Académique Documents
Professionnel Documents
Culture Documents
Technical Assistance
Manual
State of Delaware
Delaware School Nurses Association
Department of Education
Dover, Delaware
Revised:
September, 2008
-2-
Department of Education
John G. Townsend Building
401 Federal Street, Suite 2
Dover, Delaware 19901
Valerie A. Woodruff
Secretary of Education
Linda C. Wolfe, R.N.
Health Services
THIS PUBLICATION IS AVAILABLE IN MICROFICHE FROM THE DELAWARE PUBLIC ARCHIVES, P. O. BOX 1401, DOVER, DELAWARE
19903, AND PRINTED IN THE U.S.A.
THE DELAWARE DEPARTMENT OF EDUCATION DOES NOT DISCRIMINATE IN EMPLOYMENT OR EDUCATIONAL PROGRAMS,
SERVICES OR ACTIVITIES, BASED ON RACE, COLOR, ANTIONAL ORIGIN, SEX, AGE, OR HANDICAP IN ACCORDANCE WITH THE STATE
AND FEDERAL LAWS. INQUIRIES SHOULD BE DIRECTED TO DEPARTMENT OF EDUCATION, HUMAN RESOURCES, P.O. BOX 1402,
DOVER, DELAWARE 19903, AREA CODE (302) 739-4604.
DOCUMENT # 95-01/01/03/14
Section A - 1 - 4-2008
Section A.
1
Section A - 2 - 4-2008
DELAWARE DEPARTMENT OF
EDUCATION REGULATIONS
A complete set of Department of Education regulations is available at
www.state.de.us/research/AdminCode/title14
Education Regulations links:
Title 14 Education
100 Accountability
200 Administration and Operations
300 Certification
400 Construction
500 Curriculum and Instruction
600 School Climate and Discipline
Section A - 3 - 4-2008
DELAWARE DEPARTMENT OF EDUCATION REGULATIONS
SECTION 800. HEALTH AND SAFETY
804 Immunizations
1.0 Definition
"School Enterer" means any child between birth and twenty (20) years inclusive entering or
being admitted to
a Delaware school district for the first time, including but not limited to, foreign exchange
students, immigrants,
students from other states and territories and children entering from nonpublic schools.
2.0 Minimum Immunizations Required for All School Enterers
2.1 All School Enterers shall have immunizations given up to four days prior to the minimum
interval or
age and shall include:
2.1.1 Four or more doses of diphtheria, tetanus, pertussis (DTaP, DTP, or other approved
vaccine)
or a combination of these vaccines. A booster dose of Td or Tdap (adult) is recommended by
the Division of Public Health for all students at age 11 or five years after the last DTaP, DTP
or DT dose was administered whichever is later. Notwithstanding this requirement:
2.1.1.1 A child who received a fourth dose prior to his or her fourth birthday shall have a
fifth dose;
2.1.1.2 A child who received the first dose of Td (adult) at or after age seven may meet this
requirement with only three doses of Td or Tdap (adult).
2.1.2 Three or more doses of inactivated polio virus (IPV), oral polio vaccine (OPV), or a
combination of these vaccines with the following exception: a child who received a third
dose
prior to the fourth birthday shall have a fourth dose.
2.1.3 Two doses of measles, mumps and rubella (MMR) vaccine. The first dose should be
administered on or after the age of 12 months. The second dose should be administered
after
the fourth birthday. Individual combination vaccines of measles, mumps, rubella (MMR) may
be used to meet this requirement.
2.1.3.1 Disease histories for measles, rubella and mumps shall not be accepted unless
serologically confirmed.
2.1.4 Three doses of Hepatitis B vaccine.
2.1.4.1 For children 11 to 15 years old age, two doses of a vaccine approved by the Center
for Disease Control (CDC) may be used.
2.1.4.2 Titers are not acceptable in lieu of completing the vaccine series and a disease
history for Hepatitis B shall not be accepted unless serologically confirmed.
2.1.5 Varicella vaccine is required beginning in the 2003-2004 school year with kindergarten.
One
grade shall be added each year thereafter so that by the 2015-2016 school year all children
in
grades kindergarten through 12 shall have received the vaccination. Beginning in the 20082009 school year new enterers into the affected grades shall be required to have two doses
of
the Varicella vaccine. The first dose shall be administered on or after the age of twelve (12)
months and the second at Kindergarten entry into a Delaware public school. A written
disease
history, provided by the health care provider, parent, legal guardian, Relative Caregiver or
School Enterer who has reached the statutory age of majority (18), 14 Del.C. 131(a)(9), will
be accepted in lieu of the Varicella vaccination. Beginning in the 2008-2009 school year, a
disease history for the Varicella vaccination must be verified by a health care provider to be
exempted from the vaccination.
2.2 Children who enter school prior to age four (4) shall follow current Delaware Division of
Public
Health recommendations.
3.0 Certification of Immunization
3.1 The parent, legal guardian, Relative Caregiver or a School Enterer who has reached the
statutory age of
majority (18), 14 Del.C. 131(a)(9), shall present a certificate specifying the month, day, and
year that
the immunizations were administered by a licensed health care practitioner.
3.2 According to 14 Del.C. 131, a principal or person in charge of a school shall not permit a
child to
enter into school without acceptable evidence of immunization. The parent, legal guardian,
Relative
Section A - 4 - 7-2007
Caregiver or a School Enterer who has reached the statutory age of majority (18), 14 Del.C.
131(a)(9), shall be notified of this requirement in writing. Within 14 calendar days after
notification,
evidence must be presented to the school that the basic series of immunizations has been
initiated or
has been completed.
3.3 A school enterer may be conditionally admitted to a Delaware school district by
presenting a statement
from a licensed health care practitioner who specifies that the School Enterer has received
at least:
3.3.1 One dose of DTaP, or DTP, or DT; and
3.3.2 One dose of IPV or OPV; and
3.3.3 One dose of measles, mumps and rubella (MMR) vaccine; and
3.3.4 The first dose of the Hepatitis B series; and
3.3.5 One dose of Varicella vaccine as per 2.5.
3.4 14 DE Admin. Code 901 Education of Homeless Children and Youth 6.0 states that
"School districts
shall ensure that policies concerning immunization, guardianship and birth certificates do
not create
barriers of the school enrollment of homeless children and youth". To that end, school
districts shall as
stated in 14 DE Admin. Code "assist homeless children and youth in meeting the
immunization
requirements".
3.5 If the school enterer fails to complete the series of required immunizations the parent,
legal guardian,
Relative Caregiver or a school enterer who has reached the statutory age of majority (18),
14 Del.C.
131(a)(9), shall be notified that the School Enterer will be excluded according to 14 Del.C.
131.
4.0 Lost or Destroyed Immunization Record
When a students immunization record has been lost or destroyed by the medical provider
who administered
the vaccine, the parent, legal guardian, Relative Caregiver or a school enterer who has
reached the statutory
age of majority (18), 14 Del.C. 131(a)(9),shall sign a written statement to this effect and
must obtain at
least one dose of each of the immunizations as identified in 3.3. Evidence that the vaccines
were
administered shall be presented to the superintendent or his or her designee.
5.0 Exemption from Immunization
5.1 Exemption from this requirement may be granted in accordance with 14 Del.C. 131
which permits
approved medical and notarized religious exemptions.
5.2 Alternative dosages or immunization schedules may be accepted with the written
approval of the
Delaware Division of Public Health.
6.0 Verification of School Records
The Delaware Division of Public Health shall have the right to audit and verify school
immunization records to
determine compliance with the law.
7.0 Documentation
7.1 School nurses shall record and maintain documentation of each student's immunization
status.
7.2 Each student's immunization record shall be included in the Delaware Immunization
Registry.
Section A - 5 - 7-2007
2.1 School staff and extended services personnel shall provide the Mantoux tuberculin skin
test results
from test administered within the past 12 months during the first 15 working days of
employment.
2.1.1 Tuberculin skin test requirements may be waived for public school staff and extended
services
personnel who present a notarized statement that tuberculin skin testing is against their
religious
beliefs. In such cases, the individual shall complete the Delaware Department of Education
TB
Health Questionnaire for School Employees or provide, within two (2) weeks, verification
from
a licensed health care provider or the Division of Public Health that the individual does not
pose
a threat of transmitting tuberculosis to students or other staff.
2.1.1.1 If a school staff member or extended services person, who has received a waiver
because of religious beliefs, answers affirmatively to any of the questions in the
Delaware Department of Education TB Health Questionnaire for School Employees
he/she shall provide, within two (2) weeks, verification from a licensed health care
provider or the Division of Public Health that the individual does not pose a threat of
transmitting tuberculosis to students or other staff.
2.1.2 Student teachers need not be retested if they move from district to district as part of
their student
teaching assignments.
2.2 Every fifth year, by October 15th, all public school staff and extended services personnel
shall complete
the Delaware Department of Education TB Health Questionnaire for School Employees or,
within two
(2) weeks, provide Mantoux tuberculin skin test results administered within the last twelve
(12) months.
2.2.1 If a school staff member or extended services staff member answers affirmatively to
any of the
questions in the Delaware Department of Education TB Health Questionnaire for School
Employees he/she shall provide, within two (2) weeks, verification from a licensed health
care
provider or the Division of Public Health that the individual does not pose a threat of
transmitting tuberculosis to students or other staff.
2.3 All documentation related to the School Health Tuberculosis (TB) Control Program shall
be retained in
the same manner as other confidential personnel medical information.
3.0 Volunteers
3.1 Volunteers shall complete the Delaware Department of Educations TB Health
Questionnaire for
Volunteers in Public Schools prior to their assignment and every fifth year thereafter.
3.1.1 If the volunteer answers affirmatively to any of the questions, he/ she shall provide,
within two
(2) weeks, verification from a licensed health care provider or the Division of Public Health
that
the individual does not pose a threat of transmitting tuberculosis to the students or staff.
3.2 Each public school nurse shall collect and monitor all documentation related to the
School Health
Tuberculosis (TB) Control Program and store them in the school nurses office in a
confidential
manner.
4.0 New School Enterers
4.1 New school enterers shall show proof of tuberculin screening results as described in
4.1.1 and 4.1.2
including either results from the Mantoux Tuberculin test or the results of a tuberculosis risk
assessment. Multipuncture skin tests will not be accepted.
4.1.1 If the new school enterer is in compliance with the other school entry health
requirements, a
school nurse who is trained in the use of the Delaware Department of Education TB Risk
Assessment Questionnaire for Students may administer the questionnaire to the students
parent(s), guardian(s) or Relative Caregiver or to a new school enterer who has reached the
statutory age of majority (18).
4.1.1.1 If a students parent(s), guardian(s) or Relative Caregiver or a student 18 years or
older answers affirmatively to any of the questions, he/she shall, within two (2)
weeks, provide proof of Mantoux tuberculin skin test results or provide verification
from a licensed health care provider or the Division of Public Health that the student
does not pose a threat of transmitting tuberculosis to staff or other students.
4.2 School nurses shall record and maintain documentation relative to the School Health
Tuberculosis
(TB) Control Program.
5.0 Tuberculosis Status Verification and Follow up
5.1 Tuberculosis Status shall be determined through the use of a tuberculosis risk
assessment, tuberculin
skin test and other testing, which may include xray or sputum culture. Individuals who either
refuse
the tuberculin skin test or have positive reactions to the same, or give positive responses to
a
tuberculosis risk assessment shall provide verification from a licensed health care provider
or the
Section A - 6 - 7-2007
Division of Public Health that the individual does not pose a threat of transmitting
tuberculosis to staff
or other students.
5.1.1 Verification shall include Mantoux results recorded in millimeters (if test were
administered),
current disease status (i.e. contagious or noncontagious), current treatment (or completion
of
preventative treatment for TB) and date when the individual may return to his/her school
assignment without posing a risk to the school setting.
5.1.2 Verification from a health care provider or Division of Public Health shall be required
only once
if treatment was completed successfully.
5.1.3 Updated information regarding disease status and treatment shall be provided to the
public
school by October 15 every fifth year if treatment was previously contraindicated,
incomplete or
unknown.
5.2 In the event an individual shows any signs or symptoms of active TB infection, he/she
must be
excluded from school until all required medical verification is received by the school.
NON REGULATORY NOTE: See 14 DE Admin. Code 930 Supportive Instruction (Homebound)
Section A - 7 - 7-2007
presenting complaint, the nurse's assessment intervention and the outcome, the disposition
of the
situation, the parent or other contact, if appropriate, and the nurse's complete signature or
initials.
4.1.1 The school nurse shall document the care given at the time of a school based accident
by
completing the Student Accident Report Form if the student missed more than one half day
because of the accident or if the school nurse has referred the student for a medical
evaluation
regardless of whether the parent, guardian or Relative Caregiver or student if 18 years or
older, or an unaccompanied homeless youth (as defined by 42 USC 11434a) followed
through
on that request.
5.0 Submission of Records
5.1 All local school districts and charter schools shall submit the Summary of School Health
Services
Form, to the Delaware Department of Education by August 31st of each year. The form shall
include
all of the school health services provided in all schools during the fiscal year including
summer
programs.
unaccompanied homeless youth (as defined by 42 USC 11434a) if the student has a
suspected
problem.
2.2 Postural and Gait Screening
2.2.1 Each public school student in grades 5 through 9 shall receive a postural and gait
screening
by December 15th.
2.2.2 The school nurse shall record the findings on the Delaware School Health Record Form
(see
14 DE Admin. Code 811) and shall notify the parents, guardian or Relative Caregiver, or the
student if 18 years or older, or an unaccompanied homeless youth (as defined by 42 USC
11434a) if a suspected deviation has been detected.
2.2.2.1 If a suspected deviation is detected, the school nurse shall refer the student for
further evaluation through an on site follow up evaluation or a referral to the
students health care provider.
2.3 Lead Screening
Section A - 8 - 7-2007
2.3.1 Children who enter school at kindergarten or at age 5 or prior, shall be required to
provide
documentation of lead screening as per 16 Del.C. Ch. 26.
2.3.1.1 For children enrolling in kindergarten, documentation of lead screening shall be
provided within sixty (60) calendar days of the date of enrollment. Failure to provide
the required documentation shall result in the child's exclusion from school until the
documentation is provided.
2.3.1.2 Exemption from this requirement may be granted for religious exemptions, per 16
Del.C. 2603.
2.3.1.3 The Childhood Lead Poisoning Prevention Act, 16 Del.C., Ch. 26, requires all health
care providers to order lead screening for children at or around the age of 12 months
of age.
2.3.2 The school nurse shall document the lead screening on the Delaware School Health
Record
form. See 14 DE Admin. Code 811.
10
Section A - 9 - 7-2007
the container, and assisting the student in self administering the medication. Lay assistants
shall not
assist with injections. The one exception is with emergency medications where standard
emergency
procedures prevail in lifesaving circumstances.
"Field Trip" means any off campus, school sponsored activity.
"Medication" means a drug taken orally, by inhalation, or applied topically, and which is
either
prescribed for a student by a physician or is an over the counter drug which a parent,
guardian or
Relative Caregiver has authorized a student to use.
"Paraeducator" mean teaching assistants or aides.
11
6.2 Teachers, administrators and paraeducator employed by a student's local school district
are authorized
to assist a student with medication on a field trip subject to the following provisions:
6.2.1 Assistance with medication shall not be provided without the prior written request or
consent
of a parent, guardian or Relative Caregiver (or the student if 18 years or older, or an
unaccompanied homeless youth (as defined by 42 USC 11434a). Said written request or
consent shall contain clear instructions including: the student's name; the name of the
medication; the dose; the time of administration; and the method of administration. At least
one copy of said written request or consent shall be in the possession of the person assisting
a
student with medication on a field trip.
6.2.2 The prescribed medication, in addition to the requirements in 1.0, shall be prescribed
by a
licensed health care provider. The medication shall be properly labeled with the students
name; the licensed health care provider's name; the name of the medication; the dosage;
how
and when it is to be administered; the name and phone number of the pharmacy and the
current date of the prescription. The medication shall be in a container which meets United
States Pharmacopoeia National Formulary standards.
6.2.3 A registered nurse employed by the school district in which the student is enrolled
shall
determine which teachers, administrators and paraeducators are qualified to safely assist a
student with medication. In order to be qualified, each such person shall complete a Board of
Nursing approved training course developed by the Delaware Department of Education,
pursuant to 24 Del.C. 1921. Said nurse shall complete instructor training as designated by
the Department of Education and shall submit a list of successful staff participants to the
Department of Education. No person shall assist a student with medication without written
acknowledgment that he/she has completed the course and that he/she understands the
same,
and will abide by the safe practices and procedures set forth therein.
6.2.4 Each school district shall maintain a record of all students receiving assistance with
medication pursuant to this regulation. Said record shall contain the student's name, the
name
of the medication, the dose, the time of administration, the method of administration, and
the
name of the person assisting.
6.2.5 Except for a school nurse, no employee of a school district shall be compelled to assist
a
student with medication. Nothing contained herein shall be interpreted to otherwise relieve a
school district of its obligation to staff schools with certified school nurses.
NON REGULATORY NOTE: 14 DE Admin. Code 612, Possession, Use and Distribution of Drugs
and
Alcohol addresses student self administration of a prescribed asthmatic quick relief inhaler
and student self
administration of prescribed autoinjectable epinephrine.
12
Section A - 10 - 7-2007
1.3 The use of the state content standards for health education for grades K to 12 inclusive
of the core
concepts: alcohol and other drugs, injury prevention, nutrition, physical activity, family life
and
sexuality, tobacco, emotional health, personal and consumer health and community and
environmental
health with minimum hours of instruction as follows:
1.3.1 In grades K to 4, a minimum of thirty (30) hours in each grade of comprehensive
health
education and family life education of which ten (10) hours, in each grade, must address
drug
and alcohol education.
1.3.2 In grades 5 and 6, a minimum of thirty five (35) hours in each grade of comprehensive
health
education and family life education of which fifteen (15) hours, in each grade, must address
drug and alcohol education.
1.3.3 In grades 7 and 8, separate from other subject areas, a minimum of sixty (60) hours of
comprehensive health education of which fifteen (15) hours, in each grade, must address
drug
and alcohol education. If all of the 60 hours are provided in one year at grade 7 or 8, an
additional fifteen hours of drug and alcohol education must be provided in the other grade.
1.3.4 In grades 9 to 12, one half (1/2) credit of comprehensive health education is required
for
graduation of which fifteen (15) hours of this 1/2 credit course must address drug and
alcohol
education. This 1/2 credit course may be provided in the 9 th, 10th, 11th or 12th grade. In each
of the remaining three grades, fifteen (15) hours of drug and alcohol education must be
provided for all students.
1.4 Inclusion of a comprehensive sexuality education and an HIV prevention program that
stresses the
benefits of abstinence from high risk behaviors.
1.5 Inclusion of the core concepts of nutrition and family life and sexuality implemented
through Family
and Consumer Science courses.
1.6 An annual staff development plan that describes the use of effective instructional
methods as
demonstrated in sound research in the core concepts and skills inclusive of accessing
information, self
management, analyzing internal and external influences, interpersonal communication,
decision
making and goal setting and advocacy.
1.7 A description of the method(s) used to implement and evaluate the effectiveness of the
program which
shall be reported every three years as part of the Quality Review for Ensuring School and
Student
Success.
13
Section A - 11 - 7-2007
1.2 Includes procedures for communicating the policy to students, school staff, parents,
guardians or
Relative Caregivers, families, visitors and the community at large.
1.3 Makes provisions for or refers individuals to voluntary cessation education and support
programs that
address the physical and social issues associated with nicotine addiction.
2.0 The Tobacco Policy Shall Apply to
2.1 Any building, property or vehicle leased, owned or operated by a school district, charter
school or
assigned contractor.
2.1.1 School bus operators under contract shall be considered staff for the purpose of this
policy.
2.2 Any private building or other property including automobiles or other vehicles used for
school
activities when students and staff are present.
2.3 Any non educational groups utilizing school buildings or other educational assets.
2.4 Any individual or a volunteer who supervises students off school grounds.
3.0 No School or School District Property May Be Used for the Advertising of any Tobacco
Product
14
Each local school district shall have a policy which outlines the procedures for releasing
students from schools
to persons other than their parent, guardian or Relative Caregiver.
Section A - 12 - 7-2007
6.1.1 Each district and charter school shall prepare a list of surplus hazardous chemicals and
submit
15
16
eligible student seeking to amend their educational records as provided in Subpart C of the
FERPA
regulation.
4.0 Federal Complaints and Investigations
4.1 The Family Policy Compliance Office (FPCO) of the U.S. Department of Education is
responsible
for monitoring compliance with FERPA by agencies to which federal education funds have
been made
available. That office will investigate, process and review violations and complaints that may
be filed
with it concerning the privacy rights of parents and students of covered agencies. The
following is the
address of the office: The Family Policy Compliance Office, U.S. Department of Education,
400
Maryland Avenue, S.W., Washington, D.C. 20202-4605. Families of students attending
schools to
which federal education funding has not been made available may also find FPCOs
interpretations and
policy letters useful in understanding their rights under the policies required by this
regulation.
Section A - 13 - 7-2007
252 Required Educational Records and Transfer and Maintenance of
Educational Records
1.0 Definitions
The following words and terms, when used in this regulation, shall have the following
meaning unless the
context clearly states otherwise:
Court Orders shall mean any written direction from a court of competent jurisdiction
directed to the student
or affecting the students care or custody.
Discipline Record shall mean information about any and all periods of out of school
suspension or of
expulsion from the regular school setting imposed on a student as a result of an infraction of
the school or
districts code of conduct or other rules.
Emergency Treatment Card shall mean the card containing the general emergency
information and
procedures for the care of a student when the student becomes sick or injured in school as
required in 14 DE
Admin Code 811.1.1.
Identifying Data shall mean the name of the student, date of birth, sex, race and ethnicity,
address, telephone
number, Delaware student identification number and the name of the parent(s), guardian(s)
or Relative
Caregiver.
Progress Report shall mean a single record maintained for each student in kindergarten
through grade 8 that
contains end of year and up to date grades; standardized test(s) scores such as the DSTP
and attendance data for
each year of the students attendance.
School Health Record shall mean the form required by 14 DE Admin Code 811.2.0 for
Delaware public
school students.
Student Transcript shall mean a single record maintained for each student in grades 9 and
above that
17
contains the following: end of year and up to date grades; credits earned; class rank; Grade
Point Average
(GPA); withdrawal or graduation date; standardized test(s) scores such as the DSTP, SAT,
PSAT, ACT;
attendance data and school activities. If applicable, a list of the career technical
competencies achieved by a
student enrolled in a specific career technical program shall also be included.
2.0 Education Records Required by Schools in Delaware
2.1 Each Delaware school shall maintain a Cumulative Record File either as an electronic or
paper file for
each student enrolled.
2.1.1 The student Cumulative Record File shall contain the Emergency Treatment Card,
Identifying
Data, School Health Record, Progress Report, Student Transcript (for students in grades 9
and
above) and Discipline Record.
2.1.2 The student Cumulative Record File shall also contain any Court Orders in the school or
districts possession, to the extent the school or district maintains such documents for an
individual student.
2.1.3 In addition, the Cumulative Record File for a child with a disability as defined in 14 DE
Admin Code 925 shall contain any records related to the identification, evaluation,
placement,
and provision of a free appropriate public education. Such documents may be collected and
maintained separately.
3.0 Transfer of the Records of Public School and Private Schools Students
3.1 When a student transfers from a public school, private school or an educational program
operated by
the Department of Services for Children Youth and Their Families to any other school in
Delaware, the
receiving school shall immediately request the Cumulative Record File from the sending
school or
program.
3.2 The Cumulative Record File shall follow each student transferred from one school to
another including
files for each student with disabilities transferred from one school to another.
3.2.1 Public schools, school districts, private schools and educational programs operated by
the
Department of Services for Children Youth and Their Families shall promptly transfer a
students Cumulative Record File upon the request of a receiving school.
3.2.2 Unpaid student fees or fines shall not be a basis for a public school, school district or
an
educational program operated by the Department of Services for Children Youth and Their
Families to deny or to delay transfer of the Cumulative Record File.
3.2.3 Students shall not be denied enrollment into a public school on the grounds that the
students
Cumulative Record File has not been received.
Section A - 14 - 7-2007
3.3 Before transferring student records, a public school, school district or private school shall
specifically
confirm that the Cumulative Record File contains the students Discipline Record.
3.4 When students transfer to a Delaware school from any other school including a school in
a foreign
country the receiving school is responsible for having the transcripts evaluated.
4.0 Maintenance of the Education Records of Public Schools
18
4.1 The Delaware School District General Records Retention Schedule published by the
Delaware Public
Archives shall be followed as to the length of time and special considerations for the
maintenance of
education records.
4.2 Contracts for storage of student records of graduates, withdrawals and special education
students for
4.3 district storage, shall be initiated between the school district and the Delaware Public
Archives.
4.4 The Cumulative Record Files for students who have graduated from or who left school
prior to
4.5 graduation from high school shall be stored at the school or district of last attendance or
in the
4.6 Delaware Public Archives.
5.0 Destruction of Education Records of Public Schools
5.1 The Delaware School District General Records Retention Schedule published by the
Delaware Public
Archives shall be followed as to the length of time and special considerations for the
destruction of any
education records.
5.2 The destruction of educational records of children with disabilities shall also comply with
the
requirements of 14 DE Admin Code 925.
19
1.4 These regulations shall bind all Charter Schools and are incorporated into all charters
approved by the
Department with the consent of the State Board.
2.0 Definitions
2.1 The following definitions apply for purposes of interpreting the Charter School Law and
these
regulations:
Accountability Committee: Any Charter School Accountability Committee established by
the
Department to review and report to the Department as provided in Sections 511 and 515 of
the Charter
School Law.
Section A - 15 - 7-2007
Applicant: A legal entity organized under the Delaware General Corporation Law that has
applied
to the Department for, but not yet received, a charter to operate a charter school, or the
renewal or
modification of such a charter, as the context indicates.
Audit: An informal financial, programmatic, or compliance audit of a charter school.
Charter Holder: The legal entity organized under the Delaware General Corporation Law to
which
a charter is issued by the Department with the approval of the State Board.
Charter School: A non home based full time public school that is operated in an approved
physical
plant under a charter granted by the Department with the approval of the State Board for
the personal
physical attendance of all students.
DSTP: The Delaware Student Testing Program established at 14 Del.C. 151, et.seq., and,
as the
context requires, the assessments administered pursuant to the program.
Department: The Delaware Department of Education
First Instructional Day: The first day a Charter School is open with students in attendance.
Formal Review: The lawful investigation of a Charter School to determine whether the
school is
violating the terms of its charter. Formal reviews may include, but are not limited to, on site
visits,
inspection of educational records and other documents, and interviews of parents, Charter
School
employees and others with knowledge of the schools operations and educational programs.
Founding Board of Directors: The duly elected Board of Directors of an Applicant at the
time the
original application for a charter is filed with the Department.
Parent: The natural or adoptive parent, or the legal guardian, of a student enrolled in the
charter
school. Parent also includes individuals authorized to act as Relative Caregivers under the
provisions
of 14 Del. C. 202(e)(2).
Performance Review: Reserved
Renewal: The approval of an application to continue operating an existing Charter School
for an
additional five year period, available after the school has been in operation for three years.
Secretary: The Secretary of the Delaware Department of Education.
State Board: The Delaware State Board of Education.
3.0 Application Process
20
3.1 Application Deadlines: Applications to establish new Charter Schools must be submitted
to the
Department between November 1st and December 31st for schools preparing to admit
students the
second September 1st thereafter.
3.2 All applications, whether for an original charter, a modification of a charter or the
Renewal of a
charter, shall be made on forms approved by the Department.
3.3 The Department may require a criminal background check on any person involved in the
preparation
of an application, whether for an original charter, a major modification or a charter Renewal,
and on
any person involved in the development of the proposed Charter School.
3.4 An original and ten (10) copies of a completed application must be received by the
Department by the
application deadline in order for the application to be considered. Incomplete applications, or
applications received after the deadline, will not be considered.
3.5 All written communications from the Department or the Accountability Committee to an
Applicant
shall be sent to the contact person identified in the application, at the address provided in
the
application. An Applicant is responsible for notifying the Department in writing of any
change in the
contact person or contact address after its application is submitted.
3.6 An application is not complete unless all of the following requirements are met:
3.6.1 All questions on the application form are answered.
3.6.2 All documentation required by the application form or subsequently requested by the
Department or the Accountability Committee is received.
3.7 No application for a new Charter School will be accepted by the Department in any year
in which the
Department with the approval of the State Board has decided not to accept applications.
3.8 Applications will not remain pending from year to year. Applications that do not result in
the issuance
of a charter must be resubmitted in full in subsequent years to be considered in subsequent
years.
3.9 The State Board of Education may designate one or more of its members to sit as
nonvoting members
of the Accountability Committee.
3.10 In deciding whether to approve or disapprove any application for an original charter, a
major
modification of a charter or the Renewal of a charter, the Secretary and State Board shall
base the
decision on the record. The record shall consist of the application and any documents filed
therewith
Section A - 16 - 7-2007
in support of the application, the preliminary and final report of the Accountability
Committee, any
response or other evidence, oral or otherwise, provided by the Applicant to the
Accountability
Committee prior to the issuance of its final report, any comments received at any public
hearing
conducted pursuant to the provisions of the Charter School Law, including comments made
at any such
hearing by the applicant in response to the Accountability Committees final report and any
written or
21
electronic comments received at or before any such public hearing. No other evidence shall
be
considered. Written and electronic comments must be received by the Education Associate
for Charter
Schools no later than the beginning of the public hearing to be included in the record.
4.0 Standards and Criteria for Granting Charter
4.1 Applicant Qualifications
4.1.1 The Applicant must demonstrate that its board of directors has and will maintain
collective
experience, or contractual access to such experience, in the following areas:
4.1.1.1 Research based curriculum and instructional strategies, to particularly include the
curriculum and instructional strategies of the proposed educational program.
4.1.1.2 Business management, including but not limited to accounting and finance.
4.1.1.3 Personnel management.
4.1.1.4 Diversity issues, including but not limited to outreach, student recruitment, and
instruction.
4.1.1.5 At risk populations and children with disabilities, including but not limited to
students eligible for special education and related services.
4.1.1.6 School operations, including but not limited to facilities management.
4.1.2 The application must identify the certified teachers, the parents and the community
members
who have been involved in the preparation of the application and the development of the
proposed Charter School.
4.1.3 The Applicants bylaws must be submitted with the application and must demonstrate
that:
4.1.3.1 The Charter Holders board of directors will include a certificated teacher employed
as a teacher at the Charter School and a Parent of a currently enrolled student of the
school no later than the schools First Instructional Day;
4.1.3.2 The Applicants business is restricted to the opening and operation of: Charter
Schools, before school programs, after school programs and educationally related
programs offered outside the traditional school year.
4.1.3.3 The board of directors will meet regularly and comply with the Freedom of
Information Act, 29 Del.C. Ch. 100 in conducting the Charter Schools business.
4.2 Student Performance
4.2.1 Minimum Requirements
4.2.1.1 The Applicant must agree and certify that it will comply with the requirements of the
State Public Education Assessment and Accountability System pursuant to 14 Del.C.
151, 152, 153, 154, and 157 and Department rules and regulations implementing
Accountability, to specifically include the Delaware Student Testing Program.
4.2.1.2 The Applicant must demonstrate that it has established and will apply measurable
student performance goals on the assessments administered pursuant to the Delaware
Student Testing Program (DSTP), and a timetable for accomplishment of those
goals.
4.2.1.3 The Applicant must agree and certify that the Charter Schools average student
performance on the DSTP assessments in each content area will meet or exceed the
statewide average student performance of students in the same grades for each year
of test administration, unless the student population meets the criteria established in
Section 4.2.2.
4.2.2 Special Student Populations
4.2.2.1 An Applicant for a charter proposing enrollment preferences for students at risk of
academic failure shall comply with the minimum performance goals established in
Subsections 4.2.1.2 and 4.2.1.3. This requirement shall be waived where the
Applicant demonstrates to the satisfaction of the Department and State Board that the
Charter School will primarily serve at risk students and will apply performance goals
and timetables which are appropriate for such a student population.
22
Section A - 17 - 7-2007
23
1972.
4.4 Economic Viability.
4.4.1 The application must demonstrate that the school is economically viable and shall
include
satisfactory documentation of the sources and amounts of all proposed revenues and
expenditures during the schools first three years of school operation after opening for
instructional purposes. There must be a budgetary reserve for contingencies of not less than
2.0% of the total annual amount of proposed revenues. In addition, the application shall
document the sources and amounts of all proposed revenues and expenditures during the
start
up period prior to the opening of the school.
Section A - 18 - 7-2007
4.4.2 The Department may require that the Applicant submit data demonstrating sufficient
demand
for Charter School enrollment if another Charter School is in the same geographic area as
the
Applicants proposed school. Such data may include, but is not limited to, enrollment waiting
lists maintained by other Charter Schools in the same geographic area and demonstrated
parent interest in the Applicants proposed school.
4.4.3 The application shall identify with specificity the proposed source(s) of any loan(s) to
the
Applicant including, without limitation, loans necessary to implement the provisions of any
major contract as set forth below, and the date by which firm commitments for such loan(s)
will be obtained.
4.4.4 The application shall contain a timetable with specific dates by which the school will
have in
place the major contracts necessary for the school to open on schedule. Major contracts
shall include, without limitation, the schools contracts for equipment, services (including
bus
and food services, and related services for special education), leases of real and personal
property, the purchase of real property, the construction or renovation of improvements to
real
property, and insurance. Contracts for bus and food services must be in place no later than
August 1st of the year in which the school proposes to open and August 1st of each year
thereafter. Contracts for the lease or purchase of real property, or the construction or
renovation of improvements to real property must be in place sufficiently far in advance so
that the Applicant might obtain any necessary certificate of occupancy for the school
premises
no later than June 15th of the year in which the school proposes to open.
4.4.5 Reserved
4.5 Attendance, Discipline, Student Rights and Safety
4.5.1 The application must include a draft Student Rights and Responsibilities Manual that
meets
applicable constitutional standards regarding student rights and conduct, including but not
limited to discipline, speech and assembly, procedural due process and applicable
Department
regulations regarding discipline.
4.5.1.1 The Student Rights and Responsibilities Manual must comply with the Gun Free
Schools Act of 1994 (20 U.S.C.A. 8921) and Department Regulation 878.
4.5.1.2 The application must include a plan to distribute the Student Rights and
Responsibilities Manual to each Charter School student at the beginning of each
school year. Students who enroll after the beginning of the school year shall be
provided with a copy of the Student Rights and Responsibilities Manual at the time
of enrollment.
24
4.5.2 The application must include the process and procedures the Charter School will follow
to
comply with the following laws:
4.5.2.1 14 Del.C. Ch. 27 and applicable Department regulations regarding school
attendance, including a plan to distribute attendance policies to each Charter School
student at the beginning of each school year. Students who enroll after the beginning
of the school year shall be provided with a copy of the attendance policy at the time
of enrollment.
4.5.2.2 11 Del.C. Ch. 85 and applicable Department regulations regarding criminal
background checks for public school related employment.
4.5.2.3 14 Del.C. 4112 and applicable Department regulations regarding the reporting of
school crimes.
4.5.2.4 The Family Educational Rights and Privacy Act (FERPA) and implementing federal
and Department regulations regarding disclosure of student records.
4.5.2.5 The provision of free and reduced lunch to eligible students pursuant to any
applicable state or federal statute or regulation.
4.5.3 The requirement that the Applicant provide for the health and safety of students,
employees
and guests will be judged against the needs of the student body or population served.
Except
as otherwise required in this regulation, the Applicant must either agree and certify that the
services of at least one (1) full time nurse will be provided for each facility in which students
regularly attend classes, or demonstrate that it has an adequate and comparable plan for
providing for the health and safety of its students. Any such plan must include the Charter
Schools policies and procedures for routine student health screenings, for administering
medications to students (including any proposed self administration), for monitoring chronic
Section A - 19 - 7-2007
student medical conditions and for responding to student health emergencies. Any applicant
which receives funding equivalent to the funding provided to school districts for one or more
school nurses shall provide its students the full time services of a corresponding number of
registered nurses.
5.0 Nature of Charter
5.1 When granted, a charter is an authorization for the Charter Holder to open and operate a
Charter
School in accordance with the terms of the charter, including the terms of any conditions
placed on the
charter by the Department with the approval of the State Board.
