Standard 1

Program Design, Rationale and Coordination

The school nursing services program and any prerequisites include a purposeful sequence of coursework and field experiences that effectively prepare candidates to provide school nursing services to all students to optimize learning. The school nurse services program prepares candidates to understand contemporary conditions of schools and society and how school nursing services need to change and evolve to address these changing conditions.

The design of the program is based on a clearly stated rationale that has a sound theoretical and scholarly foundation anchored to the knowledge base of school nursing.  By design, the program provides extensive opportunities for candidates to (a) learn to address the health related educational needs of all students; (b) learn to access and use community resources to address the health related needs and concerns of students, parents, staff, and other members of the educational community; (c) learn to develop and implement plans of care as appropriate to the needs of students; (d) know and understand the roles and responsibilities of school the nurses within the educational setting; and (e) to demonstrate their knowledge, skills and abilities with respect to the school nurse competencies as exemplified in the School Nurse Competencies (SNCs) provided in Appendix A.

Criterion 1: The design of the program is based on a clearly stated rationale that has a sound theoretical and scholarly foundation anchored to the knowledge base of school nursing.

Of utmost importance is that the program offers quality education that prepares the school nurse candidate with the decision-making skills, based on theory and research, to provide quality healthcare to diverse client populations across environments, which includes effective leadership, supervision, management, safe and effective delegation, and application of the nursing process in the school setting. Inherent in the teaching/learning process within the program is the reciprocal responsibility of faculty and candidates in influencing the process of learning outcomes. In this relationship, faculty serve as role models and valuable resources in facilitating the advancement of competence in school nursing practice through leadership, research, and scientific inquiry. The learner is also expected to exhibit self-direction, and a sense of responsibility and accountability in mastery of knowledge and skills consistent with professional practice.

The faculty further recognizes the unique diversity of the population throughout California and the need for school nurse candidates to understand the need to deliver safe and effective care and to work harmoniously with clients and families of various ethnic backgrounds, languages, beliefs, values, learning styles, and support systems. The importance of understanding diversity is viewed as paramount into the program and it is incorporated into the curriculum. Candidates are evaluated on their ability to understand those differences and to their ability to work effectively with clients and families of other cultural and ethnic backgrounds.

The Program conceptual framework embraces that of the CSUF Department of Nursing: Conceptual Framework – The baccalaureate and graduate programs in nursing at California State University, Fresno utilize the Neuman Systems Model. The framework evolves from the philosophy and focuses on the domains of client, environment, health, and nursing. This framework is very applicable to school nursing practice in that the client is seen as a composite of variables, each of which is a subpart of all parts which forms the whole of the client. The school nurse assists the client in strengthening lines of resistance and the ability to cope with stressors, both internal and external, that impact the client’s life and/or that of the family. These stressors may be related to health and/or environmental circumstances the impact the life, or lives of the client and family, and can be intra-personal, interpersonal, and extra-personal in nature.  The Neuman Systems Model is ideal for allowing for the ever changing stressors and conditions of the individual, family or community that the school nurse may need to address at any particular time.

Definitions specific to the model:

Client/Client System – The client/client system (person) is viewed as a composite of variables (physiological, psychological, socio-cultural, developmental, and spiritual), each of which is a subpart of all parts, forms the whole of the client. The client as a system is composed of a core or basic structure of survival factors and surrounding protective concentric rings. The concentric rings are composed of similar factors, yet serve varied and difference purposes in retention, attainment, or maintenance of system stability and integrity or combination of these.

Environment – The environment consists of both internal and external forces surrounding the client, influencing and being influenced by the client, at any point in time, as an open system. The created environment is an unconsciously developed protective environment that binds system energy and encompasses both the internal and external client environment.

Health – Health is a continuum of wellness to illness, dynamic in nature, and is constantly subject to change. The client is in a dynamic state of either wellness or illness, in varying degrees, at any given point in time.

Nursing – A unique profession concerned with all variables affecting clients in their environment. Nursing actions are initiated to best retain, attain, and maintain optimal client health or wellness using the three preventions (primary, secondary, tertiary) as interventions to keep the system stable.

The school nurse is directed toward reducing stress factors that influence, or could influence, the attainment of an optimum level of wellness by an individual, family, or community. This goal is achieved through the nursing process, a systematic, problem-solving technique used for implementing independent, interdependent, and dependent nursing actions. This process consists of assessing the client’s actual and/or potential health problems, constructing a diagnostic statement, formulating goals and objectives with expected outcomes, implementing therapeutic interventions, and evaluating the effectiveness of these interventions/preventions. This process allows the school nurse to optimize student learning.  A student who has attained his/her optimal level of wellness is able to succeed in the classroom.  School nursing is advancing into a new era of expanding roles and responsibilities in primary, secondary, and tertiary preventions. Faculty are responsible for the preparation of competent school nurses who can assume current school nursing roles and adapt to future health needs and evolving healthcare requirements. The program strives to maintain a flexible curriculum that emphasizes a total client approach that is based on evolving nursing theory and knowledge from the sciences and other related disciplines. To keep abreast of current issues in school nursing practice, faculty relies on an involved advisory board made up of school nurses, school nurse administrators, school administrators, and other members of the community with a vested interest in school nursing practice and the well being of school aged children. Faculty also maintains current membership in the California School Nurses Organization and National School Nurses Organization, as well as attending local, state, and national school nurse meetings.  The current coordinators of this program are also currently employed as nurse administrators of large local districts.  They are able to provide and change curriculum that reflects the changing conditions of health issues of the school children in California. A representative of California School Nurse Organization speaks to the students at orientation, gives them applications to join at the student rate, and encourages them to be active members for the duration of their professional career. Being a member of the professional organization is a way for the student and future school nurses to stay abreast of changing issues in student health.  Every other year a School Nurse Supervisor Survey or Program Effectiveness is sent to current nurse administrators all over the state inquiring as to whether the school nurses who have completed this program are adequately prepared to handle to role of the school nurse.  That survey and results in Section 4of this document indicate the program does a very good job of preparing candidates to understand contemporary conditions of schools and society and how school nursing services need to change and evolve to address these changing conditions.

