does not occur. Further Information Commonwealth Human Rights Equal Opportunity Commission Teacher, student and employer information sheets can be obtained via the following Web site. Complaints Information Line: General Inquiries and Publications: Equal Opportunity Act 1995 Purpose The objectives of the Equal Opportunity Act 1995 is: To promote recognition and acceptance of everyone's right to equality of opportunity; To eliminate, as far as possible, discrimination against people by prohibiting discrimination on the basis of various attributes; To eliminate, as far as possible, sexual harassment; To provide redress for people who have been discriminated against or sexually harassed. 26

32 Further Information Each Department of Human Services region has a regional Equity Coordinator, who can provide further information on the Equal Opportunity Act, they are located in the Human Resource unit. Equal Opportunity Commission Advice line: or toll free

33 28

34 Section 4: Practice Guidelines PRINCIPLE: The practice of the nurse will reflect the objectives of the program and the ethical and legislative responsibilities of the nurse. The expertise of the nurse will be used to provide a quality service to promote student health and wellbeing, and encourage students ongoing positive involvement in education. 4.1 Defining Terms Health The SSN program operates in line with the World Health Organisation s definition of health, which states that health is a state of physical, mental and social wellbeing, not merely the absence of disease or infirmity Primary Health Care Primary Health Care is the development of systems of care emphasising access to first contact, the treatment of basic problems with emphasis on and concern for the total patient and his desires for support and care, and the opportunity to move from primary care to other parts of the care system in a smooth fashion Consent Students may either self refer or be referred to the nurse by the student welfare team, caregivers or guardians, teachers, or external agencies. Regardless of the referral, it is important that students present without coercion. If a student presents to the nurse without coercion, the nurse will be able to interpret this as an implied consent to see them. The question of consent to medical treatment by people less than 18 years of age is governed by common law in Victoria. Legal precedence 9 has clarified that informed consent is given if a minor has sufficient maturity and intelligence to understand the nature of the treatment which is proposed and the consequences and risks which the treatment would entail. This means that there is no fixed age at which a nurse can clearly say that a student can or cannot make their own decision/s about receiving or sharing information, seeking advice, treatment or care. Therefore, each situation should be assessed individually. The decision will depend on the maturity and capacity of the student to understand the nature and seriousness of the treatment. If a student under 18 years of age is assessed by the nurse as not able to provide informed consent, the student s parent or guardian must be asked to provide the required consent. Students may choose to seek their own information by selecting it from pamphlet racks or publicly available spaces. This activity does not require that the nurse assess whether the student is consenting to a service. 8 Diers Donna, Molde Susan, 1983) Nurses in Primary Care. The New Gatekeepers?, American Journal of Nursing, May High Court judgement in Marions case (Department of Health and Community Services v JMB and SMB (1992) 175 CLR 218) 29

35 Ensuring young people are central to the consent and decision making process about their health care is valuable in educating them to take responsibility for their health. This is consistent with the Department of Education and Training policy of involving young people in decision making in regard to their wellbeing and educational needs. Elements of Valid Consent Consent is valid when it incorporates four key elements: Capacity: The person giving consent must be legally competent; they are able to understand the nature and consequence of the proposed action (such as specific disclosure of their information). Volition: Consent must be freely given, without undue pressure. It must not be manipulated by implying disadvantage incurred by the withholding of consent. Information: Sufficient information must be provided in an easily understood form to allow for a reasoned decision. Specificity: Consent must relate to a clearly defined and specific use of information for a specified period of time. Blanket consent for any other use is not acceptable Confidentiality Conversation that occurs between the nurse and the student will not be shared or misused if, in the nurse s judgement, the student is legally capable of making decisions on their own behalf, and is fully able to understand key issues relating to protection of their information. The nurse will assure the student of confidentiality. The nurse will also provide information to the student that clearly outlines information that while strict confidentiality is the rule, some limits may apply in exceptional circumstances, such as when disclosure would be required to lessen or prevent a serious threat to a person or the public (see 4.1.7). Once confidentiality has been assured, any issue raised in the consultation may only be discussed with other staff in a manner that does not lead to identification of the student. All relevant information during a confidential consultation will be recorded in the student s health record. The nurse is not able to breach this confidentiality by providing lists of students names to school staff. If a student under 18 is assessed by the nurse, on reasonable grounds, as not having the capacity to make decisions on their own behalf, and the nurse believes a decision must be made about a health or health information matter, then the nurse should consult the student s guardian (normally a parent). The nurse should explain this to the student as clearly as possible, and document the reasons for assessing the student as not having capacity and for the decision that consultation with the parent is necessary. 30

36 4.1.5 Collection of Information The nurse can collect personal information only where it is necessary to provide a service and where the collection is at least one of the following: Consented to by the student. Required, authorised or permitted by law. Received from another organisation or person through a disclosure made by the student. Necessary for research or statistical use in the public interest when deidentified information is not sufficient and consent is not practicable. Necessary for prevention or lessening of serious and imminent threat to life, health or welfare of a student or the public. Necessary for a legal claim Disclosure of Information Information provided by a student to a nurse may not be disclosed to anyone other than the student themselves, for any purpose other than the one for which it was originally collected. The exceptions that allow for disclosure of information are: The student has provided either verbal or written consent. There is a secondary purpose directly related to or reasonably expected by the student, for example, when providing information to another service for the purpose of referral. It is necessary to lessen or prevent a serious and imminent threat to a person s life, health, safety or welfare, or to the public health. It is required by law, for example, through a court summons or warrant, or for law enforcement or investigation purposes and is not a breach of confidence. The student has an infectious disease and the nurse is required to notify to the Department of Human Services. Information that can be provided to school staff by the nurse includes: Information about general health issues. General information about where referrals have been made. That the nurse is attending an appointment with a student. General information about services involved in networking activities. Information that cannot be provided to school staff by the nurse includes any information that identifies the student, for example: Name Age Class details Family details Physical attributes. The nurse is not able to provide lists that disclose the names of students, or pass on information that the student has shared, without the student s knowledge or consent, unless to avoid serious risk of harm or required by law. 31

37 4.1.7 Duty of Care and Privacy The present duty of care that applies to nurses, principals and teachers continues undiminished by the introduction of the new Information and Privacy Legislation. In fact, the legislation will assist staff to be clear about what their duty of care is in relation to handling client information. Specifically, common law duty of care requires that all reasonable steps be taken to provide an appropriate level of care to a student in the circumstances provided. The new Privacy and Information Legislation outlines the reasonable steps to take to fulfil the duty of care in relation to handling client information. (See Appendix 4 Information Privacy: A Brief Guide) (See Appendix 5 Consent and Confidentiality Flow Chart) Access Access within the SSN program is defined as the ease with which a student is able to visit the nurse without physical or emotional hindrance, obtain information in a confidential manner and seek counselling, support and/or advocacy without fear of identification by any member of the school community. Schools will be expected as much as is possible to provide a space for the nurse that is accessible according to this definition School Community The school community encompasses all members of the public who have a relationship with the school facility. This includes, teachers, office staff, visiting staff, contracted staff, voluntary support, students, caregivers or guardians. 4.2 Primary Prevention and Health Promotion Primary prevention describes a mix of interventions that incorporate populationbased strategies that may be universally or selectively targeted. This involves building belonging and promoting wellbeing across the school. The nurse and school welfare staff will work together to identify consistent issues for students across the school and develop either whole-of-school strategies or strategies selectively targeted towards a specific group of students Social Marketing Whole-of-School Campaigns The nurse will work with the school welfare team and school staff to facilitate health promotion events or activities that involve the whole school community. The events or activities will take into consideration the cultural diversity of students and be in line with priority health needs identified for the school. The events or activities can be linked directly to a broader statewide or national campaign, for example Anti Cancer Council campaigns, like SunSmart or Quit, or Heart Foundation campaigns that focus on exercise. 32

38 4.2.2 Community Action Community action refers to social and environmental change and is an approach that can influence organisational development. The nurse can work with school staff to address an identified issue impacting upon the health and wellbeing of the school community through community action. This would involve developing a process for involving members of the school community in considering what might be adapted or changed in the school to improve response to a specific health issue. For example, reviewed processes for dealing with bullying, or enhanced awareness of a specific issue that is affecting the wellbeing of students in the school. The significance of community action is that irrespective of the form it takes, it should: Be informed by the school community. Facilitate student action. Utilise activities that have operated successfully in the school Coordination and Collaboration Local coordination and collaboration considerations: What health service providers are currently linked into the school and how will the nurse work with these links? What communication forums currently exist within the school to share information? What internal protocols exist to support students at risk or in crisis? What are the current planning cycles and processes for input in the school? Communication Systems with School Staff Collaboration with school staff is vital to the ongoing success of the program and its integration into the school environment. The nurse will work with school staff to identify established forums that operate regularly and would be appropriate for: Nurse to provide regular feedback on activities conducted by the nurse to school staff. The nurse to provide comment on health-related issues in the school. Discussion about the development of new initiatives. Discussion about the involvement of the nurse or school staff in planned activities. Systems to provide appropriate feedback to staff that have made internal referrals to the nurse will also be necessary, to inform staff of outcome and encourage ongoing referral. The nurse and student welfare team will also need to work together to identify existing systems or the need for new systems of communication and internal protocols that support students in an emergency situation. Advocacy and Referral Nurses are able to operate as an advocate for students who require support to initiate contact with a health or welfare service. Nurses will also be expected to provide referral information to a student who is able to be their own advocate. To fulfil this role nurses will need to: 33

39 Coordinate information about the most appropriate local services. Collect contact names and numbers of local services. Be aware of local events, programs and activities that may be relevant. Understand the outcomes that students can expect to achieve from contact with the service. The nurse will need to have established a relationship with local health and welfare services so that they are assured that the service being provided to the student is appropriate and effective. Liaison Networking and liaison with local health service providers will support the coordination of current information and the ongoing collaboration between the school and local services. Nurses can establish contact with the Student Support Services Officer, the Primary Care Partnership in their region, the local School Focused Youth Service, the Child and Adolescent Mental Health Service, or other networks that have been established by the school. Department of Human Services regional health promotion and mental health promotion officers may also provide support to nurses in the development and delivery of health promotion strategies Organisational Development Planning Planning is integral to the efficiency and effectiveness of the program. Structured collaboration between local service providers will be achieved through a regular planning process and a partnership approach to identifying strategies for young people. Details of planning processes for the SSN program are outlined in Section 5 of these guidelines. Capacity Building Building capacity for health in a school environment means the development of systems within the school that will: Support health promotion and the role of the nurse. Ensure that nurses expertise and skills are maintained to provide ongoing quality health information and education Ensure there is adequate time and funds available to complete activities and events. A planned approach to building this capacity is essential and is detailed further in Section 5 of the guidelines. Staff Inservice Nurses are able to provide school staff with professional development that may be relevant either to the health curriculum, or to updated interventions that relate to caring for an illness or injury, such as appropriate asthma management, managing epilepsy or diabetes. 34