5.1.1 It is the responsibility of the Charter Holder to notify the Department in writing of its
compliance with any time frames or other terms or conditions contained in or imposed on
the
charter. The Department may require the Charter Holder to produce satisfactory evidence,
including written documentation, of compliance.
5.2 Compliance with the charter, including compliance with the terms of any conditions
placed on the
charter, is a condition precedent to the authority to open and operate the Charter School.
Failure to
comply with the terms of the charter and any conditions placed on the charter, including
deadlines,
operates as a forfeiture of the authority to open the Charter School regardless of previous
approval.
These regulations are incorporated into and made a part of each charter approved by the
Department
with the consent of the State Board. A Charter Schools failure to comply with these
regulations may
be treated as a failure on the part of the school to comply with its charter.
25
6.0 Funding
6.1 The Department may withhold State and local funding from a Charter Holder not in
compliance with
the terms of the charter being funded, including compliance with any conditions placed on
such
charter.
6.2 The Department may withhold State and local funding from a Charter Holder while one
or more of its
charters is under formal review.
6.3 State and local funding of any charter on probationary status will be released in
accordance with the
terms of the probation.
6.4 Federal funding for a Charter Holder and under the control of the Department will be
disbursed
according to the laws, regulations and policies of the federal program providing the funding
and the
terms of any applicable federal grant approval including state requirements.
7.0 Reserved
8.0 Enrollment Preferences, Solicitations and Debts
8.1 Enrollment Preferences
8.1.1 An Applicant to establish a new Charter School shall indicate in its application whether
children of the Charter Schools founders will be given an enrollment preference. If a
founders preference will be given, the application shall include the standard adopted by the
Founding Board of Directors to determine the founders. The standard used to determine the
founders shall be consistent with the requirements of Section 506(b)(4) of the Charter
School
Law. If the application is approved, the Charter Holder shall provide the Department with the
identity of its founders no later than March 1 immediately preceding the First Instructional
Day.
8.2 Solicitations.
8.2.1 Any person or entity soliciting contributions, gifts or other funding on behalf of or for
the
benefit of an existing or potential Charter School shall notify the person or entity solicited
that
enrollment of an individual student in the Charter School is not contingent on, or assured by,
any such contribution, gift or other funding.
8.2.2 Written notices of fund raising activities for the benefit of a Charter School must
contain the
following statement: The [name of school] is a public school. Contributions and gifts are not
required for admission to the school and will in no way affect or improve a students
opportunity for admission.
8.3 Debts
8.3.1 Any person or entity offering a loan to a Charter School must be advised by the school
that
debts of the school are not debts of the State of Delaware and that neither the State nor any
other agency or instrumentality of the State is liable for the repayment of any indebtedness.
Section A - 20 - 7-2007
9.0 Modifications of Charters
9.1 A charter holder may apply to the Department for a modification of the charter following
the granting
of the charter.
9.2 The application shall be submitted on a form approved by the Department and shall
specify the exact
modification requested and describe the need for the modification.
26
9.3 The standards for deciding a modification application shall be as provided in Section 4.0
of these
regulations for the original grant of the charter.
9.4 The following are considered applications for a new charter and shall not be processed or
considered as
a modification application:
9.4.1 An application to collectively change the mission, goals for student performance and
educational program of the charter school; or
9.4.2 An application, at any time before the First Instructional Day, to offer educational
services at
a site other than the site approved as part of the schools charter, when the charter has
previously been amended to change the schools site; or
9.4.3 An application to replace, remove or permit the school to operate without an
educational
management organization providing administrative, managerial or instructional staff or
services to the charter holder at any time before the First Instructional Day.
9.5 An application for a major or minor charter modification may not be filed while a schools
charter is
on formal review, except where the Secretary determines that the requested modification is
unrelated
to the reason the schools charter has been placed on formal review or where the
modification
addresses the reason the school was placed on formal review provided the modification is
filed before
the preliminary report is approved by the Accountability Committee.
9.6 A charter shall not be modified to permit a charter schools first instructional day to
occur later than
the third September 15th after the date the charter is originally granted. In the event that the
first
instructional day does not occur by that date, the charter shall be deemed forfeited and the
authority to
open and operate a charter school expired. Further, no charter shall be modified to permit a
charter
school to obtain a certificate of occupancy, either temporary or final, for all or any part of
the premises
to be occupied by the school, later than June 15 immediately preceding the authorized
opening date of
the school.
9.7 An increase or decrease of up to 5% in a charter schools current authorized enrollment
shall not be
considered a modification of the schools charter. Any modification application to increase or
decrease a charter schools current authorized enrollment by more than 5% must be filed
between
November 1st and December 31st and, if approved, shall be effective the following school
year.
9.8 Major modifications
9.8.1 A major modification is any proposed change to a charter, including proposed changes
to any
condition placed on the charter, which would:
9.8.1.1 Replace, remove or permit the school to operate without an educational
management
organization providing administrative, managerial or instructional staff or services to
the charter school at anytime on or after the First Instructional Day; or
9.8.1.2 After enrollment preferences; or
9.8.1.3 Result in an increase or decrease in the schools total authorized enrollment of more
27
than 15%, provided further the major modification request must be filed between
November 1st and December 31st and, if approved, shall be effective the following
school year; or
9.8.1.4 After grade configurations; or
9.8.1.5 At any time after the First Instructional Day, offer educational services at a site other
than the site approved as part of the schools charter, except where such change is
the unavoidable result of a loss by fire or other casualty as that term is defined in
Blacks Law Dictionary; or
9.8.1.6 At any time before the First Instructional Day, offer educational services at a site
other than the site approved as part of the schools charter, provided that the charter
has not previously been amended to change the schools site; or
9.8.1.7 Alter any two of the following: the schools mission, goals for student performance,
or educational program; or
9.8.1.8 Alter the charter schools performance agreement with the Department.
9.9 Minor modifications
Section A - 21 - 7-2007
9.9.1 A minor modification is any proposed change to a charter, including proposed changes
to any
condition placed on the charter, which is not a major modification. Minor modifications
include, but are not limited to:
9.9.1.1 Changes to the name of either the charter school or charter holder; or
9.9.1.2 The first extension of any deadline imposed on the charter school or charter holder
by thirty (30) working days or less (or by 15 calendar days in the case of the First
Instructional Day); or
9.9.1.3 Changes in the standards or assessments used to judge student performance (other
than the State standards or the assessments administered pursuant to the DSTP); or
9.9.1.4 In the case of a charter school which is open with students in attendance, offering
educational services at a site other than, or in addition to, the site approved as part of
the schools charter, when use of the approved site has unavoidably been lost by
reason of fire or other casualty as that term is defined in Blacks Law Dictionary; or
9.9.1.5 Changes to alter not more than one of the following: the schools mission, goals for
student performance, or educational program; or
9.9.1.6 An increase or decrease in the schools total authorized enrollment of more than 5%,
but not more than 15%, provided further the minor modification request must be
filed between November 1st and December 31st and, if approved, shall be effective
the following school year; or
9.9.1.7 Alter, expand or enhance existing or planned school facilities or structures, including
any plan to use temporary or modular structures, provided that the applicant
demonstrates that the school will maintain the health and safety of the students and
staff and remain economically viable as provided in 4.4 above; or
9.9.1.8 Any change in the schools agreement with an educational management organization
other than as set forth in 9.4.3 and 9.8.1.1 above; or
9.9.1.9 A change to the current authorized number of hours, either daily or annually,
devoted
to actual school sessions. Regardless of any proposed change, the school shall
maintain the minimum instructional hours required by 14 Delaware Code; or
9.9.1.10 A change in the terms of the current site facilities arrangements including, but not
limited to, a lease to a purchase or a purchase to a lease arrangement; or
9.9.2 The Secretary may decide the minor modification application based on the supporting
documents supplied with the application unless the Secretary finds that additional
information
is needed from the applicant.
9.9.3 The Secretary may refer a minor modification request to the Accountability Committee
for
review if the Secretary determines, in her/his sole discretion, that such review would be
28
Section A - 22 - 7-2007
10.2 Renewals are only available to the current Charter Holder and may not be used to
transfer a charter to a
different legal entity.
10.3 Charters shall be renewed only if the school receives a satisfactory Performance
Review.
11.0 Public Hearings
11.1 Any public hearing conducted by the Department pursuant to the provisions of the
Charter School Law
shall be conducted as a joint public hearing with the State Board of Education.
Section A - 23 - 7-2007
DELAWARE DEPARTMENT OF EDUCATION REGULATIONS
SECTION 600. DISCIPLINE AND SCHOOL CLIMATE
603 Compliance with the Gun Free Schools Act
1.0 Written Policy Required
Each school district and charter school requesting assistance under the Elementary and
Secondary Education
Act (ESEA) shall have a written policy implementing the Gun Free Schools Act [(20 USC
4141) (20 USC
7151)] and 11 Del.C. 1457(j) or its successor statute. At a minimum, the policy must
contain the following
elements:
1.1 A student who is determined to have brought a firearm to school, or to have possessed a
firearm at
school, shall be expelled for not less than one year.
1.2 Modification to the expulsion requirement may be made on a case by case basis. Any
modification to
29
30
"Alcohol" shall mean alcohol or any alcoholic liquor capable of being consumed by a human
being, as defined
in 4 Del.C. 101 including alcohol, spirits, wine and beer.
"Distribute" "Distributing" or "Distribution" shall mean the transfer or attempted transfer of
alcohol, a
drug, a look alike substance, a drug like substance, or drug paraphernalia to any other
person with or without the
exchange of money or other valuable consideration.
"Drug" shall mean any controlled substance or counterfeit substance as defined in 16 Del.C.
4701 including,
Section A - 24 - 7-2007
for example, narcotic drugs such as heroin or cocaine, amphetamines, anabolic steroids, and
marijuana, and
shall include any prescription substance which has been given to or prescribed for a person
other than the
student in whose possession it is found.
"Drug Like Substance" shall mean any noncontrolled and nonprescription substance capable
of producing a
change in behavior or altering a state of mind or feeling, including, for example, some over
the counter cough
medicines, certain types of glue, caffeine pills and diet pills. The definition of drug like
substance does not
include tobacco or tobacco products which are governed by regulation 877 Tobacco Policy.
"Drug Paraphernalia" shall mean all equipment, products and materials as defined in 16
Del.C. 4701
including, for example, roach clips, miniature cocaine spoons and containers for packaging
drugs.
"Expulsion" shall mean exclusion from school for a period determined by the local district not
to exceed the
total number of student days. The process for readmission shall be determined by the local
district.
"Look Alike Substance" shall mean any noncontrolled substance which is packaged so as to
appear to be, or
about which a student makes an express or implied representation that the substance is, a
drug or a
noncontrolled substance capable of producing a change in behavior or altering a state of
mind or feeling. See 16
Del.C. 4752A.
"Nonprescription Medication" shall mean any over the counter medication; some of these
medications may
be a "drug like substance."
"Possess" "Possessing" or "Possession" shall mean that a student has on the student's
person, in the student's
belongings, or under the student's reasonable control by placement of and knowledge of the
whereabouts of,
alcohol, a drug, a look alike substance, a drug like substance or drug paraphernalia.
"Prescription Drugs" shall mean any substance obtained directly from or pursuant to a valid
prescription or
order of a practitioner, as defined in 16 Del.C. 4701(24), while acting in the course of his or
her professional
practice, and which is specifically intended for the student in whose possession it is found.
"School Environment" shall mean within or on school property, and at school sanctioned or
supervised
activities, including, for example, on school grounds, on school buses, at functions held on
school grounds, at
31
extra curricular activities held on and off school grounds, on field trips and at functions held
at the school in the
evening.
"Use" shall mean that a student is reasonably known to have ingested, smoked or otherwise
assimilated
alcohol, a drug or a drug like substance, or is reasonably found to be under the influence of
such a substance.
3.0 Each School District Shall Have a Policy on File and Update it Periodically. The Policy Shall
Include, as a
Minimum the Following
3.1 A system of notification of each student and of his/her parent, guardian or Relative
Caregiver at the
beginning of the school year, of the state and district policies and regulations. In addition a
system for
the notification of each student and his/her parent, guardian or Relative Caregiver whenever
a student
enrolls or re enrolls during the school year of the state and district policies and regulations.
3.2 A statement that state and district policies shall apply to all students, except that with
respect to
children with disabilities, applicable federal and state laws will be followed.
3.3 A written policy which sets out procedures for reporting incidents to police authorities,
parents,
guardians or Relative Caregivers and to the Department of Education, while maintaining
confidentiality.
3.4 A written policy on how evidence is to be kept, stored and documented, so that the chain
of custody is
clearly established prior to giving such evidence over to the police.
3.5 A written policy on search and seizure.
3.6 A program of assistance for students with counseling and referral to services as needed.
3.7 A discipline policy which contains, at a minimum, the following penalties for infractions
of state and
district drug policies.
3.7.1 Use/Impairment: For a first offense, if a student is found to be only impaired and not in
violation of any other policies, he/she shall be suspended for up to 10 days, or placed in an
alternative setting for up to 10 days, depending upon the degree of impairment, the nature
of
the substance used, and other aggravating or mitigating factors. For a second or subsequent
offense, a student may be expelled or placed in an alternative setting for the rest of the
school
year.
3.7.2 Possession of alcohol, a drug, a drug like substance, and/or a look alike substance, in
an
amount typical for personal use, and drug paraphernalia: For a first offense, the student
shall
be suspended for 5 to 10 days. For a second or subsequent offense, a student may be
expelled
for the rest of the school year or placed in an alternative setting for the rest of the school
year.
Section A - 25 - 7-2007
3.7.3 Possession of a quantity of alcohol, a drug, a drug like substance, a look alike
substance and
drug paraphernalia in an amount which exceeds an amount typical for personal use, or
distribution of the above named substances or paraphernalia: the student shall be
suspended
for 10 days, or placed in an alternative setting for 10 days. Depending on the nature of the
32
substance, the quantity of the substance and/or other aggravating or mitigating factors, the
student also may be expelled.
3.8 A policy in cases involving a drug like substance or a look alike substance for
establishing that the
student intended to use, possess or distribute the substance as a drug.
3.9 A policy which establishes how prescription and non-prescription drugs shall be handled
in the school
environment and when they will be considered unauthorized and subject to these state and
local
policies.
3.10 A policy which sets out the conditions for return after expulsion for alcohol or drug
infractions.
3.11 Notwithstanding any of the foregoing to the contrary, all policies adopted by public
school districts
relating to the possession or use of drugs shall permit a student's discretionary use and
possession of an
asthmatic quick relief inhaler ("Inhaler") or autoinjectable epinephrine with individual
prescription
label; provided, nevertheless, that the student uses the inhaler or autoinjectable epinephrine
pursuant to
prescription or written direction from a state licensed health care practitioner; a copy of
which shall be
provided to the school district; and further provided that the parent(s) or legal custodian(s)
of such
student provide the school district with written authorization for the student to possess and
use the
inhaler or autoinjectable epinephrine at such student's discretion, together with a form of
release
satisfactory to the school district releasing the school district and its employees from any
and all
liability resulting or arising from the student's discretionary use and possession of the
inhaler or
autoinjectable epinephrine and further provided that the school nurse may impose
reasonable
limitations or restrictions upon the student's use and possession of the inhaler or
autoinjectable
epinephrine based upon the student's age, level of maturity, behavior, or other relevant
considerations.
(For students who use prescribed asthmatic quick relief inhalers or autoinjectable
epinephrine, see 14 DE Admin. Code
817, Administration of Medications and Treatments)
33
Every Delaware public school including Charter Schools and Alternative Program sites shall
develop a School
Crisis Response Plan and shall conduct at least one practice drill annually. Following practice
drills, the
districts and heads of charter schools shall ensure that the school safety teams conduct
meetings to assess
readiness and determine the effectiveness of the existing plans. School Crisis Response
Plans shall be
developed using guidelines provided by the Department of Education and shall be made
available to the
Department of Educations Quality Review Team at the time of their visit.
Section A - 26 - 7-2007
DELAWARE DEPARTMENT OF EDUCATION REGULATIONS
SECTION 900. SPECIAL POPULATIONS
901 Education of Homeless Children and Youth
1.0 Purpose
Consistent with the provisions of the McKinney-Vento Homeless Education Assistance
Improvement Act, as
amended by the No Child Left Behind Act of 2001 (42 U.S.C. 11431 et. seq.), the intent of
this regulation is to
ensure the educational rights and protections for children and youth experiencing
homelessness.
2.0 Definitions
The following words and terms, when used in this regulation, shall have the following
meaning unless the
context clearly states otherwise:
Department means the Delaware Department of Education.
Homeless Children and Youths as defined by the provisions of the 42 U.S.C. 11434a(2),
means
individuals who lack a fixed, regular, and adequate nighttime residence (within the meaning
of 42 U.S.C.
11302(a)(1)); and includes:
Children and youths who are sharing the housing of other persons due to loss of housing,
economic
hardship or similar reason; are living in motels, hotels, trailer parks, or camping grounds due
to lack of
alternative adequate accommodations; are living in emergency or transitional shelters; are
abandoned in
hospitals; or are awaiting foster care placement;
Children and youths who have a primary nighttime residence that is in a private or public
place not
designed for or ordinarily used as a regular sleeping accommodation for human beings
(within the meaning of
42 U.S.C. 11302(a)(2)(C));
Children and youths who are living in cars, parks, public spaces, abandoned buildings,
substandard
housing, bus or train stations, or similar settings; and Migratory children (as such term is
defined in section
6399 of Title 20, the Elementary and Secondary Education Act of 1965) who qualify as
homeless because the
children are living in circumstances described above.
LEA Homeless Liaison means the Local Educational Liaison for Homeless Children and
Youths designated
under 42 U.S.C. 11432(g)(1)(J)(ii).
34
Section A - 27 - 7-2007
4.2.3 A simple, detachable form that parents, guardians, Relative Caregiver or homeless
youth can
complete and turn into the school to initiate the dispute resolution process;
4.2.4 Instructions as to how to dispute the schools decision at the district level;
4.2.5 Notice of the right to enroll immediately in the school of choice pending resolution of
the
dispute;
4.2.6 Notice that immediate enrollment includes full participation in all school activities for
which
the student is eligible;
4.2.7 Notice of the right to appeal to the State if the district level resolution is not
satisfactory; and
4.2.8 Time lines for resolving district and State level appeals.
4.3 District Level Dispute Resolution Process
4.3.1 Local school districts shall develop a dispute resolution process at the district level.
The
dispute resolution process shall be as informal and accessible as possible, but shall allow for
impartial and complete review. Parents, guardians, Relative Caregivers and homeless youth
shall be able to initiate the dispute resolution process directly at the school they choose or
the
school district or LEA Homeless Liaisons office.
35
4.3.2 Within ten (10) calendar days of the initiation of the district level dispute resolution
process;
the school district shall inform the parties in writing of its determination, along with notice of
the right to appeal to the State if the district level resolution is not satisfactory.
4.4 Interdistrict Resolution Process
4.4.1 When interdistrict issues arise, including transportation, representatives from all
involved
school districts, the State Coordinator, or his or her designee, and the parent(s), guardian(s)
or
unaccompanied youth shall meet within ten (10) calendar days of the initiation of the
dispute
process to attempt to resolve the dispute.
4.4.2 The State Coordinators role is to facilitate the meeting.
4.4.3 If the parties are unable to resolve the interdistrict dispute, it shall be referred to the
Secretary
within ten (10) calendar days of the meeting. Subsection 4.5.4 through 4.5.9 shall govern
the
review officials determination. The review official shall consider the entire record of the
dispute, including any written statements submitted and shall make a determination based
on
the childs or youths best interest, as defined in 42 U.S.C. 11432(g)(3).
4.4.3.1 Notwithstanding 4.4.3, where the interdistrict dispute is limited solely to the issue of
the apportionment of responsibility and costs for providing the child transportation to
and from the school of origin, there shall be no referral to the Secretary. Pursuant to
42 USC 11432 (g)(1)(J)(iii)(II), if the school districts are unable to agree upon such a
method of appropriation, the responsibility for the costs for transportation shall be
shared equally.
4.5 State Level Dispute Resolution Process
4.5.1 The State level dispute resolution process is available for appeals from district-level
decisions
and interdistrict disputes. Appeals may be filed by parents, guardians, homeless youths or
school districts. Appeals filed by a local school shall not be accepted.
4.5.2 To initiate the State level dispute resolution process, the appellant must file a written
notice of
appeal with the Secretary no later than ten (10) calendar days after receiving written
notification of the district level or interdistrict decision. The notice of appeal shall state with
specificity the grounds of the appeal, and shall be signed by the appellant. Where the appeal
is being initiated by a school district, the superintendent of the district must sign the notice
of
appeal.
4.5.3 A copy of the notice of appeal shall be delivered by hand or certified mail to all other
parties
to the proceeding at the time it is sent to the Secretary. A copy of any other paper or
document filed with the Secretary or review official shall, at the time of filing, also be
provided to all other parties to the proceeding.
4.5.4 Upon receipt of a notice of appeal, the Secretary or his/her designee, shall within five
(5)
calendar days decide whether to hear the appeal or assign it to an independent and
impartial
review official and shall so advise the parties.
4.5.5 The local district shall file a certified record of the district or inter-district level dispute
proceeding with the Secretary or review official within five (5) calendar days of the date the
Secretary notifies the parties that an appeal has been filed. The record shall contain any
written decision, any written minutes of the meeting(s) at which the disputed action was
Section A - 28 - 7-2007
36
taken, all exhibits or documentation presented at the district or interdistrict level dispute
proceeding, and any other evidence relied on by the District(s) in making its (their) decision.
4.5.6 Appeals are limited to the record. The parties may support their positions in written
statements limited to matters in the existing record. In order to be considered, written
statements must be filed with the review official no later than twenty (20) calendar days
after
the appeal is filed.
4.5.7 The review official shall consider the entire record of the dispute, including any written
statements submitted in reaching his or her decision. The review official shall overturn the
district or interdistrict decision only if he or she decides that the districts decision was not
supported by substantial evidence or was arbitrary or capacious or is inconsistent with state
and federal law or regulation.
4.5.8 Within thirty (30) calendar days of the receipt of the notice of appeal, the review
official shall
inform the parties of his or her determination.
4.5.9 The determination of the review official shall be final and is not subject to further
appeal
within the Department of Education.
37
Section A - 29 - 7-2007
Supportive instruction for students shall begin as soon as the documentation required by 2.0
is received.
Supportive instruction may continue upon the return to school setting only in those
exceptional cases where it is
determined that a student needs a transitional program to guarantee a successful return to
the school program as
delineated in 2.4.
1.1 Supportive instruction shall adhere to the extent possible to the students school
curriculum and shall
make full use of the available technology in order to facilitate the instruction.
1.1.1 The school shall provide a minimum of 3 hours of supportive instruction each week of
eligibility for students K to 5th grade, and a minimum of five hours each week of eligibility for
students 6 to 12th grade. There is no minimum for in school transition.
1.1.2 Nothing in this regulation shall prevent a school district from providing additional hours
of
supportive instruction to eligible students from either its Academic Excellence allotment or
other available funding sources.
3.2 Summer instruction is permitted for a student who is otherwise eligible for supportive
instruction and
as determined by the students teachers and principal, needs the instruction to complete
course work or
to maintain a level of instruction in order to continue in a school program the following
school year.
Section A - 30 - 7-2007
Section A - 31 - 7-2007
13 DELAWARE CODE
CHAPTER 7. PARENTS AND CHILDREN1
Subchapter I. General Provisions
__________
701. Rights and responsibilities of parents; guardian appointment.
(a) The father and mother are the joint natural custodians of their minor child and are
equally charged with the childs
support, care, nurture, welfare and education. Each has equal powers and duties with
respect to such child, and
39
neither has any right, or presumption of right or fitness, superior to the right of the other
concerning such childs
custody or any other matter affecting the child. If either parent should die, or abandon his or
her family, or is
incapable, for any reason, to act as guardian of such child, then, the custody of such child
devolves upon the other
parent. Where the parents live apart, the Court may award the custody of their minor child
to either of them and
neither shall benefit from any presumption of being better suited for such award.
(b) This section shall not affect the laws of this State relative to the appointment of a
guardian of the property of a
minor, or the appointment of a third person as a guardian of the person of the minor where
the parents are
unsuitable or where the childs interests would be adversely affected by remaining under the
natural guardianship
of his or her parents or parent.
(c) Any child who is the subject of a custody, visitation, guardianship, termination of parental
rights, adoption or
other related proceeding in which the Division of Family Services is a party should have a
guardian ad litem
appointed by the Court to represent the best interests of the child. The Court, in its
discretion, may also appoint
an attorney to represent the child's wishes. The guardian ad litem shall be an attorney
authorized to practice law
in the State or a Court-Appointed Special Advocate. The rights, responsibilities and duties of
the attorney serving
as guardian ad litem are set forth in section 9007A of Title 29, and the rights, responsibilities
and duties of the
Court-Appointed Special Advocate serving as guardian ad litem are set forth in Chapter 36 of
Title 31. When
determining whether to appoint an attorney through the Office of the Child Advocate or a
Court-Appointed
Special Advocate through the Family Court, the Family Court judge, in his or her discretion,
should assign the
most complex and serious cases to the Office of the Child Advocate.
707. Consent to health care of minors.
(a) Definitions. As used in this section:
(1) Medical treatment means developmental screening, mental health screening and
treatment, and
ordinary and necessary medical and dental examination and treatment, including blood
testing, preventive
care including ordinary immunizations, tuberculin testing and well-child care. Medical
treatment also
means the examination and treatment of any laceration, fracture or other traumatic injury,
or any symptom,
disease or pathology which may, in the judgment of the treating health care professional, if
left untreated,
reasonably be expected to threaten health or life.
(2) Blood testing includes Early Periodic Screening, Diagnosis, and Treatment (EPSDT)
testing and other
blood testing deemed necessary by documented history or symptomatology but excludes
HIV/AIDS testing
and controlled substance testing or any other testing for which separate court order or
informed consent as
provided by law is required.
40
Section A - 32 - 7-2007
(3) Relative caregiver or caregiver means an adult person, who by blood, marriage or
adoption, is the
great grandparent, grandparent, step grandparent, great aunt, aunt, great uncle, uncle,
stepparent, brother,
sister, step brother, step sister, half brother, half sister, niece, nephew, first cousin or first
cousin once
removed of a minor and with whom the minor resides, but who is not the legal custodian or
guardian of the
minor.
(b) Parties authorized to give consent. Consent to the performance upon or for any minor by
any licensed medical,
surgical, dental, psychological or osteopathic practitioner or any nurse practitioner/clinical
nurse specialist or any
hospital or public clinic or their agents or employees of any lawful medical treatment, and to
the furnishing of
hospitalization and other reasonably necessary care in connection therewith, may be given
by:
(1) A parent or guardian of any minor for such minor;
(2) A married minor for himself or herself or, if such married minor be unable to give consent
by reason of
disability, then by his or her spouse;
(3) A minor of the age of 18 years or more for himself or herself;
(4) A minor parent for his or her child;
(5) A minor or by any person professing to be serving as temporary custodian of such minor
at the request of a
parent or guardian of such minor for the examination and treatment of (i) any laceration,
fracture or other
traumatic injury suffered by such minor, or (ii) any symptom, disease or pathology which
may, in the
judgment of the attending personnel preparing such treatment, if untreated, reasonably be
expected to
threaten the health or life of such minor; provided, however, that the consent given shall be
effective only
after reasonable efforts shall have been made to obtain the consent of the parent or
guardian of said minor;
or
(6) A relative caregiver acting pursuant to an Affidavit of Establishment of Power to Relative
Caregivers to
Consent to Medical Treatment of Minors.
(c) Effect of consent. Any consent given by or for a minor pursuant to the authority of any
provision of this chapter
shall be valid and effective for all purposes, and, notwithstanding any misrepresentation as
to age, status as parent,
guardian or custodian or as to marital status, made to any practitioner, hospital or clinic for
purposes of inducing
the furnishing of health care to such minor, shall bind such minor, his or her parent, spouse,
heirs, executors and
administrators and shall not be subject to subsequent disaffirmance by reason of minority.
(d) Liability of persons responsible for medical care. Nothing contained in this section shall
be construed to relieve
any practitioner, hospital, clinic or their agents or employees from liability for negligence in
diagnosis, care and
41
treatment or for the performance of any procedure not reasonably required for the
preservation of life or health.
708. Affidavit of Establishment of Power to Consent to Medical Treatment of Minors.
(a) There is created an Affidavit of Establishment of Power to Relative Caregivers to Consent
to Medical Treatment
of Minors. The affidavit shall include, at a minimum, the name and date of birth of the minor;
a statement signed
by the caregiver that the caregiver is 18 years of age or older and that the minor resides
with the caregiver; the
names and signatures of the parents, legal custodian or guardian of the minor indicating
their approval of the
caregivers power or, if a parent, custodian or guardian of the minor is unavailable, a
statement of reasonable
effort made by the caregiver to locate the parent, custodian or guardian based on criteria
set forth in the
regulations; the name of the caregiver; relationship of the caregiver to the minor
documented by proof as defined
by regulation; and the dated signature of the caregiver. The signature of the caregiver shall
be notarized.
(b) The affidavit is valid for 1 year unless the minor no longer resides in the caregivers
home or a parent, custodian
or guardian revokes his or her approval. If a parent, custodian or guardian revokes approval,
the caregiver shall
notify any health care provider or health service plans with which the minor has been
involved through the
caregiver.
(c) A caregiver must present a completed Affidavit of Establishment of Power to Relative
Caregivers to Consent to
Medical Treatment of Minor when seeking medical treatment for a minor.
(d) The decision of a relative caregiver to consent to or to refuse medical treatment for a
minor shall be superseded by
a decision of a parent, legal custodian or guardian of the minor.
(e) No person who relies in good faith upon a fully executed Affidavit of Establishment of
Power to Relative
Caregivers to Consent to Medical Treatment of Minors in providing medical treatment shall
be subject to criminal
or civil liability or to professional disciplinary action because of the reliance. This immunity
applies even if
medical treatment is provided to a minor in contravention of a decision of a parent, legal
custodian or guardian of
the minor who signed the affidavit if the person providing care has no actual knowledge of
the decision of the
parent, or legal custodian or guardian.
Section A - 33 - 7-2007
(f) The decision of a relative caregiver, based upon an Affidavit of Establishment Power to
Relative Caregivers to
Consent to Medical Treatment of Minors, shall be honored by a health care facility or
practitioner unless the
health care facility or practitioner has actual knowledge that a parent, legal custodian or
guardian of a minor has
made a contravening decision to consent to or to refuse medical treatment for the minor.
(g) A person who knowingly makes a false statement in an affidavit under this section shall
be subject to a civil
penalty of $1,000 per child. Justices of the Peace shall have jurisdiction of these cases.
42
(h) The Department of Health and Social Services is authorized to promulgate regulations to
implement this section.
709. Consent of a Minor to Donate Blood Voluntarily Without the Necessity of Obtaining
Parental
Permission or Authorization
(a) Anything otherwise provided in the law to the contrary notwithstanding, any person over
17 years old shall be
eligible to donate blood in any voluntary and noncompensatory blood program without
parental permission or
authorization.
(b) The consent given by a minor under this section shall, notwithstanding his or her
minority, be valid and legally
effective for all purposes and shall be binding upon such minor, his or her parents, legal
guardians, spouse, heirs,
executors and administrators as effectively as if such minor were 18 years of age or over at
the time of giving such
consent. A minor giving such consent shall be deemed to have the same legal capacity to
act and the same legal
obligations with regard to giving such consent as if such minor were 18 years of age or over.
Consent so given
shall not be subject to later disaffirmance by reason of such minority and the consent of no
other person or court
shall be necessary for performance of the lawful procedures required to be performed in
order to receive such
donation.
(c) Such consent so given by a minor as described above shall be interpreted as a contract
permitting penetration of
tissue which is necessary to accomplish such donation.
710. Minors Consent to Diagnostic and Lawful Therapeutic Procedures Relating to Care and
Treatment
for Pregnancy or Contagious Diseases
(a) A minor 12 years of age or over who professes to be either pregnant or afflicted with
contagious, infectious or
communicable diseases within the meaning of Chapters 5 and 7 of Title 16, or who professes
to be exposed to the
chance of becoming pregnant, may give written consent, except to abortion, to any licensed
physician, hospital or
public clinic for any diagnostic, preventive, lawful therapeutic procedures, medical or
surgical care and treatment,
including X rays, by any physician licensed for the practice of medicine or surgery or
osteopathic medicine or
surgery in this State and by any hospital or public clinic, their qualified employees or agents
while acting within
the scope of their employment.
(b) Consent so given by a minor 12 years of age or over shall, notwithstanding his or her
minority, be valid and
legally effective for all purposes, regardless of whether such minors profession of pregnancy
or contagious
disease is subsequently medically confirmed, and shall be binding upon such minor, his or
her parents, legal
guardians, spouse, heirs, executors and administrators as effectively as if the minor were of
full legal age at the
time of giving of the consent. A minor giving the consent shall be deemed to have the same
legal capacity to act
43
and the same legal obligations with regard to giving consent as if the minor were of full legal
age. Consent so
given shall not be subject to later disaffirmance by reason of such minority; and the consent
of no other person or
court shall be necessary for the performance of the diagnostic and lawful therapeutic
procedures, medical or
surgical care and treatment rendered such minor.
(c) The physician licensed for the practice of medicine or surgery or hospital to whom such
consent shall be given
may, in the sole exercise of his, her or its discretion, either provide or withhold from the
parents or legal guardian
or spouse of such minor such information as to diagnosis, therapeutic procedures, care and
treatment rendered or
to be rendered the minor as such physician, surgeon or hospital deems to be advisable
under the circumstances,
having primary regard for the interests of the minor.
(d) The parents, legal guardian or spouse of a consenting minor shall not be liable for
payment for diagnostic and
lawful therapeutic procedures performed, medical or surgical care or treatment rendered or
hospital confinement
pursuant to this section.
(e) Notice of intention to perform any operation otherwise permitted under this section shall
be given the parents or
legal guardian of such minor at their last known address, if available, by telegram sent at
time of diagnosis by the
surgeon designated to perform such operation; provided, that such operation may proceed
forthwith after
Section A - 34 - 7-2007
diagnosis if there is reason to believe that delay would endanger the life of such minor or
there is a reasonable
probability of irreparable injury.
(f) Nothing contained in this section shall be construed to relieve any licensed physician,
hospital or public clinic,
their agents or employees, from liability for their negligence in the diagnosis, care and
treatment rendered such
minor.
14 DELAWARE CODE
CHAPTER 1. DEPARTMENT OF EDUCATION1
Subchapter II. Powers and Duties
131. Public school enrollees immunization program; exemptions
(a) The Department shall from time to time, with advice from the Division of Public Health,
adopt and promulgate
rules and regulations to establish an immunization program to protect pupils enrolled in
public schools from
certain diseases. Such rules and regulations shall include at least the following:
(1) The designation of a basic series of immunizations to be administered according to these
rules;
(2) The requirement that all persons enrolling in the public schools at any age or level as
authorized by this
title shall have:
a. Been immunized according to the required program prior to the time of enrollment in the
Delaware schools;
b. Begun the series of immunizations not later than the time of enrollment to be completed
within a reasonable time as prescribed by the Department in relation to the particular
immunization involved; or
44
Section A - 35 - 7-2007
5. This belief causes (me) (us) to request an exemption from the mandatory school
vaccination program for
.
Name of Child
Signature of Parent(s) or Legal Guardian(s)
SWORN TO AND SUBSCRIBED before me, a registered Notary Public, this day of , 2 .
(Seal)
Notary Public
My commission expires:
(7) Provision that, in the event that the Division of Public Health of the Department of Health
and Social
Services declares that there is throughout the State or in a particular definable region of the
State an
epidemic of a vaccine preventable disease, any child who is enrolled in a public school and
who has
45
been exempt from the immunization program for any of the causes authorized herein shall
be
temporarily excluded from attendance at a public school. Rules and regulations of the
Department
shall provide that in the event of such temporary exclusion, it will be the responsibility of the
school
and the parents or legal guardian of the enrollee to assist him or her in keeping up with his
or her
school work and that no academic penalty shall be suffered by the enrollee upon return to
school if the
student has maintained his or her relationship with the school through the assignments
prescribed. An
enrollee so temporarily excluded shall be authorized to return to school upon the lifting by
the Division
of Public Health of the epidemic declaration;
(8) Provision that in any situation where the parents or legal guardian of the enrollee states
that he or she
has been immunized, but that the record has been lost or destroyed by the provider of the
immunizations, the following procedure may be carried out by that responsible person and
shall be
accepted by the local school district board of education or its designee in lieu of compliance
with the
immunization requirement:
a. The responsible person, or the school nurse, shall sign a statement that the record of the
enrollees immunization has been lost; and
b. The responsible person shall be responsible for the enrollee obtaining one (1) dose of
each of
the vaccines prescribed in the basic series of immunization;
(9) Provision for an enrollee who has reached the statutory age of majority set by laws for
the State to be
responsible for his or her immunization program and for execution of the request for
religious
exemption herein authorized;
(10) Provision that it shall be the responsibility of each Delaware public school district to
administer, or
prescribe a designee to administer, rules and regulations herein authorized and promulgated
by the
Department of Education.