Criterion 2: The program includes a purposeful sequence of coursework and field experiences that effectively prepare candidates to provide school nursing services to all students to optimize learning.

Program prerequisites: All school nursing candidates are required to take a statistics course and a nursing research course prior to entering the program. This coursework may have been completed in conjunction with the student’s bachelor’s program or for a master’s degree. If not, it is taken prior to admission to the School Nurse Services Credential Program. This coursework gives the school nurse student the understanding for the value of research in nursing practice and the necessary insight and tools by which research can be conducted in school nursing practice. The importance of research to validate school nursing practice is strongly emphasized in the program.

Post-baccalaureate course work specific to Program Standards 1-9
(28 units)

CDDS 125, Audiology and Audiometry for School Nurses (3U)
SPED 120, Introduction to Special Education (3U)
COUN 174, Introduction to Counseling (3U) (or COUN 200)
NURS 136, Health Appraisal (3U)   (or NURS 180T)
NURS 137, Teaching Strategies for the Healthcare Client (3U)
NURS 183, Vision and Scoliosis in the School Setting (1U)
NURS 184, Introduction to School Nursing Seminar (3U)
NURS 185, Seminar in School Nursing (3U)
NURS 186, School Nurse Practicum I (3U)
NURS 187, School Nurse Practicum II (3U)

The credential coursework comprises 28 units. A course in Statistics and Nursing Research are program prerequisites prior to admission. If candidates entering the program have a bachelor’s degree in other than nursing, these candidates are required to take upper division community health coursework (both didactic and field experience) before entering the program. This coursework is offered during a summer session at CSUF. This post-baccalaureate program provides a multi-disciplinary curriculum, with a core of 13 semester units related specifically to  school nursing practice (NURS 183, 184, 185, 186, and 187 – both didactic and practicum), and six semester units in other nursing coursework (NURS 136, NURS 137). Nine of the 28 units of coursework are offered in other CSUF departments such as the Dept. of Communicative Disorders (CDDS 125), Psychology, and Education (SPED Ed 120 and COUN 174). It should be noted that all courses related to the program can be taken online, either through CSUF or other accredited universities. School nurse candidates may take some courses through other accredited universities with approval of the Program Coordinator though a total of 15 of the 28 units must be taken through CSUF, which includes 12 units of core school nurse courses (NURS 184, 185, 186 and 187). It should be noted that candidates who are newly employed and beginning school nursing practice are not encouraged to take more than six units each semester in order to avoid undue stress. Candidates new to school nursing are also encouraged to partake of new nurse orientation programs offered in their area to help them adjust to their new school nursing role. 

Program coursework:  Phase I program coursework, prerequisites to core school nurse coursework includes: CDDS 125, Audiometry for School Nurses, SPED 120, Mainstreaming the Exceptional Child, COUN 174, Introduction to Counseling, NURS 136, Heath Appraisal, and NURS 137, Teaching Perspectives for the Healthcare Client. These courses are required before the school nurse candidate enters into the core school nursing courses as each of these phase I courses contributes to the knowledge base the school nurse candidate needs in order to function competently in school nursing practice. Candidates are advised to take a course in Audiology-Audiometry first as their first class as the vast majority of candidates have already begun practicing school nursing and need this course in order to do hearing testing in their schools. CDDS 125, Audiometry for School Nurses, is offered through CSUF in the fall or it can be taken through other universities with approval from the Program Coordinator. SPED 120, Introduction to Special Education, and COUN 174, Introduction to Counseling, (or COUN 200) are offered every semester through CSUF or may be taken through other accredited universities with approval from the Program Coordinator. NURS 136, Health Appraisal, (or N180T, Physical Assessment for School Nurses) and NURS 137, Teaching Perspectives for the Healthcare Client, and NURS 183, Vision and Scoliosis in the School Setting, are also considered Phase I courses as they provide the necessary knowledge and assessment skills needed in practicum courses, therefore they are offered in the summer prior to core school nurse courses which begin in fall.

As of summer 2010, nursing courses specific to the program which were previously taken through the CSUF Dept. of Nursing are now being offered sequentially through CSUF Continuing and Global Education Special Sessions beginning in June 2010 with NURS 137, Teaching Perspectives for the Healthcare Client (3U); NURS 136, Health Assessment, (3U) or NURS 180T, Physical Assessment for School Nurses, (3U) in July; and NURS 183, Vision and Scoliosis in the School Setting, (1U) which is offered on campus in August in conjunction with a Phase II program orientation which candidates are required to attend. NURS 184, Introduction to School Nursing, (3U) is offered in the fall semester along with NURS 186, School Nurse Practicum I, (3U) with an elementary emphasis. NURS 185, School Nurse Seminar, (3U) is offered in the spring semester, along with NURS 187, School Nurse Practicum II (3U), with a secondary emphasis.

