Adopted 4-28-2010
HIAWATHA VALLEY EDUCATION DISTRICT POLICY 596
596
SCHOOL HEALTH SERVICES
I.
GENERAL STATEMENT OF POLICY
It is the policy of the education district board that education district health services be defined as
that part of the education district health program carried out by designated personnel to appraise,
protect and promote the health of students. Five common areas of the school health services
program are:
II.
A.
Health problem identification, health screening, assessment, and recording.
B.
Health counseling, referral, and follow-up services.
C.
Communicable disease control and immunization verification.
D.
First aid, emergency and episodic illness services.
E.
Special services to children with chronic health problems.
HEALTH APPRAISAL
Health appraisal is that phase of education district health service that seeks to assess the physical,
mental, emotional and social health status of individual pupils through the following means:
A.
Teacher observations:
Close daily observation by the teacher is most important. The teacher can detect behavior
or appearance changes that might indicate a need for medical care. To assist teachers in
developing sensitivity to health problems, the education district health service will, on
request:
Conduct in-service regarding prominent health problems, including orientation of new staff
to the health service procedures and policies.
Distribute information regarding observable health signs that may indicate defects and
relevant diagnosed impairments.
Supplement classroom health teachings as requested.
Explain communicable disease procedures.
Be available for building or grade level meetings if requested.
596-1
Adopted 4-28-2010
Provide Health Service policies and procedures for the staff handbook.
B.
Screening procedures:
Screening and follow-up are essential roles of education district health services. The
purpose of education district health screening is early detection of concerns in order to
provide intervention and remediation and to limit potential disability and negative
educational impact. Upon completion of any screening, parents will be informed when
passing criteria are not met. This notification will be done in writing, followed up by a
telephone call if necessary. Results of all screenings will be documented on the permanent
Pupil Health Record. No screening will be performed if parents do not desire their child’s
participation.
1.
Early Childhood Screening – A mandatory program of early childhood screening
that includes the legislated requirements is conducted annually. The goals of this
program are to identify health and developmental conditions and allow sufficient
time for further assessment and referral to health providers and educational
programs. Nurses will assist parents in obtaining further care where indicated.
Participation in early childhood screening, or an equivalent screening, is mandated
by state law for kindergarten entrance. A parent may submit a signed statement if
their child was not screened due to conscientiously held beliefs.
2.
Vision – Each student will be screened in grades K, 1, 3, 5, 7, and 10 with Snellen
or HOTV Vision Screening utilizing the Minnesota State Department of Health
(MDH) Vision Screening Procedure Manual. This screening will be done under the
supervision of the nurse. In rescreening and referring students for further vision
testing, the protocol of MDH will be followed. Color vision screening will be
completed at the 1st grade level. Screening of other students at other grade levels
will be completed upon request. The nurse submits a Vision Screening Program
Summary Report to MDH yearly from each school.
3.
Hearing – Each student will be screened in grades K, 1, 3, 5, 7, and 10 with a
pure-tone audiometer utilizing the MDH Hearing Screening Procedure Manual.
This screening will be done under the supervision of the nurse. In re-screening and
referring students for further hearing testing, the protocol of MDH will be
followed. Screening of other students at other grade levels will be completed upon
request. Annual screening of students with known hearing difficulties will be
performed in collaboration with the school audiologist. The nurse submits a
Hearing Screening Program Summary Report to MDH yearly from each school.
4.
Scoliosis – Screening will be performed with the cooperative effort of the Physical
Education Department and School Health Services, for grades 5 and 7 females and
grade 8 males, utilizing the MDH Scoliosis Screening Procedure Manual.
Re-screening and referral of students for further examination by the family
physician will be completed by the nurse, according to MDH protocol. The nurse
596-2
Adopted 4-28-2010
prepares a Scoliosis Screening Program Summary Report yearly for schools with
grades 5, 7, and 8.
III.
C.
Strep Throat Culture Program – The Strep Throat Culture Program is implemented in all
buildings. Upon parent request throat cultures will be taken by the nurse, health secretary,
or other nurse designated and trained employee according to the protocol reviewed yearly
by the advising school physician. Student cultures are transported daily to Winona
Community Memorial Hospital. The laboratory will report all positive cultures to the
parent for treatment indicated by the student’s physician. The nurse will follow up to
assure that treatment is completed. Lack of treatment after a positive culture has been
identified will result in exclusion from school until a negative culture is obtained. Payment
of the throat culture fee set by the hospital and education district is the responsibility of
parents.
D.