(b) Appeals from the decision of the Department rendered pursuant to this section shall be
to the Superior Court
and shall be made in the same manner as is provided by the Superior Court Civil Rules for
appeals from
commissions, boards and agencies. Such appeal shall be on the record before the
Department.
14 DELAWARE CODE
CHAPTER 2. THE PUBLIC SCHOOL SYSTEM1
Subchapter I. System of Free Public Schools
202. Free schools; ages; attendance within school district; nonresidents of Delaware
1 Refer to Delaware Code for complete text.
Section A - 36 - 7-2007
NOTE: Caregivers Law begins at (e) (2) c.
(a) The public schools of this State shall be free to persons who are residents of this State
and who are age 5 years
through 20 years inclusive when they are attending kindergarten through grade 12.
46
(b) The public schools of any school district which maintains schools established under 203
or 204 of this title for
persons below the age of 5 years shall be free to persons who are residents of such school
district and who have
attained the specified age below the age of 5 years for which such schools are established.
(c) Persons attending the public schools of this State shall attend the public schools in the
school district within which
they reside, except as provided in Chapters 4, 5 and 6 of this title and in Chapter 92, Volume
23, Laws of Delaware,
as amended by Chapter 172, Volume 55, Laws of Delaware. Notwithstanding the foregoing,
homeless children and
unaccompanied youth, as defined by 42 U.S.C. 11434a, shall attend school in accordance
with the McKinneyVento Homeless Education Assistance Improvement Act >42 U.S.C. 11431 to 11435;
provided any person
determined to be ineligible under the act may be denied enrollment. For the purpose of this
section and provisions
of the McKinney-Vento Homeless Education Assistance Improvement Act [42 U.S.C. 11431
to 11435], the words
awaiting foster care placement include all children in foster care.
(d) Persons who are nonresidents of this State may attend the public schools of this State
under such terms and
conditions as may be otherwise provided by law.
(e) (1) For purposes of this section, a student shall be considered a resident of the school
district in which his or her
parents or legal guardian resides. If the child's parents do not reside together and a court of
appropriate
jurisdiction has entered a custody order, the child's residency for school attendance
purposes shall be
determined as follows unless otherwise agreed in a writing signed by both parents:
a. In cases in which 1 parent is awarded sole custody, the child shall be considered a
resident of the district in
which the sole custodian resides.
b. In cases in which the parents are granted joint custody, the child shall be considered a
resident of the
district in which the primary residential parent resides.
c. In cases in which the parents are granted shared custody, the child may be considered a
resident of either
parent's district.
Under no circumstances shall a child be enrolled in 2 different schools at the same time.
(2) If a child seeks to be considered a resident of a particular school district based on the
residence of anyone other
than his or her parent(s) or legal guardian, the student must have:
a. A signed order from a court of appropriate jurisdiction granting custody to or appointing
as the child's
guardian the resident with whom he or she is residing; or
b. Suitable documentation certifying that the child resides within the district by action of the
State or approval
by the school district to be considered the student's residence; or
c. A completed and notarized Establishment of Delegation of Power to Relative Caregivers to
Consent for
Registering Minors for School (also known as "Caregivers School Authorization") pursuant to
subsection
(f) of this section confirming a caregiver's ability to provide consent in those cases where the
student is
47
being cared for by an adult relative caregiver without legal custody or guardianship.
(3) Children under the care or custody of the Department of Services for Children, Youth and
Their Families are
exempted from the provisions of this subsection. Children in the care or custody of the
Department of Services
for Children, Youth and Their Families who are in foster care shall attend school in
accordance with the
McKinney-Vento Homeless Education Assistance Act (42 U.S.C. 11431 to 11435).
(f) (1) A child may be enrolled in a particular school district based upon the submission of a
Caregivers School
Authorization if the following conditions are satisfied:
a. The child resides with a relative caregiver who is 18 years of age or older, is a Delaware
resident, and
resides in the district in which the child seeks enrollment;
b. The child resides with the relative caregiver as a result of:
1. The death, serious illness, incarceration or military assignment of a parent or legal
guardian;
2. The failure or inability of the parent or legal guardian to provide substantial financial
support or
parental care or guidance;
3. Alleged abuse or neglect by the parent, legal guardian or others in the parent or legal
guardian's
residence;
4. The physical or mental condition of the parent or legal guardian which prevents adequate
care and
supervision of the child;
5. The loss or uninhabitability of the student's home as the result of a natural disaster; or
6. Other circumstances as deemed appropriate by the school district;
Section A - 37 - 7-2007
c. The child is not currently subject to an expulsion from school (as set forth in 4130 of this
title) or
suspended from school for conduct that could lead to expulsion;
d. The child's residency with the caregiver is not for the purpose of:
1. Attending a particular school (although a caregiver's school district may be considered
when deciding
placement of the child as between 2 or more relative caregivers);
2. Circumventing the Enrollment Choice Program (Chapter 4 of this title);
3. Participating in athletics at a particular school;
4. Taking advantage of special services or programs offered at a particular school; or
5. Other similar purposes; and
e. The caregiver submits to the school district in which the child seeks enrollment a
completed and notarized
Caregivers School Authorization using the most recent form developed for this purpose by
the Department
of Health and Social Services. The Caregivers School Authorization must include the
following:
1. The name and date of birth of the child;
2. The name, address and date of birth of the caregiver;
3. The names of the child's mother, father, legal custodian or guardian;
4. Relationship of the caregiver to the child, documented by proof of relationship as defined
by
regulation;
5. A statement that the caregiver has full-time care of the student, documented as required
by regulation;
48
49
be found.
(4) A Caregivers School Authorization that complies with the requirements of this section
shall be honored by any
school in any school district. The school districts shall determine whether a particular
Caregivers School
Authorization complies with the requirements of this section. A caregiver may appeal the
school district's
decision to the local board of education of the school district. Any school district that
reasonably and in good
faith relies on a Caregivers School Authorization has no obligation to make any further
inquiry or investigation.
Section A - 38 - 7-2007
(5) Persons who knowingly make false statements in the Caregivers School Authorization
shall be subject to a
minimum civil penalty of $1000 and maximum of the average annual per student
expenditure and may be
required to reimburse the school district tuition costs. Further, such persons may be subject
to criminal
prosecution pursuant to 1233 of Title 11. The Justices of the Peace shall have jurisdiction in
these cases.
(6) Caregivers School Authorizations filed prior to January 1 shall be honored for the balance
of the current school
year and for the subsequent school year. Caregivers School Authorizations filed on or after
January 1 shall be
honored for the balance of the current school year and for the 2 subsequent school years. In
either case, the
Authorization shall expire on August 1 of the applicable school year unless the caregiver
receives permission
from the school district to extend the length of time that the Authorization will be honored.
Caregivers School
Authorizations may be cancelled at anytime if the minor stops living with the relative
caregiver or upon written
revocation of the Authorization by the child's caregiver, parent, legal custodian or guardian.
(7) The Department of Health and Social Services shall be authorized to promulgate
regulations to implement this
law. This law shall take effect upon the promulgation of such regulations. Relationship and
proof of actual
full-time caregiving will be verified as stated in the regulations.
14 DELAWARE CODE
CHAPTER 13. SALARIES AND WORKING CONDITIONS OF SCHOOL
EMPLOYEES1
1310. Salary schedules for school nurses
(a) All nurses who hold appropriate certificates shall be paid in accordance with 1305 of this
title effective July 1,
1979.
(b) A reorganized school district may employ personnel to be paid for 10 months per year
from state funds pursuant
to this section in a number equal to 1 for each 40 state units of pupils, except that in schools
for the physically
handicapped within the district the allocation shall be in accordance with the rules and
regulations adopted by the
Department with the approval of the State Board of Education; provided further, that each
reorganized school
50
district shall ensure that it has at least 1 school nurse per facility. To the extent that the
funding formula outlined
above does not provide for 1 school nurse per facility, each reorganized school district shall
meet this requirement
out of funding provided under 1707 or 1716 of the title, or out of discretionary local
current operating expense
funds. Districts shall qualify for partial funding at the rate of 30% of the fractional part of 40
state units of pupils.
14 DELAWARE CODE
CHAPTER 41. GENERAL REGULATORY PROVISIONS2
4123. Child Abuse Detection; reporting training
(a) Each public school shall ensure that each full-time teacher receives 1 hour of training
every year in detection and
reporting of child abuse. This training, and all materials used in such training, shall be
prepared by the Division
of Family Services.
(b) Any in-service training required by this section shall be provided within the contracted
school year as provided in
1305 (e) of this title.
4123A. School bullying prevention and criminal youth gang detection training.
(a) Each school district and charter school shall ensure that its public school employees
receive combined training
each year totaling 1 hour in the identification and reporting of criminal youth gang activity
pursuant to 617 of
Title 11 and bullying prevention pursuant to 4112D of this title. The training materials shall
be prepared by the
Department of Justice and the Department of Education in collaboration with law
enforcement agencies, the
Delaware State Education Association, the Delaware School Boards Association and the
Delaware Association of
School Administrators.
1 Refer to Delaware Code for complete text.
2 Refer to Delaware Code for complete text.
Section A - 39 - 7-2007
(b) Any in-service training required by this section shall be provided within the contracted
school year as provided in
1305(e) of this title. (76 Del. Laws, c. 14, 1.)
16 DELAWARE CODE
CHAPTER 9. ABUSE OF CHILDREN1
Subchapter I. Reports and Investigations of Abuse and Neglect; Child Protection
Accountability Commission
901. Purpose
902. Definitions2
As used in this chapter, the following terms mean:
(1) Abuse shall mean any physical injury to a child by those responsible for the care,
custody and control of the
child, through unjustified force as defined in 468 of Title 11, emotional abuse, torture,
criminally negligent
treatment, sexual abuse, exploitation, maltreatment or mistreatment.
(3) Child shall mean any person who has not reached his or her 18th birthday.
(4) Child Protection Registry or Registry means a collection of information as described in
subchapter II of
this chapter about persons who have been substantiated for abuse or neglect as provided in
Subchapter II of this
51
chapter or who were substantiated between August 1, 1994, and February 1, 2003.
(5) Child welfare proceeding means any Family Court proceeding and subsequent appeal
therefrom involving
custody, visitation, guardianship, termination of parental rights, adoption or other related
petitions that involve a
dependent, neglected or abused child or a child at risk of same as determined by the Family
Court.
(10) Good faith shall be presumed in the absence of evidence of malice or willful
misconduct.
(13) Neglect shall mean the failure to provide, by those responsible for the care, custody
and control of the child, the
proper or necessary: Education as required by law; nutrition; or medical, surgical or any
other care necessary for
the childs well-being.
(17) Those responsible for the care, custody, and control of the child shall include, but not
be limited to, the
parents or guardian of the child, other members of the childs household, adults within the
household who have
responsibility for the childs well-being, persons who have temporary responsibility for the
childs well being, or a
custodian as that term is defined by 901(6) of Title 10.
903. Reports required
Any physician, and any other person in the healing arts including any person licensed to
render services in medicine,
osteopathy, dentistry, any intern, resident, nurse, school employee, social worker,
psychologist, medical examiner or any
other person who knows or in good faith suspects child abuse or neglect shall make a report
in accordance with 904 of
this title. In addition to and not in lieu of reporting to the Division of Family Services, any
such person may also give
oral or written notification of said knowledge or suspicion to any police officer who is in the
presence of such person for
the purpose of rendering assistance to the child in question or investigating the cause of the
childs injuries or condition.
904. Nature and content of report; to whom made.
Any report required to be made under this chapter shall be made to the Division of Child
Protective Services of the
Department of Services for Children, Youth and Their Families. An immediate oral report shall
be made by telephone or
otherwise. Reports and the contents thereof including a written report, if requested, shall be
made in accordance with the
rules and regulations of the Division of Child Protective Services, or in accordance with the
rules and regulations
adopted by the Division.
907. Temporary emergency protective custody
1 Refer to Delaware Code for complete text.
2 Refer to Delaware Code for definitions not included.
Section A - 40 - 7-2007
907A. Safe Arms for Babies.
(a) The General Assembly finds and declares that the abandonment of a baby is an
irresponsible act by parent(s)
and places the baby at risk of injury or death from exposure, actions by other individuals,
and harm from
animals. However, the General Assembly does recognize that delivering a live baby to a safe
place is far
52
preferable to a baby killed or abandoned by the parent(s). The General Assembly further
finds and declares that
the purpose of this section is not to circumvent the responsible action of parent(s) who
adhere to the current
process of placing the baby for adoption, but to prevent the unnecessary risk of harm to or
death of that baby by
desperate parent(s) who would otherwise abandon or cause the death of that baby. The
General Assembly
further finds and declares that medical information about the baby and the baby's parent(s)
is critical for the
adoptive parents and that every effort should be made, without risking the safe placement
of the baby, to obtain
that medical information and provide counseling information to those parent(s). The General
Assembly further
finds and declares that if this section does not result in the safe placement of such babies or
is abused by
parent(s) attempting to circumvent the current process of adoption, it should be repealed.
(b) A person may voluntarily surrender a baby directly to an employee or volunteer of the
emergency department of
a Delaware hospital inside of the emergency department, provided that said baby is
surrendered alive, unharmed
and in a safe place therein.
(c) A Delaware hospital shall be authorized to take temporary emergency protective custody
of the baby who is
surrendered pursuant to this section. The person who surrenders the baby shall not be
required to provide any
information pertaining to his or her identity, nor shall the hospital inquire as to same. If the
identity of the
person is known to the hospital, the hospital shall keep the identity confidential. However,
the hospital shall
either make reasonable efforts to directly obtain pertinent medical history information
pertaining to the baby
and the baby's family or attempt to provide the person with a postage paid medical history
information
questionnaire.
(d) The hospital shall attempt to provide the person leaving the baby with the following:
(1) Information about the Safe Arms program;
(2) Information about adoption and counseling services, including information that
confidential adoption
services are available and information about the benefits of engaging in a regular, voluntary
adoption process;
and
(3) Brochures with telephone numbers for public or private agencies that provide counseling
or adoption
services.
(e) The hospital shall attempt to provide the person surrendering the baby with the number
of the baby's
identification bracelet to aid in linking the person to the baby at a later date, if reunification
is sought. Such an
identification number is an identification aid only and does not permit the person possessing
the identification
number to take custody of the baby on demand.
(f) If a person possesses an identification number linking the person to a baby surrendered
at a hospital under this
53
section and parental rights have not already been terminated, possession of the
identification number creates a
presumption that the person has standing to participate in an action. Possession of the
identification number
does not create a presumption of maternity, paternity or custody.
(g) Any hospital taking a baby into temporary emergency protective custody pursuant to this
section shall
immediately notify the Division and the State Police of its actions. The Division shall obtain
ex parte custody
and physically appear at the hospital within 4 hours of notification under this subsection
unless there are exigent
circumstances. Immediately after being notified of the surrender, the State Police shall
submit an inquiry to the
Delaware Missing Children Information Clearinghouse.
(h) The Division shall notify the community that a baby has been abandoned and taken into
temporary emergency
protective custody by publishing notice to that effect in a newspaper of statewide
circulation. The notice must
be published at least 3 times over a 3-week period immediately following the surrender of
the baby unless the
Division has relinquished custody. The notice, at a minimum, shall contain the place, date
and time where the
baby was surrendered, the baby's sex, race, approximate age, identifying marks, any other
information the
Division deems necessary for the baby's identification, and a statement that such
abandonment shall be:
(1) The surrendering person's irrevocable consent to the termination of all parental rights, if
any, of such
person on the ground of abandonment; and
(2) The surrendering person's irrevocable waiver of any right to notice of or opportunity to
participate in any
termination of parental rights proceeding involving such child, unless such surrendering
person manifests an
intent to exercise parental rights and responsibilities within 30 days of such abandonment.
Section A - 41 - 7-2007
(i) When the person who surrenders a baby pursuant to this section manifests a desire to
remain anonymous, the
Division shall neither initiate nor conduct an investigation to determine the identity of such
person, and no court
shall order such an investigation unless there is good cause to suspect child abuse or
neglect other than the act
of surrendering such baby. (73 Del. Laws, c. 187, 3, 8; 75 Del. Laws, c. 376, 1.)
908. Immunity from liability, and special reimbursement to hospitals for expenses related to
certain babies
(a) Anyone participating in good faith in the making of a report or notifying police officers
pursuant to this
chapter, performing a medical examination without the consent of those responsible for the
care, custody and control of a
child pursuant to 906(b)(5) of this title, or exercising emergency protective custody in
compliance with 907 of this
title, shall have immunity from any liability, civil or criminal, that might otherwise exist, and
such immunity shall extend
to participation in any judicial proceeding resulting from the above actions taken in good
faith. This section shall not
54
limit the liability of any health care provider for personal injury claims due to medical
negligence that occurs as a result
of any examination performed pursuant to 906(b)(3) of this title.
909. Privileged communication not recognized
No legally recognized privilege, except that between attorney and client and that between
priest and penitent in a
sacramental confession, shall apply to situations involving known or suspected child abuse,
neglect, exploitation or
abandonment and shall not constitute grounds for failure to report as required by 903 of
this title or to give or accept
evidence in any judicial proceeding relating to child abuse or neglect.
913. Child under treatment by spiritual means not neglected.
No child who in good faith is under treatment solely by spiritual means through prayer in
accordance with the tenets and
practices of a recognized church or religious denomination by a duly accredited practitioner
thereof shall for that reason
alone be considered a neglected child for the purposes of this chapter.
16 DELAWARE CODE
CHAPTER 26. CHILDHOOD LEAD POISONING PREVENTION ACT
2601. Short title.
This act shall be known and may be cited as the Childhood Lead Poisoning Prevention Act.
2602. Physicians and health care facilities to screen children.
(a) Every health care provider who is the primary health care provider for a child shall order
screening of that child,
in accordance with standards promulgated by the Division of Public Health, at or around 12
months of age for
lead poisoning.
(b) For a child who is deemed by the primary health care provider, pursuant to guidelines
promulgated by the
Division of Public Health, to be at high risk for lead poisoning, that health care provider shall
order screening of
that child for lead poisoning in accordance with guidelines and criteria set forth by the
Division of Public Health.
(c) Unless the child is at high risk for lead poisoning, as determined by the primary health
care provider, pursuant to
guidelines promulgated by the Division of Public Health, screening shall not be required for
any child who is over
12 months of age on March 1, 1995.
(d) All laboratories involved in lead level analysis will participate in a universal reporting
system as established by
the Division of Public Health.
(e) Nothing in this section shall be construed to require any child to undergo a lead blood
level screening or test
whose parent or guardian objects on the grounds that the screening or test conflicts with the
parent's or guardian's
religious beliefs.
(f) All laboratories involved in blood lead level analysis will participate in a universal
reporting system as established
by the State Board of Health.
Section A - 42 - 7-2007
2603. Screening prior to child care or school enrollment.
For every child born on or after March 1, 1995, and who has reached the age of 12 months,
child care facilities and
public and private nursery schools, preschools and kindergartens shall require screening for
lead poisoning for admission
55
or continued enrollment; except in the case of enrollment in kindergarten, such testing may
be done within 60 calendar
days of the date of enrollment. A statement shall be provided from the child's primary health
care provider that the child
has been screened for lead poisoning or in lieu thereof a certificate signed by the parent or
guardian stating that the
screening is contrary to that person's religious beliefs.
2604. Reimbursement by third party payers.
Screening, screening-related services and diagnostic evaluations as required by 2602 of
this title shall be reimbursable
under health insurance contracts and group and blanket health insurance as provided by
Chapter 33 and Chapter 35,
respectively, of Title 18.
2605. Childhood Lead Poisoning Advisory Committee.
(a) There is hereby established the Childhood Lead Poisoning Prevention Advisory Committee
to ensure the
implementation of the Childhood Lead Poisoning Prevention Act established pursuant to this
chapter and to make
any necessary recommendations for the implementation of the program or improvements of
the processes to be
followed by the agencies responsible for the implementation of said plan.
(b) The Committee shall semiannually prepare and distribute a report regarding the
Childhood Lead Poisoning
Prevention Act, the intervention activities, studies of incidence, the State Blood Lead
Screening Program, and
monitoring and implementation of regulations promulgated pursuant to this chapter.
(c) The Committee shall be cochaired by the Secretary of the Department of Health and
Social Services or the
Secretary's designee and the Secretary of Education or the Secretary's designee and shall
have no more than 7
members. The Secretary of Education and the Secretary of Health and Social Services shall,
after consultation
with the Governor, appoint 7 members comprised of individuals which shall include a
representative of the
Department of Services for Children, Youth and Their Families, which must represent the
interests of daycare
licensing, a representative of the medical community at large who is a practicing physician,
an administrative
representative of a school district, and a public member.
(d) The Committee will sunset upon full implementation of the Childhood Lead Poisoning
Prevention Act.
16 DELAWARE CODE
CHAPTER 30C. AUTOMATIC EXTERNAL DEFIBRILLATORS (AEDS)
3001C. Findings and Purpose
The General Assembly of the State has found that each year more than 350,000 Americans
experience out-of-hospital
sudden cardiac arrest. More than 95% of them die. In many cases, people die because life
saving defibrillators arrive on
the scene too late, if at all. It is estimated that more than 100,000 deaths could be
prevented each year if defibrillators
were more widely available to designated users (responders). Many communities around the
country have invested in
911 emergency response systems, emergency personnel and ambulance vehicles. However,
many of these same
56
communities do not have enough defibrillators. It is therefore the intent of this General
Assembly to encourage greater
acquisition, deployment, and use of automated external defibrillators in communities within
the State.
3002C. Definitions
The following words, terms and phrases, when used in this chapter, shall have the meanings
ascribed to them herein,
except where the context clearly indicates a different meaning:
(a) Automated external defibrillator, (AED) shall mean a medical device which is both a
heart monitor and
defibrillator that has received approval of its pre-market notification, filed with the Food and
Drug Administration
pursuant to United States Code, Title 21, section 360(k).
Section A - 43 - 7-2007
(b) Records shall mean the recordings of interviews and all oral or written reports,
statements, minutes,
memoranda, charts, statistics, data and other documentation generated by the State EMS
Medical Director.
3003C. Correct use of defibrillator; training in order to ensure public health and safety
(a) Any entity to whom AEDs are distributed shall insure that:
(1) Each prospective defibrillator user receives appropriate training by the American Red
Cross, the American
Heart Association, Delaware State Fire School or by another nationally recognized provider of
training for
cardio-pulmonary resuscitation and AED use; provided however, that such training shall be
approved by
the State EMS Medical Director;
(2) The defibrillator is maintained and tested according to the manufacturers guidelines;
and
(3) Any person who renders emergency care or treatment on a person in cardiac arrest by
using an AED shall
notify the appropriate EMS units as soon as possible and report any clinical use of the AED to
the
appropriate licensed physician or medical authority.
(b) The State EMS Medical Director shall maintain a file containing the name of each person
or entity that acquires
an AED with State funding.
3004C. Quality Review Program
All quality management proceedings shall be confidential. Records of the State EMS Medical
Director, and EMS
quality care review committee relating to AED reviews and audits shall be confidential and
privileged, are protected, and
are not subject to discovery, subpoena or admission into evidence in any judicial or
administrative proceeding. Raw data
used in any AED review or audit shall not be available for public inspection; nor is such raw
data a public record as set
forth in the Delaware Freedom of Information Act.
3005C. Provision of limited liability protections
(a) Any person or entity, who in good faith and without compensation, renders emergency
care or treatment by the
use of an AED shall be immune from civil liability for any personal injury as a result of such
care or treatment, or
as a result of any act or failure to act in providing or arranging further medical treatment, if
such person acts as an
57
ordinary, reasonably prudent person would have acted under the same or similar
circumstances and such act or
acts do not amount to willful or wanton misconduct or gross negligence.
(b) Any individual who authorizes the purchase of an AED, any person or entity who provides
training in
cardiopulmonary resuscitation and the use of an AED, and any person or entity responsible
for the site where the
AED is located shall be immune from civil liability for any personal injury that results from
any act or omission
that does not amount to willful or wanton misconduct to gross negligence.
16 DELAWARE CODE
CHAPTER 68. EXEMPTIONS FROM CIVIL LIABILITY1
Section A - 44 - 7-2007
assistance, unless it is established that such injuries or such death were caused willfully,
wantonly or recklessly or
by gross negligence on the part of such person. This section shall apply to members or
employees of nonprofit
volunteer or governmental ambulance, rescue or emergency units, whether or not a user or
service fee may be
charged by the nonprofit unit or the governmental entity and whether or not the members
or employees receive
salaries or other compensation from the nonprofit unit or the governmental entity. This
section shall not be
construed to require a person who is ill or injured to be administered first aid or emergency
treatment if such
person objects thereto on religious grounds. This section shall not apply if such first aid or
emergency treatment
or assistance is rendered on the premises of a hospital or clinic.
6802. Exempting nurses from civil liability in rendering emergency care
Any registered nurse or any licensed practical nurse, licensed as such by any state, who in
good faith renders emergency
care at the scene of any emergency or who undertakes to transport any victim thereof to the
nearest medical facility shall
not be liable for any civil damages as a result of any act or omission in rendering the
emergency care; provided,
58
however, such act or omission is not grossly negligent or intentionally designed to harm the
victim.
24 DELAWARE CODE
CHAPTER 19. NURSING
NURSE PRACTICE ACT
SECTION.
1
Section A - 45 - 7-2007
Chapter 19A INTERSTATE NURSE LICENSURE COMPACT1
1901A. Interstate Nurse Licensure Compact
1902A. Disciplinary action in Delaware
1903A. Effect of other obligations
1904A. Compact as controlling law
1905A. Continuation of Compact
1901. Declaration of legislative intent
The General Assembly hereby declares the practice of nursing by competent persons is
necessary for the protection of
the public health, safety and welfare and further finds that the levels of practice within the
profession of nursing should
59
be regulated and controlled in the public interest. In order to safeguard life and health, the
general administration and
supervision of the education, examination, licensing and regulation of professional and
practical nursing is declared
essential, and such general administration and supervision is vested in the Board of Nursing.
1902. Definitions
(a) Administration of medications means a process whereby a single dose of a prescribed
drug or biological is
given to a patient by an authorized licensed person by 1 of several routes, oral, inhalation,
topical, or parenteral.
The person verifies the properly prescribed drug order, removes the individual dose from a
previously dispensed,
properly labeled container (including a unit dose container), assesses the patients status to
assure that the drug is
given as prescribed to the patient for whom it is prescribed and that there are no known
contraindications to the
use of the drug or the dosage that has been prescribed, gives the individual dose to the
proper patient, records the
time and dose given and assesses the patient following the administration of medication for
possible untoward
side effects.
(b) (1) Advanced practice nurse means an individual whose education and certification
meet criteria
established by the Board of Nursing who is currently licensed as a registered nurse and has
a masters
degree or a postbasic program certificate in a clinical nursing specialty with national
certification. When
no national certification at the advanced level exists, a masters degree in a clinical nursing
specialty will
qualify an individual for advanced practice nurse licensure. Advanced practice nurse shall
include, but
not be limited to, nurse practitioners, certified registered nurse anesthetists, certified nurse
midwives or
clinical nurse specialists. Advanced practice nursing is the application of nursing principles,
including
those described in subsection (b) of this section, at an advanced level and includes:
a. For those advanced practice nurses who do not perform independent acts of diagnosis or
prescription, the authority as granted within the scope of practice rules and regulations
promulgated
by the Board of Nursing; and
b. For those advanced practice nurses performing independent acts of diagnosis and/or
prescription
with the collaboration of a licensed physician, dentist, podiatrist or licensed Delaware health
care
delivery system without written guidelines or protocols and within the scope of practice as
defined in
the rules and regulations promulgated by the Joint Practice Committee and approved by the
Board of
Medical Practice.
Nothing in this act is to be construed to limit the practice of nursing by advanced practice
nurses as is
currently being done or allowed including nursing diagnosis as pursuant to subsection (b)(2)
of this section.
Advanced practice nurses shall operate in collaboration with a licensed physician, dentist,
podiatrist, or
60
licensed Delaware health care delivery system to cooperate, coordinate, and consult with
each other as
appropriate pursuant to a collaborative agreement defined in the rules and regulations
promulgated by the
Board of Nursing, in the provision of health care to their patients. Advanced practice nurses
desiring to
practice independently or to prescribe independently must do so pursuant to 1906(20) of
Title 24.
(2) Those individuals who wish to engage in independent practice without written guidelines
or protocols
and/or wish to have independent prescriptive authority shall apply for such privilege or
privileges to the
Joint Practice Committee and do so only in collaboration with a licensed physician, dentist,
podiatrist or
1 Refer to Delaware Code for complete text.
Section A - 46 - 7-2007
licensed Delaware health care delivery system. This does not include those individuals who
have protocols
and/or waivers approved by the Board of Medical Practice.
(c) Assistance with medications means a situation where a designated care provider
functioning in a setting
authorized by 1921 of this title, who has taken a Board approved medication training
program, or a designated
care provider who is otherwise exempt from the requirement of having to take the Board
approved self
administration with medication training programs, assists the patient in the selfadministration of a medication
other than by injection, provided that the medication is in the original container, with a
proper label and
directions. The designated care provider may hold the container for the patient, assist with
the opening of the
container and assist the patient in taking the medication.
(d) The Compact Administrator shall be the Executive Director of the Delaware Board of
Nursing who shall be
designated as the Compact Administrator by the President of the Board.
(e) Dispensing means providing medication according to an order of a practitioner duly
licensed to prescribe
medication. The term shall include both the repackaging and labeling of medications form
bulk to individual
dosages.
(f) The Head of the Nursing Licensing Board shall be the President of the Delaware Board
of Nursing; and
(g) Independent practice by an advanced practice nurse shall include those advance
practice nurses who
practice and prescribe without written guidelines or protocols but with a collaborative
agreement with a licensed
physician, dentist, podiatrist or licensed Delaware health care delivery system and with the
approval of the Joint
Practice Committee.
(h) Licensure means the authorization to practice nursing within this State granted by the
Delaware Board of
Nursing and includes the authorization to practice in Delaware under the Interstate Nurse
Licensure Compact.
(i) Nursing diagnosis means the description of the individuals actual or potential health
needs which are
61
identified through a nursing assessment and are amenable to nursing intervention. The
focus of the nursing
diagnosis is on the individuals response to illness or other factors that may adversely affect
the attainment/or
maintenance of wellness. These diagnostic acts are distinct from medical, osteopathic and
dental diagnosis.
(j) Nursing education program means a course of instruction offered and conducted to
prepare persons for
licensure as a registered or licensed practical nurse, and/or a course of instruction offered
and conducted to
increase the knowledge and skills of the nurse and leads to an academic degree in nursing,
and/or refresher
courses in nursing.
(k) Standards of nursing practice means those standards of practice adopted by the Board
that interpret the legal
definitions of nursing, as well as provide criteria against which violations of the law can be
determined. Such
standards of nursing practice shall not be used to directly or indirectly affect the
employment practices and
deployment of personnel by duly licensed or accredited hospitals and other duly licensed or
accredited health care
facilities and organizations. In addition, such standards shall not be assumed the only
evidence in civil
malpractice litigation, nor shall they be given a different weight than any other evidence.
(l) Substantially related means the nature of the criminal conduct, for which the person
was convicted, has a
direct bearing on the fitness or ability to perform 1 or more of the duties or responsibilities
necessarily related to
the practice of nursing.
(m) The practice of practical nursing as a licensed practical nurse means the performance
for compensation of
nursing services by a person who holds a valid license pursuant to the terms of this chapter
and who bears
accountability for nursing practices which require basic knowledge of physical, social and
nursing sciences.
These services, at the direction of a registered nurse or a person licensed to practice
medicine, surgery or dentistry,
include:
(1) Observation;
(2) Assessment;
(3) Planning and giving of nursing care to the ill, injured and infirm;
(4) The maintenance of health and well being;
(5) The administration of medications and treatments prescribed by a licensed physician,
dentist, podiatrist or
advanced practice nurse; and
(6) Additional nursing services and supervision commensurate with the licensed practical
nurses continuing
education and demonstrated competencies; and
(7) Dispensing activities only as permitted in the boards Rules and Regulations.
Nothing contained in this chapter shall be deemed to permit acts of surgery or medical
diagnosis; nor shall it be
deemed to permit dispensing of drugs, medications or therapeutics independent of the
supervision of a physician
who is licensed to practice medicine and surgery, or those licensed to practice dentistry or
podiatry.
62
Section A - 47 - 7-2007
(n) The practice of professional nursing as a registered nurse means the performance of
professional nursing
services by a person who holds a valid license pursuant to the terms of this chapter, and
who bears primary
responsibility and accountability for nursing practices based on specialized knowledge,
judgment and skill derived
from the principles of biological, physical and behavioral sciences. The registered nurse
practices in the
profession of nursing by the performance of activities, among which are:
(1) Assessing human responses to actual or potential health conditions;
(2) Identifying the needs of the individual and/or family by developing a nursing diagnosis;
(3) Implementing nursing interventions based on the nursing diagnosis;
(4) Teaching health care practices. Nothing contained herein shall limit other qualified
persons or agencies
from teaching health care practices without being licensed under this chapter;
(5) Advocating the provision of health care services through collaboration with other health
service personnel;
(6) Executing regimens, as prescribed by a licensed physician, dentist, podiatrist or
advanced practice nurse,
including the dispensing and/or administration of medications and treatments;
(7) Administering, supervising, delegating and evaluating nursing activities.
(8) Nothing contained in this chapter shall be deemed to permit acts of surgery or medical
diagnosis; nor shall
it be deemed to permit dispensing of drugs, medications or therapeutics independent of the
supervision of a
physician who is licensed to practice medicine and surgery, or those licensed to practice
dentistry or
podiatry.
A registered nurse shall the authority, as part of professional nursing, to make a
pronouncement of death;
provided, however, that this provision shall only apply to attending nurses caring for
terminally ill patients or
patients who have do not resuscitate orders in the home or place of residence of the
deceased as a part of a
hospice program or a certified home health care agency program; in a skilled nursing
facility; in a residential
community associated with a skilled nursing facility; any licensed assisted living community;
in an extended care
facility; or in a hospice; and provided that the attending physician of record has agreed in
writing to permit the
attending registered nurse to make a pronouncement of death in that case.
(o) The profession of nursing is an art and process based on a scientific body of
knowledge. The practitioner of
nursing assists patients in the maintenance of health, the management of illness, injury or
infirmity or in the
achieving of a dignified death.
1905. Delaware Board of Nursing Executive Director
The Executive Director shall be a registered nurse with at least 5 years experience in an
administrative or teaching
position, have earned a masters degree in nursing, nursing education, education or a
related health field.