Faculty believes that this sequence of courses provides the student with a base of knowledge upon which to build school nursing competencies. The Phase I courses provide candidates with a framework for understanding other disciplines within the school setting and problems encountered there. This empowers the candidate with a broader perspective when entering the school nurse seminar and practicum courses. In NURS 184, Introduction to School Nursing, students are asked to develop a personal philosophy of school nursing and to examine legal/ethical issues and the expanded roles they will face as practitioners in caring for regular elementary children and those with special needs. In NURS 185, the emphasis is pre-adolescent and adolescent health issues, as well as other subject matter of importance to school nursing such as the Group Process, curriculum development and grant writing. These seminar courses contribute significantly to the school nurse candidate’s knowledge base in preparing them for their hands-on experiences in the two clinical courses.

School Nurse Services Credential Program catalog course descriptions:

CDDS 125 - - Audiometry and Audiology for School Nurses        3 units
(fall/spring)

Course description: Prepares students to obtain certification as a school audiometrist.  Provides an introduction to the profession of audiology, hearing loss and its medical aspects; the components of a hearing conservation program; basic assessment and management; and the fundamentals of interpretation.

The school nurse is the only professional in the educational setting who has the expertise test hearing, refer as necessary for more advanced testing, and secure hearing services as needed so that every student can hear as well as possible for optimal learning in the classroom. The state of California mandates that students will be screened for hearing five times during their K-12 school years.

Special Education 120 - - Introduction to Special Education        3 units
(fall/spring)

Prerequisites: EHD 50. Introduction to identification, characteristics, theories, curriculum, and instruction for students with mild to severe disabilities, legislative guidelines, nondiscriminatory assessment, parental involvement, and foundations in special education. Includes 15 hours of observation/participation.

The school nurse based on his/her possession of a registered nurse license and additional training in physical assessment, is the only educational profession who is prepared to assess the current and past health issues and identify students who may need services during the school day for physical or learning disabilities.  The school nurse is knowledgeable about the laws that govern special education and is a valuable team member in placing the student in the setting that will optimize learning.  The school nurse is also able assess the changing health conditions of students enrolled in special education and make changes in services provided as needed.

Counselor Education 174 - - Introduction to Counseling              3 units
(fall/spring)

Course description: An overview of basic counseling models, including psychoanalytic, behavioral, cognitive, and humanistic approaches. Includes a personal counseling experience.

Most students or families will have some sort of problem or crisis during their school years.  The nurse has training to help during this crisis by counseling, advising and referring to the proper agency. Student cannot take advantage of optimal learning opportunities when the student or the family is overwhelmed with day to day problems.

Counselor Education 200 - - Seminar in Counseling Techniques   3 units
(fall/spring)

Course description: Emphasis given to interviewing skills, philosophy, theory, and methodology as applied to counseling. (2 seminar/2 lab hrs)

Nursing 136 - - Health Appraisal                                                    3 units
(fall/spring)

Course description: Health appraisal integrates psychosocial and pathophysiological processes including techniques of history taking and health assessment in nursing practice and knowledge of normal findings as well as common deviations. (2 lecture/2 lab hrs)

Nursing 180T – Physical Assessment for School Nurses               3 units (summer)

Health appraisal integrates psychosocial and pathophysiological processes, which include techniques of history taking and health assessment in nursing practice and knowledge of normal findings and common deviations.

This post baccalaureate course provides the school nurse with physical assessment and history taking skills.   These skills will enable the school nurse to ascertain if a student has a particular physical condition or that condition has changed and the student needs further assessment or a change in services. The school nurse is then in a position to optimize student learning with proper placement or services and referrals.

Nursing 137 - - Teaching Strategies for the Health Care Client       3 units
(summer)

Course Description: Explorations of nurse’s role as a teacher in healthcare setting. Principles of teaching and learning applied to teaching of individuals and groups. Opportunities for microteaching are provided.

Every school nurse is in a position to guide students through health teaching to develop lifelong habits for optimal health.  The self-care skills the student learns will help them stay healthy and consequently optimize their own learning.

Nursing 183 -- Vision and Hearing Screening in the School Setting    1unit
(summer)

Course description: Guidelines for screening vision and scoliosis in California public schools to include state mandates, setting up screenings, completing screenings, and follow-up on positive findings. Application of current research and nursing theory incorporated.

Students who can hear and see as well as possible will be able to learn.  School nurses are able to provide all the screening and referral and follow-up needed to optimize their learning in the classroom.

Nursing 184 - - Introduction to School Nursing                                3 units
(fall)

Prerequisites: admissions to the School Nurse Services Credential Program, NURS 136, 137; PSYCH 168 or SPED 120; COUN 174 or 200. Corequisite: NURS 186. Role of the nurse in the school health program; parameters of school health practice. legal guidelines, professional accountability, coordinated health programs, health education, and health needs of complex multicultural school aged population. (available online.)

This course is very dynamic.  The major assignments are the weekly questions that the candidates research and write responses.  These questions are changed as needed to reflect the latest issues and changing conditions in the health of the students in California. For instance in Module II students respond to questions regarding immunizations and communicable diseases.  The questions regarding immunizations always reflect current state requirements.  There is always new and changing information regarding communicable diseases and those questions are updated in a timely manner.  Every question is evaluated and updated as needed every semester the course is offered.

Nursing 185 - - School Nurse Seminar                                          3 units
(spring)

Prerequisites: Admission to the School Nurse Services Credential Program, NURS 136, 137; PSYCH 168 or SPED 120; COUN 174 or 200. Corequisite: Role of the school nurse; parameters of school health practice; emphasis on adolescent health issues, health education, legal parameters, interdisciplinary cooperation, legislative issues, research and professional accountability.