Blood Glucose Monitoring – Blood glucose monitoring is available to students with
diabetes for the purpose of increasing the accuracy and convenience of testing their blood
sugar level. This program has been endorsed by local physicians and approved by the
education district board. A physician order/parental consent form is required yearly. A
nurse trained and delegated school person is responsible for supervising the use of the
meter in the education district health office, recording the readings, and notifying parents
of these results according to mutually agreed upon instructions. Written physician orders
will be followed regarding food, insulin or exercise. Students will be referred to the parents
for diabetes management clarification. Needles and lancets used in this screening program
will be disposed of as hazardous waste.
HEALTH RECORDS
Permanent Pupil Health Records are maintained for all students by the nurse and health secretary
assigned to buildings. The purpose of pupil health records is to bring together all pertinent
information regarding the pupil’s health. This information includes reported medical history,
immunization data, results of screening and referral, and findings of examinations. These records
are begun at Early Childhood Screening and follow the child throughout the school age years.
Health records are kept locked in the health office of each school and are reviewed annually.
These records are subject to data privacy laws and are available only on a need to know basis to
licensed staff members. Copies of the health record will be transferred with the educational record
when a student leaves the district. All graduating seniors will be given a copy of their
immunization record.
IV.
HEALTH COUNSELING
A.
Health counseling is a procedure for helping pupils and parents gain insight into the nature
and significance of conditions revealed by various appraisal techniques. The nurse will be
available to confer on health matters with teachers, parents, and pupils. A teacher or
administrator wishing to refer a child to the nurse to do so by contacting the health office
by telephone or in person.
596-3
Adopted 4-28-2010
V.
VI.
B.
Referrals can be made to the nurse for a health problem concern. Educationally licensed
personnel may eliminate students upon suspicion of a contagious disease. School
absenteeism may or may not be considered a health problem. If the building principal feels
the problem is health-related, the principal will then make a referral to the nurse for
appropriate action. Nurses have regularly scheduled times at each building. Schedules are
available from the building principal office.
C.
Sexually transmitted disease (STD): Counseling for students who believe they have
contracted a STD shall be directed toward parent responsibility or the family physician. If
this course is not acceptable to the student, referral can be made by the nurse for
confidential health care. Confidentiality will be maintained within the health office. Should
individual difficulties arise wherein the nurse feels the health of other students may be
jeopardized, direction will be sought from school administration and the consulting school
physician.
MEDICATIONS AND HEALTH PROCEDURES
A.
Medications are covered in Hiawatha Valley Education District Policy 516 – Student
Medication.
B.
Students may require individual health procedures during the day. All health procedures
including, but not restricted to, tube feedings, tracheostomy care, bowel assistance, insulin
pump administration and monitoring, blood glucose monitoring, require a physician order
and a signed parent request. The nurse will work with the building principal to address the
student’s health and safety needs, design a plan of care, and perform or delegate health
procedures as appropriate according to the Minnesota Nurse Practice Act.
EMERGENCY CARE
A.
The School Reference for First Aid Guidelines, as approved by the consulting school
physician shall be used for general first aid and emergency procedures. The principal is
responsible for emergency care within their assigned buildings. The nurse will assist with
supplies, procedure and care. In absence of these individuals, licensed personnel will
assume individual action for the safety of the student.
B.
Each school should be prepared with a plan to administer first aid in case of injury or
illness. This plan does not include medical diagnosis or treatment of any kind. First aid is
temporary care until a physician can be reached. First aid supplies are available in the
health office or Principal’s office.
C.
No drugs or medication, including aspirin, shall be given at any time without physician
direction, parent approval, and nurse delegation. Diagnosis and treatment of illness are not
the responsibility of the education district and should not be practiced by any education
district personnel.
596-4
Adopted 4-28-2010
D.
Parents should be notified before consulting a physician except in a severe case where, in
the opinion of the person in charge, time is a factor for the best interest in the care of the
child. If parents cannot be contacted, the emergency number listed for the child should be
called. When neither can be reached and the nurse and principal deem the situation
warrants further treatment, referral will be made to the local emergency service via a 911
call. It is strongly advised that school personnel not transport acutely ill or injured students.
E.
Any movement of an injured patient must be evaluated individually.
F.
Injuries or illnesses where parents or doctor are called must be reported to the principal
immediately.
Minnesota state laws, public health policies, and medical infectious disease guidelines will
be followed on an individual basis regarding all communicable diseases with regards to
admittance, attendance, and elimination from school. These references will be used to
make decisions regarding acute infectious disease such as childhood diseases, chronic
infectious disease such as HIV, or suspected biological agent threats. Nurses cooperate
with the MDH in their annual School-based Illness and Reportable Diseases reporting
systems.
Any licensed district personnel may eliminate a student from the classroom if they have
reason to believe the student has a communicable disease that immediately endanger the
health of other students or staff. Discretion must be used at all times when eliminating
students. Questions regarding specific communicable diseases should be referred to the
District’s Health Services. Right to know policies and individual confidentiality will be
respected.