1906. Delaware Board of Nursing Powers and duties
(a) The Board shall:
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(1) Adopt and, from time to time, revise such rules and regulations and standards not
inconsistent with the law
as may be necessary to enable it to carry into effect this chapter;
(2) Approve curricula and develop criteria and standards for evaluating educational
programs preparing
persons for license under this chapter;
(3) Provide for surveys of such programs at such times as it may deem necessary;
(4) Approve such programs as meet the requirements of this chapter and of the Board;
(5) Deny or withdraw approval from educational programs for failure to meet approved
curricula or other
criteria;
(6) Examine, license and renew licenses of duly qualified applicants, including applicants for
conducting
nursing educational programs and shall also prescribe the procedures for subsequent
examinations of
applicants who fail an examination;
(7) Establish categories of advanced practice nurses which shall include, but not be limited
to, pediatric nurse
practitioner, family nurse practitioner, maternal-gynecological nurse practitioner, clinical
specialist in
psychiatric-mental health nursing, nurse anesthetist and gerontological nurse practitioner
and standards for
the advanced practice nurse in each category. Such standards shall take into account the
type of advanced
levels of nursing practice which are or may be performed and the clinical and didactic
education,
experience or both needed to practice safely at those levels. In setting such standards, the
Board shall
consult with advanced practice nurses and physicians and health care organizations utilizing
advanced
Section A - 48 - 7-2007
practice nurses. The standards shall be consistent with the national certifying organization
standards of
practice recognized by the Board in its rules and regulations;
(8) Issue a temporary permit to practice nursing to applicants who apply for licensure by
endorsement and to
new graduates awaiting results of the first licensing examination;
(9) Conduct hearings upon charges calling for discipline of a licensee or revocation of a
license;
(10) Have the power to issue subpoenas and compel the attendance of witnesses, and
administer oaths to persons
giving testimony at hearings;
(11) Cause the prosecution of all persons violating this chapter and have the power to incur
such necessary
expenses therefor;
(12) Keep a record of all its proceedings;
(13) Make an annual report to the Governor;
(14) Have all of the duties, powers and authority necessary to the enforcement of this
chapter, as well as such
other duties, powers and authority as it may be granted from time to time by appropriate
statute;
(15) Appoint advisory committees as the Board deems desirable;
(16) Maintain a system of statistics related to nursing education programs and registered
nurse and licensed
practical nurse licensure in the State;
64
(17) Participate in and pay fees to the national organization of state boards of nursing, the
National Council of
State Boards of Nursing, Inc.;
(18) By regulation, establish requirements for mandatory continuing education;
(19) Create a regulatory committee entitled Joint Practice Committee to develop rules and
regulations
regarding the independent practice and prescriptive authority of advance practice nurses.
The Committee
shall consist of 9 members and shall be as follows:
a. The Board of Nursing shall appoint 1 public member and 5 advanced practice nurses.
b. The Board of Pharmacy shall appoint 1 pharmacist.
c. The Board of Medical Practice shall appoint 2 physicians.
(20) The Joint Practice Committee with the approval of the Board of Medical Practice shall
have the authority
to grant, restrict, suspend or revoke practice or independent prescriptive authority and the
Joint Practice
Committee with the approval of the Board of Medical Practice shall be responsible for
promulgating rules
and regulations to implement the provisions of this chapter regarding advanced practice
nurses who have
been granted authority for independent practice and/or independent prescriptive authority.
(21) The rules and regulations and the granting, restricting, suspension or revocation of the
independent practice
and/or independent prescriptive authority shall be subject to the approval of the Board of
Medical Practice.
(b) The Board of Nursing shall promulgate regulations specifically identifying those crimes
which are substantially
related to the practice of nursing.
1909. License requirement
No unlicensed person, except those persons issued a temporary permit by the Board, shall
practice advanced practice,
professional or practical nursing. Upon request, any person engaged in the practice of
advanced practice, professional or
practical nursing shall exhibit a license authorizing such practice.
1910. Qualifications for registered nurse
An applicant for a license to practice as a registered nurse shall submit to the Board written
evidence, verified by oath,
that the applicant:
(1) Is a graduate of and holds a certificate from a State Board of Nursing approved nursing
education program that is
authorized to prepare persons for licensure as a registered nurse;
(2) Demonstrates competence in English related to nursing;
(3) Must show evidence of an earned high school diploma or its equivalent;
(4) Is of such satisfactory physical and mental health as is consistent with the Americans
with Disabilities Act; [42
U.S.C. 12101 et. seq.];
(5) Has committed no acts which are grounds for disciplinary action as set forth in 1922(a) of
this title; however, after
a hearing, the Board, by an affirmative vote of a majority of the quorum may waive
1922(a)(2) of this title,
herein, if it finds all of the following:
a. More than 5 years have elapsed since the applicant has fully discharged all imposed
sentences. As used
herein, the term "sentence" includes, but is not limited to, all periods of modification of a
sentence,
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Section A - 49 - 7-2007
probation, parole or suspension. However, sentence does not include fines, restitution or
community
service, as long as the applicant is in substantial compliance with such fines, restitution and
community
service.
b. The applicant is capable of practicing nursing in a competent and professional manner.
c. The granting of a waiver will not endanger the public health, safety or welfare; and
(6) If seeking licensure by endorsement, demonstrates active employment in professional
nursing in the past 5 years,
or satisfactory completion of a professional nursing refresher program with an approved
agency within 2 years
prior to filing an application. In the event no refresher course is available the Board may
consider alternate
methods of evaluating current knowledge in professional nursing.
1914. Qualifications for licensed practical nurse
An applicant for a license to practice as a licensed practical nurse shall submit to the Board
written evidence, verified by
oath, that such applicant:
(1) Is a graduate of and holds a certificate from a State Board of Nursing approved practical
nursing education
program;
(2) Demonstrates competence in English related to nursing;
(3) Must show evidence of an earned high school diploma or its equivalent;
(4) Is of such satisfactory physical and mental health as is consistent with the Americans
with Disabilities Act;
(5) Has committed no acts which are grounds for disciplinary action as set forth in 1922(a) of
this title; however, after
a hearing, the Board, by an affirmative vote of a majority of the quorum may waive
1922(a)(2) of this title,
herein, if it finds all of the following:
a. More than 5 years have elapsed since the applicant has fully discharged all imposed
sentences. As used
herein, the term "sentence" includes, but is not limited to, all periods of modification of a
sentence,
probation, parole or suspension. However, sentence does not include fines, restitution or
community
service, as long as the applicant is in substantial compliance with such fines, restitution and
community
service.
b. The applicant is capable of practicing nursing in a competent and professional manner.
c. The granting of a waiver will not endanger the public health, safety or welfare; and
(6) If seeking licensure by endorsement, demonstrates active employment in practical
nursing in the past 5 years, or
satisfactory completion of a practical nursing refresher program with an approved agency
within 2 years prior to
filing an application. In the event no refresher course is available the Board may consider
alternate methods of
evaluating current knowledge in practical nursing.
1918. Renewal of license; lapse of license; penalties; retirement from practice; temporary
permit to practice
(a) Every advanced practice nurse, registered or licensed practical nurse licensed under this
chapter shall reregister
biennially by filing an application; provided, however, that the license of any licensee who is
on active military
66
duty with the Armed Forces of the United States and serving in a theater of hostilities on the
date such application
or reregistration is due shall be deemed to be current and in full compliance with this
chapter until the expiration
of 60 days after such licensee is no longer on active military duty in a theater of hostilities.
The advanced practice
nurses independent practice and/or independent prescriptive authority shall be subject to
biennial renewal upon
application made to the Joint Practice Committee. In the event the applicant has not been
actively employed in
professional practical nursing in the past 5 years, the applicant will be required to give
evidence of satisfactory
completion of a professional or practical nursing refresher program within an approved
agency within 2 years
prior to renewal before licensure by renewal will be granted.
(b) Upon receipt of the application and fee, the Board shall verify the accuracy of the
information set forth in the
application and issue to the applicant a certificate of renewal of license for 2 years, provided
that the applicant has
successfully completed continuing education requirements as may be established by the
Board. Such certificate
shall entitle the holder to engage in the practice of professional or practical nursing for the
period stated therein.
Any licensee whose license lapses for failure to renew the license may be reinstated by the
Board upon
satisfactory evidence of active employment in professional or practical nursing within the
past 5 years or
satisfactory completion of a refresher program in professional or practical nursing within an
approved agency
within a 1-year period prior to renewal and upon satisfactory explanation for the failure to
renew the license and
payment of a penalty fee to be determined.
Section A - 50 - 7-2007
(c) After a license has lapsed or been inactive for 5 or more years and the applicant has not
been in active practice in
professional or practical nursing in the past 5 years, the applicant will be required to give
evidence of satisfactory
completion of a professional or practical nursing refresher program within an approved
agency within 2 years
prior to reinstatement before licensure by reinstatement will be granted. In the event no
refresher course is
available the Board may consider alternate methods of evaluating current knowledge in
professional or practical
nursing.
(d) Any person practicing nursing during the time his or her license has lapsed shall be
considered an illegal
practitioner and shall be subject to the penalties provided for violations of this chapter.
(e) Any person licensed under this chapter who desires to retire from practice in this State
shall so notify the Board.
Upon receipt of such notice, the Board shall place the name of such person on a
nonpracticing list. While on this
list, such person shall not be required to pay any license fee, and shall not practice nursing
in this State. When
such person desires to resume practice, application for renewal shall be made under
subsection (a) of this section
67
and the license shall be reactivated if the requirements of the Board are met.
(f) Temporary permits to practice nursing may be issued by the Board to persons who have
requested reinstatement
of their license, if they have practiced nursing within the past 5 years.
(g) Every registered or licensed practical nurse licensed under this chapter primarily
engaged in the practice of
electrolysis shall be exempt from the requirement in subsection (a) of this section that states
in the event the
applicant has not been actively employed in professional practical nursing in the past 5
years, the applicant will be
required to give evidence of satisfactory completion of a professional or practical nursing
refresher program
within 2 years prior to renewal before licensure by renewal will be granted.
1920. License requirements; use of abbreviations
(a) No person shall engage in the practice of professional nursing in Delaware without being
licensed by the Board,
except those persons issued a temporary permit by the Board.
(b) No person shall engage in practice as an advanced practice nurse without a Board-issued
license as an advanced
practice nurse.
(c) No person shall knowingly employ a graduate of a professional nursing program or a
registered nurse to engage in
the practice of professional nursing without a temporary permit or license from the Board.
(d) Only registered nurses shall use that title, the abbreviation of R.N. or any other words,
letters, signs or figures
indicating that the person using the same is a registered nurse.
(e) No person shall practice practical nursing in Delaware without being licensed by the
Board, except those persons
issued a temporary permit by the Board.
(f) No person shall knowingly employ a graduate of a practical nursing program or a licensed
practical nurse to
engage in the practice of practical nursing without a temporary permit or license from the
Board.
(g) Only licensed practical nurses shall use that title, the abbreviation L.P.N. or any other
words, letters, signs or
figures indicating that the person using the same is a licensed practical nurse.
1921. Applicability of chapter
(a) This chapter shall not apply to the following situations:
(1) Nursing services rendered during an epidemic or a state or national disaster;
(2) The rendering of assistance by anyone in the case of an emergency;
(3) Emergency services rendered by ambulance personnel trained in advanced life support
under a licensed
physicians supervision as defined in Chapter 79 of Title 29. Advanced life support is defined
in Chapter
79 of Title 29;
(4) The incidental care of the sick in private homes by members of the family, friends,
domestic servants or
persons primarily employed as housekeepers;
(5) Nursing services rendered by a student enrolled in a State Board of Nursing approved
school of
professional or practical nursing when these services are incidental to the course of study; or
those nursing
services rendered by a professional nurse or practical nurse enrolled in a State Board of
Nursing approved
refresher course pending reinstatement, reactivation or endorsement of licensure;
68
(6) The practice of nursing in this State by a nurse licensed in another state whose
employment requires such
nurse to accompany and care for a patient temporarily in this State, provided the nursing
services are not
rendered for more than 3 months within 1 year and such nurse does not claim to be licensed
in this State;
Section A - 51 - 7-2007
(7) The practice of nursing by a nurse licensed in another state employed by the United
States government or
any bureau, division or agency thereof;
(8) The practice of nonmedical nursing in connection with healing by prayer or spiritual
means in accordance
with the tenets and practice of a well-recognized church or religious denomination, provided
that persons
practicing such nonmedical nursing do not claim to be licensed under this chapter;
(9) Auxiliary care services performed by nurses aides, attendants, orderlies and other
auxiliary workers in
medical care facilities, or elsewhere by persons under the direction and supervision of a
person licensed to
practice nursing, medicine, dentistry or podiatry, and performing those services which are
routine,
repetitive and limited in scope, and that do not require the professional judgment of a
registered nurse or a
licensed practical nurse; provided, however, that nothing contained herein shall limit the
right of any person
to act pursuant to paragraph (7) of subsection (e) of 1703 of this title, or persons employed
in similar
positions in the offices of podiatrists or dentists without being licensed under this chapter;
(10) Residential child care facilities regulated by the State under Title 31 where designated
child care providers,
who have successfully completed a Board-approved medication training program, assist
children in the
taking of medication, other than by injection, provided that the medication is in the original
container,
properly labeled. An annual report by the Administrator of the Program shall be made to the
Board of
Nursing. The report shall indicate compliance with guidelines as set forth in the approved
course on
Assistance with Self Administration;
(11) Administration of prescription or nonprescription medications, other than by injection,
by child care
providers who have successfully completed a state-approved medication training program,
to children in
child day care homes or child day care centers regulated by the State under 341-344 of
Title 31;
provided the medication and written permission for the administration of the particular
medication has been
obtained from the childs parent or legal guardian and further provided the medication is in
its original
container, properly labeled. Properly labeled medication shall include instructions for
administration of the
medication;
(12) Foster homes, group homes or adult day habilitation centers for individuals who are
developmentally
69
disabled regulated by the State under Chapter 55 of Title 16 where designated care
providers, who have
successfully completed a Board-approved medication training program, assist
developmentally disabled
clients in the taking of medication, other than by injection, provided that the medication is in
the original
container, properly labeled. An annual report by the Administrator of the Program shall be
made to the
Board of Nursing. The report shall indicate compliance with guidelines as set forth in the
approved course
on Assistance with Self Administration;
(13) Nursing services rendered by a graduate of a State Board of Nursing approved school of
professional or
practical nursing working under supervision, pending results of the first licensing
examination. The Board
shall establish the procedure and extent to which subsequent examinations may be taken
and the length of
time and the character of nursing service which may be rendered pending subsequent
examinations;
(14) Group homes for individuals who have psychiatric disabilities regulated by the State
under Chapter 11 of
Title 16 and other community support programs certified by the Division of Substance Abuse
and Mental
Health, where designated care providers, who have successfully completed a Boardapproved medication
training program, assist individuals who have psychiatric disabilities in the taking of
medication, other than
by injection, provided that the medication is in the original container, properly labeled. An
annual report
by the Administrator of the Program shall be made to the Board of Nursing. The report shall
indicate
compliance with guidelines as set forth in the approved course on Assistance with Self
Administration;
(15) The practice of any currently licensed registered nurse or licensed practical nurse of
another state who
provides or attends educational programs or provides consultative services within this State
not to exceed
14 days in any calendar year. Neither the education nor consultation may include the
provision of patient
care, the direction of patient care or the affecting of patient care policies;
(16) Assisted Living agencies serving elderly persons and adults with physical disabilities
regulated by the State
under Chapter 11 of Title 16, where designated care providers, who have successfully
completed a Boardapproved
medication training program, assist individuals residing in licensed assisted living facilities in
the
taking of medication, other than by injection, provided that the medication is in the original
container, and
properly labeled. An annual report by the Administrator of the Program shall be made to the
Board of
Nursing. The report shall indicate compliance with guidelines as set forth in the approved
course on
Assistance with Self Administration;
Section A - 52 - 7-2007
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(17) Educators who assist students with medications that are self-administered during school
field trips that have
completed a Board of Nursing approved training course developed by the Delaware
Department of
Education;
(18) Attendants providing basic and ancillary services defined and regulated by the
Department of Health and
Social Services in conformity with the Community-Based Attendant Services Act, Chapter 94
of Title 16.
(19) A competent individual who does not reside in a medical facility or a facility regulated
pursuant to Chapter
11 of Title 16, may delegate to unlicensed persons performance of health care acts, unless
of a nature
excluded by the Board through regulations, provided:
a. The acts are those individuals could normally perform themselves but for functional
limitations; and
b. The delegation decision is entirely voluntary.
Nothing contained herein shall diminish any legal or contractual entitlement to receive
health care services from
licensed or certified personnel.
(b) Persons involved in the rendering of electrolysis treatments shall be eligible for licensing
under this chapter
regardless of whether the applicant is in compliance with subdivision (6) of 1910 of this
title, or subdivision (6)
of 1914 of this title, so long as such applicants are in compliance with subdivisions (1)
through (5) of either
1910 or 1914 of this title.
1922. Disciplinary proceedings; appeal
(a) Grounds. The Board may impose any of the following sanctions (subsection (b) of this
section) singly or in
combination when it finds a licensee or former licensee is guilty of any offense described
herein:
(1) Is guilty of fraud or deceit in procuring or attempting to procure a license to practice
nursing; or
(2) Is convicted of a crime that is substantially related to the practice of nursing; or
(3) Is unfit or incompetent by reason of negligence, habits or other causes; or
(4) Is habitually intemperate or is addicted to the use of habit-forming drugs; or
(5) Is mentally incompetent; or
(6) Whose physical condition is such that the performance of nursing service is or may be
injurious or
prejudicial to patients or to the public; or
(7) Has had a license to practice as a registered nurse or licensed practical nurse suspended
or revoked in any
jurisdiction; or
(8) Is guilty of unprofessional conduct as shall be determined by the Board, or the willful
neglect of a patient;
or
(9) Has willfully or negligently violated this chapter.
(b) Disciplinary sanctions.
(1) Permanently revoke a license to practice.
(2) Suspend a license.
(3) Censure a license.
(4) Issue a letter of reprimand.
(5) Place a licensee on probationary status and require the licensee to:
a. Report regularly to the Board upon the matters which are the basis of probation.
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Section A - 53 - 7-2007
a. The accused may be represented by counsel who shall have the right of examination and
crossexamination.
b. The accused and the Board may subpoena witnesses. Subpoenas shall be issued by the
President or
the Vice-President of the Board upon written request and shall be served as provided by the
rules of
Superior Court and shall have like effect as a subpoena issued by said Court.
c. Testimony before the Board shall be under oath. Any member of the Board shall have
power to
administer oaths for this purpose.
d. A stenographic record of the hearing shall be made by a qualified court reporter. At the
request and
expense of any party such record shall be transcribed with a copy to the other party.
e. The decision of the Board shall be based upon sufficient legal evidence. If the charges are
supported
by such evidence, the Board may refuse to issue, or revoke or suspend a license, or
otherwise
discipline a licensee. A suspended license may be reissued upon a further hearing initiated
at the
request of the suspended licensee by written application in accordance with the rules of the
Board.
f. All decisions of the Board shall be final and conclusive. Where the practitioner is in
disagreement
with the action of the Board, he or she may appeal the Boards decision to the Superior
Court within
30 days of service or of the postmarked date of the copy of the decision mailed to him or
her. The
appeal shall be on the record to the Superior Court and shall be as provided in 1014210145 of
Title 29.
1924. Unlawful practices
(a) No person shall practice or offer to practice professional or practical nursing or shall
represent himself or herself
72
as a registered nurse or licensed practical nurse in this State, or shall use any title,
abbreviation, sign, card or
device to indicate that such person is a registered nurse or licensed practical nurse, unless
such person is licensed
under this chapter.
(b) No person, hospital or institution shall conduct or shall offer to conduct a professional or
practical nursing
education program unless such person, hospital or institution is approved under this chapter.
Section A - 54 - 7-2007
(3) Facilitate the exchange of information between party states in the areas of nurse
regulation, investigation,
and adverse actions;
(4) Promote compliance with the laws governing the practice of nursing in each jurisdiction;
and
(5) Invest all party states with the authority to hold a nurse accountable for meeting all state
practice laws in
the state in which the patient is located at the time care is rendered through the mutual
recognition of party
state licenses.
Article II Definitions
As used in this Compact:
(a) Adverse Action means a home or remote state action.
(b) Alternative program means a voluntary, non-disciplinary monitoring program approved
by a nurse licensing
board.
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(c) Coordinated licensure information system means an integrated process for collecting,
storing, and sharing
information on nurse licensure and enforcement activities related to nurse licensure laws,
which is administered
by a non-profit organization composed of and controlled by state nurse licensing boards.
(d) Current significant investigative information means:
(1) Investigative information that a licensing board, after a preliminary inquiry that includes
notification and an
opportunity for the nurse to respond if required by state law, has reason to believe is not
groundless and, if
proved true, would indicate more than a minor infraction; or
(2) Investigative information that indicates that the nurse represents an immediate threat to
public health and
safety regardless of whether the nurse has been notified and had an opportunity to respond.
(e) Home state means the party state which is the nurses primary state of residence.
(f) Home state action means any administrative, civil, equitable or criminal action
permitted by the home states
laws which are imposed on a nurse by the home states licensing board or other authority
including actions
against an individuals license such as: revocation, suspension, probation or any other action
which affects the
nurses authorization to practice.
(g) Licensing board means a party states regulatory body responsible for issuing nurse
licenses.
(h) Multistate licensure privilege means current, official authority from a remote state
permitting the practice of
nursing as either a registered nurse or a licensed practical/vocational nurse in such party
state. All party states
have the authority, in accordance with existing state due process law, to take actions
against the nurses privilege
such as: revocation, suspension, probation or any other action which affects a nurses
authorization to practice.
(i) Nurse means a registered nurse or licensed practical/vocational nurse, as those terms
are defined by each
partys state practice laws.
(j) Party state means any state that has adopted this Compact.
(k) Remote state means a party state, other than the home state,
(1) Where the patient is located at the time nursing care is provided, or,
(2) In the case of the practice of nursing not involving a patient, in such party state where
the recipient of
nursing practice is located.
(l) Remote state action means
(1) Any administrative, civil, equitable or criminal action permitted by a remote states laws
which are
imposed on a nurse by the remote states licensing board or other authority including
actions against an
individuals multistate licensure privilege to practice in the remote state, and
(2) Cease and desist and other injunctive or equitable orders issued by remote states or the
licensing boards
thereof.
(m) State means a state, territory or possession of the United States, the District of
Columbia or the Commonwealth
of Puerto Rico.
(n) State practice laws means those individual party states laws and regulations that
govern the practice of
74
nursing, define the scope of nursing practice, and create the methods and grounds for
imposing discipline. State
practice laws does not include the initial qualifications for licensure or requirements
necessary to obtain and
retain a license, except for qualifications or requirements of the home state.
Article III - General Provisions and Jurisdiction:
(a) A license to practice registered nursing issued by a home state to a resident in that state
will be recognized by each
party state as authorizing a multistate licensure privilege to practice as a registered nurse in
such party state. A
license to practice licensed practical/vocational nursing issued by a home state to a resident
in that state will be
recognized by each party state as authorizing a multistate licensure privilege to practice as
a licensed
Section A - 55 - 7-2007
practical/vocational nurse in such party state. In order to obtain or retain a license, an
applicant must meet the
home states qualifications for licensure and license renewal as well as all other applicable
state laws.
(b) Party states may, in accordance with state due process laws, limit or revoke the
multistate licensure privilege of
any nurse to practice in their state and may take any other actions under their applicable
state laws necessary to
protect the health and safety of their citizens. If a party state takes such action, it shall
promptly notify the
administrator of the coordinated licensure information system. The administrator of the
coordinated licensure
information system shall promptly notify the home state of any such actions by remote
states.
(c) Every nurse practicing in a party state must comply with the state practice laws of the
state in which the patient is
located at the time care is rendered. In addition, the practice of nursing is not limited to
patient care, but shall
include all nursing practice as defined by the state practice laws of a party state. The
practice of nursing will
subject a nurse to the jurisdiction of the nurse licensing board and the courts, as well as the
laws, in that party
state.
(d) This Compact does not affect additional requirements imposed by states for advanced
practice registered nursing.
However, a multistate licensure privilege to practice registered nursing granted by a party
state shall be recognized
by other party states as a license to practice registered nursing if one is required by state
law as a precondition for
qualifying for advanced practice registered nurse authorization.
(e) Individuals not residing in a party state shall continue to be able to apply for nurse
licensure as provided for under
the laws of each party state. However, the license granted to these individuals will not be
recognized as granting
the privilege to practice nursing in any other party state unless explicitly agreed to by that
party state.
Article IV Applications for Licensure in a Party State
(a) Upon application for a license, the licensing board in a party state shall ascertain,
through the coordinated
75
licensure information system, whether the applicant has ever held, or is the holder of, a
license issued by any other
state, whether there are any restrictions on the multistate licensure privilege, and whether
any other adverse action
by any state has been taken against the license.
(b) A nurse in a party state shall hold licensure in only 1 party state at a time issued by the
home state.
(c) A nurse who intends to change primary state of residence may apply for licensure in the
new home state in
advance of such change. However, new licenses will not be issued by a party state until after
a nurse provides
evidence of change in primary state of residence satisfactory to the new home states
licensing board.
(d) When a nurse changes primary state of residence by:
(1) Moving between 2 party states, and obtains a license from the new home state, the
license from the former
home state is no longer valid;
(2) Moving from a non-party state, and obtains a license from the new home state, the
individual state license
issued by the non-party state is not affected and will remain in full force if so provided by the
laws of the
non-party state;
(3) Moving from a party state to a non-party state, the license issued by the prior home
state converts to an
individual state license, valid only in the former home state, without the multistate licensure
privilege to
practice in other party states.
Article V Adverse Actions
Article VI Additional Authorities Invested in Party State Nurse Licensing Boards
Article VII Coordinated Licensure Information System
Article VIII Compact Administration and Interchange of Information
Article IX Immunity
Article X Entry into Force, Withdrawal, and Amendment
Article XI Construction and Severability
1902A. Disciplinary action in Delaware.
(a) All nurses holding a Delaware nursing license which is either under suspension or under
probation by the
Delaware Board of Nursing or who are participating in an established treatment program
which is an alternative to
disciplinary action, shall not practice in any other party state during the term of such
suspension, probation or
participation without prior authorization from such other party state. The Delaware nursing
licensure of any nurse
under such suspension, probation or participation who practices nursing in another party
state without prior
authorization from that state may be revoked by the Delaware Board of Nursing.
Section A - 56 - 7-2007
(b) The multi-state licensure privilege granted by this State is subject or revocation or other
disciplinary action as the
result of any disciplinary action imposed by a nurses home state.
1903A. Effect of other obligations.
This Compact is intended to facilitate the regulation of the practice of nursing and does not
relieve employers from
complying with contractual and statutorily imposed obligations.
1904A. Compact as controlling law.
76
If there is an irreconcilable conflict between the Interstate Nurse Licensure Compact and
Chapter 19 of Title 24, the
Compact shall control.
1905A. Continuation of Compact.
This Compact and this States participation therein shall remain in full force and effect
beyond June 30, 2005, and shall
not terminate without further action of the General Assembly.
Section A - 57 - 7-2007
ATTORNEY GENERALS OPINION JANUARY 20, 1994
Letter to Pascale D. Forgione, Superintendent
Delaware Department of Public Instruction
531 F. Supp. 517 (D. Hawaii 1982); Department of Education, State of Hawaii
v. Catherine D., 727
F. 2d 809 (9th Cir. 1983). Moreover, the right of a disabled child to receive
necessary medical
services extends to non-scholastic activity as well. 34 C.F.R. 104-37 (a) (2).
If disabled children can participate in field trips when provided with the same
accommodations to
which they are entitled at school, this accommodation must be offered to
them. Quaker Valley (Pa)
School District Complaint No. 03861077 Education for the Handicapped Law
Report, 352:235
(Supp. 186 February 13, 1987). A reasonable accommodation includes
providing a nurse on school
trips and other school outings. 45 C.F.R. 84-12 (a).
As to the second question regarding sick children, federal and state law does
not deny access to
academic and school related activities for sick children but for when they
suffer from contagious
illnesses such as diphtheria, measles, scarlet fever or smallpox. This raises
the question as to
whether sick children can be assisted with medication while in school and on
filed trips by someone
other than a licensed nurse. It has been argued that the assistance of
medication is the practice of
nursing. We do not believe that necessarily to be so. Accordingly, a parent
should be permitted to
designate a care provider to assist her/his sick child. A parent can also
authorize a sick child to care
for themselves.
Section A - 58 - 7-2007
The mere assistance in taking medications is not the practice of nursing
under 24 Del. C. Ch. 19. 24
Del. C. 1902 (b) (6) states that a registered nurse execute regimens which
include the dispensing
and administration of medications. Twenty-four Del. C. 1902 (f) defines the
administration of
medication as an entire process whereby a nurse verifies the prescription
drug order; removes the
dose from a previously dispensed, properly labeled container; assesses the
patients status to assure it
is given as prescribed to the proper patient and that no known
contraindications to the drug or the
dosage exists; gives a dose to the patient; then records the time and dose
given. Further, under this
statute the nurse would check the patient following the administration of the
medication for possible
78
79
80
III. STANDARDS
The complete text and description of the national Standards of Professional
School Nursing Practice are found in School Nursing: Scope and Standards of
Practice (2005). The document can be purchased through the National
Association of School Nurses (NASN) at P. O. Box 1300, Scarborough,
Maine 04070 or the NASN Bookstore.
Section A - 61 - 7-2007
STANDARDS OF PROFESSIONAL SCHOOL NURSING PRACTICE
National Association of School Nurses adopted November, 2004 1
Permission granted for republication.
STANDARDS OF PRACTICE
Standard 1. ASSESSMENT
The school nurse collects comprehensive data pertinent to the clients health or the situation.
Standard 2. DIAGNOSIS
The school nurse analyzes the assessment data to determine the diagnosis or issues.
The school nurse identifies expected outcomes for a plan individualized to the client or the situation.
Standard 4. PLANNING
The school nurse develops a plan that strategies and alternatives to attain expected outcomes.
Standard 5. IMPLEMENTATION
The school nurse provides health education and employs strategies to promote
health and a safe environment.
Standard 5c CONSULTATION
The school nurse provides consultation to influence the identified plan, enhance the
abilities of others, and effect change.
81
Standard 6. EVALUATION
The school nurse systematically enhances the quality and effectiveness of nursing practice.
Standard 8. EDUCATION
The school nurse attains knowledge and competency that reflects current school nursing practice.
The school nurse evaluates ones own nursing practice in relation to professional standards and
guidelines,
relevant status, rules, and regulations.
The school nurse interacts with, and contributes to the professional development of, peers and school
personnel
as colleagues.
The school nurse collaborates with the client, the family, school staff, and others in the conduct of
school
nursing practice.
The school nurse considers factors related to safety, effectiveness, cost, and impact on practice in the
planning
and delivery of school nursing services.
The school nurse provides leadership in the professional practice setting and the profession.
Refer to School Nursing: Scope & Standards of Practice for entire text.
Section A - 62 - 7-2007
DEPARTMENT OF EDUCATION
LICENSURE
For additional information on licensure as a Registered Nurse (R.N.), contact
the
Delaware Board of Nursing at 302-744-4515 or 302-744-4516 or
http://dpr.delaware.gov/boards/nursing/forms.shtml.
For additional information on licensure and certification as a school nurse,
contact
your districts Human Resources Department or the Department of
Professional
Accountability Office at 302-735-4120. The Department of Education
brochure,
So You Want to be a School Nurse, is available on the Delaware School
Nurses
82
Association website.
Section A - 63 - 7-2007
14 DELAWARE CODE
1500 Professional Standards Board
1582 School Nurse
1.0 Content
This regulation shall apply to the requirements for a Standard Certificate for School
Nurses, pursuant to
14 Del.C. 1220(a).
2.0 Definitions
The following words and terms, when used in this regulation, shall have the
following meaning unless
the context clearly indicates otherwise:
"Department" means the Delaware Department of Education.
"Educator" means a public school employee who holds a license issued under the
provisions of 14
Del.C. c. 12, and includes teachers and administrators, and as otherwise defined by
the Standards Board
and the State Board pursuant to 14 Del.C. 1203, but does not include substitute
teachers. For the
purposes of this regulation, school nurses are considered educators.
"License" means a credential which authorizes the holder to engage in the practice
for which the
license is issued.
"Standard Certificate" means a credential issued to certify that an educator has the
prescribed
knowledge, skill or education to practice in a particular area, teach a particular
subject, or teach a
category of students.
"Standards Board" means the Professional Standards Board established pursuant to
14 Del.C. 1201.
"State Board" means the State Board of Education of the State pursuant to 14 Del.C.
104.
3.0 Standard Certificate
In accordance with 14 Del.C. 1220(a), the Department shall issue a Standard
Certificate as a School
Nurse to a nurse who holds a valid Delaware Initial, Continuing, or Advanced
License; or a Limited
Standard, Standard or Professional Status Certificate issued by the Department prior
to August 31, 2003
and who meets the following requirements:
3.1 Bachelor's degree in Nursing or School Nursing from an accredited college or
university; and,
3.2 Current RN license, recognized by the DE Board of Nursing; and,
3.3 A minimum of three years clinical nursing experience; and
3.4 Valid and current certification in CPR.
4.0 Induction Requirements
4.1 Pursuant to 14 Del.C. 1510, 4.2 and 14 Del.C. 1511, 3.0, during the term of
the Initial License
83
Section A - 64 - 7-2007
STATE OF
DELAWARE
Department of Education
Office of Certification
The Townsend Building, P.O. Box 1402
Dover, DE 19903
(302) 7399-4686
It is the intent of this policy to provide an option for individuals who have previously taken
other appropriate
standardized tests as indicated above, consequently, exemption test scores should pre-date
both application and
employment. It is not the intent of this policy to require that other tests be taken in lieu of
the PRAXIS I. The
PRAXIS I tests remain the State of Delaware testing requirement for initial certification.
All Exemption Test Scores shall be presented to the Office of Certification as official scores.
The following means of
84
Section A - 65 - 7-2007
A SCHOOL NURSE CERTIFICATE IN BASIC SCHOOL NURSING1
Approved by the Department of Education, State of Delaware, 11-2003
Section A - 66 - 7-2007
GUIDELINES FOR RENEWAL OF A CONTINUING LICENSE
Department of Education
Office of Professional Accountability
401 Federal Street, Suite 2
Dover, DE 19901
www.doe.k12.de.us
A three-tiered licensure system is established for Delaware educators, which
includes school nurses.
In accordance with statute (14 Del Code, Chapter 12), regulations governing
the educator license
system were developed by the Professional Standards Board and approved
by the State Board of
Education.
The Department of Education is responsible for the implementation of the
licensure system. A
Continuing License will be issued to all Delaware educators who hold
standard or professional status
certificates, as those certificates are renewed. A Continuing License is valid
for five years and is
renewable. Procedures for non-public educators are provided through
Regulation 278 Non-Public
School Educator Licensure and Certification.
86
Section B.
School Entry &
Maintenance
I. Foundations of School Nursing
II. Documentation Requirements
III. School Entry
a. Immunization
b. Tuberculosis
c. Physical examination
d. Lead
IV. Screenings
a. Vision
b. Hearing
c. Postural & Gait
V. Medications
a. Prescriptions
b. OTC
c. Field trips
Section B - 2 - 6-2005
87
Section B - 4 - 6-2005
Suggested Schedule for the School Nurse
August October
Prior to the first student day:
1. Set up health room with medical supplies and equipment.
2. Review Standard Precautions with staff.
3. Organize Student Health Records in a manner that allows easy access; i.e., arrange by
homeroom, grade
level, or alphabetical order. (Get current pupil roster from school office.)
4. Review health records to identify students with special health concerns or those needing
immunizations,
tuberculosis screening, physical exams or lead testing. Communicate with appropriate
school personnel
regarding student health conditions and any needed school modification.
During the first week of school:
5. Carry out responsibilities related to staff and/or volunteer tuberculosis screening as
directed by district.
6. Obtain Emergency Data Cards on all students; maintain in nurses office for easy access.
7. Organize medication and treatment administration.
8. Obtain health records for students transferring into school; if it is believed no record will
be forthcoming,
obtain data and start record. Forward health records for students transferring out of schools.
After the start of the school year:
9. Update health records with information obtained from Student Health History Update.
10. Send copies of School Immunization Form or computer print out of new school enterers
immunizations to
the Division of Public Health Immunization Program.
11. Identify students eligible for dental clinic services, process parental permission slips,
schedule visits to
clinic, and arrange for transportation of students (if available).
12. Prepare schedule and begin screening programs. Postural/gait screening should be
completed prior to
December 15 of each year and reported to the District Liaison/Coordinator. Hearing and
vision screening
should be completed by January 15.
13. Continue contacts with parent/guardian of students needing a physical examination,
tuberculin screening,
immunizations or lead testing.
14. Inform teachers assigned to health instruction of resources and materials available
through your office or
state and local agencies.
15. Inform parents regarding scheduled, mandated screenings.
January April
1. Order supplies and equipment for next school year.
89
May June
1. Prepare District/Charter Summary of School Health Services (See Section B, page 29) and
send to district
office by designated date.
2. Prepare health records for transfer to feeder school or state archives.
3. Follow up on referrals.
90
91
Section B - 8 - 6-2005
DELAWARE EMERGENCY TREATMENT DATA CARD
Student's Name Birth Date School District
Last Name First Name M.I.