40 Primary School Transition Nurses will be involved in providing information to Grade 6 or Year 7 students, to inform them about their role and how they may be accessed. This may involve a presentation to the students (delivered by either the nurse or the Principal) during transition programs or printed information that is included in packs provided to either Grade 6 or year 7 students during transition. Secondary School Transition Programs Schools have recognised that transition from junior to middle and senior years can be a difficult time for students and have factored in transition programs and activities that attempt to manage the change. Where possible and relevant, the nurse will be involved in the development and delivery of programs that focus on the wellbeing of students during this time and promote the role of the nurse. Informing School Community about the Nurse s Role The nurse with the support of school staff will ensure that the school community is aware of the role of the nurse by providing information in regular communications with school council, teachers, the student welfare team, caregivers or guardians and students. Working across Multi-Campus Schools A small number of secondary schools locate students across a number of campuses. The nurse allocated to a multi-campus school will experience difficulty in trying to be visible at all campuses in days per week. The focus of the SSN program is on junior years, so allocating the nurse to the campus at which years 7 and 8 are located is the preferred option, with involvement in transition programs and internal referrals providing access for other students. Staff from a senior campus can contact the nurse to provide support in delivering health education or to provide resources Health Information Local Health Information Considerations: Is there an accessible point in the school at which health information can be displayed and taken by students? Is there a confidential place for a nurse to be located, to ensure that a student can safely request information? If there is not a permanently available confidential space, is there a set time at which a nurse can be located either at lunch time, recess or after school that will provide a safe place for students to access information from the nurse? Information for Students Nurses will make generic health-related information accessible to all students. Pamphlet racks or public spaces with relevant health information will be displayed and re-stocked on a regular basis. Information displayed will reflect health issues identified through the annual planning process or current health promotion activities. Information packs can also be developed and disseminated to new year 7 students containing brochures on relevant health topics, information outlining the role of the nurse and how they can access additional support through the nurse. 35

41 School Camps Camps are considered a valuable method for the nurse to make contact and begin to build a relationship with students, as well as provide health information to either individual students or groups. A nurse will not attend a camp for the sole purpose of first aid support or a supervisory role, for example, as a replacement for a teacher. However, as a member of the student welfare team, nurses may be involved in small group activities or health and wellbeing programs Health Education Local health education considerations: Who is the health educator in the school? How will a team approach be taken to the delivery of health education in the school? Does the school have visiting health agencies that provide a service to students? How will the role of the nurse complement this service? Link to Department of Education and Training Health Promotion Programs A number of schools provide structured health promotion programs for which the Department has developed teacher resources and guidelines for delivery. These focus on drug education and harm minimisation, for both students and caregivers or guardians. To maximise efficiency and effectiveness of health promotion programs across the school the nurse, teachers of health, nutrition or physical activities, and the school welfare team, will discuss partnership approaches to delivery and/or complementary programs that will enhance activities. Involvement in Curriculum Development The Framework for Student Support Services suggests that schools develop a range of curriculum programs that focus on resilience, reduction of risk behaviours and promotion of help seeking skills, as well as address prevention of and response to risk factors, particularly in the health and physical education key learning areas. The skill and expertise of the nurse can be drawn upon to inform health curriculum development. A partnership approach to planning, development and implementation of curriculum is a good practice approach endorsed by both the Department of Human Services and the Department of Education and Training. The Curriculum and Standards Framework 11 describes what students should know and be able to do in the eight key learning areas from Prep to Year 10. The Health and Physical Education Curriculum Standards Framework provides detail about the major elements of the curriculum and the standard expected of a successful learner. The processes for developing curriculum usually derive from a team approach involving teachers responsible for delivering specific curriculum components. While curriculum planning is primarily the responsibility of teachers, it would be appropriate for the nurse to contribute to and assist in the process, when the curriculum is health-related. Schools submit proposed curriculum to the school council for comment and endorsement. 36

42 Student Supervision Schools have a duty of care where a student-teacher relationship exists to take such measures that are reasonable in the circumstances to protect students under the teacher s charge from risks or injury that the teacher should reasonably have foreseen. 10 The Victorian Government Schools Reference Guide states that schools normally satisfy their duty of care by allocating responsibilities to different staff, for example, the Principal is responsible for making and administering arrangements for supervision according to the circumstances in the school, and teachers are responsible for carrying out their assigned supervisory duties in such a way that students are, as far as can be reasonably expected, protected from injury. These supervisory duties can be extended to the nurse by the Principal if there is a specific situation that requires that the nurse have sole responsibility for a group of students. The approach endorsed by both the Department of Human Services and the Department of Education and Training is that a partnership approach is taken to providing health education to large class groups. In some circumstances, it may be appropriate for a nurse to be involved as a sole facilitator with a small group of students assessed by the teaching staff as not requiring intensive supervision. There may also be times when confidential discussion with a small group of students may benefit from having the nurse as sole facilitator. Delivering Health Education A team approach by the nurse and classroom teacher is encouraged in the delivery of health education lessons. The classroom teacher and the nurse can work together to identify which components of the health curriculum can be delivered by the nurse, which by the teacher, or both, or whether the nurse attends the class simply to answer specific questions from the students. The Principal s endorsement of an alternative teaching arrangement is required for a nurse to deliver education sessions to a class of students. Nurses will only be involved in the delivery of health-related curriculum. The standard strongly endorsed by both the Department of Human Services and the Department of Education and Training is that if the nurse is to deliver health education to a class, the teacher is also in attendance. This will allow for the skills of both the nurse and the teacher to be practiced and provide the best quality approach to the delivery of health education. Delivery of curriculum will be assessed and reported upon. This is the role of the class teacher, in which event it will be necessary for the teacher to either be responsible for the delivery of the curriculum material, or in attendance if the nurse is delivering a component of the curriculum. If discipline is required in a classroom situation and both the teacher and nurse are in attendance, it is appropriate that the educator who is experiencing the difficulty 10 Department of Education Employment and Training, Victorian Government Schools Reference Guide sec 4.6, DE&T Victoria, September

43 resolve it in the first instance. For example, if a student is being disruptive while a nurse is in control of the class, the nurse will draw attention to the disruption and request a more appropriate behaviour. If the situation continues, it may become necessary for the teacher to support the request of the nurse. Continued unacceptable behaviour may require that the teacher follow agreed classroom or school disciplinary procedures to rectify the situation. A planned approach to team teaching developed between the nurse and the classroom teacher will help to identify strategies for the nurse to take in addressing difficult situations in a classroom. Collaborative Teaching A collaborative or team approach to teaching may also occur across the SSN program, with nurses sharing a particular expertise that reflects their additional training, work experience or personal interest. Nurses in the program may be invited by a colleague to support the delivery of education, or to provide additional benefit for students by using a gendered approach to the delivery of a topic, for example where male and female students are separated into discussion groups on healthy relationships or sexual health. Small Group Activities In some instances, the most effective approach to delivering health education or providing selective support is through targeted small groups, such as genderbased discussion groups that focus on sexual health or a health issue-based group discussing management of a chronic illness. The decision about whether a small group can be facilitated solely by the nurse is up to each school. As mentioned above (see Student Supervision) the Principal can extend supervision responsibility to the nurse, if the situation dictates that it is appropriate or necessary for the nurse to have sole responsibility for the small group. The decision made by the Principal will be guided by the school s policy on the number of students that one person can supervise. Small group activities that are held before or after school will require the endorsement of the Principal. Activities held during class times will require both consultation with the classroom teacher and endorsement by the Principal. 4.3 Early Intervention Early intervention involves strengthening coping skills and reducing risk for students identified as at risk Risk Assessment Internal Referrals Student welfare staff and/or teachers employed within the school have constant contact with students. This contact can alert staff to changes in a student s behaviour or issues a student is experiencing that can affect their capacity to learn or their general health or wellbeing. 38

44 Members of the student welfare team, school welfare staff or teachers are able to suggest to the student that they can seek confidential support through the nurse. If the student does not consent to information being passed on to the nurse, the staff member can provide the nurse with information that does not identify the student in any way, unless the staff member is concerned that the student poses a serious threat to themselves or to the school community. The nurse can also be informed of issues that school staff have been alerted to that would benefit from a focused health promotion activity, or selective support activities for groups of students. Referrals from Primary School Nurses Primary school nurses are responsible for the identification of health-related issues in all Preparatory (Prep) students across Victoria. They conduct screening tests for vision and targeted hearing tests, and are alerted to any other health and wellbeing issues for the primary school student by caregivers or guardians. Primary school nurses develop care plans for all primary students that require regular monitoring. In consultation with students and caregivers or guardians and within privacy guidelines, information that is collected by primary school nurses that is relevant to the ongoing needs of the student as they enter secondary school will be passed on to the secondary school nurse. Secondary Consultation A nurse can seek secondary consultation with general health, mental health or allied health professionals in the local area to inform their decisions about ongoing support or appropriate strategies for a student. In the event that the nurse seeks a secondary consultation, any information that identifies the student involved will not be disclosed without the consent of the student. The nurse can, however put forward a scenario or a series of issues that will provide the service with sufficient de-identified information to provide the nurse with the support requested and the capacity to develop the most appropriate strategies to support the student. Secondary consultation through Protective Services is in the main not provided, and where available, can only be offered where there is no information given which identifies the child or young person, or their family. Contact with Protective Service will usually require that detailed information about the student is given (see Section for additional information relating to Mandatory Reporting) Supporting Parents and Carers Local Parent Support Consideration: Are there school policies or procedures that parents, caregivers or guardians currently follow to seek support or advocacy? Parent/Carer Advocacy A nurse is able to provide support to parents/carers to seek an advocate through an external service, if access through an advocate will enhance the health and wellbeing of the student. 39

45 Parent/Carer Counselling A nurse may be involved in health counselling with both the parent/carer or guardian and the student. For this to occur, either the student s consent will need to be obtained or the nurse will have assessed that the student is unable to consent and identified a joint counselling session as a positive strategy that will benefit parent and student. Parent/Carer Information Exchange In the event that the student has agreed for the nurse to disclose information to their parent or carer and the student continues to receive ongoing support for the same issue, regular feedback processes will be established to keep the caregivers or guardians informed of the student s progress. In the event that an additional issue is raised by the student, further consent from the student must be sought before information can be provided to the parent/carer. Parent/Carer Support Support to parents/carers can be provided by the nurse, in the form of information or referral to appropriate services. Additional support requirements will need to be accessed either through the Principal of the school, the school welfare team or external services. Providing Information to Parents The nurse will inform the student of the benefits to be made from sharing the information with caregivers or guardians. They will make every attempt to gain consent if in their opinion it is in the best interests of the student. The nurse will not disclose information to caregivers or guardians that has been given to them by a student if in the opinion of the nurse the student understands the situation, is not a serious threat to themselves or the public, and they do not consent for the information to be shared Nursing Practice Nursing practice local considerations: What are the first aid processes in the school? Is there a policy that guides first aid practice? Is there a forum for the nurse to be involved in discussion about first aid policy and practice? Is there a school policy that relates to the distribution of condoms? Involvement in First Aid Activities The nurse is not the school s first aid officer. The Victorian Government Schools Reference Guide (4.5.1) offers guidelines for the school in first aid practice. The nurse may offer advice or support to a student, in the event that the staff member responsible for first aid is unavailable. They will provide nursing care in an emergency situation. If advice is sought from the nurse in relation to a first aid event, the nurse will give a professional opinion about the nature of the injury and suggested a referral to an appropriate medical service for further investigation if needed. The school s first 40