This course is similar to 184 in that it is very dynamic.  The weekly questions are constantly updated to reflect changing conditions in health issues of the school age children in the state of California.  There is an emphasis on legal issues that affect areas of student learning.  For instance there has been recent legislation on who in the school is allowed to administer insulin to students with diabetes or Diastat to students with seizure conditions.  The candidates investigate these bills and respond to questions as well as write letters to their legislator in support or nonsupport of that bill. Students cannot be successful and learn if they do not receive services from qualified school personnel.

Nursing 186 - - School Nurse Practicum I                                      3 units
(fall)

Prerequisites: admission to the School Nurse Services Credential Program, CDD 125; NURS 136, 137; PSYCH 168 or SPED 120; COUN 174 or 200. Corequisite: NURS184. Elementary school nurse experience, including special education; direct supervision by a credentialed school nurse require. Scheduled preceptor and faculty conferences. Class participation online. (9 clinical hours/week)

This elementary school practicum class gives the candidates opportunities to master all the skills and competencies as given on the checklist in Section 4 Assessment.  Each of these competencies directly relate to assuring that every student is assessed for a multitude of physical, social and psychological issues. The candidate is then in a unique position to determine what barriers there are to learning and provide services as needed.

Nursing 187 - - School Nurse Practicum II                                     3 units
(spring)

Prerequisites: admissions to the School Nurse Service Credential Program; CDD 125; NURS 136, 137; PSYCH 168 or SPED 120; COUN 174 or 200; NURS 184. Corequisite: NURS 185. Secondary school nurse experience, including alternative education; direct supervision by credentialed school nurse required. Scheduled conferences with preceptor and faculty. Class participation online. (9 clinical hours/week).

This practicum is identical to NURS 186, but is directed to the secondary level. 

Criterion 3: The design of the program provides extensive opportunities for candidates to learn to address the health related educational needs of all students.

While working under the supervision of a qualified school nurse preceptor, candidates have the opportunity to achieve optimal levels of wellness with children and adolescents by taking “teachable moments” in the health office and advising parents while in clinical practice in NURS 186, elementary school nursing in the fall, and in NURS 187, secondary school nursing in the spring, while working under the supervision of a qualified school nurse preceptor. Candidates also have the opportunity to develop a health lesson plan and to execute that plan by carrying out a health teach in classroom in both NURS 186, with children at the elementary level, and again in NURS 187, students have the opportunity to facilitate small groups or develop curriculum, a lesson plan and carry out a classroom teach at the secondary level. Preceptors and/or classroom teacher provide candidates support and timely feedback related to their teaching effectiveness.

It should also be noted that candidates have generally had opportunities in their undergraduate education to do health teaching with individuals and groups. Preceptors and classroom teacher provide immediate feedback to candidates on their teaching effectiveness. Previous work experience has also afforded many students the opportunity to practice client and group teaching. In lecture, seminar and practicum courses there is evidence of curriculum components that comprise this standard are present in didactic coursework:

In NURS 137, Teaching Strategies for the Healthcare Client, prior to taking core school nurse courses, candidates focus on teaching-learning theories, learning styles, developmental/ cultural/language differences, application of theories/models, learning contracts, design/ implementation/evaluation of educational units, teaching plans, and micro-teaching.

In NURS 184 (Introduction to School Nursing), candidates spend Week 10 of the semester gaining further insight into the role of the school nurse as an educator. Some of the questions for that week include learning more about goals of health instruction in the school setting, characteristics of successful curricula, the school nurse role in development of curriculum, and health promotion for school aged children, faculty and staff.

In NURS 185, School Nurse Seminar, candidates are asked to respond to questions related to health education throughout the semester. Examples are found in the following weeks: Week 1, discuss learning strategies that work with pre-adolescents and adolescents; Week 2, “Health Framework for California Public Schools, planning to teach small groups, coordinated school health programs; Week 3, supporting student success; Week 4, goals of health instruction, characteristics of successful curricula, the Health Education Process, the Group Process, and creating and facilitating groups, worksite promotion, CHEM – comprehensive health education model; Week 5, working with the P.E. department to provide health teaching and health promotion; Week 6, tobacco prevention/cessation programs, other; Week 7, HIV/AIDS education, sex Ed. curriculum; Week 8, health teaching and small groups, i.e. pregnant teens; Week 9, eating disorders and programs; Week 10, suicide prevention and intervention; Week 13, writing and publishing articles relevant to health and school nursing.

In NURS 186, School Nurse Practicum I, candidates have many opportunities to teach children and families on an individual bases with regard to disease prevention, medication administration at school, safety, prevention of spread of communicable disease, community resources, other. Candidates in NURS 186 also have the opportunity to develop a Health Teaching Plan that includes a classroom presentation. In order to carry out this assignment, students must review the CDE (California Dept. of Ed.) Health Framework for California Public Schools (2003) for grade level concepts, content, and examples of skills and behaviors, research relevant subject matter, apply learning theories, develop a teaching outline, carryout the presentation, and evaluate learning effectiveness. Candidates also share their teaching outlines on Blackboard for the benefit of other students, who are able to print them out and include them in a “Personal Reference Manual” for use in their own school nursing practice.