School Grade Homeroom or Teacher Bus No.
Home Address Development Home Phone
Resides with Relationship
Mother/Guardian's Name Father/Guardian's Name
Mother's Place of Employment Phone Ext.
Father's Place of Employment Phone Ext.
Pager number Cellular number
If parents/guardians cannot be reached, call:
92
1.
Name Address Phone
2.
Name Address Phone
3.
Name Address Phone
Family Physician Phone Family Dentist Phone
Indicate student's serious medical conditions
Student is allergic to: ( ) Penicillin ( ) Aspirin ( ) Other
Medical Insurance: Medicaid No. Other:
Certificate No. Group No. Type
This information may be shared only on a need to know basis with school personnel and emergency
medical staff.
Section B - 9 - 6-2005
Last Name First and Middle Name M F Date of Birth
Immunizations
(May attach State Form)
Exempt Type 1 2 3 4 5 6
DTP/DtaP
OPV/IPV
Hep B
Measles
Mumps
Rubella
HIB
Varicella
Other
93
Testing
Date Test Type (circle one) Results Initials Date Test Type (circle one) Results Initials
Long-term Medications
Name Start Stop Name Start Stop
Section B - 10 - 6-2005
Student Name: (Last) (First)
Screening Results
Vision Screening
Date
Device
Acuity: Far R
L
Both
Near R
L
Both
Glasses/Contacts
Muscle Balance
Initials
Hearing Screening
(P = Pass; F = Fail)
Grade
Date
Decibels
R 1000
2000
4000
L 1000
2000
4000
Aid
Initials
Postural Screening Other Information
(Ex: Comments, Conferences, etc)
Grade
Phase I Date
Results
Phase II Date
Initials
Referral Information
Summary Issue/Concern
Date Sent
Section B - 11 - 6-2005
Student Name: (Last) (First)
Delaware School Health Record
94
Follow-up Summary
Additional Notes
Date Conferences, Comments, Etc.
STATE OF DELAWARE
INDIVIDUAL HEALTH SERVICES LOG
District/School:
_____________________________________________________________________________________________
______________________
School Nurse: __________________________________________________
_______________________________________________________________
Reason
(Category/Chief Complaint)
Initials
Section B - 13 - 6-2005
STATE OF DELAWARE
CHILDRENS SERVICES COST RECOVERY PROJECT LOG
EPSDT Nursing Service Description by Medicaid Reporting Number
Date: ____/_____/______ District/School:
School Nurse:
Signature(s) Required (Initial below if more than one nurse)
EPSDT
Reporting
Number
Time
In
Time
Out
Student Name
Document #229
Section B - 14 - 6-2005
Childrens Services Cost Recovery Project (CSCRP)
EPSDT Nursing Service Description by Medicaid Reporting Number
Nursing Service Description: Treatment
1 Care of the Sick
2 Wound Care First Aid
3 Wound Care Ongoing
4 Collateral Contacts for Updating Medical Information: Community Agencies,
Doctors, Staff, Family
5 Medications Administration & Monitoring
6 Physician Prescribed Medical Treatments
7 Nursing Evaluation
95
Document #229
NURSING INTERVENTION CLASSIFICATION
Section B - 15 - 6-2005
NURSING CARE
Admission Care ADMINCARE facilitating entry of student into school (health needs)
Airway Management AIRMGTfacilitation of patency of air passages
Airway Suctioning AIRSUCremoval of airway secretions by inserting a suction catheter into the
patients oral airway &/or trachea
Allergy Management ALLERGYidentification, treatment, & prevention of allergic responses to
food, medications, insect bites, contrast material, blood, & other substances
Artificial Airway Management ARTAIRmaintenance of endotrachial/tracheostomy tubes &
prevention of complications associated with their use
Aspiration Precautions ASPIRprevention/minimization of risk factors in the patient at risk for
aspiration
Asthma Management ASTHMAidentification, treatment and prevention of reactions to
inflammation/constriction of the airway passages
96
Bleeding Reduction: Nasal NOSEBL Limitation of blood loss from the nasal cavity
Bleeding Reduction: Wound BLEEDlimitation of the blood loss from a wound that may be a
result of trauma, incisions, or placement of a tube or catheter
Bowel Management BWLestablishment & maintenance of a regular pattern of bowel elimination
Cast Care: Maintenance CASTcare of a cast after the drying period
Chest Physiotherapy CHESTassisting the patient to move airway secretions from peripheral
airways to more central airways for expectoration &/or suctioning
Diarrhea Management DIARRprevention & alleviation of diarrhea
Emergency Care (illness) ERILLproviding life-saving measures in life-threatening situations
caused by illness
Emergency Care (injury) ERINJproviding life-saving measures in life-threatening situations
caused by injury
Enteral Tube Feeding TUBEFEEDdelivering nutrients & water through a gastrointestinal tube
Feeding FEED feeding of patient with oral motor deficits
Fever Treatment FVRmanagement of a patient with hyperpyrexia caused by nonenvironmental
factors
First Aid WOUNDFAproviding initial care for a minor injury
Health Care Information Exchange (illness) INFOILLproviding patient care information to
other health professionals related to illness
Health Care Information Exchange (injury) INFOINJproviding patient care information to
other health professionals related to injury
Heat/Cold Application (injury) HTCLDstimulation of the skin & underlying tissues with heat or
cold for the purpose of decreasing pain, muscle spasms, or inflammation
Heat Exposure Treatment HEATXmanagement of patient overcome by heat due to excessive
environmental heat exposure
Hemorrhage Control HMRRreduction or elimination of rapid & excessive blood loss
High-Risk Pregnancy Care PREGidentification & management of a high-risk pregnancy to
promote healthy outcomes for mother & baby
Hyperglycemia Management HYPERGpreventing & treating above-normal blood glucose
levels
Hypoglycemia Management HYPOGpreventing & treating low blood glucose levels
Medication Administration MEDADMpreparing, giving, & evaluating the effectiveness of
prescription & nonprescription drugs
Medication Management MEDMGTfacilitation of safe/effective use of prescription & over-thecounter
drugs
Multidisciplinary Care Conference (illness) CONFILLplanning & evaluating patient care with
health professionals from other disciplines
Multidisciplinary Care Conference (injury) CONFINJplanning & evaluating patient care with
health professionals from other disciplines
Neurologic Monitoring NEUROcollection & analysis of patient data to prevent or minimize
neurological complications
Non-Nursing Intervention NONNURSE providing service not requiring nursing skills/expertise
Nursing Intervention NURSE intervention requiring professional nursing knowledge and skills
(not available on current list)
Nutrition, Special Diet SPDIETmodification & monitoring of special diet
Ostomy Care OSTO maintenance of elimination through a stoma & care of surrounding tissue
Pain Management PAINalleviation of pain or a reduction in pain to a level of comfort that is
acceptable to the patient
Positioning POSIdeliberative placement of the patient or a body part to promote physiological
&/or psychological well-being
Referral Management REFMGT arrangement for services by another healthcare provider or
agency
Respiratory Monitoring RESPcollection & analysis of patient data to ensure airway patency &
adequate gas exchange
Rest REST providing environment & supervision to facilitate rest/sleep after nursing evaluation
Resuscitation RESUSadministering emergency measures to sustain life
Seizure Management SZRcare of a patient during a seizure & the postictal state
Self-Care Assistance, Nursing SELFNURassisting another to perform activities of daily living
Self-Care Assistance, Non-Nursing SELFNONassisting another to perform activities of daily
97
living
HEALTH EDUCATION
98
Substance Use Prevention (group) SUBABG prevention of an alcoholic or drug use lifestyle
through a group process
Weight Management WGTMGT facilitating maintenance of optimal body weight & percent
body fat
HEALTH PROMOTION/PROTECTION
SCREENING
Section B - 17 - 6-2005
NIC links to CSCRP
99
Section B - 18 - 6-2005
100
101
Section B - 19 - 6-2005
Nursing Intervention - #14 Catheterization
Urinary Catheterization insertion of a catheter into the bladder for temporary or permanent
drainage of
urine
102
Section B - 20 - 6-2005
Health Screening - Vision detecting possible vision deviations through screening measures
(DE)
103
on current list)
Referral Arrangement - arrangement for services by another healthcare provider or agency
Self-Care Assistance, Non-Nursing assisting another to perform activities of daily living (DE)
Seizure Precautions prevention or minimization of potential injuries sustained by a patient
with a known
seizure disorder
Smoking Cessation Assistance (group) helping another to stop smoking
Substance Use Prevention (group) prevention of an alcoholic or drug use life-style
Suicide Prevention reducing risk of self-inflicted harm with intent to end life
Surveillance: Safety purposeful and ongoing collection and analysis of information about
the patient and
the environment for use in promoting and maintaining patient safety
Sustenance Support helping a needy individual/family to locate food, clothing, or shelter
Section B - 21 - 6-2005
Approved Abbreviations and Symbols
A butt buttocks
a before
@ at C
abd abdomen c with
abdt abduction Ca carcinoma
abr abrasion cal calorie
a.c. before meals cap capsule
add adduction cath catheter
adeq adequate CBC complete blood count
ADL activities of daily living cc cubic centimeters
ad lib freely, as directed C.D. communicable disease
admin administration CHN Community Health Nurse
adv advise circ circulation
AFO ankle foot orthosis CMV cytomegalovirus
a.m. before noon, morning c/o complained of
amb ambulate COA children of alcoholics
amt amount comm communication
ans answer conf conference
ant anterior cont continued
AP apical pulse couns counselor
approx approximately C.P. cerebral palsy
appt appointment C.P.E. complete physical exam
AROM active range of motion CPR Cardiopulmonary resuscitation
ASAP as soon as possible C.R. classroom
ASHD anteriosclerotic heart disease CV cardiovascular
ASOM acute serous otitus media
asst assistance D
aud auditory DAT diet as tolerated
Ax temp axillary temperature d.c. discontinue
demo demonstrate
B D/I dry and intact
band Band-Aid diam diameter
B.C. pills birth control pills dig digoxin
104
Section B - 26 - 6-2005
L
109
5. Subjective Data
Objective Data
Date of last tetanus shot
Assessment
Intervention
CONTINUE TO NEXT PAGE
Section B - 28 - 6-2005
STUDENT ACCIDENT REPORT FORM - continued
6. How did accident happen? What was student doing? Where was student? List specifically
any unsafe
act(s) and/or unsafe condition(s). Specify any tool, machine or equipment involved.
7. What action(s) was taken and by whom?
First aid treatment By whom? (Enter name)
Sent to school nurse By whom? (Enter name)
Sent home By whom? (Enter name)
Sent to physician By whom? (Enter name)
Sent to hospital By whom? (Enter name)
10. Total number of school days lost (To be recorded when student returns to school)
11. Student is covered by Student Accident Insurance Yes No
12. Person in charge when accident occurred (Signature)
Nurse Principal
Section B - 29 - 7-2007
DEPARTMENT OF EDUCATION
DISTRICT/CHARTER SUMMARY OF SCHOOL HEALTH SERVICES
July 1, 20__ through June 30, 20__
Due Date: 8/31/_____ Return to : Linda C. Wolfe, RN, Health Services
Justification: The State Board shall prescribe rules and regulations governing the protection of health, physical
welfare and physical inspection of public school children in the State. 14
Del Code 122(b)(2)
School or School District: ________________________________________________
I. Clients Students Staff Visitors Total % Total Stud
Population
% Total Staff
Population
A. Unduplicated Clients receiving Health Services
110
Section B - 30 - 7-2007
111
1. Hearing
2. Immunization
3. Postural/Gait
4. Physical report
5. TB Questionnaire/Reading
6. Vision
7. Total Number of Required Screenings
B. Non-Required (Students)
1. Blood Pressure
2. BMI
3. Dental
4. Developmental
5. Pediculosis
6. Record Review
7. Other
8. Total Number of Non-Required Screenings
C. Total Student Screenings
D. Staff
1. BP
2. TB Questionnaire/Reading
3. Other
4. Total Number
E. Total Screenings (III. C + III. D.4)
Date: _______________________ Signature _________________________________
Section B - 31 - 7-2007
PAGE DELETED
Section B - 32 - 6-2005
Section B - 33 - 6-2005
AGREEMENT TO RELEASE
This permission is good for one year after I sign it.
I agree to the interagency sharing of information. I can take away my permission at any time. I can
also change it at any time
unless the information has already been released.
Print Name:
Signature:
Date:
Please check all that apply:
Parent [ ] Guardian [ ] Legal Adult (18 years) [ ] Minor 12-18, required below *[ ] Custodian [ ]
*A minor must specifically consent to the release of HIV [ ], STD [ ], and pregnancy information [ ].
Signature of minor: Date
ORGANIZATIONS AFFIRMATION
As the participating organizations representative, I affirm that I have reviewed this form and its use
with the consenting person
and that to the best of my knowledge he/she understands.
Witness Date
Agency
TRANSLATORS STATEMENT
112
I have orally translated/read/signed the above into (language). To the best of my knowledge, I believe
the consenting person understands the nature and use of this form.
Translators Signature Date
..
Revocation Statement
I, (consenting person), take away the consent I gave to
(originating organization) on (date). I understand
that (originating organization) will notify any participating organization to
which information has been sent or from which information has been received.
Signature Date
Witness Date
Agency Revocation letter attached (Yes/No)
_ The Interagency Consent to Release Information Form is based on the Interagency Confidentiality
Agreement for
Accessibility in Data Sharing between Participating Organizations: Department of Health & Social
Services (DHSS),
Department of Services for Children, Youth and their Families (DSCYF), Department of Education (DOE),
Department of
Correction (DOC), Department of Labor (DOL) and local school districts. This document has been
approved by the
Attorney Generals Office. This form may not be altered in any manner without written authorization
from the State of
Delaware Interagency Confidentiality Committee. This form may be photocopied for use by the
participating organizations.
The State of Delaware does not discriminate or deny services on the basis of race, religion, color,
national origin, sex, disability
and/or age.
Section B - 34 - 6-2005
113
2.1.3.1 Disease histories for measles, rubella and mumps shall not be accepted unless serologically
confirmed.
2.1.4 Three doses of Hepatitis B vaccine.
2.1.4.1 For children 11 to 15 years old age, two doses of a vaccine approved by the Center for Disease
Control (CDC) may be
used.
2.1.4.2 Titers are not acceptable in lieu of completing the vaccine series and a disease history for
Hepatitis B shall not be
accepted unless serologically confirmed.
2.1.5 Varicella vaccine is required beginning in the 2003-2004 school year with kindergarten. One
grade shall be added each year
thereafter so that by the 2015-2016 school year all children in grades kindergarten through 12 shall
have received the vaccination.
Beginning in the 2008-2009 school year new enterers into the affected grades shall be required to
have two doses of the
Varicella vaccine. The first dose shall be administered on or after the age of twelve (12) months and
the second at kindergarten
entry into a Delaware public school. A written disease history, provided by the health care provider,
parent, legal guardian,
Relative Caregiver or School Enterer who has reached the statutory age of majority (18), 14 Del.C.
131(a)(9), will be accepted
in lieu of the Varicella vaccination. Beginning in the 2008-2009 school year, a disease history for the
Varicella vaccination must
be verified by a health care provider to be exempted from the vaccination.
2.2 Children who enter school prior to age four (4) shall follow current Delaware Division of Public
Health recommendations.
3.0 Certification of Immunization
3.1 The parent, legal guardian, Relative Caregiver or a School Enterer who has reached the statutory
age of majority (18), 14 Del.C.
131(a)(9), shall present a certificate specifying the month, day, and year that the immunizations were
administered by a licensed
health care practitioner.
3.2 According to 14 Del.C. 131, a principal or person in charge of a school shall not permit a child to
enter into school without
acceptable evidence of immunization. The parent, legal guardian, Relative Caregiver or a School
Enterer who has reached the
statutory age of majority (18), 14 Del.C. 131(a)(9), shall be notified of this requirement in writing.
Within 14 calendar days after
notification, evidence must be presented to the school that the basic series of immunizations has been
initiated or has been completed.
3.3 A school enterer may be conditionally admitted to a Delaware school district by presenting a
statement from a licensed
health care practitioner who specifies that the School Enterer has received at least:
3.3.1 One dose of DTaP, or DTP, or DT; and
3.3.2 One dose of IPV or OPV; and
3.3.3 One dose of measles, mumps and rubella (MMR) vaccine; and
3.3.4 The first dose of the Hepatitis B series; and
3.3.5 One dose of Varicella vaccine as per 2.5.
3.4 14 DE Admin. Code 901 Education of Homeless Children and Youth 6.0 states that "School districts
shall ensure that policies
concerning immunization, guardianship and birth certificates do not create barriers of the school
enrollment of homeless children and
youth". To that end, school districts shall as stated in 14 DE Admin. Code "assist homeless children and
youth in meeting the
immunization requirements".
3.5 If the school enterer fails to complete the series of required immunizations the parent, legal
guardian, Relative Caregiver or a school
enterer who has reached the statutory age of majority (18), 14 Del.C. 131(a)(9), shall be notified that
the School Enterer will be
excluded according to 14 Del.C. 131.
4.0 Lost or Destroyed Immunization Record
114
When a students immunization record has been lost or destroyed by the medical provider who
administered the vaccine, the parent, legal
guardian, Relative Caregiver or a school enterer who has reached the statutory age of majority (18), 14
Del.C. 131(a)(9),shall sign a
written statement to this effect and must obtain at least one dose of each of the immunizations as
identified in 3.3. Evidence that the
vaccines were administered shall be presented to the superintendent or his or her designee.
5.0 Exemption from Immunization
5.1 Exemption from this requirement may be granted in accordance with 14 Del.C. 131 which permits
approved medical and notarized
religious exemptions.
5.2 Alternative dosages or immunization schedules may be accepted with the written approval of the
Delaware Division of Public Health.
Section B - 36 - 4-2008
6.0 Verification of School Records
The Delaware Division of Public Health shall have the right to audit and verify school immunization
records to determine compliance with
the law.
7.0 Documentation
7.1 School nurses shall record and maintain documentation of each student's immunization status.
7.2 Each student's immunization record shall be included in the Delaware Immunization Registry.
Section B - 37 - 4-2008
SAMPLELETTER
Immunizations1
5 or more doses of DTaP, DTP or TD vaccine (unless 4th dose was
given after the 4th birthday)
4 doses of IPV or OPV (unless the 3rd dose was given after the 4th
birthday)
2 doses of measles, mumps and rubella vaccine (first dose after the
age of 12 months, second dose after the 4th birthday)
3 doses of Hepatitis B vaccine
2 doses of Varicella or a written disease history by a licensed
healthcare provider (08/09 School Year: New enterers to
Grades K-5; 09/10 School Year: New enterers to Grades K-6;
10/11 School Year: New enterers to Grades K-7, etc.)
Physical2
Current, within the two years prior to entry into school
Tuberculosis3
Results of Mantoux screening completed within the past 12
months or risk assessment as recommended by Delaware
Division of Public Health
Lead blood test4
Documentation for children entering kindergarten or pre-school
program
Please provide the school nurse with the necessary information. We
appreciate your
cooperation in complying with the law.
Sincerely,
(Superintendent or Principal)
Delaware Code, Title 14, Section 131
Department of Education Regulation 804
3 Department of Education Regulation 805
4 Delaware Code, Title 16, Chapter 26
1
2
Section B - 38 - 4/2008
SAMPLE
(School/School District Name)
VARICELLA (Chickenpox) IMMUNITY STATEMENT
Name: Birthdate:
Please Print
Check one of the following boxes regarding Varicella (Chickenpox) Immunity:
_ Varicella Vaccine Date Given:
_ Varicella Lab Evidence Date:
_ Varicella Disease Age of child when he/she had Chickenpox:
Name:
Licensed healthcare provider
Signature: Date:
Section B - 39 - 6/2005
AFFIDAVIT REQUIRED PER 14 DEL. CODE SEC. 131
AFFIDAVIT OF RELIGIOUS BELIEF
STATE OF DELAWARE
116
. COUNTY
1. (I) (We) (am) (are) the (parent[s]) (legal guardian[s]) of ..
Name of Child
2. (I) (We) hereby (swear) (affirm) that (I) (we) subscribe to a belief in a
relation to a
Supreme Being involving duties superior to those arising from any human
relation.
3. (I) (We) further (swear) (affirm) that our belief is sincere and meaningful
and occupies a
place in (my) (our) life parallel to that filled by the orthodox belief in God.
4. This belief is not a political, sociological or philosophical view of a merely
personal
moral code.
5. This belief causes (me) (us) to request an exemption from the mandatory
school
vaccination program for .
Name of Child
Signature of Parent(s) or Legal Guardian(s)
SWORN TO AND SUBSCRIBED before me, a registered Notary Public, this
day of , 2 .
(Seal)
Notary Public
My commission expires:
Section B - 40 - 6/2005
Instructions for Completing School Immunization Records
117
Student Name:
Sex: _Male _Female Last First Mi
Race: _Alaskan Native Student Address:
_AmericanIndian
_African American
_Caucasian
Address
_Hispanic
_Pacific Island/Asian
_Unknown _Other
City State Zip
3. Immunizations Shaded Vaccines Required
DTP/Hib 1
//
DTP/Hib 2
//
DTP/Hib 3
//
DTP/ Hib 4
//
DTaP/Hib 4
//
DTP/DTaP 1
//
DTP/DTaP 2
//
DTP/DTaP 3
//
DTP/DTaP 4
//
DTP/DTaP 5
//
DT/Td 1
//
DT/Td 2
//
DT/Td 3
//
DT/Td 4
//
DT/Td 5
//
OPV/IPV 1
//
OPV/IPV 2
//
OPV/IPV 3
//
OPV/IPV 4
//
OPV/IPV 5
//
MMR 1
//
MMR 2
//
HepB 1
//
HepB 2
//
HepB 3
//
Hib 1
//
Hib 2
//
Hib 3
//
Hib 4
118
//
Hep B 1 (2 dose
Version Only)
//
Hep B 2 (2 dose
Version Only)
//
Hep B/Hib 1
//
Hep B/Hib 2
//
Hep B/Hib 3
//
Varicella 1
//
Varicella 2
//
Lyme Vax 1
//
Lyme Vax 2
//
Lyme Vax 3
//
Pneumococcal
Conjugate 1
//
Pneumococcal
Conjugate 2
//
Pneumococcal
Conjugate 3
//
Pneumococcal
Conjugate 4
//
Pneumococcal
Polysaccharide1
//
Pneumococcal
Polysaccharide 2
//
Hep A 1
//
Hep A 2
//
Influenza 1
//
Influenza 2
//
Other:
//
Other:
//
CH- 125 New 12/00
DOC. # 35-05-20/00/12/06
Section B - 41 - 7-2007
CDC RECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATION SCHEDULE
Taken from: www.cdc.gov
Section B - 42 - 7-2007
119
students, immigrants, students from other states and territories, and children entering from
nonpublic
schools. For purposes of this regulation, new school enterer shall also include any child
who is reenrolled
in a Delaware public school following travel or residency of one month in a location or facility
identified by the Delaware Division of Public Health as an area at risk for TB exposure.
School Staff and Extended Services Personnel means all persons hired as full or part time
employees in a
public school who are receiving compensation to work directly with students and staff. This
includes, but is
not limited to teachers, administrators, substitutes, contract employees, bus drivers and
student teachers
whether compensated or not.
Tuberculosis Risk Assessment means a formal assessment by a healthcare professional to
determine
possible tuberculosis exposure through the use of a health history or questionnaire.
Verification means a documented evaluation of the individuals disease status.
Volunteers mean those persons who give their time to help others for no monetary reward
and who share
the same air space with public school students and staff on a regularly scheduled basis.
2.0 School Staff and Extended Services Personnel
2.1 School staff and extended services personnel shall provide the Mantoux tuberculin skin
test results
from a test administered within the past 12 months during the first 15 working days of
employment.
2.1.1 Tuberculin skin test requirements may be waived for public school staff and extended
services personnel who present a notarized statement that tuberculin skin testing is against
their religious beliefs. In such cases, the individual shall complete the Delaware
Department of Education TB Health Questionnaire for School Employees or provide,
within two (2) weeks, verification from a licensed health care provider or the Division of
Public Health that the individual does not pose a threat of transmitting tuberculosis to
students or other staff.
2.1.1.1 If a school staff member or extended services person, who has received a
waiver because of religious beliefs, answers affirmatively to any of the
questions in the Delaware Department of Education TB Health Questionnaire
for School Employees he/she shall provide, within two (2) weeks, verification
from a licensed health care provider or the Division of Public Health that the
individual does not pose a threat of transmitting tuberculosis to students or
other staff.
2.1.2 Student teachers need not be retested if they move from district to district as part of
their
student teaching assignments.
2.2 Every fifth year, by October 15th, all public school staff and extended services personnel
shall
complete the Delaware Department of Education TB Health Questionnaire for School
Employees
or, within two (2) weeks, provide Mantoux tuberculin skin test results administered within
the last
twelve (12) months.
2.2.1 If a school staff member or extended services staff member answers affirmatively to
any
of the questions in the Delaware Department of Education TB Health Questionnaire for
School Employees he/she shall provide, within two (2) weeks, verification from a licensed
health care provider or the Division of Public Health that the individual does not pose a
threat of transmitting tuberculosis to students or other staff.
120
2.3 All documentation related to the School Health Tuberculosis (TB) Control Program shall
be
retained in the same manner as other confidential personnel medical information.
3.0 Volunteers
3.1 Volunteers shall complete the Delaware Department of Educations TB Health
Questionnaire for
Volunteers in Public Schools prior to their assignment and every fifth year thereafter.
3.1.1 If the volunteer answers affirmatively to any of the questions, he/she shall provide,
within
two (2) weeks, verification from a licensed health care provider or the Division of Public
Health that the individual does not pose a threat of transmitting tuberculosis to the
Section B - 43 - 7-2007
students or staff.
3.2 Each public school nurse shall collect and monitor all documentation related to the
School Health
Tuberculosis (TB) Control Program and store them in the school nurses office in a
confidential
manner.
4.0 New School Enterers
4.1 New school enterers shall show proof of tuberculin screening results as described in
4.1.1 and 4.1.2
including either results from the Mantoux Tuberculin test or the results of a tuberculosis risk
assessment. Multi-puncture skin tests will not be accepted.
4.1.1 If the new school enterer is in compliance with the other school entry health
requirements,
a school nurse who is trained in the use of the Delaware Department of Education TB Risk
Assessment Questionnaire for Students may administer the questionnaire to the students
parent(s), guardian(s) or Relative Caregiver or to a new school enterer who has reached
the statutory age of majority (18).
4.1.1.1 If a students parent(s), guardian(s) or Relative Caregiver or a student 18 years
or older answers affirmatively to any of the questions, he/she shall, within two
(2) weeks, provide proof of Mantoux tuberculin skin test results or provide
verification from a licensed health care provider or the Division of Public
Health that the student does not pose a threat of transmitting tuberculosis to
staff or other students.
4.2 School nurses shall record and maintain documentation relative to the School Health
Tuberculosis
(TB) Control Program.
5.0 Tuberculosis Status Verification and Follow-up
5.1 Tuberculosis Status shall be determined through the use of a tuberculosis risk
assessment,
tuberculin skin test and other testing, which may include x-ray or sputum culture. Individuals
who
either refuse the tuberculin skin test or have positive reactions to the same, or give positive
responses to a tuberculosis risk assessment shall provide verification from a licensed health
care
provider or the Division of Public Health that the individual does not pose a threat of
transmitting
tuberculosis to staff or other students.
5.1.1 Verification shall include Mantoux results recorded in millimeters (if test were
administered), current disease status (i.e. contagious or non-contagious), current treatment
(or completion of preventative treatment for TB) and date when the individual may return
to his/her school assignment without posing a risk to the school setting.
5.1.2 Verification from a health care provider or Division of Public Health shall be required
only once if treatment was completed successfully.
121
5.1.3 Updated information regarding disease status and treatment shall be provided to the
public
school by October 15 every fifth year if treatment was previously contraindicated,
incomplete or unknown.
5.2 In the event an individual shows any signs or symptoms of active TB infection, he/she
must be
excluded from school until all required medical verification is received by the school.
Section B - 44 - 6-2005
Employee Name: Date:
Employee Signature:
Please consider the following questions and indicate one response in the box
below:
1. In the past five years, have you lived or been in close contact with anyone who
had TB disease?
2. Do you currently have any of the following symptoms which are unexplained and
which have lasted
at least three weeks?
Cough
Fever
Night sweats
Weight loss
3. Have you ever had a positive HIV test?
4. In the past five years, have you ever used illegal intravenous drugs?
5. In the past five years, have you been incarcerated?
6. In the past five years, have you been homeless?
7. Consider the list of countries/continents below:
Africa
Asia
Eastern Europe
Caribbean
Latin America
Pacific Islands
In the past five years, have you stayed/lived in one of these countries for 1 month
or longer?
In the past five years, have you lived or been in close contact with someone who
stayed/lived in one
of these countries for 1 month or longer?
If you checked YES, you are required (within 2 weeks) to provide verification from a
licensed health care
provider or the Division of Public Health that there is no communicable threat.
If you have any questions about your risk of infection, please speak with your
healthcare provider or
contact the Delaware Division of Public Health TB Elimination Program at 302-7412923.
Developed in collaboration with the Division of Public Health, 2/05.
Regulation 805 can be accessed at http://www.state.de.us/research/AdminCode/title14/800
3 Anyone with a previous positive Mantoux shall provide updated information regarding
disease status and treatment
to the public school by October 15 every fifth year if treatment was previously
contraindicated, incomplete or
unknown.
1
2
Section B - 45 - 6-2005
Delaware Department of Education1
Student TB Risk Assessment Questionnaire
Prior to use of this form, the school nurse must review the students health records
and assure that the
student is compliant with the requirement for a current physical (within past 2
years) and up-to-date
immunizations. The questionnaire must be administered by the school nurse to the
parent/guardian in
person or by phone and signed by the parent who answered the questions.
Name:
Last First MI
Date of Birth: ____/_____/____ Date Form Completed ___/___/___
1. Has your child had any contact with a case of TB?
2. Was any household member, including your child, born in or has he/she traveled
to areas where TB is
common (i.e., Africa, Asia, Latin America, and the Caribbean)?
3. Does your child have regular (i.e., daily) contact with adults at high risk for TB
(i.e., those who are
HIV infected, homeless, incarcerated, and/or illicit drug users)?
4. Does your child have any health conditions or take medications that might affect
his/her immune
system?
Any yes response is considered a positive risk factor and is an indication for
administering a Mantoux
tuberculin skin test to the child.
This child has been screened by his/her school nurse for risk of exposure to
tuberculosis. Based upon the
results of the TB Risk Assessment Questionnaire the child,
____does not require a Mantoux skin test
____does require a Mantoux skin test
Mantoux testing and documentation is required to be completed and given to the
school nurse by
____/_____/____ (date) or your child will be excluded from school.
School Nurse comments:
School Nurse (signature)
123
I give permission for the school nurse and my childs primary care physician
____________________________ (name of physician) to share information relating to
this form.
Parent/Guardian (signature)
Student questionnaire was developed in collaboration with the Division of Public Health,
8/04. Regulation 805,
The School Health Tuberculosis (TB) Control Program, can be accessed at
http://www.state.de.us/research/AdminCode/title14/800
1
Section B - 46 - 6-2005
Name Date
All school employees are required to have a tuberculosis (TB) skin test. The purpose
of this requirement
is to safeguard school-aged children from exposure to TB in the school setting. In
the same way, this
questionnaire is designed to identify volunteers who MAY have been exposed to TB
and thus need further
screening. A school designee will collect and monitor the Health Questionnaire,
which will be stored in
the School Nurses office in a confidential manner.
1. Have you ever lived or been in close contact with anyone who had TB disease?
2. Have you ever had a positive HIV test?
3. Have you ever used illegal intravenous drugs?
4. Have you ever been incarcerated?
5. Have you ever been homeless?
6. Do you currently have any of the following symptoms which are unexplained and
which have lasted
at least three weeks?
Cough
Fever
Night sweats
Weight loss
7. Consider the list of countries/continents below:
Africa
Asia, including China, Vietnam, Korea, Indonesia, India, Pakistan, Bangladesh
Eastern Europe, including Russia and former Soviet Union, Armenia
Haiti
Latin America, including Mexico, Guatemala, and South America
Pacific Islands, including Philippines
Were you born in one of these countries?
Have you ever stayed/lived in one of these countries for 1 month or longer?
Have you ever lived or been in close contact with someone who stayed/lived in one
of these countries
for 1 month or longer?
Can you answer yes to any of the above questions? ( ) Yes ( ) No
If you checked yes, you are required to have a Mantoux test prior to your
assignment as a
volunteer.
124
Have you ever had a positive skin test for tuberculosis? ( ) Yes ( ) No
If you checked yes, you are required to provide documentation related to current
disease status
prior to your assignment as a volunteer.
These requirements are for the safety of our school and for your personal health.
Screening for
tuberculosis is recommended by health professionals for any individual who is at
risk. Routine screening,
using a Mantoux tuberculin skin test, can detect if a person has been exposed to
tuberculosis. Such early
identification is of great benefit in reducing the effects of disease.
If you have any questions about your risk of infection, please speak with your
healthcare provider or plan
to discuss it at your next examination. For additional information, you can contact
the Delaware Division
of Public Health TB Elimination Program at 302-739-6620.
Section B - 47 - 6-2005
Affidavit of Religious Belief
STATE OF DELAWARE
COUNTY
1. (I) (We) (am) (are) the (parent[s]) (legal guardian[s]) (Relative
Caregiver[s]) of
Name of Child
1. (I) (We) hereby (swear) (affirm) that (I) (we) subscribe to a belief in a
relation to a
Supreme Being involving duties superior to those arising from any human
relation.
2. (I) (We) further (swear) (affirm) that our belief is sincere and meaningful
and occupies a
place in (my) (our) life parallel to that filled by the orthodox belief in God.
3. This belief is not a political, sociological or philosophical view of a merely
personal moral
code.
4. This belief causes (me) (us) to request an exemption from the mandatory
Mantoux
tuberculin skin test for .
Name of Child
Signature of Parent(s) or Guardian(s)
SWORN TO AND SUSCRIBED before me, a registered Notary Public, this
day of , 20____.
(Seal)
Notary Public
My commission expires:
Section B - 48 - 7-2007
815 Physical Examinations and Screening
125
126
Section B - 49 - 6-2005
DELAWARE SCHOOL PHYSICAL EXAMINATION FORM
To be completed by licensed medical physician, nurse practitioner or physicians assistant.
Name: Sex: DOB:
Date: Examiner:
PLEASE CHECK IF CHILD HAS HAD DIFFICULTY WITH ANY OF THE FOLLOWING.
GIVE DATES AND ADDITIONAL INFORMATION UNDER COMMENTS.
[ ] ADD/ADHD [ ] Body Piercing/Tattoo [ ] Emotional [ ] Physical Disability
[ ] Allergies [ ] Bone/Spine [ ] Hearing [ ] Seizures
[ ] Asthma [ ] Bowel/Bladder [ ] Heart [ ] Speech
[ ] Behavior [ ] Chicken Pox [ ] Infections [ ] Surgery
[ ] Bleeding [ ] Diabetes [ ] Kidney [ ] Vision
[ ] OTHER
Comments:
Height: Weight: BP: Pulse:
Vision: Right Left
Hearing: Right Left
Lead Screening: Date Completed Results
Hematocrit/Hemoglobin: Date Completed Results
PPD (Mantoux): Date Placed Date Read Results (in mm)
or
TB Risk Assessment: Date Completed Results
3. Immunizations Shaded Vaccines Required
DTP/Hib 1
//
DTP/Hib 2
//
DTP/Hib 3
//
DTP/ Hib 4
//
DTaP/Hib 4
//
DTP/DTaP 1
//
DTP/DTaP 2
//
DTP/DTaP 3
//
DTP/DTaP 4
//
DTP/DTaP 5
//
DT/Td 1
//
127
DT/Td 2
//
DT/Td 3
//
DT/Td 4
//
DT/Td 5
//
OPV/IPV 1
//
OPV/IPV 2
//
OPV/IPV 3
//
OPV/IPV 4
//
OPV/IPV 5
//
MMR 1
//
MMR 2
//
HepB 1
//
HepB 2
//
HepB 3
//
Hib 1
//
Hib 2
//
Hib 3
//
Hib 4
//
Hep B 1 (2 dose
Version Only)
//
Hep B 2 (2 dose
Version Only)
//
Hep B/Hib 1
//
Hep B/Hib 2
//
Hep B/Hib 3
//
Varicella 1
//
Varicella 2
//
Lyme Vax 1
//
Lyme Vax 2
//
Lyme Vax 3
//
Pneumococcal
Conjugate 1
//
Pneumococcal
Conjugate 2
//
Pneumococcal
Conjugate 3
//
Pneumococcal
Conjugate 4
128
//
Pneumococcal
Polysaccharide1
//
Pneumococcal
Polysaccharide 2
//
Hep A 1
//
Hep A 2
//
Influenza 1
//
Influenza 2
//
Other:
//
Other:
//
Page 1 of 2
Section B - 50 - 6-2005
CHILDS NAME
PHYSICAL
EXAMINATION
Check (_)
NORMAL ABNORMAL
COMMENTS
General Appearance
Head/Scalp
Eyes
Ears
Nose/Throat
Mouth/Teeth/Gums
Heart
Chest/Lungs
Skin
Abdomen/Hernia
Genitalia
Neurological
Developmental
Musculoskeletal
Nutrition
Section B - 51 - 6-2005
page document. Pages one, two and four require your signature while page five is a
reference for
you to keep. This physical evaluation must be completed after May 1 of the current
year playing
sports and runs through June 30 of the following year.