46 aid procedures will apply and caregivers or guardians notified of an injury or illness to a student. If, as a result of the notification of an injury or illness to the parent, a referral recommendation is made, it is the responsibility of parent/guardian to take the recommended action. A student may seek first aid or health advice from the nurse in confidence. If, in the nurse s opinion the student is able to provide consent and a referral is provided, it is the responsibility of the consenting student to take the recommended action and seek further investigation of the injury/illness. If the student does not follow through on the recommended action and the nurse considers the student s health to be at risk, the nurse can inform the Principal. They will follow school first aid procedures and inform a parent or guardian who will become responsible for further investigation, as referred by the nurse. The school nurse does not attend the school on a full time basis, and is therefore not always available or accessible to attend to first aid. This may hinder the provision of first aid if time is spent searching for the nurse. The nurse s expertise and knowledge can be used to provide valuable input to first aid policy and procedures. First Aid Emergencies If a nurse is on school premises during a medical emergency, they will provide necessary nursing care within the boundaries of their skills and knowledge. The nurse will manage an emergency situation until such time as an ambulance arrives or alternative response arrangements are made. If necessary, the nurse will administer emergency medication that has been provided by a guardian or caregiver during a medical emergency. Administering Medication The Victorian Government Schools Reference Guide (4.5) provides guidelines for the distribution of medication to students by a school staff member designated with first aid responsibilities. A nurse may be required to provide medication to a student in the event that the first aid staff member is unavailable. Prescribed medications, or analgesics like paracetamol, should only be given with the permission of the caregiver or guardian. A record is maintained to monitor student intake. It is recommended that the nurse becomes familiar with students in the school with chronic illnesses to ensure a skill level adequate for administering medication in an emergency situation. A nurse is not responsible for the monitoring of regular medication to students. Individual school policies will outline the processes that caregivers or guardians should take for this to occur. 41

47 Emergency Contraception Nurses who are approached by a student requesting emergency contraception will provide the student with details of a relevant local health service to make an appointment with a doctor for a prescription. The nurse will discuss relevant health strategies that will support the student to make decisions about further safe sexual and contraceptive practices. Pregnancy Testing Nurses who are approached by a student requiring a pregnancy test will provide the student with the information to seek an appointment with a doctor or nurse practitioner to have the pregnancy test conducted and to receive ongoing medical advice for contraception and/or pregnancy-related decisions. The nurse will also support the student to disclose information about the pregnancy test to a family member or friend for ongoing support. Distribution of Condoms The distribution of condoms in schools is a school council decision. Individual school councils can develop policy that provides guidance on how or if condoms will be distributed. The nurse s expertise can be used to provide a rationale for good policy development. The nurse will distribute condoms within the parameters of the school policy. In relation to condom vending machines, the Department of Education and Training s policy is that the decision to introduce condom vending machines in stand-alone campuses of secondary schools with senior students (years 10 12) is best made by the individual school council. The Department has developed procedures for schools wanting to install condom vending machines which require them to undertake a full consultation process with all members of their school community, including distributing information in school newsletters and the facilitation of parent information sessions. 4.4 Intervention Intervention is aimed at providing access to treatment and support for students in crisis Health Consultation and Emotional Support Health counselling and emotional support local considerations: What is the school s policy on students leaving the school grounds with a supervising adult? What is the school s policy on students being absent from class to visit the nurse? What are the debriefing processes in the school for teachers? How will support be provided to nurses for home visits? What is the protocol that applies to the school and a referral to Protective Services? Is there a place to keep nurse s records secure? 42

48 Individual Consultations Nurses are able to meet with individual students to discuss issues affecting their health and wellbeing. The nurse will discuss strategies with the student and make an assessment of further actions that may involve either referral or further consultations. During the consultation, the nurse will assess the ability of the student to fully comprehend all elements of their presenting issue and understand the implications of any planned actions. Students Visiting the Nurse during Class Time A student who makes an appointment to see the nurse during class time will be required to use whatever processes the school has developed to inform the teacher or year level coordinator of their absence. The student does not need to disclose details, but can inform the appropriate staff member that they have an appointment with the nurse. The nurse is not able to disclose the details of a student s visit during class times to any staff member without the consent of the student. Minimising Time Away from the Class One of the nurse s primary functions is to ensure that the student s health and wellbeing provides the maximum opportunity for the student to learn. Nurses may need to assess the effects of time spent out of class if a student is initiating a significant amount of regular contact with the nurse during class time. The nurse may need to develop strategies that will support the student to discuss issues during lunch breaks or after school. Care Plans The nurse may make an assessment that the student will benefit from ongoing support or monitoring and will make another time to discuss planned actions further. The nurse will then register the student and establish a care plan that will provide a planned approach to the resolution of presenting health issues and the capacity to review planned actions with the student. Therapeutic Counselling Nurses employed in the SSN program are not expected to have the skills or expertise to conduct therapeutic counselling, make mental health assessments or develop the most appropriate emotional or mental health strategies for a student. However, given that mental health has been recognised as the leading cause of burden of disease in the world by , nurses need to be mindful of mental health issues in the young people that they see individually. Nurses can do this by making comments in their notes about the student s mood or any information about the student s state of mental health that may require further exploration. Nurses can seek secondary consultation through local mental health services. The nurse s health counselling role utilises their health, assessment and listening skills to offer advice on health-related issues, provide a point of first contact for students to discuss emotional or mental health issues, and provide appropriate referrals for students. Nurses will maintain a monitoring role to ensure that the student s wellbeing is maintained and improved. 11 Murray CJL & Lopez AD (1996) The Global Burden of Disease. World Health Organisation, Harvard School of Public Health and World Bank 43

49 Involvement of Student Welfare Team and Internal Referrals As a member of the student welfare team, the nurse will meet with the team on a regular basis. Discussions about individual students who have visited the nurse may occur during those meetings, to obtain the best possible holistic support for the student. The discussion will occur with the consent of the student. If consent cannot be obtained due to an impromptu discussion, the nurse can relate that they are aware of an issue and will attempt to seek consent from the student to provide additional information to the student welfare team, if appropriate. The nurse s professional judgement may also identify that a student will benefit from further discussion with Department of Education and Training staff who either visit the school on a regular basis or are based within the school (for example, the School Support Services Officer). In this event, after seeking consent from the student, the protocols established by the school for referral will be used. Referral to External Agencies The nurse will work with the Student Welfare Coordinator to access and use referral protocols established between local agencies and the school. Network contacts developed by school staff and additional contacts made by the nurse are used to develop referral points for students, or a means of secondary consultation for nurses (see Section Secondary Consultation). Referrals to external agencies may involve contacting an intake worker who will make a decision on the appropriate mechanism of support for the student. For example: Referrals can be made to the local Child and Adolescent Mental Health Service (CAMHS) intake worker, who will record the referral and discuss the initial response, which may be the assignment of a clinician for assessment, a secondary consultation, further advice to the nurse about eligibility criteria and/or information about other services. If in the professional opinion of the nurse, a student is legally capable of consenting and the nurse makes a referral to an external agency, it is the responsibility of the student to attend the agency or follow through with the action recommended by the nurse. In the event that a referral is made and the student does not follow through and subsequently becomes a serious threat to her or himself, the school community or public, the nurse will disclose information to the Principal. The Principal is then able to inform the parent/guardian of the need for external support for the student, without the consent of the student. When a referral is made, the nurse can request the student s consent to follow up with the relevant health worker, service or agency to ensure the appropriate action has been taken to support the student. Services that the nurse may refer a student to can include: Child and Adolescent Mental Health Services (contacted through the local hospital). Community Health Service. Drug and Alcohol Service. Family Planning and Sexual Health Clinic. 44

50 Family Violence and Child Protection Service. Migrant Resource Centre. School Focussed Youth Service. Student Support Service Officers (guidance officers, psychologists, social workers, speech therapists). Visiting teachers (hearing, visual and physical). Women s health services. Youth specific health services. Dealing with a Crisis The nurse may be required to deal with a crisis situation, with a student at risk of harm that may involve: Drug misuse. Issues of family violence or abuse. Mental health crisis. The nurse will identify existing internal school protocols for dealing with a situation that needs an immediate response to protect the student, which may involve: Consulting with the student welfare coordinator. Informing the Principal. Seeking a secondary consultation. Referring to an appropriate service that can provide immediate response, such as CAMHS or Protective Services. Mandated Responsibility The Children and Young Persons Act (1989) defines several sources of significant harm. These sources of significant harm can be characterised as physical abuse, sexual abuse, neglect, emotional abuse and abandonment. Where parents are unlikely to protect children from such harm, the child may be in need of protection. In such circumstances, and where the significant harm results from physical or sexual abuse, notification is mandatory for some professionals. Notification of significant harm resulting from neglect, emotional abuse and abandonment is not mandatory, but may be desirable if other available strategies to minimise the harm are unlikely to be successful. Under the Children and Young Persons Act Section 64(1A) & (1C), nurses, doctors, police, primary and secondary school teachers must notify Child Protection if they form a belief based on reasonable ground while undertaking their professional duties that a child is in need of protection because: The child has suffered or is likely to suffer significant harm and the child s parent(s) have not protected or are unlikely to protect the child from such harm. The child has suffered, or is likely to suffer, significant harm as a result of sexual abuse and the child s parents have not protected or are unlikely to protect the child from harm of that type Children and Young Persons Act 1989, section 63 & (d) as referred to in section 64 (1A) 45