Communicable diseases are covered in Hiawatha Valley Education District Policy 420 –
Students and Employees with Sexually Transmitted Infections and Diseases and Certain
Other Communication Diseases and Infectious Conditions.
G.
A designated Health Service area is available in each school. The decision to accompany
the student to the health area must be made on an individual basis, considering the
condition and capacity of the student. Any student using health office facilities must be
supervised. Any child who becomes ill should be sent home as soon as possible. Parents
are considered responsible and must be contacted if the child is in the health area more
than thirty minutes. Arrangements for sending ill children home need to be made as
quickly as possible. Oral disposable thermometers are available for use. Temperatures
exceeding 100 degrees should be reported to the parents. Parents should be asked to make
plans for accepting care of their ill children as soon as possible.
H.
A stretcher is available in all school buildings.
I.
Basic first aid kits are available for teacher use on field trips.
596-5
Adopted 4-28-2010
VII.
J.
Accident reports are the responsibility of the witness to the accident. The nurse or health
secretary may add to this report if indicated.
K.
Disposable gloves are available and advised for use when handling blood and body fluids.
Disinfectant for surface cleaning of areas contaminated with blood or body fluids is
available in all buildings. A freshly prepared solution of sodium/hypo-chloride (household
bleach), one part to 10 parts water may be used. Specific procedures are found in the
district’s Exposure Control Plan Manual and Bloodborne Pathogens Employee Handbook.
Further information is available from the District’s Exposure Control Officer or the district
nurse.
DENTAL HEALTH PROGRAM
Dental health education will occur in each grade during the time allowed for health education. The
Dental Health Card Program sponsored by MDH will be used in elementary grades. Teachers are
responsible for distributing and collecting cards. Teachers are asked to refer students to the nurse
whose dental care is not being completed. The nurse will attempt to assist the family to secure
care. The nurse submits a Dental Health Card Program Summary Report to MDH yearly from
each elementary school.
VIII. IMMUNIZATIONS
Immunization requirements are covered in Hiawatha Valley Education District Policy 530 –
Immunization Requirements. Minnesota Statutes, section 121A.15 requires all students to show
evidence of immunization or properly documented exemption.
IX.
COMMUNICABLE DISEASES
Minnesota state laws, public health policies, and medical infectious disease guidelines will be
followed on an individual basis regarding all communicable diseases with regards to admittance,
attendance, and elimination from school. These references will be used to make decisions
regarding acute infectious disease such as childhood diseases, chronic infectious disease such as
HIV, or suspected biological agent threats. Nurses cooperate with the MDH in their annual
School-based Illness and Reportable Diseases reporting systems.
Any licensed school personnel may eliminate a student from the classroom if they have reason to
believe the student has a communicable disease that immediately endanger the health of other
students or staff. Discretion must be used at all times when eliminating students. Questions
regarding specific communicable diseases should be referred to the District’s Health Services.
Right to know policies and individual confidentiality will be respected.
Communicable diseases are covered in Hiawatha Valley Education District Policy 420 – Students
and Employees with Sexually Transmitted Infections and Diseases and Certain Other
Communication Diseases and Infectious Conditions.
596-6
Adopted 4-28-2010
X.
HOME VISITING – HOMEBOUND
Students placed on homebound instruction by their physician for medical reasons may be visited
by the nurse upon referral and discretion of the building principal. The nurse shall report
significant findings from the home visits to the appropriate school personnel. No home visits will
be made if the parent does not desire the nurse to enter the home.
XI.
ALTERNATIVE PHYSICAL EDUCATION SERVICES
The nurse, upon request of the Physical Education teacher, will secure a signed statement
from the student’s family doctor regarding short term limited physical education, long term
limited physical education, or adapted physical education when indicated. It is advised that these
forms be renewed annually.
XII.
CHILD ABUSE AND NEGLECT
As mandated reporters, nurses and health secretaries will respond to reports or observations
of child abuse and neglect as outlined by Minnesota law. Decisions regarding the authenticity of
the report or observation will be made by the social service worker or police officer, not by the
reporter. Health office personnel will inform the principal of any child abuse/neglect report that
has been made to a social worker or police officer. Mandatory reporting is covered in more detail
by Hiawatha Valley Education District Policy 414 – Maltreatment of Minors by School Personnel
and Policy 415 – Mandated Reporting of Maltreatment of Vulnerable Adults.
XIII. PARENT AND STUDENT INFORMATION
Appropriate policies and procedures will be published in individual handbooks for both parent and
student information. Special attention will be given to the medication, first aid policies and
communicable disease policies. Media releases and parent newsletters may be utilized to
disseminate health information throughout the school year. Nurses will be available as requested
for informational parent meetings such as Kindergarten roundups and orientations.