If you check any sport in this box it means the athlete will not be permitted to participate in
that sport.
4. By this signature, I hereby consent to allow the physician(s) and other health care
providers(s) selected
by myself or the schools to perform a pre-participation examination on my child and
to provide treatment
for any injury received while participating in or training for athletics for his/her
school. I further consent
to allow said physician(s) or health care provider(s) to share appropriate information
concerning my child
that is relevant to participation, with coaches, medical staff, Delaware
Interscholastic Athletic
Association, and other school personnel as deemed necessary. Such information
maybe used for injury
surveillance purposes.
Parent Signature:______________________________ Date: _________________
Section B - 52 - 6-2005
131
I hereby state that, to the best of my knowledge, my answers to the above questions are complete and
correct.
Signature of athlete Signature of parent/guardian Date
2004 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American
Medical Society
for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.
132
Section B - 53 - 6-2005
Section B - 54 - 6-2005
134
the school, or the opposing teams school. The healthcare providers have my permission to
release my childs medical
information to other healthcare practitioners and school officials. In the event I cannot be
reached in an emergency I give
permission for my child to be transported to receive necessary treatment. I understand that
Delaware Interscholastic
Athletic Association or its associates may request information regarding the athletes health
status, and I hereby give my
permission for the release of this information as long as the information does not personally
identify my child.
Parent/Guardian Signature:_______________________________________ Date:_______________
Athletes Signature:_____________________________________________ Date:_______________
Section 4: Clearance for Participation
__ Cleared without restrictions __ Cleared with the following restrictions:
Health Care Providers Signature:_____________________________________ MD/DO, PA,NP
Date:__________
Section B - 55 - 6-2005
135
for the current academic year without completing your two-year commitment or receiving a release
from the sending school. (Reg.
1008.2.3.3; Reg. 1009.2.3.4)
10. If you participated in the Delaware School Choice Program during the previous academic year and
transferred to another choice
school for the current academic year unless you are playing a sport not sponsored by the sending
school. (Reg. 1008.2.4.6.1; Reg.
1009.2.4.7.1)
11. If you reached the age of majority (18), occupied a residence in a different attendance zone than
your custodial parent(s) or court
appointed legal guardian(s), and have not been in regular attendance at your receiving school for at
least 90 school days unless you
are participating in the Delaware School Choice Program and your application was properly submitted
prior to your change of
residence. (Reg. 1009.2.2.1.7)
12. If you attend a high school and more than four years has elapsed since you first entered 9th grade,
or more than five years has
elapsed since you just entered 8th grade in schools with 8th grade eligibility for high school sports. (Reg.
1009.2.7.1 and 2.7.2.1)
13. If you attend a junior high/middle school in which only grades 7-8 are permitted to participate in
interscholastic athletics and
more than two years has elapsed since you first entered 7th grade. (Reg. 1008.2.7.1)
14. If you attend a junior high/middle school in which grades 6-8 are permitted to participate in
interscholastic athletics and
more than three years has elapsed since you first entered 6th grade. (Reg. 1008.2.7.2)
15. If you have played on or against a professional team or have accepted cash or a cash equivalent
(savings bond, certificate of deposit,
etc.); a merchandise item(s) with an aggregate retail value of more than $150; a merchandise
discount; a reduction or waiver of fees;
a gift certificate or other valuable consideration for athletic participation. (Reg. 1009.2.5.1.4 and
2.5.1.5)
16. If you have used your athletic status to promote a commercial product or service in an
advertisement or personal appearance. (Reg.
1009.2.5.1.7)
17. If you have not received a physical examination from a licensed physician (M.D. or D.O.), a certified
nurse practitioner or a certified
physicians assistant on or after May 1 and written consent from your custodial parent(s) or court
appointed legal guardian(s) to
participate in interscholastic athletics is not on file in the school office. (Reg. 1009.3.1.1.1 and Reg.
1008.3.1.1)
18. If you participate in an all-star game not approved by DIAA before you graduate from high school.
(Reg. 1009.5.4)
19. If you are a foreign exchange student not participating in a two-semester program listed by the
Council on Standards for
International Educational Travel (CSIET). (Reg. 1009.2.8.1.2)
20. If you are an international student not in compliance with all DIAA regulations including Reg.
1009.2.2 residency requirements.
(Reg. 1009.2.8.2)
*IF YOU ARE NOT IN COMPLIANCE WITH THESE REQUIREMENTS, YOU MAY NOT PRACTICE, SCRIMMAGE
OR
PLAY IN A GAME.
NOTE: Consult with your coach, athletic director, or principal for information concerning additional
eligibility requirements.
Section B - 56 - 6-2005
STUDENT HEALTH HISTORY UPDATE
This information will be shared on a need to know basis with staff, administration and emergency medical staff in
the case of an
emergency unless you notify us otherwise.
PLEASE CHECK IF CHILD HAS HAD DIFFICULTY WITH ANY OF THE FOLLOWING. GIVE
DATES AND ADDITIONAL INFORMATION UNDER COMMENTS.
1. [ ] ADD/ADHD [ ] Body Piercing/Tattoo [ ] Emotional [ ] Physical Disability
[
[
[
[
[
]
]
]
]
]
Comments:
2. Does your child have allergies to medicine, food, latex or insect bites?
NO [ ] YES [ ] To What What happens
Treatment
3. Has your child had any illnesses since school ended in June?
NO [ ] YES [ ] Type of illness, with date(s)
4. Has your child had surgery since school ended in June?
NO [ ] YES [ ] Type of surgery, with date(s)
5. Has your child received any immunizations since school ended in June?
NO [ ] YES [ ] List immunizations, with dates
6. Is your child being treated or evaluated for any health conditions?
NO [ ] YES [ ] List condition
7. Is your child on any medication or treatment?
NO [ ] YES [ ] Name of medication and/or treatment
Does your child need medicine during school hours?
NO [ ] YES [ ] *If yes, please contact the school nurse to make arrangements.
8. Has your child ever been examined by an eye doctor?
NO [ ] YES [ ] Date of last exam
NO [ ] YES [ ] Glasses Prescribed
If your child wears glasses or contact lenses, when was the prescription last
changed
9. Has your child had any emotional upsets (recent move, death, separation,
divorce) since school ended
in June?
NO [ ] YES [ ] List
10. What is the name of your childs dentist?
What is the date of his/her last dental exam?
11. What is the name of your childs primary healthcare provider?
What is the date of his/her last physical exam?
Thank you.
Section B - 57 - 6-2005
Current Program
The Childhood Lead Poisoning Prevention Act requires all healthcare
providers to order
screening for children at or around 12 months of age. Child care facilities,
public and private
nursery schools, preschools and kindergartens shall require screening for
lead poisoning for
admission or continued enrollment.
137
Schools are responsible for informing parents of this mandate at the time of
registration for PreK
or Kindergarten. Documentation that a blood lead test was completed must
be on file in the
Student Health Record. Results of the test are not required although
encouraged. Schools
should work with families of children with high blood levels to assure followup and appropriate
treatment. Families failing to provide documentation should be notified early
in the school year.
Children without documentation will be excluded from school after 60 days of
the date of
enrollment.
History
In 1995, legislation was passed requiring lead exposure. Its goal is the
foundation of todays
program: to assure all Delaware children have reduced exposure to lead and
receive early
identification.
In 2001, the Division of Public Health reported that 1.4% of Delaware children
screened had
levels above 10 microgram. The national average at that time was 4.4%.
With Delawares
mandated blood lead testing for school entry at PreK or Kindergarten, the
number of children
tested in Delaware continues to rise as the number of children with elevated
blood levels
continues to decline.
Overview of Lead Poisoning
Lead has existed since antiquity and occurs naturally in the environment.
Egyptians used lead in
mascara and the United States later used it in paint, plumbing and gasoline.
Paint containing
lead was banned in the late 1970s; however, the military continued to use it.
Lead poisoning is
a silent disease with subtle, if any, signs and symptoms, but very damaging
because it affects soft
tissues of the body (ex. brain, kidneys, bone, etc.) and can be passed
through the placenta to a
fetus. Lead poisoning effects concentration and the ability of children to
learn. High blood
levels have been associated to lower IQs. Lead poisoning can be obtained by
inhalation or water,
but the most common mode is hand-to-mouth. More than 80% of houses
built prior to 1950-55
have lead even if well maintained.
138
While lead poisoning is more likely to occur in early childhood, older children
and adults can
also be exposed and affected. In 2005 the CDC issued Recommendations for
Lead Poisoning in
Newly Arrived Refugee Children. The report noted: Although blood lead
levels (BLLs) in
children aged 1 to 5 years are decreasing in the United States, the
prevalence of elevated BLLs
among newly resettled refugee children is substantially higher than children
born in the United
States. The complete Recommendations for Lead Poisoning in Newly Arrived
Refugee Children
Section B - 58 - 6-2005
are available online at www.cdc.gov/nceh/lead. In Delaware, Medicaid will
cover testing costs
for newly arrived refugee children. Possible exposure, signs and symptoms
include:
Exposure:
Breathing air or dust with lead
Dust from lead-based paint
Work-site where lead paint is used
Certain hobbies (stained glass, home renovation, removing lead paint,
making lead
fishing weights, etc.)
Ingesting contaminated food/water
Non-western cosmetics
Health-care products, not produced in the U.S., with lead
Folk remedies with lead
Improperly glazed pottery, ceramic dishes or leaded-crystal glassware
Lead piping for plumbing
Signs/Symptoms associated with lead poisoning:
Poor concentration
Anemia
Weakness in fingers, wrists or ankles
Decreased reaction time
Mental retardation
Decreased physical growth
Resources
www.cdc.gov/lead
www.cdc.gov/nceh/lead
Section B - 59 - 6-2005
IV. Screening
Section B - 60 - 7-2007
139
1.1 All public school students shall have a physical examination that has been administered
by a licensed
medical physician, nurse practitioner or physician's assistant. The physical examination shall
have been
done within the two years prior to entry into school. Within fourteen calendar days after
notification of the
requirement for a physical examination, new enterers shall have received a physical
examination or shall have
a documented appointment with a licensed health care provider for a physical examination.
1.1.1The requirement for the physical examination may be waived for students whose
parent, guardian or Relative
Caregiver, or the student if 18 years or older, or an unaccompanied homeless youth (as
defined by 42 USC
11434a) presents a written declaration acknowledged before a notary public, that because
of individual
religious beliefs, they reject the concept of physical examinations.
1.1.2 The school nurse shall record all findings on the Delaware School Health Record Form
(see 14 DE
Admin. Code 811) and maintain the original copy in the childs medical file.
NON REGULATORY NOTE: See 14 DE Admin. Code 1008.3 and 14 DE Admin. Code 1009.3 for
physical examination requirements associated with participation in sports.
2.0 Screening
2.1 Vision and Hearing Screening
2.1.1 Each public school student in kindergarten and in grades 2, 4, 7 and grades 9 or 10
shall receive a vision
and a hearing screening by January 15th of each school year.
2.1.1.1 In addition to the screening requirements in 2.1.1, screening shall also be provided to
new
enterers, students referred by a teacher or an administrator, and students considered for
special
education.
2.1.1.1.1 Driver education students shall have a vision screening within a year prior to their
in car
driving hours.
2.1.2 The school nurse shall record the results on the Delaware School Health Record Form
and shall notify the
parent, guardian or Relative Caregiver or the student if 18 years or older, or an
unaccompanied homeless
youth (as defined by 42 USC 11434a) if the student has a suspected problem.
2.2 Postural and Gait Screening
2.2.1 Each public school student in grades 5 through 9 shall receive a postural and gait
screening by December
15th.
2.2.2 The school nurse shall record the findings on the Delaware School Health Record Form
(see 14 DE
Admin. Code 811) and shall notify the parents, guardian or Relative Caregiver, or the student
if 18
years or older, or an unaccompanied homeless youth (as defined by 42 USC 11434a) if a
suspected
deviation has been detected.
2.2.2.1 If a suspected deviation is detected, the school nurse shall refer the student for
further
evaluation through an on site follow up evaluation or a referral to the students health care
provider.
2.3 Lead Screening
140
2.3.1 Children who enter school at kindergarten or at age 5 or prior, shall be required to
provide
documentation of lead screening as per 16 Del.C. Ch. 26.
2.3.1.1 For children enrolling in kindergarten, documentation of lead screening shall be
provided within
sixty (60) calendar days of the date of enrollment. Failure to provide the required
documentation
shall result in the child's exclusion from school until the documentation is provided.
2.3.1.2 Exemption from this requirement may be granted for religious exemptions, per 16
Del.C.
2603.
2.3.1.3 The Childhood Lead Poisoning Prevention Act, 16 Del.C., Ch. 26, requires all health
care
providers to order lead screening for children at or around the age of 12 months of age.
2.3.2 The school nurse shall document the lead screening on the Delaware School Health
Record form
form. See 14 DE Admin. Code 811.
Section B - 61 - 6-2005
Vision Screening Procedures
The American Optometric Association identifies seven vision skills that are
needed in school:
near vision, distance vision, binocular coordination, eye movement skills,
focusing skills,
peripheral awareness, and eye/hand coordination
(http://www.aoa.org/x1802.xml). The primary
goal of school vision screening is early identification and referral of children
with visual
abnormalities which can interrupt educational, physical and emotional
growth.
I. Preparation
A. Obtain class rosters to use as a worksheet and to record results of screening, if
results are not
directly entered in a computer program.
B. Notify parents (school newsletter, note, other), students and faculty of upcoming
screening.
C. Schedule screenings to assure completion by January 15.
D. Review equipment and manufacturers directions.
II. External Exam
During vision screening the school nurse has the opportunity to observe for other
signs/symptoms
which could indicate conditions that should be referred for further evaluation.
Alignment of the eyes, symmetry
Red or swollen eyelids
Drainage from the eyes or abnormal conjunctiva
Pruitis
Red, pink, bluish-tone or yellow-stained sclera
Cloudy appearance of lens or cornea
Pupil size
III. Acuity
If corrective lenses are usually worn by the student, all testing should be done with
the glasses in
141
place.
A. Non Instrument (appropriate for Grade Pre-K-adult)
1. Equipment Needed
a. Lighted chart (Snellen, Good Lite, Instaline, NOTV) or graduated cards (ex.
Lighthouse, Blackbird)
b. Plastic occluder
c. Plus lens: +2.25 and +1.75 lens
d. Near Vision Card
e. Quiet room at least 20 feet in length (or 10 feet if using 10-foot chart) with
adequate
lighting
(1) Illumination of chart, evenly diffused over chart without glare
(2) General illumination not less than 1/5 of chart illumination and nothing in the
field of vision brighter than the chart
2. Recommended Procedures
a. Distance Vision Acuity (appropriate screening tool for Grades Pre-K through adult)
(1) Place the child at a mark exactly 20 feet or 10 feet, depending upon the chart
used, from the chart with the eye level at the 20/20 or 10/10 line. If standing, the
heels should be on the 20 or 10-foot mark. If seated, the back legs of the chair
should be on the mark.
(2) Children with prescriptive glasses for distance should be tested wearing the
glasses.
(3) Prior to screening review the symbols or letters with the child to ascertain the
childs ability to recognize and communicate the symbol.
(4) Teach the child to use the occluder to cover one eye while keeping both eyes
open during test.
(5) Expose one symbol or letter at a time.
Section B - 62 - 6-2005
(6) Test the right eye first, then the left, then both eyes.
(7) Begin with the 30 or 40-foot line and proceed to include the 20-foot line. With
children suspected of low vision, begin with the 200-foot line.
(8) Move rhythmically from one symbol to another at a pace that is comfortable to
the child. Reading the majority (i.e., more than half) of the symbols on a line is
considered passing.
(9) Observe for thrusting head forward, tilting head, eyes watering, frowning or
scowling, closing one eye during the test of both eyes together, and excessive
blinking.
(10) Stop when the child fails a line and record last line read correctly. Record visual
acuity in order given for the right eye, left eye, for both eyes. Numerator equals
distance from the chart; denominator represents the line read (20/60 means 20
feet distance over 60-foot line.)
(11) A second screening is recommended on all children who fail prior to referral.
b. Near Vision using plus lens or chart
(1) Plus lens (testing hyperopia)
(a) Place the plus lens glasses on the child. Use small framed (+2.25) glasses for
preschool through second grade and larger framed (+1.75) glasses for third
grade and up.
(b) As before, show the symbol at 20 feet or 10 feet and ask the child to read the
20-foot or 10-foot line.
(c) If a child is able to read with either eye the 20/20 or 10/10 line through a plus
142
Section B - 63 - 6-2005
Section B - 64 - 6-2005
Section B - 65 - 6-2005
SAMPLE
Date
145
Dear Parent/Guardian:
A recent vision screening test at school indicates that____________________________
(student and grade)
may have some vision difficulty. An eye examination is recommended. Please take
this form with you at the time of examination.
(School Nurse)
(School)
REASON FOR REFERRAL
Vision Test Results
______Frequent headaches after reading ______Blinking ______Blurred Vision
______Squinting ______Watering Eyes
Remarks
Section B - 66 - 6-2005
Hearing Screening Procedures
The ability to communicate effectively impacts the well-being of a child, in
terms of education,
physical and social development. Early identification and intervention of
hearing loss is critical
in supporting speech/language development and full participation in the
learning process. Even
mild hearing losses may be educationally and medically significant.
I. Preparation
A. Obtain class rosters to use as a worksheet and to record results of
screening, if results are
not directly entered in a computer program (see Class Record Form,
Section B, page
69).
B. Notify parents (school newsletter, note, other), students and faculty of
upcoming
screening.
C. Schedule screenings to assure completion by January 15.
D. Review equipment and manufacturers directions.
E. Testing area should be:
146
1. Quiet and free from ambient noises such as fans, typewriters, blowers,
flushing
toilets, band rehearsals, gymnasiums, or playgrounds. Experience has shown
that
rooms treated with acoustical tile, heavy drapes covering windows,
carpeting, and
solid core doors help to eliminate extraneous noise.
2. Of sufficient size to accommodate the evaluator and the student. In some
cases it is
helpful to have space that permits the seating of 2 to 4 additional students
so that they
may observe the test procedure.
3. Supplied with an electrical outlet (110V AC).
F. Set up a table sufficient in size to accommodate the audiometer and
provide the evaluator
with ample writing space. Seating for the tester and the student should be of
appropriate
size.
G. Assemble necessary forms: class roster for recording results,
parent/guardian letter, and
referral form.
H. Children with hearing aids or a medical diagnosis of hearing loss do not
require screening
further.
II. External Exam
A. Hearing screening affords the opportunity to observe for the following and
make
appropriate referrals:
1. Hair/scalp conditions
2. Piercings, which may be un-healed or may interfere with alignment of
headphones
during procedure
3. Drainage or cerumen from ear
III. Acuity
A. Equipment needed
1. Pure tone audiometer, calibrated annually to current ANSI standards.
B. Recommended procedure
1. Turn on audiometer. Some manufacturers recommend allowing the
machine to
warm up for 15-20 minutes. Leave the machine on for the entire screening
period.
2. Always test the audiometer before using it. (Test it on yourself.)
3. Arrange the chairs so the student cannot view the equipment or the
recording sheet.
4. Give directions to the student on an appropriate response to hearing the
tone.
147
Section B - 67 - 6-2005
5. Place earphones on the students head, being sure to line up the
microphone with
the students ear canal. Typically, the red earphone goes on the right ear. It
may be
necessary to remove earrings, headbands and glasses.
6. Screening should be performed only at the following frequencies: 1000,
2000,
and 4000 Hertz (Hz).
7. Intensity level of screenings will be 20 decibels (dB) at each frequency.
(NOTE: If
there appears to be a fair amount of extraneous noise, screening intensity
level can
be raised to 25 dB for each frequency.) Press the tone for 2-4 seconds. Vary
the
interval between tones.
8. Only clean the rubber earphones with a lightly damp cloth. Do not put
liquid on
the microphones which are located in the center of each earphone!
NOTE: Some students with significant limitations may be incapable of
screening
via the traditional audiometric screening as described in this section. For
these students, the school may elect to purchase specialized equipment to
facilitate a screening. The School Nurse should receive appropriate
training in the use of the equipment as a screening tool and follow
recommended guidelines for appropriate screening frequencies, decibels,
referral criteria, etc.
C. Screening Failure Criteria
1. Failure to respond at the recommended screening level at any frequency
in either
ear constitutes failure.
2. All failures should be re-screened within the same session. This should be
accomplished by removing and repositioning the earphones and carefully
reinstructing
the student.
3. Any student who fails the initial screening should have a repeat screening
done
within two (2) weeks.
4. Any student failing the initial screening and repeat screening will be
referred for
appropriate follow-up and re-screened the following year.
5. An otoscopic exam should be done for any student who fails the initial and
repeat
screenings. Immediate referral is indicated for signs of otitis, cerumen buildup or
foreign body.
148
4. Sussex County: Refer for audiology or A & O services to: Sussex County
Health
Unit, Hearing Services, 544 South Bedford Street, Georgetown, DE 19947
(8565213).
D. Discuss suspected or known deviations with the appropriate school
personnel.
NOTE: Nurses are urged to follow-up the hearing of students receiving
private care within a
reasonable period of time or to check with the student or family on what care
was given
so as to insure adequate follow-up of the suspected hearing loss.
VI. Resource
A. The Ear and Hearing, A Guide for School Nurses, National Association of
School
Nurses, Inc. 1998.
Section B - 69 - 6-2005
Hearing Screening
Class Record Form
Section B - 70 - 6-2005
SAMPLE
DATE: _________________
Dear Parent/Guardian:
Your son/daughter recently failed a hearing screening
and may have a hearing problem. You may already be aware of this possible problem and
are taking steps to correct
it. If not, a medical examination is recommended. Please contact me to discuss the
suspected problem.
Many hearing losses today may be corrected before they become serious. While some
individuals have a temporary
hearing loss during a cold or other infection, it is important that the cause of such a
temporary loss be determined and
treated to protect the individual's future hearing.
Nurse
School
---------------------------------------------------------------------------------------------------EXAMINING PHYSICIAN
(Please complete and return to the school nurse.)
Name____________________________ School_____________________ Grade________
Diagnosis
State Treatment Complete
Additional Medical Recommendations:
Prognosis: Stationary _____ Will improve _____ Progressive _____ Intermittent _____
Educational Recommendations:
Do you advise any of the following educational recommendations for the student?
Speech reading _____ Auditory Training _____ Use of hearing aid or amplifier _____
Date of Examination:______________ Examiner______________ M.D.______________
Date of Return Visit: ____________________
NOTE: Please complete and return to the school nurse. Thank you.
Address
Fax
Section B - 71 - 6-2005
Postural & Gait Screening
I. Preparation
A. Obtain class roster to use as work sheet and to record results of screening.
B. Notify parents, students and faculty of upcoming screening. Include
information on
rationale for screening and procedure.
C. Boys should be dressed in shorts and sleeveless top; girls should wear
shorts and
sleeveless blouse or one that opens in the back. This allows for adequate
examination
of head, arms, back, legs and feet.
D. Make arrangements to complete screenings by December 15.
II. Procedure
A. Examination should be done in this sequence:
1. Student walks toward examiner, look for:
a. Symmetry of the body
151
SAMPLE
DATE: _________________
Dear Parent/Guardian:
A recent postural/gait screening test at school indicates that may
have a postural or gait irregularity which could affect his/her during these
growing years.
The physical therapist will be at this school on to perform Phase II of the
postural
screening. He/she will examine your child to determine if a referral to the
doctor is needed.
Please make every attempt to have your child at school on time this day.
After this exam, you will be notified if the physical therapist feels that your
child needs to have an
additional exam by his/her doctor.
Please call the school nurse with any questions.
School Nurse
Phone
Section B - 75 - 6-2005
VI. Medications
Section B - 76 - 7-2007
154
student by the school nurse when a written request to administer the medication or
treatment is on
file from the parent, guardian or Relative Caregiver or the student if 18 years or older, or an
unaccompanied homeless youth (as defined by 42 USC 11434a). The school nurse shall
check the
student health records and history for contra indications and all allergies, especially to the
medications, and shall provide immediate medical attention if an allergic reaction is
observed or
make a referral if symptoms or conditions persist. The school nurse shall also document the
student's name, the name of medication and treatment administered, the date and time it
was
administered and the dosage if medication was administered.
2.0 Licensed Health Care Provider
2.1 Any prescribed medication administered to a student, in addition to the requirements in
1.0, shall
be prescribed by a licensed health care provider. Treatment, including specialized health
procedures, shall be signed by a licensed health care provider with directions relative to
administration or supervision.
3.0 Prescription Medications
3.1 Prescription medication shall be properly labeled with the student's name; the licensed
health care
provider's name; the name of the medication; the dosage; how and when it is to be
administered;
the name and phone number of the pharmacy and the current date of the prescription. The
medication shall be in a container which meets United States Pharmacopoeia National
Formulary
standards.
3.2 Medications and dosages administered by the school nurse shall be limited to those
recommended
by the Federal Drug Administration (FDA), peer review journal that indicates doses or
guidelines
that are both safe and effective or guidelines that are specified in regional or national
guidelines.
3.2.1 The prescription and the medication shall be current and long term prescriptions shall
be re
authorized at least once a year.
3.2.2 All medications classified as controlled substances shall be counted and reconciled
each
month by the school nurse and kept under double lock. Such medications should be
transported
to and from school by an adult.
4.0 Non Prescription Medications
4.1 Non prescription medications may be given by the school nurse after the nurse assesses
the
complaint and the symptoms to determine if other interventions can be used before
medication is
administered and if all requirements in 1.0 have been met.
5.0 IEP Team
5.1 For a student who requires significant medical or nursing interventions, the Individual
Education
Program (IEP) team shall include the school nurse.
6.0 Assistance With Medications on Field Trips
6.1 Definitions
"Assist a Student with Medication" means assisting a student in the self administration of a
medication, provided that the medication is in a properly labeled container as hereinafter
155
provided.
Assistance may include holding the medication container for the student, assisting with the
opening of the container, and assisting the student in self administering the medication. Lay
assistants shall not assist with injections. The one exception is with emergency medications
where
standard emergency procedures prevail in lifesaving circumstances.
"Field Trip" means any off campus, school sponsored activity.
"Medication" means a drug taken orally, by inhalation, or applied topically, and which is
either
prescribed for a student by a physician or is an over the counter drug which a parent,
guardian or
Relative Caregiver has authorized a student to use.
"Paraeducator" mean teaching assistants or aides.
6.2 Teachers, administrators and paraeducator employed by a student's local school district
are
authorized to assist a student with medication on a field trip subject to the following
provisions:
6.2.1 Assistance with medication shall not be provided without the prior written request or
consent of a parent, guardian or Relative Caregiver (or the student if 18 years or older, or an
unaccompanied homeless youth (as defined by 42 USC 11434a). Said written request or
Section B - 77 - 7-2007
consent shall contain clear instructions including: the student's name; the name of the
medication; the dose; the time of administration; and the method of administration. At least
one copy of said written request or consent shall be in the possession of the person assisting
a
student with medication on a field trip.
6.2.2 The prescribed medication, in addition to the requirements in 1.0, shall be prescribed
by a
licensed health care provider. The medication shall be properly labeled with the students
name; the licensed health care provider's name; the name of the medication; the dosage;
how
and when it is to be administered; the name and phone number of the pharmacy and the
current date of the prescription. The medication shall be in a container which meets United
States Pharmacopoeia National Formulary standards.
6.2.3 A registered nurse employed by the school district in which the student is enrolled
shall
determine which teachers, administrators and paraeducators are qualified to safely assist a
student with medication. In order to be qualified, each such person shall complete a Board of
Nursing approved training course developed by the Delaware Department of Education,
pursuant to 24 Del.C. 1921. Said nurse shall complete instructor training as designated by
the Department of Education and shall submit a list of successful staff participants to the
Department of Education. No person shall assist a student with medication without written
acknowledgment that he/she has completed the course and that he/she understands the
same,
and will abide by the safe practices and procedures set forth therein.
6.2.4 Each school district shall maintain a record of all students receiving assistance with
medication pursuant to this regulation. Said record shall contain the student's name, the
name
of the medication, the dose, the time of administration, the method of administration, and
the
name of the person assisting.
6.2.5 Except for a school nurse, no employee of a school district shall be compelled to assist
a
student with medication. Nothing contained herein shall be interpreted to otherwise relieve a
school district of its obligation to staff schools with certified school nurses.
156
NON REGULATORY NOTE: 14 DE Admin. Code 612, Possession, Use and Distribution
of Drugs and Alcohol addresses student self administration of a prescribed asthmatic quick
relief inhaler and student self administration of prescribed autoinjectable epinephrine.
Section B - 78 - 6-2005
Recommended Procedures to Follow for Controlled Substances
Controlled substance medications should be brought to school by a responsible adult
member of the
students family and given to the school nurse in the original container.
If it creates a hardship for the family to deliver the medication, it is the parent/guardians
responsibility to
count the number of pills or capsules sent to the school and to verify this with the school
nurse.
The controlled substance medication is to be counted on arrival by the school nurse in the
presence of an
adult family member, if possible. In the event that the parent/guardian did not deliver the
medication, a
copy of this account should be sent to the parent/guardian who should contact the school
nurse if there are
questions. A copy of the communication sent to the parent/guardian should be kept on file.
All controlled substances are to be kept under double lock. (The storage cabinet plus
locked room should
be sufficient.) Only authorized licensed personnel should have access to the area.
Documentation will show the students name, time, date of administration and dosage*.
All controlled substances will be counted and reconciled at least once a month.
When controlled substances are sent home (end of school year, etc.), the school nurse will
give the
medication to a responsible family member after a count is verified and signed by both the
school nurse and
the adult. If it presents a hardship for a family member to pick up the medication, the school
nurse will
verify numbers with an adult staff person and inform the parent/guardian of the number of
pills/capsules
that are being sent home.
Reviewed by the State Board of Education on 10/17/96.
* Change 3/05.
Section B - 79 - 6-2005
Parental Request to Have Prescription Medication/Treatment
Administered in School
If it is necessary for your child to receive medication during the school day, please do the
following:
Send the medication to school with a responsible individual if you are unable to take it to
school.
Send the medication in the original container properly labeled with correct name, time,
dose and
date.
Count the tablets (unless the number of tablets is the exact number on the label) or
approximate
amount of liquid in the bottle.
Fill out the following information:
Date
Students Name
Medication
Dose Time
Reason for Medication
157
Section B - 80 - 6-2005
Information on Controlled Substances
General Information - To determine if a drug is a controlled substance, check the PDR
(Physicians Desk Reference)
which will indicate whether or not the drug is controlled and the schedule under which is
located.
Some examples are:
Brand Name
Generic Name
Schedule
Title I6
Section #
Opium or Derivative
Narcotics
* Codeine Codeine II 4716(b) (1)
Morphine Morphine II 4716(b) (1)
Percodan, Tylox Oxycodone II 4716(b) (1)
Tussionex, Hycodan Hydrocodone III 4718(e) (4)
Opium Tincture Opium Tincture III 4718(e) (7)
Paregoric Camphorated Tincture of
Opium
III
4718(e) (7)
Dilaudid Hydromorphone II 4716(b) (1)
Barbiturates (Non-Narcotic)
Fiorinal Butalbital III 4718(c) (1)
Phenobarbital Phenobarbital IV 4720(b) (11)
Seconal Secobarbital II 4716(e) (3)
Nembutal Pentobarbital II 4716(e) (4)
Non-Narcotic Stimulants
Ritalin Methylphenidate II 4716(d) (4)
Preludin Phenmetrazine II 4716(d) (2)
Tenuate, Tepanil Diethylpropion IV 4720(h) (1)
Voranil Clortermine III 4718(g)
Sanorex Mazindol IV 4720(j)
Didrex Benzphetamine III 4718(h)
Pleoine, Prelu-2,
Bontril
Phendimetrazine
III
4718(j)
Adipex, Fastin Phentermine IV 4720(f)
Non-Narcotic Tranquilizers and
Depressants
Talwin Pentazocine IV 4720(g)
Librium Chlordiazepoxide IV 4720(b) (12)
158
Section B - 81 - 6-2005
SAMPLE
Section B - 82 - 6-2005
Section B - 83 - 6-2005
Assistance with Medication
Information for School Staff
(For Field Trips
_
Only)
When assisting with medications, it is expected that assistance will be given in a manner
which protects the
student from harm. It is expected both from a legal and ethical standpoint that you will not
knowingly
participate in practices which are outside your legally permissible role or which may
endanger the well
being of the student.
Medication is given to the right student, at the right time, in the right amount (dose), and by
the right route
(such as orally, topically, by inhalation). The following information is developed around these
FIVE
RIGHTS:
AT THE RIGHT TIME
THE RIGHT STUDENT
THE RIGHT MEDICATION
AT THE RIGHT DOSE
BY THE RIGHT ROUTE
THE RIGHT TIME
Routine medications are taken at established times. This helps to insure that the desired
levels of
medication will be maintained and doses will not be given dangerously close to each other.
Medications may be given hour before or after the indicated time except for medications
to be
given with meals. These may be medications which must be given with food.
Some medications should not be given at the same time or in combination with other
medications.
If two or more practitioners prescribe medications, the person assisting must check
medication
compatibility with the nurse, pharmacist, or poison control center.
THE RIGHT STUDENT
Unlike acute care medical facilities, most schools and other institutions do not require
personal
identification tags. This presents a problem in assisting with medications as levels of
communication and cooperation vary. Even a student may answer to another students
name.
160
Section B - 84 - 6-2005
pill bottle with the contents of a new pill bottle; there may be a change in the brand or dose
which
will create confusion and error.
Read the prescription label and check against the medication log sheet.
THE RIGHT DOSE
All medications, including over-the-counter (OTC) products, are given in some measured
amount.
Common measurement terms and their abbreviations for tablets, pills and capsules are
milligrams
(mg or mgm), grams (GM) and grains (gr). The prescription will indicate how many pills have
to
be given so you will not need to figure out the number of milligrams. For example, the
prescription
may read: Tegretol 200 mg tablets; give two tablets daily. You would give two tablets. The
actual milligram dosage is 400 mg daily but you are not asked to compute this, only to
comply with
the label.
Common measurement terms and their abbreviations for liquids are: ounce (oz), tablespoon
(Tbsp.), and teaspoon (tsp.). Some prescriptions may indicate a measurement in milliliters
(ml).
5 mls = 1 teaspoon; however, teaspoons can vary in size and should not be used routinely.
Liquid
medication measuring cups/containers are available and should be used.
Ear and eye liquids are usually measured in drops (gtt or gtts) or droppers full. Droppers
should be
included in the medication package.
Prescriptions will state the specific amount of medication to be measured out. If confused
about a
measurement, DO NOT GIVE until you have checked with the parent/guardian or school
nurse or
the pharmacist. Follow the practitioners orders carefully.
When assisting with medications, you are legally responsible for making sure that you
comply with
161
Section B - 85 - 6-2005
(4) Liquids: Pour liquids away from the labeled side to keep the label legible. Two types
of oral liquids exist for our purposes: liquids with a short shelf life, and liquids with a
long shelf life.
(a) Short shelf life: Most prescription antibiotics have a short shelf life and
frequently have to be either refrigerated or kept away from heat and out of direct
sunlight. They should be used completely and the container discarded. The
printed expiration date on these bottles indicates the life of the DRY medication.
