Academic journal article Journal of School Health

School Nursing: A Framework for Practice. (the School Health Service)

Academic journal article Journal of School Health

School Nursing: A Framework for Practice. (the School Health Service)

Article excerpt

Inspired and challenged by the visions of Jerome Lysaught in "Bell, Book, and Candle: The National Commission and the School Nurse," we are no longer content to sit back passively and await the extinction of school nursing. Declining enrollments, budgetary cutbacks, and the inability of school nurses to articulate and account for their practice have all been cited as factors contributing to the current crisis in school nursing. Of these three reasons, nursing has direct responsibility for the latter. As Lysaught succinctly states "... the trouble may not be in our stars, but in ourselves." (1)

The purpose of this article is to facilitate acceptance of this responsibility by providing school nurses with a conceptual framework that can be used to structure their practice.


By Aldous' definition, (2) concepts are useful ideas that "... enable man to learn from experience, to identify current events, to behave appropriately and to study systematically such phenomena ..." as school nursing. When concepts are organized into a conceptual framework that may be thought of as a cluster of concepts relating to a particular phenomenon, their application to practice is facilitated. The cluster of concepts we have chosen as our framework is schematically represented in Figure 1. Overlapping areas constitute the scope and focus of school nursing.

In discussing each concept, we will provide a definition, a rationale for inclusion, and examples illustrating the applicability to school nursing practice.

Public Health

According to Fredlund, (3) school nursing is a part of community nursing and therefore has as its basis an understanding of "public health." In its broadest sense, public health may be thought of as "... a continuum of activities to protect the health of the community." (4) These activities are organized into three levels (5) which are as follows: (1) "primary prevention" which includes health promotion and specific protection; (2) "secondary prevention" which includes early diagnosis, prompt treatment, and disability limitation; and (3) "tertiary prevention" which focuses primarily on rehabilitation.

The school nurse specifically focuses on promotion of "high level wellness" which Dunn (6) defines as "... an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable within the environment where he is functioning." It follows logically from this definition that the school nurse's client system should include not only the school child but also his family, school personnel, and the community at large.

The following examples will demonstrate the applicability of public health concepts to the practice of school nursing. At the primary prevention level, an immunization program illustrates both "health promotion" and "specific protection" activities. Successful implementation of any immunization program for school children requires active coordination of the efforts of all involved personnel by the school nurse in planning, implementation, and follow-up, including delegation of appropriate tasks, as depicted in Figure 2.

At the secondary prevention level, the school nurse conducts various screening programs such as vision, hearing and scoliosis. In each program, the nurse is involved with planning, implementation and follow-up activities. Although the primary recipient in these screening programs is the child, the family and community are also involved. The nurse initiates contact with the family when deviations are noted and facilitates their referral to existing community resources for necessary follow-up. If no resource is readily available for follow-up, the truly "public health-oriented" school nurse will intervene at the community level to stimulate appropriate agencies or groups to develop a resource.

At the tertiary prevention level, the school nurse works to facilitate the positive adaptation of a handicapped child in the school setting. …

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