In NURS 187, School Nurse Practicum II, throughout the semester, candidates have many opportunities to teach pre-adolescents/adolescents in the area of wellness, disease prevention, self-care, safety, and insight into community health resources. In NURS 187, there are two assignment related specifically to health teaching. Candidates have a choice of doing one or the other. They are as follows: The Aggregate Teaching/Small Group Activity, This assignment provides candidates with the opportunity to expand their teaching skills into a series of presentations with a focus on group dynamics and support, as well as the adolescent’s developmental stage and unique needs.  With this assignment, the candidate is asked to consult with their preceptor, a school psychologist, and/or a counselor in locating an aggregate of 6-12 pupils with a particular health education/counseling need (i.e., pregnant minors, school-aged parents, at-risk students, athletes, smokers, others), the candidate then develops 2 or 3 informal lesson plans (after reviewing CDE Health Framework for California Public Schools for subject matter/age appropriateness, researching subject matter, reviewing CA Ed Code, and district policy) for the purpose of facilitating two or three sequential lessons relative the health issues of the group. To do this assignment, candidates need to review the Group Process and Creating and Facilitating Groups that they learned about in N185 (week 4). With the second assignment, Health Education Curriculum Proposal and Teach, the candidate is asked to review current health curriculum in a secondary health class to determine if there is an area that has not been addressed, i.e. dangers of Hepatitis B and infections with tattooing. With approval from classroom teacher, the candidate then reviews the CDE Health Framework for California Public Schools (2003), CA Ed Code, district policy, researches the topic, gathers the materials and develops a complete teaching outline (which could be picked up and used by other than the candidate), presents the lesson, and evaluates learning outcomes. Both of these health teaching experiences are shared on Blackboard for the benefit of follow students, who will be able to print out the teaching outlines and include them in a Personal Reference Manual for use in their own school nursing practice. School nurse preceptors are asked to be present to give feedback to candidates on their performance, as well as the classroom teacher.  Health teaching activities are evaluated by clinical instructors through review of written assignments and student journaling.

Evidence of opportunities for candidates to learn to address health related educational needs.

Supporting Documentation:
Program Curriculum Matrix, Sec. 2,
Syllabi, Sec. 3 - NURS 137, p. 81; NURS 184, p 108; NURS 185, p. 238; NURS 186, p. 199; NURS 187, p. 328.

Weekly Questions Booklets, Sec. 3 - NURS 184, p. 136; NURS 185, p. 261

Examples of Student Assignments relevant to criterion:
N184, responses to questions on Health Education, week 10
N185, responses to Health Education related questions, weeks 1-13
N186, Health Teaching Plans, module 3
N187, Health Education Curriculum Proposal paper and Teach, module 3 Aggregate Teaching/Small Group Activity, module 3

See also:
N184, N185, N186, N187 completed assignments/journaling stored in Bb courses.
N184, N185, N186, N187 binders of samples of student work on site.

Criterion 4: By design, the program provides extensive opportunities for candidates to learn to access and use community resources to address the health related needs and concerns of students, parents, staff, and other members of the educational community.

While the Ryan Act (1970) eliminated the requirement for a PHN (Public Health Nurse) certification, CSUF program faculty recognizes that public health nursing brings an important community focus to school nursing practice. School nurse candidates graduating from BSN programs have taken community health coursework in their under graduate program. Nurses who graduated from Associate of Art/Science degree two-year programs, and who hold bachelor’s degrees in other than nursing, have not. Faculty, with recommendation from the School Nurse Services Credential Program Advisory Board, made the decision to require 5 units of university community health coursework as a prerequisite (3U didactic and 2U of field experience) for nurses who had not taken community health course work in their undergraduate programs. This requirement gives those nurses the global understanding for community health issues and insight into the various resources that school nurses needs in order to effectively assist children, adolescents, and families. Knowledge acquired by taking community health coursework gives the school nurse candidate insight into important resources such as Health Departments programs and services, Social Services, Family Planning services, as well as sources of food, clothing and shelter. CSUF community health coursework can be taken during the summer. The didactic portion is offered online and the practicum experience, for those outside the area, can be taken in their own community under the supervision of a qualified PHN preceptor as long as a University/Agency Internship Agreement is in place. Evidence that curriculum components that comprise this standard are present in didactic coursework in seminar courses and in the candidate’s clinical experience:

In NURS 184, Introduction to School Nursing (seminar), didactic coursework. Evidence of the importance of community involvement is addressed in weekly research questions throughout the semester. Examples of this are found in the following weeks: Week 1, dynamics of school district organization, the role of the State Board of Education, and funding sources for education; Week 2, coordinated school health programs, local, state, and federal roles; Week 3, HIPAA/FERPA, confidentiality issues as they relate to community health agencies and care providers; Week 4, school nurses as managers of school health programs; Week 7, working with migrant programs, dental screening programs involving community; Week 8, communicable disease control, tuberculosis screening programs and working with community health agencies; Week 9, coordinated school health programs and community involvement; Week 11, cultural differences, child abuse reporting; Week 13, parent rights, SELPAs (Special Education Local Planning Areas), understanding for grief stricken parents; Week 14, interaction with families; Week 15, the evaluation and outside referral of children with special physical health needs. (See N184 Weekly Questions Booklet for questions.)

Further, in NURS 184, candidates are required to write a School Board Paper. This requires that school nurse students research the purpose, election process, and makeup of School Boards. They must also spend a minimum of 1.5 to 2 hours attending a local school board meeting, observing the proceedings, determining the players, the issues and concerns that come before the board and from whom, and what value and purpose attendance at school board meeting has for the school nurse. Other NURS 184 assignments that increase the students understanding for families, community, and major issues regarding cultural/ethnic differences are the Cross-Cultural Interview (a personal interview with family of a different culture other than that of the student), or the Cross-Cultural Book Report (Ann Fadiman’s The Spirit Catches You and You Fall Down, 1997). Students frequently express appreciation of the insight they gain from these assignments with regard to resolving communication problems, barriers to education, understanding, tolerance, and access to care. (See NURS184 Syllabus for assignment details.)