XIV. EARLY CHILDHOOD SPECIAL EDUCATION
Services to the Early Childhood Special Education will include that of health and immunization
records, emergency, illness, communicable disease and medication policies of the district.
Additional responsibilities of the nurse will include individual health planning, accumulation of
historical data, health assessments, referrals, family health counseling and cooperative planning
with district educators and other community service personnel.
XV.
INDIVIDUAL HEALTH PLANNING/SPECIAL EDUCATION/SECTION 504
Nurses will provide individual health planning for students identified with special health or
medical needs. Nurses will provide a written sensory and health status review for students
in assessment for special educational services. Nurses will provide assistance with third party
billing and Extended School Year Programs.
596-7
Adopted 4-28-2010
Nurses will participate in Section 504 planning as indicated, at the request of the building Section
504 Officer. Requests for Section 504 food plan accommodations will be directed to the director
of food services.
XVI. DELIVERY OF SCHOOL HEALTH SERVICES
A.
All health services personnel are directly responsible to their building administrator.
Nurses licensed by the state of Minnesota provide professional school nursing services,
weekly as scheduled and as needed. They are immediately available each school day via
cell telephones. Nurses are responsible for developing, implementing, and managing the
school health program. Among the duties of the nurse are support of health services
delivery district wide, monitoring and updating of policies and procedures, evaluation of
the school district health program and standards of care, and monitoring compliance with
changing state laws. A narrative and statistical report is submitted yearly by the nurse to
the executive director, the education district board, the Health Services Administrator, and
the consulting school physician.
B.
Health secretaries are available in some public school buildings. Trained in CPR, first aid,
and basic screening techniques, the health secretaries provide daily assistance to students
under the direction of and determined by the nurse. In the absence of health secretaries,
building secretaries provide daily health assistance for students under direction of the
nurse. Medically fragile students may have LPN prepared assistants who provide nursing
services directly and exclusively to that student. Any medical care provided during the
school day is planned, delegated, and monitored by the licensed nurse.
XVII. SCHOOL HEALTH SERVICES TO NONPUBLIC SCHOOLS
Nonpublic schools within the district receive school health services following this Hiawatha
Valley Education District Health Services Policy. Onsite visits are provided on a weekly basis by
a licensed nurse and a health secretary.
XVIII. SCHOOL NURSE CONSULTATION
The nurses are a source of health information to such programs as the Area Learning Center Child
Care, Key Kids Program, Early Childhood Family Education, Community Education, Kampus
Kids, and neighboring education districts. Each program is responsible to design its own health
policy and procedures. Minnesota State laws, MDH recommendations, and education district
policy can serve as program guidelines.
XIX. ADVISING SCHOOL PHYSICIAN
A community pediatrician or family medicine physician will be consulted by the district nurse
each fall and incidentally throughout the school year on issues of school health policy.
596-8
Adopted 4-28-2010
XX.
NURSING AND HEALTH EDUCATION STUDENT SERVICES COLLABORATION
Request for post-secondary student observations of health services and participation in screening
or health education will be under the direction of the administration and the nursing faculty.
Previously written agreements need to be on file between the student’s institution and the
education district board.
XXI. SCHOOL AND COMMUNITY COLLABORATION
Providing effective health services requires collaboration with district educators, area health
care providers, and other community agencies. Nurses partner with many agencies
including Winona Community Health, Public Health Nursing, Winona State University,
Minnesota Southeast Technical College, Winona Clinic, Family Medicine, Winona Health,
Southeastern Minnesota Citizen Action Council, and others.
Legal References:
Minn. Stat. § 121A.15 (Immunizations, School Children)
Minn. Stat. § 121A.17 (Early Childhood Screening)
Minn. Stat. § 121A.21 (School Health Services)
Minn. Stat. § 121A.22 (Administration of Medications)
Minn. Stat. § 144.29 (Health Records, School Children)
Minn. Stat. § 148.171 (Nurse Practice Act)
Cross References:
Hiawatha Valley Education District Policy 414 (Mandated Reporting of Child
Neglect or Physical or Sexual Abuse)
Hiawatha Valley Education District Policy 415 (Mandated Reporting of
Maltreatment of Vulnerable Adults)
Hiawatha Valley Education District Policy 420 (Students and Employees with
Sexually Transmitted Infections and Diseases and Certain Other Communicable
Diseases and Infectious Conditions)
Hiawatha Valley Education District Policy 516 (Student Medication)
Hiawatha Valley Education District Policy 530 (Immunization Requirements)
596-9