51 The Act requires that a child protection worker be notified of the belief, and the reasonable grounds for it as soon as practicable...after forming the belief. The role of the nurse is not to investigate or to collect evidence to indict an offender, or to prove that a child is in need of protection, but to collect enough information to make an assessment about how best to support the student. In gathering information, it is important to: Make notes; record and date observations. Consult with colleagues and management for support and advice, to compare notes or brainstorm possible strategies in a de-identified manner, or with the student s consent. Develop action plans based on procedures established at the school. Consider strategies to support the family. Talk to the student about mandated responsibility. If the nurse assesses that a notification to Protective Service needs to be made, the nurse will inform the student and Principal prior to a notification being made. Most schools have developed a protocol with regional Protective Services. The nurse will be expected to operate within the protocol framework. Critical Incident Reporting Both the Department of Human Services and the Department of Education and Training have procedures for reporting serious or emergency situations. The nurse will be required to report to the Regional Nurse Manager, incidents that occur during supervision of a situation or during an event that they are responsible for. The nurse is also required to report to the Regional Nurse Manager, any critical incident relevant to, or arising as a consequence of, the provision of services under the Secondary School Nursing Program Guidelines. Where a nurse makes a report to the Department of Human Services, the Principal will be informed of the incident and of the report being made. The Department of Human Services and the Department of Education and Training have separate procedures for reporting serious or emergency situations. The Department of Human Services has three levels of critical incident that are required to be reported. Category One Incidents Category One incidents are the most serious and include: The death of or serious injury to a client note that death of a student or teacher will be dealt with using Department of Education and Training procedures. The nurse would only need to report if the death of a student occurred during her direct supervision of an event, or whilst she was in control of an emergency medical situation. A serious fire or damage, which poses a threat to the health and safety of staff and/or clients note damage to school buildings would also be dealt with through school procedures. Allegations of or actual serious sexual or serious physical assault. The nurse would follow mandatory reporting processes to deal with this incident. 46

52 An event that has the potential to involve the Minister. For example, an illegal activity that is linked to the secondary school nurse or the SSN program. An event that has the potential to subject the Department to high levels of public or legal scrutiny. For example, media activity that criticises specific activities of the SSN program. Reporting Category One Incidents Incident occurs Nurse informs the principal Nurse informs Regional Nurse Manager Regional Nurse Manager to complete an incident report and inform Regional Director via line manager Regional Director to make decision about informing the Minister Category Two Incidents Category Two incidents involve events that seriously threaten clients or staff, but do not meet the Category One definition. They typically include: Incidents that result in physical injuries requiring medical attention and assaults that are not classified as Category One incidents. For example, a student receiving an injury during, or as a result of, a session supervised by the nurse. Incidents that have the potential to escalate to Category One. For example local media articles critical of the SSN program. Reporting Category Two Incidents Incident occurs Nurse informs the principal Nurse informs Regional Nurse Manager Regional Nurse Manager to complete Incident Register Regional Nurse Manager to make decision about further processing Category Three Incidents Category Three incidents are where normal work and routine is interrupted, but the significance of the incident does not extend beyond the workplace or facility, and includes those which: Can be dealt with adequately by the facility or work unit. For example, in the event that a student s behaviour is disruptive during a session that the nurse is supervising. Have no further implications for the Department, region or the community. For example a family issue involving the nurse that is resolved with the Principal. 47

53 Reporting Category Three Incidents The nurse will report Category Three incidents to the Principal and only in the event that resolution cannot be reached in the school environment, will the nurse inform the Regional Nurse Manager. Additional information on the Department s Critical Incident Policy can be located through KnowledgeNet under Legislation Policy and Procedures and listed in the alphabetical listing as Incident Reporting. Department of Education and Training Emergency Management The Department of Education and Training defines an emergency as a Sudden event that endangers or threatens to endanger the safety or the health of any person, or which destroys or threatens to destroy or damage property or the environment and includes: Fatality. Serious injury/serious assault/sexual assault. Siege/hostage/firearms. Bomb threat. Collapse/major damage to building or equipment. Motor vehicle collision/impact with school. Impact by equipment/machinery/aircraft. Earthquake or other natural event. Fire in school building/bushfire. Fumes/spill/leak contamination by hazardous material. Outbreak of disease. Flood/windstorm. Vandalism and criminal damage. It also includes incidents that occur when students are on camp or excursions and while they are travelling to or from school. Nurses should familiarise themselves with Department of Education and Training emergency procedures, by reading through the documents held at each school: Emergency Action Guide Managing School Emergencies: Minimising the Impact of Trauma on Staff and Students. The nurse will not be required to report incidents that occur under the supervision of teachers or school staff. The schools own procedures will be used in these instances. Support to Teachers Teachers may seek information for their own referral purposes from nurses. However, nurses are not able to provide direct health counselling or professional support to teachers. All schools have an established protocol and policy outlining support systems for teachers. Although local to each school, the framework for student support services suggests that the most effective support for staff should include administrative support, personal support, collegiate support, professional support, and structured defusing or debriefing meetings, coordinated by appropriately trained professionals. 48

54 Home Visits Nurses may make a decision to visit a student at home to: Provide support or follow up after an illness or hospitalisation. Provide support and/or advocacy for a student to disclose information to family members. Discuss strategies to support a student in addressing specific health issues. The nurse will discuss the home visit with the student and seek their agreement for the visit. The nurse will use professional discretion in assessing personal safety considerations in visiting a student at home. It is recommended that a nurse not attend an initial home visit alone. In the event that the nurse is intending to be accompanied by a colleague (school welfare staff, Principal, Regional Nurse Manager) the nurse will seek consent from the student to inform the colleague of the home visit. The nurse will not have to disclose the nature of the visit. In the event that the nurse is accompanied by a colleague, the nurse may still conduct a discussion with the family or student alone. On organising a home visit (accompanied or not), the nurse will: Advise the Principal of the home visit, along with details of time of departure and expected return. Advise the Regional Nurse Manager of the details of the visit who will be attending the visit, the time, place and point of return. Keep their mobile phone switched on. Have prior knowledge of who will be on the premises. Breach of School Rules or Unlawful Conduct In the instance that a nurse becomes aware of a student breaching the school rules or student code of conduct through a consultation with the student, the nurse will discuss the implications of the breach with the student and assess the seriousness of the breach. The nurse will provide appropriate support and/or information to the student and encourage disclosure of the information to a family member, friend, or an appropriate school staff member for ongoing support. If the assessment made by the nurse concludes that the student or school community is at risk, the nurse can disclose information without the student s consent to the Principal of the school. If in the course of a consultation the nurse is made aware of unlawful conduct that has occurred outside of the school grounds, the nurse will provide relevant health information, counselling and monitoring support to the student. The information disclosed to the nurse will be maintained as confidential, unless there is a serious threat to the safety of the student or public. The nurse will encourage disclosure of the information to a family member or friend for ongoing support. In the event that a nurse is witness to a breach of school rules or an unlawful act on school grounds, the nurse will disclose the act to the Principal or appropriate senior school personnel. 49

55 Support and Advocacy for Medical Intervention In the event that a student requests support and/or an advocate to facilitate medical intervention, the nurse will encourage the student to disclose information to a family member or friend who will support and/or advocate for the student. In the instance that this is not possible, the nurse may support the student by attending a medical appointment with the student, or making a phone call to seek information on behalf of the student. Students Leaving School Grounds during School Hours If a nurse is leaving the school grounds with a student during school hours including recess or lunch breaks the nurse will inform the Principal. The nurse will not disclose the purpose of the medical appointment unless the student has consented. Individual schools have their own policy on students leaving the school grounds; the student and the nurse will comply with these policies. The student may need to inform a classroom teacher of their absence by stating that they have an appointment with the nurse. The Principal can delegate supervisory responsibilities for the student to the nurse. In the event that the school policy requires parental consent for a student to leave the school grounds, the nurse will work within the policy. In this situation, the nurse will either encourage the student to seek support from a family member or friend to attend an appointment during school hours, or make an appointment outside of school hours, which provides an opportunity for the nurse to attend the appointment as an advocate for the student. The nurse is not able to transport a student in a personal vehicle to attend an after hours appointment. Transporting Students In the event that a nurse is required to transport a student to a health or allied health professional for the purpose of addressing a health concern, the nurse will access either a Government pool vehicle, or a school vehicle if available. To be eligible for access to a Government vehicle, the nurse will need to adhere to regional and/or school processes to register as a driver. In the instance that a Government vehicle is unavailable, the nurse can access a taxi voucher through the Regional Nurse Manager. A student cannot be transported in the nurse s private vehicle under any circumstances. Although uncommon, in cases of necessity school staff will use their own private vehicle to transport students, however this requires parental permission for each student. School staff, including the Principal, are not able to direct a nurse to transport a student in a private vehicle. Appearance in Court A nurse may be requested to appear in court to provide information about observations they have made of a student as a result of contact with that student. A nurse will only be required to appear in court if subpoenaed to do so. A subpoena is an order issued by a court and may also be called a Witness 50

56 Summons or a Summons. A subpoena takes the form of a legal document and requires the production of documents, a person to give evidence in court, or both. A subpoena is addressed to a particular person whose name and address is shown. If that person is required to produce documents, the documents are specified so that they can be identified and produced at a named court by a date shown. The documents must be received by the Registrar of the Court no less than two days before the first day shown on the subpoena. In the instance that the nurse must give evidence, they are advised to prepare a concise and objective statement of their knowledge or understanding of the specific situation. Should the nurse be required to produce documents, only those documents that are specifically requested in the subpoena need to be produced. The subpoena will usually relate to student files held by the nurse these would be of a regional concern and the regional Department of Human Services office will be expected to deal with the subpoena. Should the request be for old files, they will be located in Archives Services in Bourke Street, and the subpoena will become the responsibility of Legal Services Branch. Documents that are required by law can be disclosed without consent and not breach confidence. A nurse who is subpoenaed to appear in Court will notify the Principal of the school without disclosing any specific information, unless consent has been given by the student. The nurse will inform the Regional Nurse Manager, who will notify central SSN program staff. If Legal Services support is required, central program staff will seek advice and inform the Regional Nurse Manager of outcomes. Debriefing and Supervision for the Nurse Secondary school nurses do not require day-to-day or clinical supervision. Nurses are able to contact Regional Nurse Managers for support as required. The Nurse Manager will also provide regular forums for support for nurses, through means developed at the regional level. Forums may take many forms, for example monthly cluster group supervision sessions, discussion at regional meetings, or one on one supervision that occurs each term. In the event that a traumatic event occurs and debriefing or ongoing counselling is required the nurse can access additional debriefing support through the Department s Critical Incident Stress Management Service (CISM), available through regional offices. If the nurse experiences a difficult personal event that affects their capacity to work effectively, there is additional support available through the Employee Assistance Program. Both of these services are available without charge to Department of Human Services employees. Record Keeping Nurses are required to keep detailed electronic records of students whom they have assessed as requiring further support and monitoring beyond the initial visit. The nurse will record information about the students using the School Nursing 51