The pharmacy label gives the date when the mixed solution will expire. DO
NOT USE BEYOND THE PHARMACISTS LABEL OF EXPIRATION
DATE.
(b) Long shelf life. Most OTC liquids have a long shelf life. The label expiration
date should be checked periodically to insure freshness.
b. TOPICAL: Medications which are applied to surfaces (skin, eyes, ear canals)
(1) Topical skin/hair medications may be creams, liquids, powders, soaps, shampoos,
ointments.
(a) Wear gloves when assisting with topical medications.
(b) Never dip anything (for example a Q-tip) into the medication. Pour (or with a
clean spoon) dip out just enough of the medication for one application into a
clean container and use from there. Never put unused medication back into its
original container.
(c) Ointment in a tube can be squeezed onto a sterile gauze pad or a bandage.
(d) Avoid splashing facial medications into eyes; they can be very irritating.
(e) Do not share tubes of ointment or liquid medications between students to avoid
spreading infections.
c. INHALANTS:
(2) Nasal Inhalants: Follow the directions on the package insert exactly. DO NOT place
the tip of the inhaler deeply into the nose, place the inhaler tip just at the opening of the
nose.
(3) Oral Inhalants such as mist asthma inhalants: Follow the directions on the package
insert exactly. Be very aware of discard dates on these medications as they MUST be
162
Section B - 86 - 6-2005
For the safety of the student, the first dose of any medication should be given under the
supervision of the
parent/guardian or school nurse.
a. DESIRED: good response, mission accomplished, the medication bringing desired results
b. NO RESPONSE: medication does not seem to be working
c. ADVERSE REACTIONS: (This is to alert you to potential difficulties, even though no
problems have been documented on field trips.)
(1) ALLERGY: medication causes rashes (sometimes with itching), hives, fatal shock. An
allergy can occur several days after a student has been on a medication or from a
medication the client has had many times before. IF THE STUDENT IS HAVING
TROUBLE BREATHING, CALL 911; otherwise, call the healthcare provider and
parent/guardian.
(2) UNTOWARD REACTION: This means the effect of the medication is the opposite of
what is expected and desired. Examples are: giving an antihistamine for a cough but
having the student become behaviorally out of control or giving a medication to control
nausea but vomiting occurs instead. Treat as you would an illness that develops on a
field trip.
(3) SIDE EFFECTS: These are undesirable but known reactions to the medication. Report
observations to the parent/guardian and school nurse.
RESOURCES ON DRUG INFORMATION
It is the responsibility of every individual who assists with medication to review possible side
effects of the
medication being given. Information on medication side effects should be available as part
of the
medication log.
For over-the-counter (OTC) medications, the information concerning how to use the
medication and how to
properly store it is printed on the package or bottle. Also, any pharmacist can provide
answers to questions
on use and storage.
a. For prescription medications, the following resources are available concerning how to use
the medication and how to properly store it:
(1) The container label will give directions for use including whether it should be taken
with or without food. If a drug must be refrigerated or has to have special handling, the
pharmacist indicates that on the container.
163
(2) The pharmacy listed on the container can be called if information is needed concerning
use and storage.
(3) The persons practitioner listed on the container can be contacted for information in
accordance with school policy.
b. Written information references about medications are available upon request from the
following sources:
(1) The pharmacy: Upon request a package insert from particular medications can be
provided. Usually the insert will describe the drug, its intended use, side effects which
can occur with use, side effects which warrant immediate medical consultation,
warnings about individuals who should not be using the drug, and any special handling
or storage directions as appropriate.
(2) The insert is available for prescription medications. Similar information can be found
on the packaging of over-the-counter medications.
MEDICATION STORAGE AND SAFETY
Medication storage and safety indicate a two fold obligation:
a. Medication must be carried in such a manner as to protect it from being accessed by
unauthorized persons a situation which could lead to misuse/abuse. Medications taken on a
Board of Nursing Approval 5/10/00
Section B - 87 - 6-2005
field trip should be in the personal possession of the person assisting with the medication
and
secure from unauthorized use.
b. Medication must be carried in a manner that protects the product from deterioration or
container breakage.
(1) Medications which need refrigeration or storage away from light should be
appropriately labeled by the pharmacy and stored accordingly. If medication needs to
be refrigerated, it should be carried in a cooler.
(2) Medications MUST be stored in their original containers. Should an adaptation of a
container be needed, it MUST be obtained from a pharmacist and it must bear the
appropriate pharmacy label. This includes over the counter medications. No
medication may be stored in a container other than the original container. Only a
pharmacist or practitioner can generate a container other than that in which the
medication was originally distributed from the manufacturer.
DISPOSAL OF MEDICATION CONTAINERS
Medication containers should be returned to the parent/guardian or the school nurse.
MEDICATION RECORDS
Records pertaining to medication use include: parent/guardians written permission, the
pharmacy label
(original container label), and any other records such as a medication log sheet which are
required by your
school.
The medication log sheet is a record sheet which you initial/sign after each student has
received the
appropriate medication. (A signature sheet identifying the initials must be included on the
sheet.)
The log sheet must show the students name, name of the medication, dose, route of
administration, and
time received by the student.
Example: John Doe ampicillin 250 mg by mouth at 1:00 p.m.
The log should be returned to the school nurse and attached to the regular daily log.
For the readers information: Controlled substances must be counted and accounted for to
conform
with federal law, state law, and school policy. Ritalin is a controlled substance.
Errors in recording medication information should be handled according to school policy.
164
24 Delaware Code Section 1921 (a) (16) allows for assistance in self administering
medication during
school field trips upon completion of a training course. The law does not guarantee that one
will not be held
liable, and thereby protected from litigation. There are no such guarantees despite the fact
that
parents/guardians must sign a statement that they fully and completely waive any claim
for liability that
may exist against any staff member, resulting from the assistance with medication to my
child.
Board of Nursing Approval 5/10/00
Section B - 88 - 6-2005
SIGN-OFF SHEET
SCHOOL EMPLOYEE MEDICATION ON FIELD TRIP_ INFORMATION
I received, read, and understand the medication information in the
Assistance with Medication Information for School Staff.
I will abide by the safe practices and procedures set forth therein. I am aware that
any questions
regarding this information or the medication should be discussed with the School
Nurse.
Date Information
Printed Name of School Employee Signature of School Employee Received
and Read
SAMPLE
Parent/Guardian Permission to Assist with Medication to Student
on Field Trip
I give permission for to go on
(Students Name) (Specify field trip)
on . I understand a staff member will assist my child with
(date)
medication. Information about the medication that needs to be taken by
(Students
is as follows:
Name)
Name of medication
Dose (amount to be taken)
Time to be taken
How it is taken
I understand I must send the medication in the original container.
All of the above information is on the label on the container prepared by the
pharmacist as prescribed by
(Doctors Name)
The following are any allergies or health conditions my child has:
Date Parent/Guardian Signature
165
Section C.
Illnesses & Injuries:
Acute & Chronic
Section C - 2 - 02-2006
166
getting students home or to some other place of safety, and for guiding families,
when necessary,
to sources of treatment.
Care of the Sick and Injured
School nurses should use the nursing process to assess clients and limit themselves
to the usual
and accepted practices of first aid in managing emergencies due to sickness or
accident unless
provided with Standing Orders or with client-specific protocols from a licensed
healthcare
provider. Student emergency plans should be current and easily accessible.
Exclusion of Student
The decision to exclude a child from the classroom or any school activity is based
upon the
individual needs of the child and the risk for the school population to communicable
disease
exposure. The school nurse must make a nursing judgment relative to the
presenting symptoms,
health history and known diagnosis of the child in order to determine if exclusion, a
referral to a
healthcare provider or other appropriate intervention is needed.
Notifying Parent/Guardian/ Relative Caregiver
The students primary caregiver should be notified of any serious accident, illness or
necessary
exclusion as promptly as possible. To facilitate this, data should be secured early in
the school
year from the family and kept current on the emergency card, which should be
maintained in the
health room for easy accessibility. The school nurse should contact the
parent/guardian/Relative
Caregiver to coordinate who will pick up the child and assume responsibility for
his/her care. If
neither the parent/guardian/Relative Caregiver nor the emergency contacts are
available, the
childs healthcare provider may be contacted. The decision for moving and securing
medical aid
defaults to school officials. The first consideration must always be the welfare of the
student.
Role of the School Nurse
The school nurse provides direct care to students and staff who present with
symptoms of illness
or injury. Using the nursing process, the school nurse gives timely, appropriate
nursing
assessment and first aid as necessary and within the scope of school nursing
practice. Referral to
other healthcare providers is provided as necessary. The school nurse is responsible
for the
administration of medications and treatments as prescribed by a licensed
healthcare provider for
the treatment of illness or injury.
167
The school nurse communicates with those responsible for the clients well-being
regarding the
need for ongoing observation, evaluation, or referral to other healthcare
professionals.
Appropriate confidentiality is maintained for the protection of the client.
Individualized
documentation of the illness or injury is accomplished in a retrievable manner using
standardized
language or recognized terminology (National Association of School Nurses [NASN],
2005).
Section C - 4 - 02-2006
The school nurse coordinates care delivery by creating and implementing individual
health care
plans as appropriate.
The school nurse reviews data regarding patterns of illness or injury for safety or
disease issues.
Proper hand washing and healthy lifestyle choices are taught and encouraged
throughout the
school. Administrators are informed of unusual patterns or severity of occurrences.
The school
nurse reports to proper authorities if abuse is suspected.
References
NASN, 2002. Issue Brief: School Health Services Role in Health Care. Scarborough,
Maine.
NASN and ANA, 2005. School Nursing: Scope and Standards of Practice. Nurse
Books,
Washington, DC.
Section C - 4 - 02-2006
REFERRAL TO THE SCHOOL NURSE Page 1 of 2
Although teachers cannot diagnose a childs condition or recommend medication, they are
many times the
first ones to note that a child is not performing like his/her peers or is having difficulty in the
classroom.
This information is valuable in facilitating the nurses assessment and possible referral for
further
evaluation.
The School Nurse values your input and comments. Please complete this form with your
concerns and
return it to the School Nurse. Listed below are some signs of conditions and examples of
behavior that
may provide clues to physical and emotional problems. While none of these are infallible,
none should be
overlooked. Extremes such as constantly disruptive behavior, continual unhappiness,
inability to learn, are
especially significant. Please remember that this information is confidential.
Student Grade/Section
Date Student Achievement: Good Fair Poor
General Appearance
Facial tic
Lethargic, unresponsive
Poor posture
Radical changes in weight
Unusual gait or limp
168
Unclean/unkempt
Very pale or flushed
Very thin or overweight
Ears
Asking to have things repeated
Discharge
Speaking loudly
Turning head to hear
Eyes
Crossed or turned out
Frequent styes
Holding page/book too close
Inflamed, watery
Squint, frown, scowl
Nose and Throat
Chronic cough
Enlarged glands in neck
Frequent colds
Nasal discharge
Persistent mouth breathing
Skin or Scalp
Bald spots
Frequent scratching
Nits on hair
Numerous pimples, blackheads
Patches of very dry skin
Rashes, sores or bruises
Teeth and Mouth
Bad bite
Cracked lips, esp. at corners of mouth
Dental caries
Inflamed or bleeding gums
Irregular teeth
Speech problem, hard to understand
School Performance
Compulsive neatness to the point that
assignments are never completed
Excuses from P.E.
Failure to achieve
Frequent absences
Marked deterioration in work
Poor memory
Poor reasoning
Very careless work
General Behavior
Aggressive, cruel
Always tired
Constant need for attention
Cries easily
Depressed, unhappy
Destructive
Docile, apathetic
Excessive daydreaming, inattentive
Excessive requests to leave classroom
Restless, hyperactive
Temper tantrums
Unusually timid, fearful
Behavior at Play
Breathless after moderate exercise
Difficulty playing with other
Easily fatigued
169
Extremely excitable
Lack of interest
Poor coordination
Very clumsy
Section C -5 - 02-2006
Page 2 of 2
Brief description of health problem(s):
Signature of Person Referring
Response to referral:
Signature of School Nurse
Date
Section C -6 - 02-2006
Section C -8 - 02-2006
171
NASN and ANA. (2005). School Nursing: Scope and Standards of Practice.
Washington, DC:
NurseBooks.Org.
Section C -9 - 02-2006
Standard Precautions
(Previously called Universal Precautions)
Purpose To insure that all blood body fluids are handled properly.
Those Affected All school staff should be alerted to dangers of infections from
body fluids.
School nurses, custodians and teachers should be particularly alert to the proper
techniques
in handling and disposal of materials.
Equipment Needed
Soap Disposal Bags Disposable gloves
Water Dust pans Mops
Paper towels Buckets Protective eyewear PRN
Disinfectants - should be one of the following classes:
a. Ethyl or isopropyl alcohol (70%)
b. Phenolic germicidal detergent in a 1% aqueous solution (e.g. Lysol*)
c. Sodium hypochlorite solution (household bleach), 1 part bleach to 10 parts water.
(Example 1-1/2 cups bleach to one (1) gallon of water. Needs to be prepared each
time used.)
(1) Handle carefully, avoid skin contact.
(2) Will corrode metal.
(3) Will discolor materials such as rugs, clothing.
d. Quaternary ammonium germicidal detergent in 2% aqueous solution (e.g.
Triquat*,
Mytar*, or Sage*).
e. Iodophor germicidal detergent with 500ppm available iodine (e.g. Wescodyne*).
*Brand names are used as examples and are not endorsement of products.
Procedures
General
a. Wear disposable gloves before making contact with body fluids.
b. Wear protective eyewear if blood or body fluid may come in contact with
eyes.
c. Discard gloves after each use.
d. Wash hands after handling fluids and contaminated articles, whether or not
gloves are worn.
e. Discard disposal items including tampons, used bandages and dressings in
plastic-lined trash container with lid. Close bags and discard daily.
f. Do not reuse plastic bags.
g. Use disposable items to handle blood and body fluids whenever possible.
h. Use paper towels to pick and discard any solid waste materials such as
vomitus or feces.
i. Double-bag soiled clothing and send home with student.
Handwashing
a. Use soap and warm running water. Soap suspends easily removable soil and
microorganisms allowing them to be washed off.
b. Rub hands together for approximately 20 seconds to work up a lather.
c. Scrub between fingers, knuckles, backs of hands, and nails.
172
d. Rinse hands under warm running water. Running water is necessary to carry
away
debris and dirt.
e. Use paper towels to thoroughly dry hands.
f. Discard paper towels.
Cleaning the Environment
Cleaning is a form of disinfection that renders environmental surfaces safe to use or
handle by removing organic matter, salts and visible soils, all of which interfere with
microbial inactivation. The physical action of scrubbing with detergents and
surfactants and rinsing with water removes large numbers of microorganisms from
surfaces.
Although contaminated surfaces can serve as reservoirs of potential pathogens,
these
surfaces generally are not directly associated with transmission of infections to
either
staff or patients. The transferal of microorganisms from environmental surfaces to
patients is largely via hand contact with the surface. Hand washing is imperative to
minimize the impact of this transfer; however, cleaning and disinfecting
environmental
surfaces as appropriate is fundamental in reducing their potential contribution to
the
incidence of healthcare-associated infections.
Most, if not all, housekeeping surfaces need to be cleaned only with soap and water
or
a detergent/disinfectant depending on the nature of the surface and the type of
contamination. The actual physical removal of microorganisms and soil by wiping or
scrubbing is probably as important, if not more so, than any antimicrobial effect of
the
cleaning agent used. When using a detergent/disinfectant, the manufacturers
instructions for appropriate use of the product should be followed
(www.cdc.gov/ncidod/hip/enviro/guide.htm).
For washable surfaces
a. For tables, desks, etc.:
(1) Use ethyl or isopropyl alcohol (70%), Lysol, or household bleach solution of
1 part bleach to 10 parts water, mixed fresh.
1 part bleach
10 parts water
(2) Rinse with water if so directed on disinfectant.
(3) Allow to air dry.
(4) When bleach solution is used, handle carefully.
(a) Gloves should be worn since the solution is irritating to skin.
(b) Avoid applying on metal since it will corrode most metals.
b. For Floors:
(1) One of the most readily available and effective disinfectants is the bleach
solution (1-1/2 cups bleach to one [1] gallon water.)
1 part bleach
10 parts water
(2) Use the two bucket system--one bucket to wash the soiled surface and one
bucket to rinse as follows:
173
(d) Put mop into bucket #2 (rinse bucket) that has clean disinfectant (such
as Lysol, bleach solution).
(e) Mop or rinse area.
(f) Return mop to bucket #1 to wring out. This keeps the rinse bucket
clean for second spill in the area.
(g) After all spills are cleaned up, proceed with #3.
(3) Soak mop in the disinfectant after use.
(4) Disposable cleaning equipment and water should be placed in toilet or plastic
bag as appropriate.
(5) Rinse non-disposable cleaning equipment (dust pans, buckets) in
disinfectant.
(6) Dispose disinfectant solution down a drainpipe.
(7) Remove gloves, if worn, and discard in appropriate receptacle.
(8) Wash hands thoroughly.
For non-washable surfaces (rugs, upholstery)
a. Apply sanitary absorbing agent, let dry, vacuum.
b. If necessary, use broom and dust pan to remove solid materials.
c. Apply rug or upholstery shampoo as directed. Re-vacuum according to directions
on shampoo.
d. If a sanitizing carpet cleaner (only available by water extraction method is used,
follow the directions on the label).
e. Clean dustpan and broom, if used. Rinse disinfectant solution.
f. Air dry.
g. Wash hands thoroughly.
For soiled washable materials (clothing, towels, etc.)
a. Rinse item under running water using gloved hands if appropriate.
b. Place item in plastic bag and seal it until item is washed.
c. Wash hands as described in #2.
d. Wipe sink with paper towels, discard towels.
e. Wash soiled items separately, washing and drying as usual.
f. If material is bleachable, add 1/2 cup bleach to the wash cycle. Otherwise, add 1/2
cup non-chlorine bleach (Clorox II, Borateem) to the wash cycle.
g. Discard plastic bag.
h. Wash hands thoroughly after handling soiled items.
Special Considerations for the School Setting
Cleaning medical equipment
Manufacturers of medical equipment provide care and maintenance instructions
specific to their equipment. These instructions should also include compatibility with
chemical solutions for cleaning, whether the equipment is water-resistant or can be
safely immersed for cleaning, and how the equipment should be decontaminated if
the
need arises.
Specialized environmental and reusable instrument cleaning
Disinfection and sterilization principles are available at:
http://www.apic.org/AM/Template.cfm?
Section=Search§ion=Brochures&template=/C
174
M/ContentDisplay.cfm&ContentFileID=238
Table 1
Transmission Concerns in the School Setting
Body Fluid Source of Infectious Agents
Body Fluid-Source Organism of Concern Transmission Concern
Blood Hepatitis C Bloodstream inoculation
-cuts/abrasions Hepatitis B. virus through cuts and
-nosebleeds HIV abrasions on hands
-menses Cytomegalovirus
-contaminated needle and others Direct blood stream
inoculation
*Feces Salmonella bacteria Oral inoculation from
-incontinence Shigella bacteria contaminated hands
Rotavirus
Hepatitis A virus
and others
*Urine Cytomegalovirus Bloodstream, oral and
-incontinence mucus membrane
inoculation from hands
175
1-888-295-5156
OR
302-744-4541
177
Epidemiology Branch:
Analyzes Information
Makes Recommendations & Conducts Investigation if indicated
Consults with Northern and Southern
Health Services if indicated
Criteria to determine communicable disease exposure:
Possible student(s) exposure to communicable disease
based on:
Diagnosis, report or symptomology of student/staff within
the building.
If yes to any of the following, notify Epi:
-Confirmed diagnosis of a communicable disease?
-Highly suspicious symptoms w/ diagnosis pending?
-Capacity for direct or indirect transmission?
-Suspicious symptomology or syndrome activity?
School Nurse
Passive Syndromic Surveillance
Final 7-28-05
information will assist the Epidemiology staff in analyzing the situation and
determining whether
further investigation is necessary. Strict confidentiality of student identifiers will be
maintained
unless public health concerns are compromised. In this case, the matter will be
thoroughly
discussed with school administration. School nurses should continue to follow their
normal
internal communication procedures.
The following is a list of questions the school nurse may be asked by a member of
the
Epidemiology staff. It should be noted that each particular circumstance will warrant
a unique set
of questions and this should only be considered as a general guide.
1) What is the detailed symptomology?
2) Who is affected? (i.e., Confined to a single classroom? Specific grade? Number of cases by
grade?)
3) When were the first symptoms noted?
4) How long have symptoms lasted?
5) How many children are symptomatic?
6) If a single child, are family members symptomatic?
7) If a single child, who are their closest contacts? (Whom do they sit beside in class? Who
are their
closest friends?)
8) Is any school staff symptomatic?
9) Is the illness confined to one classroom? One region of the school? School-wide?
10) Do those presenting with symptomology share a common restroom?
11) Do those presenting with symptomology share common meals?
12) Is the child on any medication?
13) What is the name of the childs physician?
14) Is the child/ren involved in any extracurricular activities?
15) Did the child/ren become ill after playground activities?
16) Has there been any unusual activity on or around school property?
notifying you of this possible exposure, we are trying to prevent new cases of this
disease.
Thank you for your cooperation.
Sincerely,
Description
Terminology
Pediculosis (head lice) is an infestation of head lice (pediculus capitus) that can
occur on the hair,
eyebrows and eyelashes. Body lice (pediculus corporis) and crab lice (phthirus
pubis) can also
lead to infestation of the clothing and pubic area, respectively (Control of
Communicable
Diseases Manual, 2004).
There are three forms of lice:
Nit: Nits are head lice eggs. They are hard to see and are often confused for
dandruff or hair
spray droplets. Nits are found firmly attached to the hair shaft. They are oval and
usually
yellow to white in color. Nits take about 1 week to hatch.
Nymph: The nit hatches into a baby louse called a nymph. It looks like an adult
head louse,
but is smaller. Nymphs mature into adults about 7 days after hatching. To live, the
nymph
must feed on blood.
Adult: The adult louse is about the size of a sesame seed, has six legs, and is tan
to grayishwhite.
In persons with dark hair, the adult louse will look darker. Females lay nits; they are
usually larger than males. Adult lice can live up to 30 days on a persons head. To
live, adult
lice need to feed on blood. (CDC, 2004)
Biology
The head louse generally inhabits warm areas, preferring the nape of the neck and
behind the
ears. The color of the louse varies with the coloration of the human host. The louse
attaches to
the hairs with hook-like claws located on its six legs.
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The nymph and adult louse feed on human blood by piercing the skin of the scalp,
injecting saliva
to prevent clotting and sucking blood into its digestive tract. Itching, the primary
symptom of
infestation, is caused by the saliva injected prior to this blood sucking.
Communicability
Head lice can be acquired by direct contact with an infected person or indirectly by
contact with
personal items, particularly coats, caps, scarves, combs and brushes; lying on
infested carpets or
beds; resting the head against upholstered furniture that has been used by an
infested person.
Fallen hairs with viable nits attached may contaminate the environment and serve
to transmit the
louse. Lice can survive for a week without a food source.
Those at highest risk include children ages 3-10, their families and females.
Pediculosis is rare
amongst African-Americans in the United States. (CDC, 2004)
Symptoms
Persons infested with lice will present with itching. Additional signs of infestation are
tiny bite
marks on neck and scalp, possible swelling of the cervical and axillary lymphs, and
secondary
bacterial infection due to scratching.
Preventative Measures
Although lice have existed for over 2000 years, they continue to be common
amongst children
worldwide and elude eradication. There is no scientific consensus on the best way
to control
head lice infestation in school children. (NASN, 2004) Best practice indicates the
infestation
can be reduced by minimizing the sharing of personal items (i.e., combs, hats,
bedding, pillows,
etc.), early identification and prompt treatment.
Nursing Assessment and Intervention
Technique for inspection
Part the hair (nape of neck or behind ears) with wooden applicator sticks or gloved
hands. Nits
and crawling forms can be seen with the naked eye or assisted with a magnifying
glass and
illumination. If crawling forms cannot be observed, look for nits silvery ovals
usually attached
within inch of the scalp. Nit cases (inactive infestation) remaining once the lice
have hatched
are empty, translucent, and found on hair shafts farther than inch from scalp. If in
doubt as to
whether the condition represents an active or inactive infestation, remove several
shafts of hair
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with nits attached and examine them under a microscope. Dandruff, debris, and
hair spray drops
can be mistaken for nits. Free-living bugs like aphids may be mistaken for the
crawling forms of
head lice as well.
Referral
Students with active infestation should be excluded from school until treated.
Pharmacists and
physicians can assist in recommending over-the-counter or prescribed topical
medication.
Directions from the treatment labels should be followed exactly regarding
application and any
repeat treatments.
Removal of nits is important in further decreasing the likelihood of re-infestation.
Comb hair
with a fine tooth metal comb to remove nits. Over-the-counter products or hot
vinegar may help
in loosening the nit from the hair shaft.
Prevention of spread or re-infestation
Personal items can be cleaned by any of the following methods:
Washing in hot water in washing machine
Putting in hot dryer for 20 minutes
Dry cleaning
Storing in a sealed bag for one week
Boiling combs, brushes, curlers, etc. for 10 minutes
Soaking in 2% Lysol solution and water for one hour
Freezing for 48 hours
Thorough vacuuming of carpets, floors and furniture is all that is necessary in the
rest of the
household. Insecticide sprays are not recommended.
Treating head lice
Treating Head Lice, a Fact Sheet prepared by the CDC in 2004, is helpful to families
and nurses.
Role of the School Nurse
The school nurse is the most knowledgeable professional in the school community
and so ideally
suited to provide education and anticipatory guidance to the school community
regarding best
Dear Parent/Guardian:
Your child was sent home today because he/she has head lice. Lice are small insects
which spend
their entire lives living on humans. Having lice is not a sign of poor hygiene habits.
Properly
treated cases are no longer infectious.
How would I know if my child has lice?
Lice cause scalp itching. Look for the lice or their eggs on the hair where the hair
comes out of
the scalp. Lice are small (less than 1/8 inch long), tan-colored insects, alive and
moving. They
prefer the back of the scalp, behind the ears, and above the neck. The eggs (nits)
are gray-white
specks glued to the hair. Eggs more than 1/4 inch out on the hair shaft are generally
dead or
empty. Even if you can't find the insects, lice must be there if the eggs are there.
How could my child get lice?
Lice don't jump or fly and depend on direct person-to-person contact or sharing of
personal items
such as combs, brushes, hats, scarves, jackets, sweaters, sheets, pillow cases,
blankets, etc. to
spread. Your child probably got head lice one of these ways.
How do you get rid of head lice?
You may purchase an over-the-counter, non-prescription product (RID*, A-2000*,
Nix*, or
Pronto*) from the drugstore, or physician-prescribed treatment. Follow the directions
as given on
the bottle. Repeat the treatment in 7 to 10 days to kill any surviving nits.
Clean personal items by any of the following methods:
1. Wash in hot water in washing machine
2. Put in hot dryer for 20 minutes
3. Dry clean
4. Store in a sealed plastic bag for one week
5. Boil combs, brushes, curlers, etc. for 10 minutes
6. Soak in 2% Lysol* and water for one hour
7. Freeze for 48 hours
Thorough vacuuming of carpeting, floors, and furniture is all that is necessary in the
rest of the
household. The insecticide sprays are not recommended.
How do I get the nits off after successful treatment?
Use a fine-tooth metal comb dipped in warm vinegar. It is important all nits be
removed.
REMEMBER: Head lice are not choosy about whom they infest. Anyone can get
them. They
cause no illness, only some inconvenience. The important thing is to treat promptly
and
thoroughly. Your cooperation is essential in preventing the spread of head lice.
If you have any questions, please feel free to call the (school nurse) at
(phone no.) .
Sincerely,
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* Brand names are mentioned for identification purposes and do not constitute
endorsement.
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determine the schools response to emergencies and the role of the school nurse.
Questions to
be considered:
o Have safety issues been addressed?
o Are emergency supplies adequate?
o Are additional school personnel trained in first aid and/or CPR?
o How (and who) will call 911 to activate EMS? Who will meet EMS responders and
guide them to the student?
o Who will assist the school nurse in the event of an evacuation or mass casualty?
o Does district policy address reporting injuries or illness?
o Under what circumstances does administration want to be notified?
o Are communication systems adequate?
_ Emergency equipment and supplies should be evaluated periodically (minimally at
the
beginning of each school year). These should be up-to-date and in working order.
The
school nurse should be comfortable with their use.
_ Parents/Guardians should be notified of acute, or potentially, acute conditions or
situations.
Information on when (i.e., signs and symptoms) to seek additional medical care
should be
reviewed at that same time.
_ Administration should be notified when 911 is called and for any serious
illness/injury. For
other situations, follow district policy or administrative directives.
_ The school nurse should be familiar with both state and local school/district policy
regarding
emergency procedures, including appropriate state/district documentation after the
incident.
Section C - 27 - 02-2006
Nursing Process
All school nurse assessments should follow the nursing process and include an
ABCD
assessment, both initial and ongoing:
Airway/C-spine immobilization
Breathing
Circulation
Disability (Neurological Status)
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If any of these initial assessments are abnormal, nurses should proceed with
emergency
resuscitation techniques including a c-spine immobilization, if necessary, and CPR.
EMS should
be activated immediately by calling 911. The students Emergency Treatment Card
should be
accessed and shared with EMS upon arrival. Once the initial or primary assessment
is complete,
a secondary assessment is necessary using the nursing process. The systematic
collection of data
should include subjective and objective data, diagnosis, plan/intervention and
evaluation of
outcomes.
Subjective
History
Objective
Inspection
Auscultation
Percussion
Palpation
Diagnosis
Plan/Intervention
Outcome and Evaluation
Within the following pages, recommended HIAPePa are provided along with specific
actions.
The most probable interventions are identified using the Nursing Intervention
Classification
(NIC) language; however, specific interventions are determined by the needs of the
student and
others may also be indicated. (Refer to Section B, pages 15-20). In all situations
these NICs
should be considered: Health Education, Health Care Information Exchange, Health
System
Guidance, Referral Management and Telephone Consultation.
The Guidelines for Parent/Guardian/Relative Caregiver (Section C, page 60) may be
helpful in
providing instructions.
ABDOMINAL PAIN
NIC: Bleeding Reduction: Wound; Bowel Management; Emergency Care (injury); First Aid;
Medication Administration; Pain Management; Rest; Vital Signs Monitoring
NOTE:
Good history taking is essential. There are many conditions related to abdominal pain,
some of which may be life-threatening. Abdominal injury is common in children and
may not be immediately obvious. Chronic or severe pain should be referred for medical
evaluation.
1. HIAPePa
a. During the assessment, consider:
Appendicitis
Bowel habit disturbance
Dehydration
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Dysmenorrhea, mittelschmerz
Emotional distress
Gastroenteritis
Heart attack
Henoch-schlonlein purpura
Internal injury
Obstruction
Pharyngitis
Pregnancy
Urinary Track Infection (UTI)
b. Assessment note:
Duration and location of pain. Most simple pains are at the center of the abdomen.
Pain level using the Wong-Baker Faces Pain Rating Scale at
http://www.intelihealth.com/IH/ihtIH/WSIHW000/29721/32087.html#wong or the numeric
scale (0-10 with o being no pain and 10 the worst, unbearable pain)
Fever, vomiting, or diarrhea and characteristics of emesis and stool
Groin pain, urine problems, or rash
When and how much did student last eat? (Spicy foods or foods high in lactose or sorbitol
are
associated with abdominal pain.)
Ask about relationship of pain to activity, meals, and time of day
o Night pain or pain on awakening suggests peptic origin.
o Pain that occurs in the evening or during dinner can be a feature of constipation.
Constipation is most often left sided or suprapubic.
Ask about sleep pattern.
Evaluate absentee record of the student, any stressors.
If female, does the student have menses?
What medications does the student take?
c. Red Flags persistent fevers, involuntary weight loss, deceleration of linear growth, GI
blood
loss, frequent vomiting, arthritis, chronic severe diarrhea, iron deficiency anemia, and
dysuria
2. Nursing Actions
a. Pain associated with injury:
Maintain ABCDs of emergency care.
Determine mechanism of injury and provide wound care (refer to Wounds in this section).
Call 911 for severe and/or persistent pain, rapid or thready pulse, diaphoresis, decreased
level
of consciousness, abdominal muscle guarding, rebound tenderness. Notify parent/guardian
and administration.
Avoid changing position of the student. Keep him/her warm and comfortable.
Monitor vital signs.
190
AIRWAY OBSTRUCTION
NIC: Airway Management; Airway Suctioning; Artificial Airway Management; Emergency
Care;
Medication Administration; Resuscitation
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NIC: Bleeding Reduction: Wound; Emergency Care; Hemorrhage Control; Vital Signs
Monitoring
NOTE:
Of special importance is addressing potential life threatening emergencies (i.e., shock,
hemorrhage) that may occur at same time as amputation. ABCDs of emergency care
must be a priority. Continue to reassess throughout care. The student will be
frightened and in extreme pain.
1. HI
2. The first priority is the student. Control bleeding.
a. Apply sterile gauze and direct pressure.
b. Immobilize and slightly elevate the extremity.
c. Do not apply tourniquet.
d. Keep student NPO.
3. Call 911. Notify parent/guardian and administration.
a. If EMS is delayed and it is necessary to clean the stump, use only large amounts of sterile
saline to flush the area.
4. Retrieve the amputated part.
a. Any size part should be retrieved and transported.
b. Gently rinse part with cool water or saline solution.
c. Do not rub or clean with soap, water or antiseptic solution.
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d. Wrap amputated part in sterile gauze soaked in saline solution or water. Part should be
kept
moist, but not soaked.
e. Place part securely in waterproof, plastic bag, and place on ice. It is preferable to double
bag. Do not freeze or allow part to come into contact directly with ice. Do not use dry ice.
The part needs to be kept cool, not frozen, to enhance the prospects of reattachment.
f. Label the bag with the name of the student and body part and transport with the student
to the
hospital.
5. Once bleeding is stabilized, monitor for shock and assess for additional injuries.
6. Future considerations:
a. Observe for signs of infection.
b. Promote wound healing.
c. Provide health education on wound care with student and parent/guardian.
d. Provide emotional support.
ANAPHYLAXIS
NIC: Airway Management; Emergency Care
Anaphylaxis is a life-threatening event that requires immediate medical attention. Public
schools are
provided with annual Standing Orders for the treatment of allergic reactions in undiagnosed
individuals.
Students with known life-threatening allergies should have individual emergency orders and
medication
available.
ASTHMA EPISODE
NIC: Airway Management, Airway Suctioning, Asthma Management, Emergency Care,
Medication
Administration, Vital Signs Monitoring
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BLISTER
BRUISE/CONTUSION
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BURNS
NOTE:
Burns may be associated with abuse, intentional self-mutilation or playing with fire.
THERMAL BURNS
NIC: Emergency Care; First Aid; Heat/Cold Application; Pain Management; Vital Signs
Monitoring;
Wound Care
195
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3. Notify parent/guardian for medical care as directed by Poison Control Center (1-800-7227112) or
if burn involves:
_ Face, hands, feet, groin or buttocks
_ Area greater than 2-3 inches
ELECTRICAL BURN
NIC: Emergency Care; First Aid; Heat/Cold Application; Pain Management; Respiratory
Monitoring;
Vital Signs Monitoring; Wound Care
1. If you are called to the scene, take care not to expose yourself or others to further
electrical shock.
Turn off current to electrical charge. DO NOT TOUCH THE VICTIM UNTIL POWER SOURCE
IS OFF.
2. Maintain ABCDs of emergency care.
3. Call 911. Notify parent/guardian and administration. All electrical burns must be evaluated
by a
healthcare provider due to the potential for cardiac dysrhythmias. Electrical burns may
appear
minimal on the surface, but can be more severe in underlying tissue.
4. HI
a. Check for entry and exit burns.
b. Consider underlying tissue damage.
5. Monitor/treat for shock, respiratory/cardiac distress and altered consciousness.
6. Cover burn with clean dry dressing.
CHILD ABUSE
Section C - 35 - 02-2006
CHOKING
COUGH
NIC: Airway Management; Allergy Management; Medication Administration; Pain
Management;
Respiratory Monitoring
NOTE:
Although rare, pertussis (whooping cough) has presented more frequently in recent
years even amongst those immunized. The American Academy of Pediatrics now
recommends a booster shot for children aged 11-18.