In NURS 185, Seminar in School Nursing, evidence of the importance of community involvement is addressed in the weekly research questions throughout the semester. Examples of this are found in the following weeks: Week I, school nurses as managers; Week 2, coordinated school health programs; Week 3, promoting the school nurse image; Week 6, alcohol and families; Week 7 communicable disease in the community; Week 8, visiting community programs, services for pregnant teens; Week 9, referral for mental health issues, Week 10 suicide prevention and intervention; Week 11, gangs, violence, campus emergencies and community involvement; Week 12,  school based clinics, politics 101 and legislative involvement; Week 13, grants and sources of funding; Week 14, targeted case management; Week 15, the school nurse community. (See NURS 185 Weekly Questions Booklet.)

Further, in NURS 185, candidates are required to write a Legislative Paper. This involves having insight into the role of the school nurse in affecting legislation the affects children’s health, families, and the school community. This assignment includes communication with a state senator or legislator, even the Governor. Students are asked to identify a bill or some proposed legislation (state) that has the potential to affect the school health program or school nursing practice in California. Students are asked to write a letter or actually visit the office of a local legislator. During an office visit, students are encouraged to educate the senator/legislator on current issues in school health and the role of the school nurse as a member of the education team. (See N185 Syllabus for assignment details.)

In NURS 186 and NURS 187 (practicum courses) throughout practicum experiences, candidates must interact with members of the community, i.e., families, health care providers, and agencies in their efforts to assist children and families with needed services. To further their insight into community resources, candidates are required to  spend 8-10 hours each semester out in the community participating in various community activities, such as health clinics, health fairs; visiting referral agencies and programs, i.e., for pregnant and parenting teens, sports clinics, Early Childhood programs, health referral agencies; and attending meetings that involve community members/agencies, such as an School Attendance Review Board meeting and PTA (Parent Teacher Association) meeting. In NURS 186, the Cross-Cultural Special Ed Case Study is a good example of an assignment where students must involve families and the use of community resources in order to meet the needs of the subject of their case study. In NURS 187, as an assignment, candidates are required to develop a Newsletter that frequently includes information about community resources specific to health care. The target population for receiving the newsletter may be faculty, pupils, families, and/or community. Many candidates in the practicum courses include investigation and evaluation of various community agencies as one of their Student Goals and/or Learning Objectives. Some students choose to develop a Reference Manuals with detailed information about various referral agencies including referral criteria, services available, and contact persons. Candidates are also encouraged to become involved with community agency boards and to interface with local public health nurses and hospital nurses. (See syllabi for assignment details.) Participation in community activities are evaluated by clinical instructor through student journaling and monitored by the candidate’s preceptor.

Opportunities for candidates to learn to access and use community resources to address the health related needs and concerns of students, parents, staff, and other members of the educational community.

Supporting Documents:
Program Curriculum Matrix, Sec. 2,
Syllabi, Sec. 3 - NURS 184, p 108; NURS 185, p. 238; NURS 186, p. 199; NURS 187, p. 328.

Weekly Questions Booklets, Sec. 3 - NURS 184, p. 136; NURS 185, p. 261

Examples of Student Assignments relevant to criterion:
N184, School Board Paper
N186, responses to clinical journal question relating to SARB
N186, N187, clinical journaling on required 8-10 hrs in each practicum spent out in the community

See also:
N184, N185, N186, N187 binders of samples of student work on site.
N184, N185, N186, N187, completed assignments stored in Blackboard courses
(Note: Community health coursework required prior to entering program)

Criterion 5: By design, the program provides extensive opportunities for candidates to learn to develop and implement plans of care as appropriate to the needs of students.

Candidates are asked to use a systematic approach to problem solving in nursing practice in the program. This includes developing appropriate individual healthcare plans for clients. Before a plan of care can be developed and implemented, school nurse students must have a clear understanding for the sequential steps in the Nursing Process. This is something that nurses learned in their undergraduate nursing programs. This knowledge is reinforced in the program. To begin with, candidates are asked to acquire the NASN (National Association of School Nurses) publication, School Nursing: Scope & Standards of Practice (2005), and the basic textbook used in NURS 184 and NURS 185, a compilation of work by multiple school nurse authors and edited by Janice Selekman, School Nursing: A Comprehensive Text (2005). Individual healthcare plans are well addressed in this text. And, the first six standards in NASN’s School Nursing: Scope & Standards deal specifically to the Nursing Process – assessment; diagnosis; outcomes identification; planning; implementation, and evaluation. Candidates are expected to know and use the Nursing process in evaluating the healthcare needs of their clients and in developing and implementing individual healthcare plans and emergency actions plans related to client chronic health conditions. It should also be noted that candidates are also required to use standardized language in developing these individual healthcare plans. To accomplish this, students are asked to acquire NASN’s (2004) Using nursing languages in school nursing practice. NASN (2007-2008) NANDA’s Nursing Diagnoses: Definition and classification is also recommended. Use of Individual Healthcare Plans is addressed in didactic coursework and in the candidate’s practicum experience:

In NURS 184, Introduction to School Nursing (seminar), didactic instruction in nursing theory and implementation of the Nursing Process, especially related to care plans and workups on children being evaluated for special education programs, is covered. Weekly research questions for the  following weeks specifically address the need to develop individual healthcare plans and emergency action plans: Week 5, food allergy; Week 8, Sickle Cell disease; Week 9, all questions for this week relate to chronic conditions that ask school nurse students to develop individual healthcare plans for, i.e., asthma, ADHD, obesity, seizure conditions, Cystic Fibrosis, diabetes, allergic rhinitis, and encopresis; Research questions for Weeks 13-15 deal with children with special needs and medically fragile children (physical and/or developmentally delayed clients) in school population and questions for those weeks require the development of care plans.