57 Information System (SNIS) located on the nurse s laptop computer. Once information about the student is recorded on SNIS, the student becomes registered as a client and information is updated and reviewed on each visit. In the event that a student specifically requests that information is not recorded on their file, the nurse will need to assess whether the situation has the potential to become serious. If the student has simply come in to collect information and requests that details not be recorded and there is no potential risk involved, the nurse need only record the student s name and a broad description of the visit. If, for example a student seeks support relating to a sexually tansmitted infection and there is an obvious potential risk, the nurse is required to record details of the visit. Accurate, non-judgemental records must be kept in a form that is accessible by the student on request. They must be held in a secure location and information within them not disclosed without the student s consent, unless required by law or in accordance with the Health Records Act 2001 (see above in Section 4.1.4). Student Health Records developed and maintained by the nurse remain the property of the Department of Human Services. Reasonable steps must be taken to protect the health information from misuse, loss or from unauthorised access, modification and disclosure. Any disclosure of information, and the student s consent or refusal of consent to the disclosure, must be clearly documented in the student s health record. The accuracy of records kept is essential, it is important that the following points are applied at all times for electronic or paper records: Collect only information you need. Inform the person of why you need it and how you will use it. Disclose only as necessary for the purpose of the service. Provide the person with access to their own information. Secure information against unauthorised use or disclosure. Student records should be sufficiently detailed and comprehensive to: Provide effective communication to health providers if required. Enable evaluation of the student s progress and health outcomes. Because the primary purpose of keeping records is to enable better student care, it is important that the information in the records is current, clear, accurate, complete and readily available. To ensure that the record is accurate and complete: Information should be recorded at the time of consultation, or as soon as it becomes available. Each entry should be clearly dated, with time of day where necessary, The record should be periodically reviewed for correctness. Alterations or deletions should not be made. Original incorrect entries should not be erased but lined through so the original entry remains readable, and such action should be explained to the student and for written records signed by the nurse. There should be an audit trail for electronic records. 52

58 Security of Records Nurses will be responsible for the security of all documentation. Any paper records that are kept to support electronic records must remain in a locked filing cabinet at the relevant school, with access limited to the nurse. Laptop computers used for SNIS data entry must not be left unattended. They can either be locked away in a filing cabinet, secured in a car boot whilst travelling, or locked away at the nurse s home. Electronic records kept on SNIS are encrypted, which does provide security against unauthorised access in the event that the laptop is stolen. However any information that has been entered on to the laptop after the last LAN dock is not recoverable, and will need to be recalled and re-entered by the nurse. 4.5 Infrastructure Local infrastructure considerations: What is the process for accessing administration support? How will taking time in lieu be negotiated? Where can the nurse locate the school s injury register? Data Collection Nurses are required to collect data on all direct time they spend with students, indirect time they spend planning and preparing for activities, on professional development or meetings they attend and administration duties, all via the SNIS. The data collected will record whether the nurse has been involved with an individual student, a group of people or an organisation, the issue that was focused upon, the activity conducted, the outcome of the activity, and the direct and indirect hours involved in the conduct of the activity. The nurse will be responsible for recording data during work hours at school, and as soon after the event as possible, to avoid having to remember details of the event some days later and prevent duplication of resources by having to keep both a paper and an electronic record. The information collected on SNIS will enable the nurse to provide regular reports to the Principal, to monitor targets set by the program, to provide accountability at a central level for the SSN program and to allow for evaluation of the program. Nurses have been provided with a laptop for the purpose of collecting data. Data collected on the laptop has been electronically secured and is unable to be accessed except by Regional Nurse Managers and the SNIS Support Team Leader located at Central Office. There is an audit trail for electronic data, which means that each time the data is accessed a record is kept of by whom and when the data was viewed. Nurses will be responsible for ensuring that the laptop is secured at all times. The laptop is not to be left at the school, or unattended by the nurse at any time. In the event that the nurse must leave the office for lunch or a meeting and plans on returning to the school, the room or the laptop will need to be secured against any access. At the end of each day, the laptop will be taken home or to the regional office with the nurse. 53

59 The accuracy of the data collected is integral to the validity of the reports produced, hence nurses will be required to input data to SNIS on a daily basis and attend training in the use and updates of SNIS when required. If nurses require additional support in entering data, the SNIS support can be contacted through the Department of Human Service Help Desk on The interpretation of the codes under which data is collected is standardised through a data dictionary that is located in the SNIS User Manual. In the event that a nurse requires further clarification of how to record a particular activity, the nurse can contact the SNIS support team through the Help Desk. SNIS is reviewed regularly and nurses will be informed by the Regional Nurse Manager or the SNIS support team leader about how and when to update the program. Nurses will be required to access the network by connecting (using the blue lead) to a network point at a Department of Human Services office (LAN docking). Nurses will need to LAN dock as regularly as possible, at a minimum once a fortnight, for the purpose of keeping a current record of activities at a central level. Nurses will also be required to LAN dock prior to taking holidays, to ensure that the information collected is safe Regional Office Accommodation The Department of Human Services regional office is the point at which nurses can obtain access to the necessary network points that will enable them to meet the LAN docking requirements stated in The regional office will be required to make a desk available or arrange a suitable alternative location for LAN docking to occur. Nurses will also require access to office space during school holidays, as school closures will limit their capacity to continue with administrative or planning functions necessary to the success of their position. In the event that there is no office space available, the nurse can negotiate with the Regional Nurse Manager to work from home, (see Section Occupational Health Safety Working from Home for further information) Administration Nurses will be responsible for doing their own word processing and data entry, however they will require administrative support through the school in the form of access to: Adequate stationery resources to fulfil their role (for example, pens and paper). A photocopier. Internal mail services. Fax machine. School computer for Edumail and Department of Education and Training policy documents. The nurse will work within the processes of the school to obtain access to administration and equipment as required. 54

60 4.5.4 Work Place Entitlements Professional Development Nurses employed in the SSN program are expected to maintain current knowledge and skills in core areas required of their role: Emergency clinical practice, including cardiac pulmonary resuscitation (CPR), asthma attack and responding to anaphylaxis. Mental health. Health promotion. Adolescent health and development. Sexual health. Child Protection systems. Cross-cultural issues. Drugs and alcohol. Primary health care. Public health. Chronic conditions such as diabetes and asthma. Community health. SNIS Updates Regular updates in the following areas are considered mandatory to maintain current knowledge and advise the school on any changes to first aid practice or emergency techniques: Cardiac Pulmonary Resuscitation (CPR) annual updates required. Asthma annual updates required. First Aid as required to keep Certificate current. Mental health emergencies or crisis as required to keep knowledge of appropriate response current. Professional development needs will be identified through work plan discussions that involve the nurse, Principal and Regional Nurse Manager. Professional development undertaken will reflect the mandatory requirements of CPR, Asthma and First Aid, along with the school s health priorities identified through the annual planning process and gaps in the currency of the nurse s knowledge of the core topics listed above. Payment for professional development will be negotiated between the regional Department of Human Services office and the nurse. The school may request that a nurse attends specific professional development and if agreed by the nurse, the school may cover associated costs. Professional development will either be available through activities organised by the regional office, and/or relevant activities conducted in the school environment, and/or publicly advertised courses for which attendance is organised by the nurse. Professional development activities will be authorised by the Regional Nurse Manager. Time spent away from the school is negotiated with the school Principal. 55

61 Work Related Travel Nurses will only be approved to use their private vehicle for work purposes under the following circumstances: There is no access to a Government vehicle, taxis, or public transport. The nurse is able to provide evidence of full comprehensive car insurance. The Regional Nurse Manager has been informed and approved the use of a private vehicle for work-related travel. Where a nurse does have approval to use their private vehicle for work travel, they will be reimbursed according to the rates agreed from time to time between the Department of Human Services and the Australian Nursing Federation. Details are available from the Department s Human Resources Branch on (03) Payment of travel reimbursement means that: The nurse will be compensated for costs associated with running and insuring the vehicle. The Crown is indemnified from all responsibilities relating to property damage or personal injury. Time in Lieu Overtime, being additional hours will require authorisation by the Regional Nurse Manager. Overtime, or time in lieu of overtime, is to be granted in accordance with the relevant award or certified agreement provisions. Time taken away from the school will be negotiated with the Principal to minimise impact on students. Attendance at School Camps School camps provide an opportunity for the nurse to build relationships with students, and to be involved in transition activities that are acknowledged as generating difficulties for some students. A nurse may request to attend a school camp for the purpose of: Conducting health promotion activities. Facilitating health education programs. Provide health counselling. The nurse will not attend the camp for the reason of providing first aid, or to replace the role of a teacher to supervise students, although the nurse has an obligation to provide emergency first aid care if present at an emergency. As a member of the student welfare team the nurse may be involved in small group activities or health and wellbeing programs. Attendance at a school camp will not extend beyond two days and will not interfere with time spent at a second school, without the permission of the Principal of that school. The nurse will be required to inform the Principal of the period of absence from the school. If the nurse is working at two schools and attendance at the school camp means that the nurse will not be able to attend the second school, negotiation and endorsement of changed days with the Principal of the second school will be required, prior to approval being sought from the Regional Nurse Manager. 56

62 Where a nurse does request to attend a school camp, the following will apply: The nurse will make the request to the Regional Nurse Manager. The Regional Nurse Manager will consider the request. In considering the request, the Regional Nurse Manager will recognise that students may access the nurse outside of normal working hours for healthrelated matters and may approve time in lieu for a set amount of three hours per day for being present outside of normal hours. There is no award prescription or formal agreement with the ANF. Occupational Health and Safety Designated Work Groups The Occupational Health and Safety Act 1985 requires that a Designated Work Group (DWG) is established in a workplace to provide employees with a forum to discuss and monitor health and safety issues and improvements. Within the SSN program, the DWG will exist as a component of regular regional meetings attended by all nurses in the secondary school nursing program. A permanent agenda item at the meeting will facilitate discussion of occupational health and safety concerns or issues that relate to Departmental responsibility, specifically: Workload Stress Travel Transporting equipment Working at home. Occupational health and safety issues raised through the DWG that relate to school facilities and/or equipment will be managed between the nurse, the Regional Nurse Manager and the school Principal, using the process documented below under the heading of Occuptional Health and Safety in the Workplace. Occupational Health and Safety Representative At a regional level, the nurses will nominate an occupational health and safety representative to address issues raised at the DWG with the Department s regional representative. The nominated nurse will also be required to: Represent their DWG in regional health and safety consultation processes as requested. Provide feedback on health and safety issues to nurses in the DWG. Assist in the development of health, safety and wellbeing improvements with the regional Department of Human Services occupational health and safety representative. Occupational Health and Safety in the Workplace The Department of Human Services is responsible for providing a safe workplace for school nurses, but it has little control over a school environment. To rectify this unique situation, a process agreed by the Department of Human Services and the Department of Education and Training will guide the reporting of any safety issues in the workplace. A nurse experiencing difficulties with safety in the workplace will: 57

