NASN school nurse (Print)最新文献

Dissociation is a normal life adaptation that can become pronounced and disruptive in the setting of repeated or extreme exposure to trauma. Children and adolescents may experience dissociation due to a trauma or stressor-related disorder, anxiety, or depressive disorders. Children and adolescents also may mimic behavior they see online as a way of expressing internally painful and intolerable experiences. Myth and misinformation surround the diagnosis of dissociative identity disorder (DID), formerly multiple personality disorder. The purpose of this article is to provide school nurses with evidence-based information on DID and resources for practice regarding how to provide a secure, consistent approach to students who are being traumatized, misunderstood, or excluded at home or at school. Part 1 of this two-part series describes DID foundations and DID in school-aged children, reviews controversy spurred by social media representation, and presents the Trauma-Informed Care (TIC) model. TIC offers useful perspectives regardless of a student's presentation or diagnostic status. Part 2 will discuss recommendations for managing dissociative presentations using a team-based approach, focusing on the school nurse's roles and responsibilities.

Students with intellectual and developmental disabilities (IDD) are likely to experience psychiatric symptoms, like depression, anxiety, and distress, throughout their lifetime. Due to communication differences and minimal use of specialized diagnostic assessments for anxiety and depression, emotional pain can often be overlooked or underestimated in students with IDD. This is often complicated by atypical presentations of anxiety and depression, such as externalized aggression, self-injurious behaviors, or other behavioral dysregulation, that can indicate emotional distress, physical pain, or other medical complications. School nurses play an important role in assessing for emotional and physical pain in students with IDD using assessment tools currently available and clinical judgment. Tools that have been created for use in this population may account for the diversity of communication, sensory, and developmental differences in students with IDD. Through leading education and advocacy for the interprofessional school team, school nurses can increase the access that students with IDD have to equitable emotional health evaluations and services. School nurses can also promote emotional wellness for students with IDD through the incorporation of mindful and community activities in the care plan.

School nurses are members of the school-based mental and behavioral health support team. This consensus document was developed by school nurses and school nurse leaders in collaboration with leaders from national associations and organizations with a vested interest in K-12 mental and behavioral health. The document is also publicly available on the National Association of School Nurses website.

According to the 2017 U.S. Census, 74.3 million children younger than 18 years of age live in the United States. Of this group, 14.6 million children and adolescents have special health care needs or a chronic illness. Students who attend school with complex health conditions, including mental and physical diagnoses, require comprehensive planning by a professional school nurse. School nurses should write an individualized healthcare plan (IHP) for these students. An IHP is written by the school nurse in collaboration with the parent/guardians, student, and health care providers. This plan serves as a tool to guide health care for a student throughout the school day and in mandated school-sponsored events.

Developmental norms suggest that children are ready for toilet training between the ages of 18 and 24 months; however, many children now enter school without this self-care skill. Many factors can contribute to delayed toilet training including child readiness, developmental disabilities, poverty, lower parental education levels, and higher rates of single and teen-aged parents who may lack parenting skills including toilet training. Most children enroll in a kindergarten program at 5 years of age. Because children will be accepted to kindergarten regardless of toilet training status, schools need to be ready for children who lack this self-care skill. Although school staff are willing to support these children, the main purpose of school is education. The school nurse can take an active role in classroom toileting programs by collaborating with school administrators, teachers, staff, and parents to promote successful toilet training and fostering a healthy learning environment.

This article shares an updated structure for school nurse evaluation using the School Nursing Practice Framework and the fourth edition of the School Nursing: Scope and Standards of Practice. This evaluation structure is modeled on work originally published in the January 2020 issue of NASN School Nurse. The original linking of the Framework for 21st Century School Nursing Practice and the 3rd edition of the School Nursing: Scope and Standards of Practice allowed the school nurse and their evaluators to understand the complex roles and responsibilities of the school nurse. This updated version incorporates the growing understanding of social issues and complex health concerns impacting school nursing practice. The School Nursing: Scope and Standards of Practice (4th ed.) competencies recognize issues including emerging technologies, structural barriers to health, and the complex health needs of students in an environment of inequities, violence, and underfunding, as well as the impact of natural disasters, public health crises, human migration, and social media on students. The updated School Nursing Practice Framework (Framework) likewise incorporates an understanding of the foundational aspect of the standards and the interconnectedness of the key principles. Our revised evaluation tool accomplishes the integration of the revised Framework with the updated standards of school nursing practice.

Asthma is common among the pediatric population. Exacerbations of this chronic condition can lead to emergency department visits and hospitalizations, resulting in time away from school. Children spend the majority of their day at school, where they may need access to quick relief medication to treat respiratory distress. Students' personal asthma medication is not always available in school. School nurses in Illinois collected data and undertook a quality improvement project to increase the number of schools in North Suburban Cook County with undesignated asthma medication. A toolkit was created and shared, helping to remediate barriers associated with obtaining undesignated asthma medication. With access to undesignated asthma medication, school nurses ensure students with asthma receive prompt treatment and coordination of care.