In NURS 185, Seminar in School Nursing, candidates have an opportunity to write a research paper on an adolescent mental health issue, or a behavioral problem leading to other health issues. In the assignment, the student is to research the health problem/concern and discuss ways to strengthening lines of resistance and restoration that individual back to optimal health, which includes the Nursing Process and developing a healthcare or emergency plan.

In NURS 186 and NURS 187 (practicum courses), while under the watchful eye of a qualified school nurse preceptor, candidates are confronted with challenges on a daily basis that require use of the Nursing Process and may lead to the development of a individual healthcare plan and/or an emergency action plan to safeguard the clients health and well being. Candidates are also expected to review client health records and to interview parents of clients with chronic health care issues and/or life threatening allergic conditions to determine the need for an individual healthcare plan or emergency action plans.

One of the most thorough examples of an assignment that requires the school nurse student to use the Nursing Process and problem solving techniques is in the completion of a Cross Cultural Special Ed Case Study assignment for NURS 186. In this assignment, students are asked to collect data on a child from a different cultural/ethnic background and to interpret the data to determine potential or actual health problems that may impact the child’s ability to learn, as well as cultural, communication, poverty, and/or dysfunctional family issues that may also stand in the way of learning and access to health care. Students are asked to generate nursing diagnoses and implement interventions in conjunction with IEP process and meeting. This frequently leads to the development of a care plan. As time constraints allow, school nurse students are encouraged to evaluate the effectiveness of these interventions.

In both NURS 186 and NURS 187 (practicum courses), candidates are expected to use a systematic approach to problem solving in assessing the health status of children and adolescents that come into the health office and those who are referred to the school nurse by teachers and others. Candidates are also encouraged to go beyond the child to use a systematic approach to assisting families in solving problems such as access to health care, shelter, food, and clothing, Before a candidate can teach a health lesson or facilitate a small group discussion, that student must carry out the Nursing Process - assess the need, research the material, identify outcomes, plan, prepare, implement, and evaluate outcomes to determine teaching effectiveness.  Use of the Nursing Process and Plans of Care developed by candidates are evaluated by the clinical instructor through student journaling and the candidate’s preceptor through direct observation.

Opportunities for candidates to learn to develop and implement plans of care as appropriate to the needs of students:

Supporting Documentation
Program Curriculum Matrix, Sec. 2,
Syllabi, p. 81; NURS 184, p 108; NURS 185, p. 238; NURS 186, p. 199; NURS 187, p. 328.

Weekly Questions Booklets, Sec. 3 - NURS 184, p. 136; NURS 185, p. 261

Examples of Student Assignments relevant to criterion:
N184, weekly questions, special needs pupils, weeks 8-15
N186, Cross-Cultural Special Ed Case Study
N186, N187, journaling on pupils with special needs

See also:
N184, N185, N186, N187 binders of samples of student work on site.
N184, N185, N186, N187, completed assignments stored in Blackboard courses.

Criterion 6: By design, the program provides extensive opportunities for candidates to know and understand the roles and responsibilities of school nurses within the educational setting.

The candidate synthesizes the role of the school nurse - as insight and knowledge of the multifaceted role develops, school nurse students begin to understand how all aspects of school nursing work together to complete the picture. Following is an explanation of what is included in the sequential coursework in the program that helps the candidate develop a rounded and global understanding for school nurse roles and responsibilities within the educational setting:

Phase I courses (16 units), which include coursework in audiology, health teaching, mainstreaming, counseling, health assessment, vision and scoliosis screening techniques gives candidates the necessary tools to meet the needs of children, adolescents, and staff in the school setting – to conduct screening to detect deviations from the norm, promote and teach health, understand the issues related to special needs pupils, counsel effectively, and carry out meaningful health assessments on clients in the school setting. Community health coursework is required prior to entering the program, which gives candidates initial insight into community health issues. CDDS 125, Audiometry and Audiology for School Nurses (3U), taken through the CSUF Department of Communicative Disorders, is one of the first courses that is recommended for school nurse students to take. This gives candidates the skill and ability to carry out state mandated hearing testing in the school setting and to assess those children referred by other members of the education team for suspected hearing loss which impacts the child’s ability to learn. NURS 137, Teaching Perspectives for the Healthcare Client, gives the school nurse student the necessary insight into the principles of teaching and learning applied to teaching individuals and groups. Health teaching and health promotion is a significant part of what the school nurse does on a daily basis in health office, within the school community, and as a guest in the classroom. In SPED 120, Mainstreaming Exceptional Students, students gain insight into the special needs of exceptional children, as well ethical issues and legal guidelines that dictate how the needs of these children must be met, including the contributing role of the school nurse. PSYCH 169, an alternative course choice for SPED 120, gives school nurse student insight into psychological theory and research related to the impact of disability on disabled persons (children and adolescents in the school setting) and attitudes towards disability, which in turn, helps the school nurse student understand how the school nurse role fits into the picture. COUN 174, Introduction to Counseling, (or COUN 200) gives the school nurse student insight into methodology and the interviewing skills needed to gain client confidence and trust and to elicit the necessary information in order to help the client make positive lifestyle changes and/or meet his/her health related needs. This skill is particularly valuable for the school nurse student in helping adolescents find answers to confidential health issues. NURS 136, Health Appraisal, provides the school nurse student with the knowledge, ability, and skill to obtain a meaningful health history on a client and to carry out a thorough health assessment in keeping with the Nursing Process. Assessment is at the core of what is involved in the multifaceted role of the school nurse. School nurse students may take phase I course work through other accredited universities with approval from the program coordinator. In phase II, core school nurse courses, synthesis is furthered as students take what they have learned in didactic courses (NURS 184, Introduction to School Nursing, and NURS 185, School Nurse Seminar) and put it into practice in their practicum courses (NURS 186 and NURS 187).