63 Discuss the issues with the Principal and negotiate improvements. If this is not successful, the nurse will report the issues to the Regional Nurse Manager, who will notify the regional occupational health and safety representative and a further negotiated process will commence. In the event that a satisfactory conclusion cannot be reached, the Departments have agreed that the Department of Education and Training occupational health and safety consultant, Noel Arnold and Associates, can be contacted (see Appendix 4, ) to inspect a work site for safety issues and make appropriate recommendations. In the event that the recommendations made required modification to the space or school equipment, the school would be required to make the space safe according to the recommendations. If this is not possible in the short term, the nurse may be relocated until such time as the space is made safe. In the event that the recommendations made reflect an issue with the nurse s workload, the Regional Nurse Manager will be responsible for rectifying this situation. Nurses travelling between two schools may have work-related equipment and resources to constantly relocate. This has the potential to create occupational health and safety concerns and if so, should be addressed by the Regional Nurse Manager. Working from Home In the event that a nurse completes work at home, for example during school holidays, the nurse will be required to seek approval from the Regional Nurse Manager. The Regional Nurse Manager will be required to ensure that the nurse has completed a Working From Home Checklist for Setting Up a Workstation. The checklist is available on the Human Services Intranet or through the Regional Nurse Manager. Occupational Health and Safety and Injury Reporting If a nurse is injured whilst working in a school they must: Complete the school s injury register as a visitor to the school. Inform the Principal of the injury. Contact the Regional Nurse Manager to report the injury. Complete a Diseases, Injury and Near Miss Accident Report (DINMA). The DINMA can be completed by the Regional Nurse Manager in the absence of the nurse. Compensation for an injury is not possible unless the DINMA is completed. The Regional Nurse Manager will then be responsible for contacting the Organisational Health Unit within the regional office, who will inform their Department of Education and Training regional contact of the injury in the school and its cause. The solution to the cause of the injury will be discussed and in the event that it relates to school maintenance or equipment, the school will take responsibility for rectifying the situation. If the solution relates to workload or stress issues, the Department of Human Services will assume responsibility for the solution. 58

64 Performance Management The Regional Nurse Manager or the Principal of a school may identify a concern relating to a nurse s work performance. In the event that a Principal questions the work performance of a nurse, they will contact the Regional Nurse Manager, who will: Investigate the concerns raised by the Principal and provide the nurse with the opportunity to respond. Discuss the issues with the nurse and provide the nurse with the opportunity to respond. Where the concerns are substantiated, the Regional Nurse Manager will put in place appropriate mechanisms to support the nurse in addressing the issue, for example, having another nurse act as a mentor. Develop a mechanism for keeping the Principal informed of the processes developed. Develop a process to receive regular updates on performance from the nurse and the Principal. The Regional Nurse Manager will be expected to put in place processes to manage under-performance according to policy, as documented and available on the Department of Human Services Intranet. In the event that performance issues cannot be resolved, the Regional Nurse Manager will contact human resources staff at the regional office and initiate appropriate action according to Department of Human Services employment policies. The nurse will be entitled to seek industrial or personal support throughout the process. 59

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66 SECTION 5: PROGRAM DELIVERY PRINCIPLE: The delivery of services by the nurse within the school will be informed by a planned approach that is evaluated, builds on local evidence and respects workload expectations. 5.1 Planning Planning in the secondary school nursing program will provide an opportunity for the nurse, school staff and the school community to work in partnership to ensure: The most efficient and effective use of the nurse s time whilst in the school. That the development of strategies will improve the health and wellbeing of students. That the nurse s role is proactively integrated with the school s charter and curriculum. That duplication of service is reduced and the integration of health and welfare services provided in the school is enhanced. That the priority health needs of students at a local level direct the programs and activities conducted by the nurse. There is an opportunity to identify and develop the necessary infrastructure required to ensure the program s ongoing success in the school. Planning will involve: Problem definition identifying needs of young people in the broader environment and in the local school environment. Priority setting assessing the most important health issues for students in the school; developing goals and objectives to address priority issues. Strategy development developing actions to address health priorities. Capacity building ensuring that the school has the infrastructure to support improvements in health, through the school nurse. Evaluation reviewing the actions undertaken during the process, impact and outcome stages of the program, to ensure they address priority health needs and program objectives. Two Stage Planning Process Nurses within the SSN program will facilitate a two stage planning process that will involve all elements of the above. It will consist of a broad annual plan and a specific health promotion plan for individual activities and events. The aim of this approach is to produce a plan that uses the bigger picture to inform local initiatives. It will provide nurses with the opportunity to integrate relevant knowledge held by key stakeholders, create efficiencies in workload by building on existing external and school initiatives and clearly articulate health promotion activities to students, school staff and external networks. Annual Planning This occurs in partnership with the Principal, school welfare coordinator, school welfare team, students and caregivers or guardians. A template has been developed for the annual planning process (see Annual Action Plan, Appendix 6). This plan will: Identify which stakeholders will be consulted in the planning process. Establish how health needs will be identified. 61

67 Identify priority health issues for students. Link the areas of work to the objectives of the SSN program, list target groups, identify proposed health promotion activities and a proposed timeline. Assess the infrastructure requirements of the nurse. Health Promotion Planning This provides a mechanism to ensure that the activities of the nurse are linked to the objectives of the program, the needs of students and will facilitate a quality improvement process using structured evaluation. The Health Promotion Plan will be completed by individual nurses, using a planning tool that has been developed by Primary Care Partnerships. The planning tool is included here as Appendix 7 and will specifically identify: Clear objectives for each health promotion activity. Strategies to be used. Timelines for each strategy. Targets. Qualitative and quantitative impacts of the activity. Figure 1 Planning and Evaluation for Health Promotion Planning Problem definition and priority setting Strategy development Ensuring the capacity of the system for quality improvement in health Process evaluation Implementation Implementation of program strategies Health promotion Health literacy Outcomes Social influence and action Impact evaluation Healthy public policy and organisational practice Intermediate Health outcomes Healthy lifestyles Effective health services Healthy environments Outcome evaluation Long Term Health Decrease in mortality, Increase in quality of life, and Social Outcomes morbidity, disability functionalindependence, equity Source: Aged Community and Mental Health Division and the Public Health Division, Primary Care Partnerships Draft Health Promotion Guidelines, Victorian Government Department of Human Services, December

68 5.1.1 Problem Definition Defining what issues exist for secondary school aged people will provide the knowledge on which to plan work priorities for the nurse. It is through a combination of needs identification, data analysis and priority setting that these problems will become clear. The SSN program is linked into Primary Care Partnerships, School Focussed Youth Services and regional networks. These networks produce comprehensive evidence-based planning documents that can support the nurse and the school by identifying health issues experienced by young people in the community. Both the SSN program and the Department of Education and Training are committed to the overall wellbeing of students and acknowledge the value of a social model of health. This translates, in planning, to identifying the health needs of students on two levels. The first level identifies the health issues that are specific to the broader geographical and cultural environment and have an affect on young people. The second level identifies health issues that are specific to the school environment (see Figure 2 for potential partners in gathering information about these issues). Broader Environment The Annual Action Plan lists the potential partners to be approached by the nurse and/or school staff to gather information about health needs of young people in the broader environment. These partners have already produced detailed plans specifically focussed on the health of the community and will allow the nurse to build on existing expertise and will streamline access to developmental health initiatives. Looking at the broader environment that students live in will help to identify specific factors that will influence the health and wellbeing of students and/or identify population groups most at risk. School Environment Given the direct contact that occurs on a regular basis with students in a school environment, student welfare coordinators, student welfare teams, year level coordinators, Principals, school council, caregivers or guardians and teachers have the potential to provide information about issues that occur within the school that can and/or do impact on student s health and wellbeing. Nurses can access information directly from students, by providing them with opportunities to discuss their needs through focus groups, class discussions or written surveys. 63

69 Figure 2 Development of an Annual Plan DHS regional data Focus groups: caregivers or guardians, students, staff PCP Health Plan School Statistics DE&T Annual Plan Broad Health Issues Identified Annual Actual Plan Local School Health Issues School Council Local Govertment Health Plan Evaluation of health education sessions External Health Agencies Questionnaires: students, staff, caregivers or guardians Priority Setting The selection of priorities should form a realistic and practical basis to inform the work of the nurse and key stakeholders involved. The number of priorities selected should reflect the workload capacity of the nurse and not exceed three different health issues. Decisions about selecting priority health issues to work on will need to involve all key stakeholders. The following questions should be considered: Which issues have the greatest impact on health and wellbeing? Will addressing this issue reduce health and wellbeing inequities? Will addressing the priority promote equity in access to services? For which issues is it possible for the nurse to make a meaningful difference? What is the level of community concern and support for the action? Is the priority short or long term? The decision about the number of health issues and activities that are prioritised cannot be made in isolation from additional expectations of the nurse, which are: To attend regional reference group meetings. To attend regional Department of Human Services meetings. Regular data entry activities. To keep professional skills and knowledge current by attending relevant professional development. To attend student welfare team meetings. To participate in other relevant school meetings, for example curriculum development Strategy Development The development of strategies is the stage of the planning process where decisions are made about what concrete actions will be taken. The critical point of strategy development is to ensure that identified goals and objectives developed to meet priority health issues in the school are addressed. 64

70 The annual planning process will require that nurses work with relevant members of the school community to: Develop broad strategies that reflect the objectives of the program and the priority health needs identified. Link to health programs and curriculum operating within the school. Link to strategies developed by external agencies that will complement the identified needs of the school. The second planning process, which will build on the priority health needs identified, will require that nurses focus on the health promotion activities to be conducted during the year. They will need to: Consider the mix of health promotion interventions that will best address each health need. Develop goals and objectives for each intervention. Develop a series of strategies to achieve these goals and objectives. Nurses will work collaboratively with relevant school staff to develop these health promotion strategies, ensuring that they: Are linked to evidence-based plans developed in the region. Supported by the school community. Are able to be implemented successfully Capacity Building Building capacity to improve health is the behind the scenes effort by practitioners that increases the likelihood that effective health programs will be sustained. Building capacity for health in a school environment means: The development of systems and structural relationships within the school that will support health promotion and the role of the nurse. To ensure that expertise and skills of the nurse are maintained, to provide ongoing quality health information and education. That there are adequate time and funds available to complete activities and events. The majority of schools have been influenced in some way by the: Health Promoting Schools project. Student Support Services Framework. Statewide introduction of various health promotion projects. This influence has supported schools to develop some capacity to improve a focus on health in the school environment. Schools have done this by acknowledging the importance of: Health education. Health and wellbeing-related policies. Procedures to maintain and monitor student health. Health curriculum. 65

71 These established processes and structures and the skills developed by school staff should be used as a basis for planning to further develop the capacity to improve health within a school environment. There are three main areas that planning will need to address to successfully build a capacity to improve health: Organisational development looking at how the school integrates health into the regular activities of the whole school community. Workforce development building the skills and knowledge of school staff to encourage an understanding of health. Resource allocation incorporating not only the budget that is allocated at a regional level for the secondary school nursing program, but the resources that are required within the school environment to support health initiatives. The SSN program s intent is to improve health in the school community by ensuring that: The school s infrastructure has the capacity to enable health promotion activities or events to occur. The role of the nurse is sustainable. There is a capacity within the school to solve problems relating to health issues. In planning to sustain the work of the nurse within the school and to build the school s capacity to improve the health of students in an ongoing way, the following need to be considered: 66

