Family Medicine Vital Signs

By Judi Yaworsky, RN

I have been a school nurse for 14 years. I currently work in the Salt Lake City School District, and have for 8 years, and before that I worked 6 years in Georgia.  I have learned that people view the role of school nurses differently depending on who you ask. Opinions vary from “applying bandages”, and “giving out ice packs”, to “performing miracles”, or they may not have an answer, and just give you a blank stare. It all depends on who you ask. Although all of these answers are in part correct, they are a very small part of my job.

To be clear, a School Nurse’s job is to provide an environment that promotes health, safety and academic success, beginning in the elementary schools, and progressing with students through middle and high school. This involves disease prevention through screenings, immunizations, and education, as well caring for students with preexisting health conditions. In order to do this, I work with physicians, social workers and therapists, to help me to do my job.

Disease prevention through immunization and screening is important in elementary schools. It is difficult for children to be successful in school, and throughout life if they cannot see well. School-based vision screenings frequently detect vision problems that if left untreated, can result in learning deficits, and in permanent vision loss. I am one of five school nurses in the SLCSD, and every fall, all of us work together to vision screen all Kindergarten, 1^st, 2nd, 3rd, and 5^th grade students in 28 elementary schools. According to our districts Nursing Workload Study from 2015-16, we screened 9948 children last year. Of those 9948 children, 1611 were referred for further evaluation. Diagnosis’s and treatments can be as simple as a prescription for glasses, or  as serious as strabismus, which left  untreated, can result in significant vision loss.

The majority of childhood immunization booster shots are due prior to entering elementary school. To make sure that this has happened, we review all new student’s immunization records, verifying each student has received all of the required age appropriate vaccines before entering school.

According to the Utah State Health Department’s July Monthly Communicable Disease Report, there have been 268 cases of Pertussis, 106 cases of Chicken Pox, and 2 cases of Measles, in Utah so far this year.  Utah’s percentages of immunized children, are just below the recommended 95% by Healthy People National Standards, set to boost herd immunity. Although Utah percentages are in the 90s, we still need to improve, and it all starts with providing education about vaccines to parents.

Decisions to exempt children from receiving immunizations are often made without knowing the facts. Because it is the law that all students must be fully immunized for their age before registering for school, we have the opportunity to educate parents about the important benefits of immunizing their children at the recommended ages, assisting them in finding places to receive vaccinations, or if the student qualifies, providing the required vaccinations through the Vaccines for Children program.

Elementary age children are at high risk for both accidents and illness, so it is important to consider both when working in elementary schools. Creating a safe environment for all students includes: providing appropriate education to staff, and faculty about how to keep schools safe by preventing injuries, what to do in emergency situations, and how to care for students with chronic health conditions.

In our 28 elementary schools, there are approximately 14,000 students. The most common health conditions seen in this age group frighten a lot of teachers because they don’t feel like they are prepared to provide the appropriate care. In these schools, we have approximately 700 students diagnosed with asthma, 300 students diagnosed with life threatening food allergies that cause anaphylaxis, and 19 with type 1 diabetes. We also have students with accident related injuries like head trauma (TBI), and 130 students with other medical conditions such as spina bifida, adrenal hypoplasia, cystic fibrosis, and cerebral palsy, and others.

There are also 11 special education self-contained classrooms in our elementary schools, where students with severe disabilities and fragile medical conditions learn functional life skills.  In these classes there are students with tracheostomy tubes, gastrostomy tubes, and students who have seizures. Some require one on one supervision and monitoring and at times, emergency seizure medication.

Providing training to staff and faculty is key to providing a safe and healthy school environment. We offer annual emergency training for common medical conditions such as asthma, anaphylaxis, seizures, hypoglycemia, and choking in all of the schools. We also offer CPR certification to all faculty/staff. In order to provide safe appropriate care for students with preexisting health conditions, we teach teachers and paraprofessionals skills such as how to properly perform g-tube feedings, administer medication, and oxygen, and care for students with type I diabetes, by coordinating with physicians, parents and other healthcare professionals to develop individualized healthcare plans for these students.

It takes a lot of planning and teamwork to provide an environment that promotes health, safety and academic success. Doing this successfully not only benefits students, but also their parents, teachers and even their school nurses by giving them peace of mind that their students are attending school safely, supporting their educational success.

Judi Yaworsky, RN is a s Salt Lake City School DistrictNurse