Phase II, or core school nurse coursework, enables candidates to further identify, delineate, and clarify their role as a professional school nurse. Practical and theoretical knowledge of school nursing practice based on legal guidelines are included throughout didactic coursework in both NURS 184 and NURS 185 seminars and candidates are expected to put this knowledge into practice in their clinical experiences in NURS 186 and NURS 187 (practicum courses).

The didactic coursework (NURS 184 and NURS 185) covers the multiple and varied aspects of school nursing practice. It is based on professional standards of school nursing practice, nursing theories, legal guidelines (Nurse Practice Act, CA Education codes, and other state and federal codes and laws) and ethical behavior. Candidates gain insight into the fact that the school nurse is the only health professional in the school setting and, as such, must be equipped with the knowledge and skills to effectively and safely manage multiple types of health related situations. Candidates also gain insight into their role as leaders and program managers, health educators, and members of the education team.

In NURS 184, some specific things that are addressed are legal basis for school nursing practice, Standards of School Nursing Practice, coordinated school health programs, screening programs, health promotion and education for pupils and staff, case management of pupils with various acute and chronic health problems, individuals with disabilities, the IEP (Individual Education Plan) Process, environmental safe issues, pupil and parents’ rights, etc. To incorporate the role of the pediatric nurse practitioner, nurse practitioners entering the program are asked to discuss their role in school nursing and asked how it would differ from that of other school nurses. Role confusion, burnout and ineffectiveness are also addressed in that same week. The first assignment the school nurse student has is to develop a Personal Philosophy of School Nursing. This assignment gives them insight into their own attitudes and understanding for others that may need to change. The assignment involves researching standards of nursing practice, theoretical concepts, moral/ethnical responsibilities, personal values and beliefs, and perception of the school nurse role. After review by the course instructor, students are to place their philosophy in their Personal Reference Manual. Upon the completion of core school nurse courses in the spring semester, students are invited to review their philosophy to see if it has changed. This assignment gives candidates an opportunity to sincerely reflect on their own values, ethics, and beliefs as they relate to their school nursing practice.

In NURS 185, School Nurse Seminar, candidates learn about the complexities of adolescent health issues, spends time gaining insight into school nursing research, finding out about funding sources, grant writing, and legislative issues, etc. In Week 12, students are asked to define competency with regard to school nursing practice, what serves as a framework for professional expectations, and standards of performance that describe a competent level of behavior in that professional role.

In the practicum courses (NURS 186 and NURS 187), candidates have the opportunity to demonstrate their ability to put into practice what they have learned in the didactic coursework. Students are expected to use the Nursing Process effectively in the school setting. They are evaluated on their critical thinking skills, effective communication and collaboration, and ability to exercise sound judgment. Candidates are encouraged to think globally, to see the whole child (including family) and community in their problem solving efforts. School nurse students are expected grow in their knowledge of community resources and services for children and families; insight into funding sources; legislation that impacts the health and well being of children and school nursing, and to recognize the school nurse’s role as advocates for children and families. Candidates also need to recognize the need for continued lifelong learning and professional growth. They are required to keep a journal on their clinical activities which is reviewed regularly by the student’s clinical instructor. Meaningful assignments in practicum courses include: A Cultural Special Ed Case study, teaching health lessons in the classroom, reviewing health policies, facilitating a small groups relevant to health promotion and teaching, learning to write a professional newsletter, and gaining insight into the roles and responsibilities of other members of the education team. These assignments are discussed more fully within other standards in the document.

Opportunities for candidates to know and understand the roles and responsibilities of school nurses within the educational setting:

Supporting Documentation
Program Curriculum Matrix, Sec. 2,
Syllabi, Sec. 3 - CDDS 125, p. 2;  COUN 174 (200), p. 16 and 29; SPED 120, p. 45; NURS 136, p.60; NURS 137, p. 81; NURS 183, p. 97; NURS 184, p.108; NURS 185, p. 238; NURS 186, p. 199; NURS 187, p. 328.

Weekly Questions Booklets, Sec. 3 - NURS 184, p. 136; NURS 185, p. 261
N186/N187 Preceptor Syllabus, Sec. 3, p. 367

Student insight into role and clinical experience relevant to criterion:
Assignments throughout core school nurse courses, both didactic and clinical, and Phase I coursework, that gives candidates the necessary assessment tools and insight into lesson planning and teaching, work together to give candidates an understanding for the multi-complex school nurse role and responsibilities in the educational setting.

See also:
N184, N185, N186, N187, completed assignments/journaling stored in Bb courses.
N184, N185, N186, N187 binders of samples of student work on site.

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