72 Figure 3 Questions to Support Planning for Capacity Building Infrastructure Sustainability Problem solving ORGANISATIONAL Does the school support Is the nurse and the Are school community DEVELOPMENT development of health development of health members involved in the promotion initiatives promotion programs SSN program and are through their strategic integrated into school they contributing to directions? planning processes? identifying and addressing health issues in the Is there a policy that Does the school planning community that impact ensures the nurse is able to processes include support on the school work with the school using for the development of the community? a whole-of-school approach? nurse s planning activities? Are reports of the Is health promotion Do health promotion program presented in reflected in school policy activities developed in the school decision making documents? school support Key Learning forums? Areas? Are the specific functions of the nurse reflected in school Are there clearly identified policy documents? lines of communication and reporting for the SSN Are there good links program within the school between the school, its local system? community and the health sector? How are the skills of the nurse integrated into Are there structures to relevant policy development provide access to the nurse and decision making and health promotion processes? activities across multiple campuses? Does the school understand the role of the school nurse? WORKFORCE Do school staff have the Does the nurse contribute DEVELOPMENT opportunity to access the to the planning and support nurse to enhance their of teacher workforce knowledge of specific health development programs issues or for health based on school health promotion expertise? priorities? Are there opportunities for nurses to develop skills to implement and sustain the program? 67

73 Infrastructure Sustainability Problem solving RESOURCE Does the school ensure Are there resources Is there school staff time ALLOCATION that there is mandatory allocated to support the allocated to supporting health education provided integration of the SSN the nurse to contribute to students? program into regular towards problem solving work practices, for with the community and Does the school ensure example administration other sectors? that the nurse has the and practical support? capacity to keep records confidential? Are there resources allocated to health promotion? 5.2. Evaluation Is there appropriate access to DE&T and school policies and relevant documentation? Evaluation is the process of determining whether a program has achieved its goals and objectives. Evaluation should be conducted throughout the life of the program and is essential to the ongoing quality improvement of the program. Processes for evaluation should be considered during planning to occur at various intervals throughout the program s implementation. There are three key levels of evaluation: process, impact and outcome Process Evaluation This covers all aspects of the process of delivering a program. The six main questions to be asked during process evaluation include: Are all activities conducted within the program reaching all the target or interest groups? Are participants satisfied with the program? Are all activities of the program being implemented? Are all materials and components of the program of good quality? Does the school have the capacity to support the program and its activities? Does the planning lead to implementation? Impact Evaluation This level of evaluation measures the achievement of program objectives within the action plan. What impact has the activity had on individual students, the school community and the school as an organisation? Impacts can be described and evaluated in three components: Health literacy has the students ability to maintain their health been improved by increased access to information, and a better understanding of the information? 68

74 Social action and influence how have activities affected the actions of the school community? Healthy public policy and organisational practices have school policies been influenced and/or changed to overcome barriers that impinge on the health of students? A guide to identifying and measuring impact indicators is currently in development and will be available for use by nurses in the program Intermediate Outcome Evaluation This level of evaluation measures the change in intermediate health outcomes for students. This includes: Personal behaviours have student behaviours changed? Has the lifestyle of students changed to reduce the risk of ill health? Has the student achieved improved educational outcomes and/or school retention? Access has access to appropriate health services been improved? Healthy environments has the students environment been improved, e.g. reduction in bullying or aggressive behaviours? For each activity the nurse is involved in, it is important to document the evaluation outcomes for the purpose of review and to feed into regional and statewide evaluation processes Long Term Outcomes Nurses currently working in the SSN program will not be expected to achieve long term outcomes. However, the long term outcomes from the program will be expected to achieve an improvement in: Mortality Morbidity Disability Quality of life Functional independence Equity. 69

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76 Section 6: References 1. Aged, Community and Mental Health (2000), Victorian Secondary School Nursing Program: Consultation Paper, Victorian Government Department of Human Services, Melbourne. 2. Australian Nursing Council (1993), Code of Ethics for Nurses in Australia, Australian Nursing Council Inc. 3. Australian Nursing Council (1995), Code of Professional Conduct for Nurses in Australia, Australian Nursing Council Inc. 4. Central Sydney Area Health Service and NSW Health (1994), Program Management Guidelines for Health Promotion, NSW Department of Health; Central Sydney Area Health Service. 5. Child Protection and Care (2001), Safe from Harm: The Role of Professionals in Protecting Children and Young People (Professional Development Kit), Victorian Government Department of Human Services, Melbourne. 6. Commonwealth Consolidated Acts, Disability Discrimination Act Commonwealth Consolidated Acts, Human Rights and Equal Opportunity Commission Act Department of Education, Employment and Training (1996), Victorian Government Schools Reference Guide, Department of Education, Melbourne. 9. Department of Education, Employment and Training (1999), Framework for Student Support Services in Victorian Government Schools, Department of Education, Melbourne. 10. Department of Education, Employment and Training (2001), Making the Partnership Work: Roles and Responsibilities, State of Victoria. 11. Department of Human Services Legal Services (2000), Process for Dealing with Subpoenas in DHS, Victorian Government Department of Human Services, Melbourne. 12. Developmental Research and Programs Inc., Communities that Care: Risk and Protective Factor Focused Prevention Using the Social Development Strategy, Seattle, USA. 13.Education Act 1985, Version No. 085, Act No. 6240/ Gregg, E. Toumbourou, J. Bond, L., Thomas, L., Patton, G. (2000), Improving the Lives of Young Victorians in Our Community: A Menu of Services, Centre for Adolescent Health, Melbourne. 15. Health (Infectious Diseases) Regulations 2001, Statutory Rules 2001, S.R No. 41/2001; Health Act Health Records Act 2001, Act No. 2/ Information Privacy Act 2000, Act No. 98/ Legal Services (2000), Duty of Care, Victorian Government Department of Human Services, Melbourne. 19. NSW Health (1999), Indicators to Help with Capacity Building in Health Promotion, NSW Health Department, Sydney. 20. Nurses Act 1993, Version No. 023 Nurses Act 1993 Act No. 111/193, The Parliament of Victoria 21.Occupational Health and Safety Act 1985, Version No. 052, Act No / Public Health, Aged Community and Mental Health (2000) Primary Care Partnerships Draft Health Promotion Guidelines, Victorian Government Department of Human Services, Melbourne. 71

77 Public Health Division Evidence-Based Health Promotion: Resources for Planning No. 2 Adolescent Health, Victorian Government Department of Human Services, Melbourne 24. Racial Discrimination Act Ryan PRN FRCNA (1991), Primary Health Care Nursing Concepts and Practices, Royal College of Nursing Australia. 26. Secondary School Nursing Program (2001), Secondary School Nursing Program Orientation Materials, Department of Human Services Secondary School Nursing Program Victorian Government Department of Human Services, Melbourne. (Unpublished) 27. Sex Discrimination Act Success Works (2001), Evaluation of the School Focused Youth Service, Education Victoria and Victorian Government Department of Human Services, Melbourne.

78 Section 7: Appendices Appendix 1 Risk and Protective Factors Risk Factors The following risk factors have been identified through research as reducing the resilience of young people. Community Low neighbourhood attachment. Community disorganisation. Personal transitions and mobility. Community transitions and mobility. Laws and norms favourable to drug use. Perceived availability of drugs. Family Poor family management. Poor discipline. Family conflict. Family history of anti-social behaviour. Parental attitudes that are favourable towards drug use. Parental attitudes that are favourable towards anti-social behaviour. School Academic failure. Low commitment to school. Peer/Individual Rebelliousness. Early initiation of problem behaviour. Impulsiveness. Anti-social behaviour. Attitudes that are favourable towards anti-social behaviour. Attitudes that are favourable towards drug use. Perceived risks of drug use Interaction with anti-social peers. Friends use of drugs. Sensation seeking. Rewards for anti-social involvement. Adapted from: Improving the Lives of Young Victorian in Our Community, Centre for Adolescent Health. Protective Factors There are several protective factors that enhance resilience: A sense of belonging at school. A relationship with at least one competent, caring adult. Positive social behaviours and problem solving skills. A sense of spiritual and communal belonging. Strong family relationships and minimal family stress. Peer connectedness. Adapted from: Framework for Student Support Services in Victorian Government Schools Teacher Resource. 73

79 Appendix 2 What Is a Registered Nurse? The Nurses Board of Victoria (NBV) is a self-funded statutory authority incorporated under the Nurses Act The Board s main purpose is to protect the public of Victoria through the regulation of the nursing profession. This is achieved by registering nurses, accrediting nursing programs in universities and vocational education and training institutions, setting standards and guidelines for nursing practice, and providing a complaints process. Registration There are currently 71,000 registered nurses in five divisions of the Register, however Divisions 3,4 and 5 were closed to new registrants in Division 1 includes graduates from accredited university courses, plus midwives, maternal and child health and psychiatric nurses by endorsement and in the near future, nurses practitioners as well. Division 2 includes graduates from accredited courses in the VET sector. Only nurses registered by the NBV are entitled to use the title registered nurse or midwife in this State. Nurses and midwives are required to renew their registration annually. Registration is valid until 31 December each year. If renewal of registration has not been completed before 31 December, the Board may renew registration, provided the application is made prior to 31 March and is accompanied by an additional late fee. It is illegal to practice nursing without being registered, and substantial penalties for nurses, nurses agents and employers can apply. Employers should require registered nurses to supply evidence of registration by 31 March each year. Employers and members of the public can check if a nurse is registered via the NVB web site at The public register is updated annually. Before a nurse s registration is renewed, the Board must be satisfied that the nurse has had sufficient nursing experience in the last five years and that they are competent to practice. The Role of the Registered Nurse Division 1, 3 or 4 It is the mutual responsibility of all nurses and midwives to understand each other s scope of practice in the respective divisions. Nurses and midwives registered in Division 1, 3 or 4 of the Register are licensed to practice nursing in the field/s in which they are registered. These nurses practice as part of a team, independently and inter-dependently, in accordance with professional standards. Nursing practice involves technical knowledge, practical, ethical and personal understandings that inform a nurse s actions. Nurses and midwives engage in particular contexts with people from diverse cultures and backgrounds in supporting their health and wellbeing through changing situations. The roles of Division 1, Division 3 And Division 4 nurses include clinician, care coordinator, facilitator, counsellor, health teacher, advocate, change agent, clinical preceptor and colleague. 74

80 Practice Standards The Board has adopted codes of practice and guidelines to assist nurses in their practice. There are also statements regarding nurse s scope of practice and role in undertaking clinical practice / procedures. All NBV policies are available on Complaints To maintain the highest standards of nursing care the NBV reviews all complaints regarding registered nurses. Valid complaints are fully investigated and the Board ensures that everyone involved is treated fairly and with respect. Informal and formal hearings can be conducted and actions taken may include fines, further education, conditions on or suspension of registration. If a nurse is suffering physical or mental illness then the Board will help him or her in a rehabilitative manner. Wherever possible, the NBV looks for positive outcomes for everyone concerned, but the final responsibility is to the Victorian public. More information about the complaints process can be found at Nurses Board of Victoria Level 2, 595 Little Collins Street Melbourne 3000 General inquiries: (03) Registration inquiries: ( 03)

