Framework for the 21st Century School Nursing Practice

At ESC 19 Head Start Birth to Four Education Program, Health Services has always worked to assure our efforts for our students occur within the context of the students' family and community. We touch on all of the principles of the Framework, but the Community/Public Health principle covers the biggest part of our work.

The main practice components of this principle guide our work:

ACCESS TO CARE:  On enrollment, we stress to parents the importance of their being the primary healthcare providers for the student and family.  Establishing a medical home  (to include physical, dental and immunizations) is a major goal for each family. We provide a Parent Resource Guide handbook, a Parent Handbook and, as our Family Service Workers (FSWs) make their initial home visit, they provide the Health Services Parent Handbook and help parents update Health Requirements.  We help parents make and follow up with appointments, give and follow up on referrals for any pending medical / dental concerns. If need determines, Head Start funds can be used to help our students be current on physical and dental exams and immunizations.

HEALTH EDUCATION:  Through our Parent Development and Leadership services area, we use the Abriendo Puertas program that is presented through our Family Development Centers.  The program includes several sessions of health and well-being presentations.   At our annual Parent Conference, several of the breakout sessions cover health topics with the sessions having full capacity in attendance. 

HEALTH PROMOTION/OUTREACH:  Our nurses present on health related topics center parent meetings and participate in community and school health fairs.  They perform anemia, lead and cholesterol screenings/testing as well as height, weight and blood pressure screenings and provide basic health information on a one-to-one basis.  We try to have parents administer medication at home, since we do not have a nurse at each of However, if needed, the center manager determines which staff can be delegated to administer medication and the nurses do the training, overview and follow up for any student that needs to have medication administered while at the center.

SCREENINGS / REFERRAL / FOLLOW UP:  Our FSWs  make up part of the Health Services team.  They screen our children for height, weight, and blood pressure.  They are trained in Vision (to include screening for strabismus), Hearing screening / testing and have  access to the latest equipment to include  Eroscan and OAE screeners. The nurses provide the anemia and lead screening / testing  for those students whose healthcare provider has not  followed up on those tests.  The FSWs follow up with referrals for abnormal findings on any of the screening.

      From the principle, CARE COORDINATION:

CASE MANAGEMENT:   The FSWs, as well as our nurses, follow the steps of case management in almost every aspect of their interaction with students, staff and family.  At In Service and pull-out training sessions, staff from ESC Region 19, as well as guest speakers help train our teachers, mentors, resource teachers and Infant/Toddler Teachers (for Early Head Start) on the steps of case management.  Our information system, ChildPlus, helps with the documentation and follow up of all of our actions.

STUDENT CARE PLANS:  The nurses, along with input from healthcare provider and the parents, develop a care plan for each student with chronic health condition. Once the parent discloses the condition, the care plan is shared with all staff that need to know how to interact with the child.

At ESC 19 Head Start, the Framework for  21st Century School Nursing Practice, is an integral part of all that we do for our children and their families.

Arturo (Art) Oaxaca, BSN, RN
Health Services Coordinator
Region 19 Head Start

How The School Nursing Framework is Being Applied by Our School Nurses