School health counselors, also known as school nurses, have a significant role in providing a wide range of health services to our students - and over time those roles have expanded in some ways to address the changing needs of the students in the school community. 

Today, there are students entering the school system with chronic physical health or mental health concerns, which has presented a dilemma requiring health management of students during the school day, according to the National Association of School Nurses. The purpose of the school nurse is to provide preventive health care services by early identification of problems, interventions, and referrals to promote health and educational achievement and provide follow-up health care management for students with pre-existing health condition.

I have learned that the best approach when caring for our students is the holistic approach addressing the physical health and emotional well-being of each child, thus the title of the school health counselor, which is more widely used today. 

School nurses here on Guam have taken the lead for supporting not just the school health system by expanding the boundaries of their work - most of these are done in a volunteer capacity. They have partnered with school physicians, community physicians, and community organizations, according to the American Academy of Pediatrics. School nurses facilitate access to Medicaid and the State Children's Health Program to help families and students enroll in state health insurance programs and may assist in finding a medical home for each student who needs one. Locally, school nurses have often partnered with the Guam Department of Public Health and Social Services, or local community efforts like former Sen. Dennis Rodriguez's Todu Guam. School nurses also often participate in regional outreach efforts, such as medical assistance following typhoons. 

What is school nursing or health counseling?

The National Association of School Nurses define school nursing as: A specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To accept this challenge school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning.

Across the nation, students face family crises, homelessness, immigration, poverty, and violence. Locally, we have seen these manifest in students who come to school intoxicated or withdrawn from their teachers and/or peers. But all of these real life conditions can lead to intensifying their physical and mental health care needs. School nurses perform a critical role within the school health program by addressing the major health demands experienced by students, according to the National Association of School Nurses. This has presented a dilemma requiring health management of students during the school day. In addition, school nurses provide interventions and direct care for acute and chronic illness, injuries and emergencies, communicable diseases, obesity, substance use and abuse, adolescent pregnancy, mental health, dental disease, nutrition, and sexually transmitted infections. School nurses need to be physically present in schools to address these responsibilities appropriately. To improve student outcome result there schools have to have a full-time school nurse. Inadequate staffing threatens the school nurse's role as a medical home extender. There is a strong correlation between health and learning, as there is between school nurse availability and student’s well-being and educational success, the school nurse association notes. 

These nurses also provide direct health care management for challenged students with special health care needs. In dispensing these duties, they assess and treat within the scope of professional nursing practice, communicate with parents, assist with referrals to physicians, and supervision of prescribed nursing care, the association states. Individual health care plan for students with chronic conditions; diabetes, asthma, kidney, rheumatoid arthritis problem etc. is establish and provided with care. Health care plan management is directed by the child's pediatrician. The school nurse ensures that the student's individualized health care plan is part of the individualized education plan (IEP), and that both plans are developed and implemented with full team participation, which includes but not limited to the student, occupational therapist, family, and pediatrician etc..

The scope of work of the school nurse today, includes:

1. Impart leadership for the provision of health services, health policies and programs at the schools site. These include health promotion and protection, chronic disease management, coordinated school health programs, school wellness policies, crisis/disaster management, emergency medical condition management, mental health protection and intervention, acute illness management, and infectious disease prevention and management.

2. Offer health screening and referral for health conditions. Screening includes but is not limited to vision, hearing, and BMI assessments (as determined by local policy).

3. Observe a safe school environment by monitoring (playgrounds, indoor air quality, and potential hazards); partake in the prevention and management of school violence, bullying, disasters, terrorism and coordinates with school counselors in developing suicide prevention plans, establish community resources.

4. Provides health education information, assist in health curriculum for students, family and community; topics include nutrition, exercise, smoking prevention and cessation, oral health, prevention of sexually transmitted disease and other infectious diseases, substance use and abuse, immunizations, adolescent pregnancy prevention, parenting.

By Marie Virata Halloran RN is certified in death and grief studies. She also is the Rainbows for All Children Guam/LifeWorks Guam executive director.

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