81 Appendix 3 Accountability Flow Chart for Nurses DHS DHS Employee FOR Work performance WHY Adhering to DHS policy and processes including legislative responsibilities listed in Appendix 4 Nurse Accountable to Public Including: Students, Caregivers/ Guardians, General Public Registration with Nurses Board of Victoria To act responsibly and in the best interests of students, school community and general public, including within legislative responsibilities listed in Appendix 4. WHY FOR Australian Nursing Council To abide by code of ethics and professional code of conduct. DE&T WHY School is Workplace FOR Comply with school policy and procedures Conduct activities with a duty of care and within legislative responsibilities listed in Appendix 4 76

82 Appendix 4 Information Privacy: A Brief Guide 1. What Is Information Privacy? Information privacy law and policy recognises the need to protect personal information from misuse. Personal information is information about a person that identifies them, or could be used with other readily available information to identify them. Information privacy protects individuals from harm that may arise from misuse of their information. It also enables services to collect information they need clients are usually more willing to provide full and frank information if satisfied it will be treated in confidence. 2. New Privacy Laws The new Victorian laws are the Information Privacy Act 2000 (IPA), covering nonhealth information; and the Health Records Act 2001 (HRA), covering health information. The HRA is the relevant privacy law regarding all personal information handled by school nurses. While the Act will not commence fully until mid-2002, Department of Human Services policy currently applies and requires practice to be in line with the spirit of the Act in advance of that date. What about current obligations? The HRA does not replace other laws and obligations regulating personal information handling, it supplements them. It sits alongside existing protections such as medical confidentiality, and existing responsibilities to disclose information, such as mandatory reporting. 3. Privacy in Practice The HRA protects health information by setting out restrictions on how it is handled, from collection to disposal. The key messages in the Act relevant to school nurses are: Collect only the information which you need for your purpose (i.e. provision of health advice, referral and advocacy). Keep the person information ensure they know why you need it and how you will handle it. Do not disclose the information without the person s consent (exceptions below). Provide the person with access to their information on request. Keep the information secure to prevent unauthorised use or disclosure. These are all requirements which reflect current good practice and professional obligations. * NB: This list has been edited to show only those exceptions most directly relevant to student information handled by school nurses. The full list of exceptions can be found in Principle 2.2 (Schedule 1) of the HRA. 77

83 4. Confidentiality of Health Information The HRA prohibits disclosure of a person s health information to anyone other than the person themselves, for any purpose other than the provision of the health service for which it was collected, unless one of the prescribed exceptions applies.*: The person has consented to the disclosure (see below). The disclosure is necessary to lessen or prevent a serious and imminent threat to a person s life, health, safety, or welfare, or to the public health, safety or welfare. The disclosure is required by law (a court summons or warrant), or for law enforcement or investigation purposes and is not a breach of confidence. 5. Consent If an individual consents to a particular disclosure of their information, then it is lawful to make that disclosure. However, it is important to note that the consent must be valid. Consent is valid if it is (a) given by a person who is legally capable of consenting and (b) informed, freely given, specific and current. Legal Capacity A person is legally capable of consenting on their own behalf if they have the mental ability and maturity to understand the nature and effect of the thing they re consenting to. Age will be a relevant factor in assessing this, but not a decisive one except in the case of very young children (generally below the age of 10). In relation to secondary school students, it would seem reasonable to presume that they are capable of understanding the nature and effect of consenting to a disclosure of their information, unless there is evidence before you which indicates otherwise. Incapable Persons Where a person lacks capacity because of mental or physical impairment, consent can only be given on their behalf by a person who is their authorised representative. In the case of a young person under 18, their authorised representative will usually be a parent or other legal guardian. However, if there is any evidence available to you that an order is in place limiting or removing a parent s guardianship rights (such as a Family Court order), then you should check with the student as to who is their legal guardian. Legal Validity Information means the person has sufficient information to understand the nature and effect of what they re consenting to. 78

84 Freely given means the person can make their own decision, free from influences or pressures that may impair their free will. Specific means the consent is not a general all-purpose one, but is specific to the particular disclosure proposed. Current means the consent must be relatively recent (not so long ago that relevant circumstances or the student s views may have changed). 6. What about Duty of Care? As health professionals, your duty of care to your clients continues unaffected. In fact, privacy policy and legislation assists you to be clear about what that duty is in relation to health information. In brief, the common law duty of care requires that you take reasonable care of a person. This means taking all reasonable steps to provide an appropriate level of care to your client in the circumstances including the client s condition, the setting, available resources, your level of responsibility, and the seriousness of the risk of harm. Privacy policy and legislation provide a guide to what are reasonable steps to take in relation to handling your client s health information. 79

85 Appendix 5 Consent and Confidentiality Flow Chart Student presents to nurse without coercion Nurse explains role within school and boundaries of confidentiality Nurse establishes student's ability to comprehend issues and encourages involvement of appropriate parent/significant adult Nurse strongly encourages involvement of parent/significant adult Nurse assesses student unable to fully comprehend issues Nurse assesses student able to comprehend issues Student agrees Student refuses to disclose Imminent threat to individual or public safety Assess risk of situation Work with student to disclose appropriately Explain to student reasons why confidentiality cannot be assured If referral appropriate, seek students permission to disclose as appropriate No imminent threat to individual or public safety Encourage student involvement in process Assure confidentiality Discuss with Principal and Nurse Manager if appropriate Document in health record Discuss with Principal in de-identified manner if appropriate 80

86 Appendix 6 Annual Action Plan VICTORIAN SECONDARY SCHOOL NURSING PROGRAM ANNUAL ACTION PLAN (2002) School Name School Number School Contact Person Phone Name Signature Date Principal School Nurse Regional Nurse Manager Please complete the following plan, and return it to the (name and address) Department of Human Services School Nursing Manager by December The purpose of the Secondary School Nursing Program Annual School Plan is to outline how each school intends to further implement the SSN program to enhance the health and wellbeing of students. The secondary school nurse, as a part of the school welfare team is to provide primary health care through assessment, support, referral and health promotion consistent with the policies of the Department of Human Services and the Department of Education, Education and Training s Student Welfare policy: The Framework for Student Support Services in Victorian Government Schools. Victorian Secondary School Nursing Program Annual Action Plan November

87 SECTION A EVALUATION OF 2001 PLAN Please consider the plan that your School completed for 2001 and complete the following: WHAT WERE YOU ABLE TO ACHIEVE FOR 2001? WHAT WAS UNABLE TO BE ACHIEVED? WHY? WILL IT BE A PRIORITY IN 2002? SECTION B 2002 ACTION PLAN The points listed under each of the questions below are not exhaustive or prescriptive. They have been suggested as examples of possible responses. WHO DO YOU PLAN TO CONSULT WITH IN THE DEVELOPMENT OF THIS PLAN? School Nurse Parents School Welfare Coordinator Students Year Level Coordinators Student Support Services Staff School Council Principal Other Who will complete the consultation? Victorian Secondary School Nursing Program Annual Action Plan November

88 1. HOW DO YOU PLAN TO IDENTIFY THE HEALTH NEEDS OF THE SCHOOL COMMUNITY? (please note the following list suggests some mechanisms that can be used to support the identification of health needs) Questionnaires Students Questionnaires Staff Questionnaires Parents Focus Groups Students Focus Groups Staff Focus Groups Parents DEET DEET Annual Plan DHS Regional data source Outside Health agencies School Health Forum Local Govt Health Plan PCP Health Promotion Plan SNIS Data Reports Other The identification of health needs will require collaboration between the nurse and school staff. Please note whom in the school will be involved By when? 3. WHAT DO YOU FORESEE AS THE THREE MAJOR HEALTH ISSUES IN YOUR SCHOOL TO BE ADDRESSED OVER THE 2002 YEAR? Smoking Safe Sex Drug and Alcohol Use Healthy Eating/Nutrition Relationships Self esteem Bullying Body Image Depression/Anxiety Communication Skills Other Suicide Social skills Management chronic conditions (e.g.asthma, diabetes, epilepsy) 4. WHICH OF THE FOLLOWING SCHOOL INITIATIVES WILL THE NURSE BE INVOLVED IN? ISDES Get Wise Get Real Creating Conversations Catching On Mind Matters Transition programs School camps Curriculum review Other 5. WHAT ADDITIONAL AREAS OF WORK WILL THE NURSE BE INVOLVED IN? (Please complete relevant work areas only) Boxes already ticked are mandatory areas of work for the nurse. Individual student counselling Networking Regional DHS meetings Data entry School meetings Regional reference group meetings Professional development Student welfare team meetings External network meeting Other Victorian Secondary School Nursing Program Annual Action Plan November

89 6. NOTING RESPONSES TO QUESTIONS 3,4, AND 5, LIST THE PRIORITY AREAS OF WORK FOR THE NURSE IN THE NEXT 12 MONTHS? NOTING PRIORITIES LISTED ABOVE, PLEASE COMPLETE THE FOLLOWING: Program Objectives Which area of work/ health priority will you apply to the objective. Reduce negative health outcomes and risk taking behaviours Prevention of ill health by coordinating with existing school & community-based health services Support community in addressing contemporary health & social issues Provide appropriate primary health care through clinical, assessment, referral and support Against each of the priorities, list the group/s of students/ staff/services to be targeted. List proposed health promotion activities to be conducted if appropriate. These activities will form the basis for SSN health promotion plans During which term of the year will the activity occur? Victorian Secondary School Nursing Program Annual Action Plan November

90 SECTION C 1. IN ORDER FOR THE NURSE TO UNDERTAKE A QUALITY SERVICE TO STUDENTS IN YOUR SCHOOL, THEY REQUIRE THE FOLLOWING: Requirement Has been provided (please tick) Yes No Confidential space for seeing students Telephone Where is it located? Will be provided (please tick) Yes No By when? Locked filing cabinet Access to photocopier and administrative resources Budget line item for administration expenditure Optimal health and safety equipment / environment Access to Edumail 2. DO YOU HAVE ANY OTHER ISSUES OR CONCERNS THAT YOU WOULD LIKE TO NOTE? Thankyou for taking the time to discuss and complete this plan for the forthcoming school year. Victorian Secondary School Nursing Program Annual Action Plan November

91 Program Goal: Target group/s: Program Objectives Objective 1: Interventions/Capacity Building strategies By whom & Timelines PRIMARY PREVENTION AND HEALTH PROMOTION INTERVENTIONS: Risk Assessment People Health information People Health education People Social Marketing People Community action People Organisational Development CAPACITY BUILDING: Organisational Development Health Promotion Strategy: Program Plan Settings Settings Workforce Development Staff Resource Allocation Stake holders Appendix 7: Health Promotion Strategy: Program Plan Reach Impacts* (Qualitative &/or Quantitative) * Note choose only the interventions/capacity building strategies that meet the objective * List strategies under each of the interventions/capacity building strategies chosen 86

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