1. HIA
a. The assessment should include the throat, nose, ears and chest.
2. Reassure student as any difficulty in breathing can be frightening.
3. Identify and address any underlying or contributing factors; ex. allergic reaction, potential
upper
respiratory infection, trauma to neck, choking, etc.
4. The cough may be alleviated or reduced with frequent sips of water, a lozenge or a piece
of hard
candy. Choking precautions are important if the student is given something to suck on.
5. Notify parent/guardian.
a. Advise medical attention for:
_ Difficulty breathing
_ Stridor
_ Wheezing (if previously undiagnosed or reported)
_ Cyanosis
_ Lethargy
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DENTAL
AVULSED TOOTH
NIC: Bleeding Reduction: Wound; First Aid
1. HI
2. Notify parent/guardian and advise dental care.
Section C - 36 - 02-2006
3. Partially avulsed tooth
a. Reposition in mouth for stability.
4. Complete tooth avulsion
a. This is a dental emergency and care must be taken to replant tooth within 30 minutes.
b. Contact the parent/guardian for immediate transport.
c. Limit handling of avulsed tooth. Hold by the crown and not the roots.
d. Gently rinse the tooth in cool tap water. Do not use soap or other cleanser. Do not scrub.
e. Tooth should be placed in tooth socket to preserve and increase viability if possible.
f. If replantation takes longer than 30 minutes and the student is unable to hold in tooth
socket,
place tooth in moist saline gauze or milk during transport. Commercial products are also
available.
5. Future consideration:
a. Encourage mouth protection/guards during sport activities.
FRACTURED TOOTH
NIC: Bleeding Reduction: Wound; First Aid; Pain Management
NOTE:
Tooth injury may be related to falls, sports related activities, physical abuse or foreign
bodies (ex. tongue piercing).
1. HIPa
2. Observe for bleeding around gums, pain or chipped tooth.
a. External palpitation of the face and neck assesses for possible skeletal trauma with
accompanying tenderness and lymph node involvement indicates possible infection.
3. Notify parent/guardian and advise prompt dental care.
4. Future considerations:
a. Encourage mouth protection/guards during sport activities.
b. Discuss effect of some oral jewelry on teeth integrity.
LOOSE TOOTH (shedding of baby/deciduous tooth)
NIC: Bleeding Reduction: Wound; First Aid; Pain Management
1. HI
2. Encourage child to wiggle tooth to promote avulsion.
3. Indications for parent/guardian contact to refer for dental evaluation:
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Section C - 37 - 02-2006
3. Give analgesic, if directed by parent/guardian.
4. A compress, warm or cool, may provide some pain relief. Choice of temperature will
depend upon
students comfort.
5. Future considerations:
a. Encourage good oral health care, including routine dental exams.
b. Encourage a healthy diet, including snacking.
c. Determine fluoridation status of family/community water and advise PRN.
DIARRHEA/VOMITING
199
b. Vomiting: Only small sips (1 teaspoon to 1 ounce) of clear fluid should be encouraged.
c. Observe for signs of dehydration, fever, dry mouth, decreased urination, drowsiness,
sunken
eyes, bloody or dark stool/vomitus, severe or prolonged abdominal pain, inability to hold
down fluids for 8 hours, headache, stiff neck and lethargy. If any of these symptoms are
present, notify parent/guardian and advise immediate medical care.
3. Exclusion of the student is indicated if:
a. Diarrhea/vomiting is due to infection.
b. Student has more than three loose stools or requires frequent trips to the bathroom.
c. Diarrhea/vomiting is accompanied with fever or discomfort.
4. Notify parent/guardian and advise medical evaluation:
_ Diarrhea lasting more than 2 days
_ Fever
_ Vomiting
_ Severe pain
_ Unusual stools
_ Any signs of dehydration
Section C - 38 - 02-2006
_ Pregnancy
5. Future consideration:
a. Encourage frequent and good handwashing.
DYSMENNORRHEA
EAR
NOTE:
Ear pain or foreign body may be a result of an injury. Consider and evaluate for head
trauma.
FOREIGN BODY
NIC: First Aid; Pain Management
NOTE:
An impaled object should be stabilized so that the student can be transported without
further damage from the object.
1. HIPa
2. Only attempt removal if foreign body is easily visible upon external examination and
easily
grasped.
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3. If the object is a live insect, instill a few drops of mineral oil to the affected ear. Do NOT
instill if
there is any disruption in the tympanic membrane (i.e., tubes or injury). A flashlight beam
may
attract a live insect out of canal.
4. For other foreign bodies, do not irrigate the ear as it may cause swelling of the object and
make
removal difficult.
5. Notify parent/guardian and advise medical care and evaluation.
6. Future consideration:
a. Teach children not to put anything into their ears, including cotton swabs.
Section C - 39 - 02-2006
INJURY
NIC: Bleeding Reduction; First Aid; Heat/Cold Application; Pain Management; Wound Care
1. HI
2. If foreign body, refer to text above.
3. If bleeding externally, treat accordingly. (Refer to Wounds, Abrasions/Lacerations, Section
C,
pages 54-55)
4. If bleeding from ear canal:
a. Cover outside of ear with sterile dressing.
b. Lie on affected side.
c. Consider head/neck injury and treat/immobilize accordingly.
d. Monitor for shock.
e. Call 911. Notify parent/guardian and administration.
5. If bruise/contusion, refer to Bruise/Contusion, Section C, page 31.
PAIN
NIC: First Aid; Heat/Cold Application; Pain Management
1. HIPa
a. Determine if febrile.
b. Observe for pain with movement of auricle, tragus and pinna.
c. Observe for nasal discharge and respiratory congestion.
d. Otic exam can evaluate condition of ear canal and tympanic membrane.
(1) Fluid in the ear may cause erythematous and dull tympanic membrane with dull light
reflex and difficulty visualizing landmarks. Tympanic membrane may appear to
bulge with increased fluid pressure within middle ear.
(2) Edema, tenderness and erythemal of the canal may be visualized.
e. Observe for drainage.
(1) White or yellow discoloration of tympanic membrane may be present with infection.
2. Notify parent/guardian and advise medical care for abnormal signs and symptoms.
3. A warm moist compress may help alleviate some pain. Apply to affected ear and lie on
unaffected
side, unless there is drainage.
4. Future consideration:
a. Observe and refer for allergy symptoms, frequent pain or frequent congestion.
EYE
NOTE:
Immediate medical attention is needed for any sudden loss of vision or blurriness.
CHEMICAL BURNS (Refer to Burns, Chemical Burns, Eye, Section C, page 33)
CONJUNCTIVITIS
NIC: Heat/Cold Application; Medication Administration; Pain Management
NOTE:
If student wears contacts, advise removal and use of glasses during course of illness.
1. HI
2. Allergic conjunctivitis
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a. Conjunctiva may be red and both eyes may itch and burn, with clear tearing.
b. Observe for excessive rubbing of eyes and swollen, pale nasal mucosa.
c. Remove contacts.
Section C - 40 - 02-2006
d. Apply cold compress.
e. Notify parent/guardian and advise medical care for:
(1) Symptoms of infection;
(2) Accompanying, undiagnosed allergy symptoms.
NOTE:
In the case of bacterial or viral conjunctivitis:
_ Wash hands frequently and thoroughly.
_ Keep hands away from eyes.
_ Discard eye make-up.
_ Discontinue contact lens use until course of medication is completed.
_ Avoid sharing eye make-up.
_ Change personal towel, face cloth and pillow case often. Do not share.
3. Bacterial conjunctivitis
a. Assess eyes for red/pink sclera, inflamed lining of eyelid, photophobia, moderate tearing,
minimal itching, purulent discharge, dried discharge on eyelids and swollen eyelids.
b. Remove contacts.
c. Notify parent/guardian and refer for medical care.
d. Exclude from school until treatment is implemented or symptoms are gone for 24 hours.
4. Viral conjunctivitis
a. Assess eyes for red/pink sclera, inflamed lining of eyelid, profuse tearing, minimal itching,
sudden onset photophobia and pre-auricular node. Initially only one eye is involved.
b. Remove contacts.
c. Apply cold compress for comfort.
d. Advise student to keep hands away from eyes.
e. Notify parent/guardian to advise medical care if needed.
f. The student should be excluded from school until the following conditions are treated
and/or
resolved:
(1) Increased drainage or symptoms
(2) Symptoms of bacterial infection; i.e., treatable
(3) Being unable to refrain from touching eye(s)
5. Future considerations:
a. Monitor other students for possible infection.
b. Encourage routine and thorough handwashing.
CORNEAL ABRASION
NIC: First Aid; Pain Management
NOTE:
Contact lenses are a common source of corneal abrasions if worn too long or if foreign
body is trapped between lenses and cornea. Foreign bodies may cause corneal
abrasions as well as more severe injuries to the eye.
1. HI
a. Student will have pain, tearing, sensation of foreign body still in the eye, and
photophobia.
b. Visual acuity may be normal or slightly decreased.
2. Patching
NOTE:
Reference texts differ in recommendations regarding patching.
a. In general, it is advised that the eye be at rest until medical examination. The student
may be
willing and able to voluntarily keep his/her eyes closed.
Section C - 41 - 02-2006
202
b. In the event of bleeding, pain or other condition, the affected eye may be better protected
with patching. The student may be able to tolerate the patching of both eyes.
c. Small lesions with minimal discomfort may not need patching.
3. Notify parent/guardian and advise medical care from an eye specialist.
FOREIGN BODY
NIC: First Aid; Pain Management; Wound Care
NOTE:
If object is sticking out of the eye or embedded, do not touch or attempt removal. Seek
immediate medical attention.
1. HI
a. History is important because exposure to metal components in the eye have potential for
continued injury.
b. Determine if student is wearing contact lenses. Contacts should not be removed.
c. If there is a possibility of a metal foreign body, seek medical attention.
2. If the object is visible and floating such as an eyelash, encourage blinking. Flush well with
lukewarm water until object is out.
3. Treat as corneal abrasion (see above) if unsuccessful in removing the foreign body, or for
continued
pain, redness, tearing, sensitivity to light or discomfort.
4. Notify parent/guardian and advise medical care. Immediate medical attention is indicated
if:
_ Unable to remove object
_ Continued redness
_ Pain
_ Any signs of corneal abrasion
_ Any visual changes or complaints
5. Future consideration:
a. Encourage protective eyewear whenever engaging in a potentially hazardous activity that
can lead to trauma, dust/foreign body, chemical insult or heat to the eye.
INJURY (blow to the eye)
NIC: First Aid; Pain Management; Wound Care
NOTE:
Any severe blow to the eye requires medical attention. Head trauma and sports injuries
can lead to a detached retina. An orbital fracture or hyphema may occur with a blunt
force injury with a fist or ball such as a baseball, tennis ball or even a badminton birdie.
Any penetrating trauma requires stabilization of the eye using a paper cup or similar
object.
1. HI
2. Do not attempt to remove contacts.
3. Call 911. Notify parent/guardian and administration.
4. Apply cool compress, but avoid any pressure.
5. Encourage student to rest or lie comfortably with head elevated and eyes closed.
6. Future consideration:
a. Encourage protective eyewear whenever engaging in a potentially hazardous activity that
can lead to trauma, dust/foreign body, chemical insult or heat to the eye.
STY
NIC: Pain Management; Wound Care
1. HI
Section C - 42 - 02-2006
2. Remove contacts.
3. Gently apply warm compress to outer eyelid for 10 minutes.
4. Do not attempt to open the sty.
5. Indications for medical referral:
_ Interference with vision
_ Persistent, beyond several days
203
_ Reoccurring
_ Spreading
6. Future consideration:
a. Encourage use of warm compress several times a day until clear.
FAINTING
FATIGUE/MALAISE
Section C - 43 - 02-2006
FEVER
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HEAD/NECK INJURY
NIC: Emergency Care; First Aid; Heat/Cold Application; Neurological Monitoring; Pain
Management;
Rest; Vital Signs Management; Wound Care
NOTE:
Whenever a head injury occurs, consider accompanying injury to the neck/spine and vice
versa.
While most injuries at school are minor, they can be serious and should be assessed
thoroughly and appropriately referred for any concerns or unusual symptoms/complaints.
1. Maintain ABCDs of emergency care.
2. HIPa
a. History and mechanism of injury will yield important clues to injuries that may not be
readily
visualized.
b. Assess level of consciousness and the duration of any loss of consciousness following the
injury. The Glasgow Coma Scale is helpful when assessing injury and provides a baseline for
future evaluation in serious head injuries. It can be accessed at
http://www.bt.cdc.gov/masstrauma/gscale.asp.
c. Assess neurological status and personality/judgment since the event. Consider:
Section C - 44 - 07-2007
(1) Judgment, problem-solving
(2) Orientation to time and place
(3) Memory
(4) Affective disturbance
(5) Calculation disturbance
d. Assess for dizziness, headache, nausea or vomiting, confusion, and pallor. Do not move
the
student until fully assessed.
3. Call 911 and notify parent/guardian and administration for:
_ Any altered level or loss of consciousness
_ Any clear or bloody fluid from ears/nose
_ Darkness/bruising below eyes or behind ears
_ Decreased blood pressure
_ Dizziness
_ Loss of bowel or bladder control
_ Neurological/visual/respiratory changes
_ Seizure
_ Severe bleeding to face or scalp
205
_ Slurred speech
_ Stiffness or pain in neck
_ Tingling, paralysis or weakness of extremities
_ Unequal pupils
_ Vomiting/nausea
4. Have student lie flat and apply ice to injured area.
5. Immobilize for any suspected neck injury.
6. Monitor/treat for shock.
7. Caution:
a. Do not remove head gear or hat.
b. Do not wash the wound if there is a deep wound, imbedded object or severe bleeding.
c. Do not apply pressure to stop bleeding if fracture is suspected.
8. If student has only bumped his/her head and does not have any other complaints or
symptoms,
a. Treat with ice to injured area.
b. Observe throughout day for delayed symptoms.
c. Notify parent/guardian of head injury. Advise continued observation for 24 hours and
discuss
signs of a serious head injury that would need medical attention.
9. Future considerations:
a. Traumatic Brain Injury (TBI) can occur with little or no loss of consciousness. Be alert for
possible symptoms over next weeks and months.
b. Localized external swelling to head; i.e., goose egg, may take weeks to subside.
c. Encourage head protection during sport activities.
HEADACHE
Section C - 45 - 07-2007
Rare causes are:
* Aneurysm * Brain Tumor * Encephalitis
* Encephalitis * Meningitis * Stroke
* Transient ischemic attack
Additional references on headaches include:
* Kolar, Fisher & Gordon, (2001) Nurse, My Head Hurts: A Review of Childhood
Headaches. JOSN, 17, (3). Pp. 120-125.
* http://www.umm.edu/ency/article/003024.htm
* http://www.mayoclinic.com/health/headaches/HQ00428
1. HIPePa
a. Determine:
o Location
o Level of pain using the Wong-Baker Faces Pain Rating Scale at
http://www.intelihealth.com/IH/ihtIH/WSIHW000/29721/32087.html#wong or the numeric
206
scale (0-10 with 0 being no pain and 10 the worst, unbearable pain)
o Quality dull, aching, acute, throbbing, pressure
o Quantity intensity, how much pain is there
o Chronology how has the pain changed since it started?
o Setting where was the student when it started hurting? What was he/she doing?
o Aggravating and alleviating factors
o Associated manifestations what happened when it started (nausea, vomiting, vision
changes)?
o Diet/sleep/tension/other associated symptoms
b. History
o Relation to menstrual cycle, diet, post gym, sleep, medications, emotions
o Ask specifically about the use of oral contraceptives
c. Physical Signs vital signs, neurologic assessment, muscle tone
o Inspect head and face; palpate for tenderness.
o Are the lymph nodes enlarged?
o Assess eyes, ears, nose, and throat.
d. Red Flags sudden onset, increasing severity, severe pain on awakening, seizures, history
of head
trauma, fever, nuchal rigidity, increasing blood pressure, irritability, change in behavior,
lethargy,
slurred speech, extremely specific pain, petechiae or ecchymosis, and vomiting without
nausea
2. Notify parent/guardian and refer for medical attention if:
Altered behavior or personality
Altered consciousness, lethargy, or confusionBalance or gait disturbance
Bruising or petehiae
Fever
Head injury or history of head injury
Increased blood pressure
Increasing irritability
Neck stiffness or pain
Pain that wakes student from sleeping or is present upon waking
Persistent, progressing severity and frequency of headache during short time frame
Seizure
Skin rash
Sudden onset
Tingling
Violent or incapacitating pain
Visual disturbances
Vomiting and nausea
3. Nursing Interventions reassurance, rest in dark, quiet room for 15-30 minutes,
carbohydrate snack,
relaxation techniques, massage the neck and temples, ice packs to occipital region, or apply
cold
washcloths over eyes for 20 minutes
a. For children with frequent c/o of headaches:
1) Encourage independent management of pain. Praise and reward normal activity when
report of
pain has been made.
Section C - 46 - 07-2007
2) Encourage parents to treat pain requiring a reduction in activity as an illness. The child
should
remain in bed even if pain has resolved. Do not permit watching television, playing games,
or
special treatment.
207
3) Encourage and educate the parents and the student about the need to maintain a diary
about
headaches.
4) Reduce response to pain behavior.
5) Encourage student to discuss feelings use open-ended questions.
6) Counseling, stress management, and behavioral therapies such as biofeedback should be
considered.
7) Indoor air quality may affect headaches and need further investigation.
8) Consider dietary intake and allergies. (Potential dietary precipitants include: cheese,
processed
meats, chocolate, nuts, pickles, and monosodium glutamate).
b. Administer analgesics according to district policy, IHP, and parent/guardian permission
1) Many children respond well to ibuprofen. Consider any contraindications: bleeding
disorders,
GI issues, other medications, frequency of use
2) It is important to take enough medication, use the medication early in the course of the
headache, and have medication available at all times.
3) It is important to address the cause of the headache, rather than to mask the symptoms
with
analgesics.
c. Refer child to doctor if headache requires the child to be sent home more than once a
semester.
1) The International Headache Society suggests that if analgesics are used more than 9 days
each
month for headache, the child should be assessed by a physician.
2) Based upon diagnosis, an IHP may be needed.
4. Additional references on headaches include:
National Headache Foundation. Impact of headache on children at school and with their
families.
http://www.headaches.org/consumer/educationalmodules/childrensheadache/aghome.html
Andrasik, F. & Schwartz, M.S. (2006). Behavioral assessment and treatment of pediatric
headache.
Behavior Modification, 30(1), 93-11
208
a. If conscious, keep calm and reassure student. Have him/her rest comfortably, but do not
lie
down.
b. If unconscious, position in recovery position.
5. Future considerations:
a. Provide education to staff on early signs of cardiac arrest and CPR.
b. Determine if an AED is needed in the school based upon student/faculty profile.
Section C - 47 - 02-2006
HEAT EMERGENCIES
NIC: Emergency Care; Heat Exposure; Neurological Monitoring; Rest; Vital Signs Monitoring
NOTE:
Heat cramps may be the first sign of heat exhaustion, which untreated leads to heat
stroke.
HEAT CRAMPS
NOTE
Muscle cramps occur during exercise most often due to inadequate fluid replacement
during exercise.
1. HI
2. Move student to cool area.
3. Gently massage affected muscles.
4. If no vomiting, replace fluids with sports drink, such as Gatorade.
5. If no improvement or accompanied with other symptoms, notify parent/guardian and refer
for
medical attention.
HEAT EXHAUSTION
NOTE:
Heat exhaustion is usually triggered by exercise in hot weather, with fluid loss through
sweating.
1. HI
a. Assess body temperature.
b. Student will likely present with:
_ Pale, ashen skin
_ Cool, moist skin and sweating profusely
_ Weakness or altered mental status
_ Dizziness, nausea/vomiting and headache
_ Hypotension, tachycardia, tachypnea and severe thirst
_ Dark urine
_ Muscle cramps
_ Temperature elevation from slight to 104
2. Treatment:
a. Student should be placed in cool environment, preferably an air-conditioned area, lying
flat
with feet elevated.
b. If not vomiting, give sports drink or clear juice.
c. Place cool wet cloths on forehead and body.
d. Use mist and fan to cool student.
e. Loosen clothing and remove extra layers.
f. Monitor for shock.
3. Notify parent/guardian. Advise medical care if symptoms are severe, become worse or
persist
longer than one hour.
4. Future considerations:
a. Encourage wearing light, loose clothing during exercise and activities in the heat.
b. Maintain adequate hydration.
c. Avoid overheating if student is on medication that impairs heat regulation or is obese.
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Section C - 48 - 02-2006
HEAT STROKE
NOTE:
This is a medical emergency. The student can no longer control his central
thermoregulation mechanisms.
1. Maintain ABCDs of emergency care.
2. HI
a. The student will present with:
_ Reported exertion in hot environment
_ Core temperature is greater than 104-106
_ Mental status may be confused, non-responsive, irrational
_ Skin is red, hot and dry
_ Hypo/hypertension and tachycardia (with shallow or very strong pulse)
3. Treatment
a. Call 911. Notify parent/guardian and administration.
b. Move to cool environment, preferably with air conditioning.
c. Apply cool, wet cloths to neck, forehead and groin. Use fan to keep cool, but do not chill.
d. Monitor temperature and watch for shock.
e. If alert and not vomiting, give sips of clear juice or sports drink. Do not give caffeine.
f. Loosen clothing and remove any extra layers.
g. Do not give antipyretic.
h. Notify parent/guardian and administrator.
4. Future considerations:
a. Encourage wearing light, loose clothing during exercise and activities in the heat.
b. Maintain adequate hydration.
c. Avoid overheating if student is on medication that impairs heat regulation or is obese.
d. Review sun safety with students.
e. Share Parent Fact Sheet with staff and families:
http://www.kidshealth.org/parent/fitness/safety/heat_exhaustion_heatstroke_sheet.html.
IMPETIGO
NIC: Skin Surveillance; Wound Care
1. HI
a. Impetigo presents as isolated pustules or clusters of bumps, which rupture with yellow or
honey crusting. The skin is red and oozing. It typically appears on the face or hands.
b. The infection spreads quickly. It is usually caused by a break in the skin being infected
with
either staphylococcal or streptococcal infection.
2. Notify parent/guardian and refer for medical care.
3. Impetigo is contagious and students should be excluded from school for 48 hours after
treatment
has begun to prevent the spread to classmates.
4. Future considerations:
a. Monitor and assist with compliance with treatment.
b. Observe for new infection or spreading.
c. Encourage good handwashing, keeping fingernails short and clean and avoiding touching
wound sites. Primary Healthcare Provider may recommend covering some areas.
d. Promote healing by gently washing off crusted areas with warm soap and water.
e. Systemic infection or scarring is rare.
f. Clean wounds thoroughly.
g. Items such as clothing, towels or bed linens that have been infected should be thoroughly
washed in hot water.
Section C - 49 - 02-2006
INSULIN REACTION
210
MUSCULOSKELETAL INJURIES
NIC: Bleeding Reduction: Wound; Emergency Care; First Aid; Heat/Cold Application; Pain
Management
BACK AND NECK INJURY
See Head/Neck Injury, Section C, pages 42-43.
DISLOCATION AND FRACTURES
NOTE:
_ Any dislocation or fracture is an emergency situation due to possible disruption in
blood flow and injury to nerves.
_ It is difficult to distinguish between dislocation and fractures. A medical evaluation
is required.
1. HIPa
a. Note mechanism of injury and force of injury.
b. Assess range of motion and observe for deformity, guarding, pain, joint tenderness,
decreased movement, bruising, swelling and asymmetry.
c. Always assess and record peripheral neurovascular status.
2. Treatment
a. Dislocation or Simple Fracture
(1) Immobilize affected area in position found unless neurovascular status impaired. Do
not attempt to straighten or return to normal alignment.
(2) Apply ice to reduce swelling.
(3) Elevate if possible to reduce swelling.
b. Open Fracture
(1) Cover entire wound with sterile dressing.
(2) Control bleeding using standard precautions. Do not apply tourniquet.
(3) Immobilize affected area.
(4) Assess neurovascular status.
3. Call 911 for open fractures. Alternative transportation may be considered for dislocations
or simple
fractures. Notify parent/guardian and administrator.
4. Future consideration:
a. Stress fractures can occur in athletes.
SPRAINS AND STRAINS
NOTE:
It is difficult to distinguish between sprains (injury to ligament) and strains (injury to
tendons). Symptoms are similar to fractures and a medical evaluation is needed.
1. HIPePa
a. Symptoms include pain, difficulty weight-bearing, and swelling.
2. Treatment: RICE Rest, Ice, Compression and Elevation
a. Ice should be applied for 20 minutes at a time.
Section C - 50 - 02-2006
b. Use elastic bandage to provide support and reduce swelling.
3. Notify parent/guardian and advise medical care to rule out fracture.
4. Future consideration:
a. Elevation during the first 24 hours helps to reduce swelling.
NECK
See Head/Neck Injury, Section C, pages 42-43.
NOSE
EPISTAXIS
NIC: Bleeding Reduction: Nasal
NOTE:
Nosebleeds may be caused by nose picking, strong or frequent nose blowing, foreign
211
body, excessive dryness, rhinitis, injury, allergies, extreme hot/cold air, infection,
bleeding disorder, chemical irritant or high blood pressure.
1. HI
a. Consider possible head injury.
b. Determine medications and underlying health conditions as possible contributing factor.
2. If injury, see Fracture (below) or Wounds (Section C, page 54-59).
3. Control bleeding
a. External bleeding:
(1) Treat as wound (see Wounds, Abrasion/Laceration, Section C, page 54-55).
b. Anterior Epistaxis (bleeding out front of nose) or Posterior Epistaxis (bleeding down
throat):
(1) Pinch nose together at fleshy area. Hold for approximately 10 minutes.
(2) If bleeding does not stop, repeat pinch for 5 minutes. Apply cold/ice compress to
bridge of nose.
4. Notify parent/guardian and advise medical care if:
_ Unable to stop bleeding after 15 minutes
_ Student feels weak or faint
_ Excessive blood loss
_ Injury
_ Pale with tachycardia
_ Student is taking medication with blood-thinning effect
_ History of difficulty with blood clotting
5. Document contributing factors and amount of bleeding.
6. Future considerations:
a. For the remainder of the day: discourage nose blowing, picking or rubbing
b. If nasal mucosal dryness is a contributing factor, encourage increased air humidification.
Nasal membranes can be moisturized with thin layer of petroleum jelly.
c. Students with frequent nosebleeds should be referred for medical evaluation.
FOREIGN BODY
NIC: First Aid; Respiratory Monitoring
1. HI
a. Associated symptoms: difficulty breathing; sensation of something being in the nose;
purulent nasal draining; foul odor
2. Instruct student to breathe through the mouth and avoid inhaling through nose.
Section C - 51 - 07-2007
3. Instruct student to gently blow nose in attempt to dislodge and remove foreign object. It
may be
helpful to gently occlude the unaffected nostril.
4. If the foreign body is clearly visible and easily grasped, remove gently with tweezers. Do
not probe
or insert other object into the nose.
5. Notify parent/guardian and advise medical care if:
_ Purulent nasal discharge or foul odor
_ Unable to remove object
_ Possible infection
_ Difficulty breathing
_ Noisy breathing
FRACTURE
NIC: Bleeding Reduction: Nasal; First Aid; Respiratory Monitoring
NOTE:
Facial fractures are frequently associated with nose fractures. Always consider a
possible head/neck injury and monitor breathing.
1. Maintain ABCDs of emergency care.
2. HIAPa
a. Possible symptoms: bleeding, soft tissue swelling, hematoma, periorbital ecchymosis,
212
PAIN
213
e. Self-Report of Pain
o The Wong-Baker FACES scale is the preferred and most reliable assessment instrument of
children.
o Encourage pain diaries in students with chronic pain issues or frequent complaints of pain.
2. Nursing Intervention Strategies
a. The goal of interventions is to keep students in school. If this is not possible, then partial
or
complete return to school should be an early target.
b. Target possible underlying pain mechanisms, as well as symptom-focused management
addressing pain, sleep disturbance, anxiety, or depressive feelings.
c. Apply heat/cold pack as warranted.
d. Administer analgesics according to district policy, IHP, and parent/guardian permission.
e. Provide education regarding pain experience and pain problem, cognitive-behavioral,
behavioral
techniques (reinforcement), family interventions, physical interventions (massage, PT, OT),
and
systemic and regional pharmacological interventions.
f. Adverse school experiences are associated with increased recurrent pain levels.
g. Interventions that build up self worth and perceived academic competence may have
beneficial
effects on pain.
3. Additional References:
American Pain Society. Pediatric chronic pain: A position statement from the American Pain
Society.
http://www.ampainsoc.org/advocacy/pediatric.htm
Merkel, S. & Malviya, S. (2000). Pediatric pain, tools, and assessment. Journal of
PeriAnesthesia
Nursing, 15(6), 408-414.
McGrath, P.J. & Finley, G.A. (2005). Commentaries on pain in infants, children, and
adolescents.
PediatricPain Letter, 7(2-3). http://www.pediatric-pain.ca/ppl.
PEDICULOSIS
See Section C, pages 18-21.
Section C - 52 - 02-2006
POISONING
RASHES
214
NIC: Allergy Management; Heat/Cold Application; Pain Management; Skin Care; Skin
Surveillance
NOTE:
The Mayo Clinic website offers a Slide Show of Common Skin Rashes with
recommendations for care. Refer to http://www.mayoclinic.com/health/skinrash/
SN00016.
Rashes have varied causes. An accurate assessment (with history, inspection and palpation)
will help
determine cause and intervention. Common causes are:
_ Allergic reactions, which may lead to hives (refer to Allergies, Section C, pages 75-78)
_ Bites and stings (refer to Wounds, Bites and Stings, Section C, pages 54-59)
_ Contact dermatitis
_ Heat rash
_ Infection (refer to Communicable Disease Control, Section C, pages 6-21), such as
Varicella,
Measles, Scarlet Fever, Scabies (see below)
_ Reactions to plants, such as Poison Ivy, Poison Oak or Poison Sumac
_ Tinea (refer to Ringworm below)
RINGWORM (Tinea)
Section C - 53 - 02-2006
b. Pruritis is likely to be present.
c. Alopecia may be present in infections of the scalp.
2. Cover lesion.
3. Notify parent/guardian and refer for treatment.
a. For area on foot or skin, a pharmacist may provide direction.
b. Infected nails, scalp lesions or unresponsive lesions (after 10 days of antifungal cream)
require a healthcare providers evaluation.
4. Student should be excluded from school until under treatment.
5. Future considerations:
a. Avoid sharing of combs, brushes, hats, clothing, towels, socks or shoes.
b. Avoid going barefoot in school or public area.
c. Clean mats/floors with disinfectant that destroys fungus. Particular attention is needed for
those areas where floor comes in contact with bare skin; for example, a
gymnastics/wrestling
mat or pool area.
d. Keep skin clean and dry.
e. Wash skin and clothing after perspiring.
SCABIES
NIC: Infection Protection; Skin Care; Skin Surveillance
1. HIPa
a. Symptoms include:
(1) Red, raised lesions or rash at finger webs, wrists, elbows, knees, shoulder blades,
axillary folds, belt line and/or thighs. External genitalia of males may be involved.
Females may have areas at nipples, abdomen and lower part of buttocks.
215
SEIZURE
See Section C, pages 97-101.
Section C - 54 - 07-2007
NOTE:
_ Substance Abuse is the misuse or overuse of any (legal or illegal, prescribed or overthecounter) medication or drug, including alcohol.
_ More information is available on Substance Abuse (Section D, pages 3-6).
_ Some drugs can create extreme aggression and illogical thinking. Consider your
own safety and that of others. The priority is to maintain ABCDs of emergency care
and get immediate medical attention. Confrontation should be avoided. It is
possible that you will not be able to reason with the student or obtain a good history.
1. Maintain ABCDs of emergency care.
2. HIA
a. Determine level of consciousness and affect; i.e., anxious, fearful, restlessness,
excitement,
irritability, decreased fatigue, paranoia/delusions, sleepiness, unconsciousness, aggression.
b. Take vital signs with attention to possible significant increase or decrease in cardiac rate,
blood pressure, body temperature, and breathing.
c. Observe for mydriasis, seizure activity, tremors, cardiac murmurs, shortness of breath.
3. Keep student from harming self.
4. Call 911 for hospital evaluation. Notify parent/guardian and administration.
5. Future considerations:
a. Monitor for continued substance abuse.
b. Encourage appropriate follow-up.
c. Support school activities and programs that address substance abuse and related
conditions.
THROAT
SORE THROAT
NIC: Fever Treatment; Medication Administration; Pain Management; Respiratory Monitoring;
Rest
NOTE:
Most sore throats are caused by viral infection. An exception is Group A streptococcus,
which accounts for 15-30% of sore throats and requires antibiotics to reduce the risk of
216
rheumatic fever. Other causes of sore throats include: allergies, common cold, dry
weather, dust, flu, foreign body in throat, overuse of voice, mononucleosis and mouth
breathing.
1. HIAPePa
a. Assessment:
o Assess vital signs; rule out respiratory distress
o Examine color of skin, oral mucosa, posterior pharynx, and tonsils
o Heavy, gray malodorous exudates can be from Epstein Barr virus
o Examine neck for adenopathy
NOTE:
Strep throat symptoms: fever, white patches on throat, bright red throat, enlarged lymph
nodes in neck, petechiae on hard palate, headache, stomachache, nausea, and vomiting.
Viral causes more likely to be associated with cough, conjunctivitis, and diarrhea.
b. History:
o How long has throat pain been present?
o Is the pain sharp or dull?
o Does the student have allergies, post nasal drip (color and quantity)?
o Is the sore throat associated with fever, headache, or abdominal pain?
o Does the student have upper respiratory tract symptoms or distress?
o Is the student sexually active or having oral sex?
o What aggravates or alleviates the pain?
Section C - 55 - 07-2007
o What is the pain level? Use the Wong-Baker Faces Pain Rating Scale at
http://www.intelihealth.com/IH/ihtIH/WSIHW000/29721/32087.html#wong or the numeric
scale (0-10 with 0 being no pain and 10 the worst, unbearable pain).
2. Nursing Interventions
a. Administer antipyretic according to district policy, IHP and parent/guardian permission if
fever
present. Provide lozenges or analgesic for pain according to district policy, IHP and
parent/guardian permission.
b. Encourage adequate fluid intake.
c. Teach student gargling with warm salt water (1/2 teaspoon per glass) to relieve throat
irritations,
remove secretions, and promote healing.
d. Provide student with lemon and honey in warm tea.
e. Eliminate irritants from environment.
f. Encourage student to discard toothbrush and use a new one when symptoms resolve.
3. Notify parent/guardian if:
a. Prompt medical attention is indicated for any difficulty in breathing, swallowing, or
drooling (in
young child).
b. Refer for medical care for accompanying halitosis, blood in saliva, dehydration, exudates
of
pharynx or tonsils, fever over 103, hoarseness over one week, malaise, pain for more than
3 days
with no rhinitis, rash, chronic/recurring sore throat, tender or swollen glands, and/or contact
with
someone having strep infection.
c. If accompanied with elevated temperature, exclude from school (refer to Fever in this
section). If
no fever is present, the severity of symptoms should determine exclusion.
4. Future considerations
a. Symptoms should subside within a week.
TICK
(see Wounds, Bites and Stings, Tick Bite, Section C, pages 57-58)
217
Section C - 56 - 02-2006
_ Wound is difficult to clean
_ Tetanus booster is needed
4. If bleeding is mild or absent, gently clean wound with antiseptic soap and water, if
possible, and
bandage. An antibacterial ointment may be necessary.
5. Review wound care with student.
6. Indications for parent/guardian contact:
_ Need for medical evaluation
_ Need for observation at home
_ Injury occurs at school
_ Wound is dirty and/or there is a risk of infection or delayed healing
_ Need to review wound care
7. Future considerations:
a. Observe for signs of infection.
b. Promote wound healing.
c. Provide health education on ongoing wound care.
BITES AND STINGS
ANIMAL BITE
NIC: Bleeding Reduction: Wound; Emergency Care; First Aid; Heat/Cold Application;
Hemorrhage
Control; Vital Signs Monitoring
NOTE:
_ Dogs, cats, rodents, horses, reptiles, bats, raccoons and skunks can inflict deep
lacerations and puncture wounds and possible crushing wounds. Only warmblooded
mammals can carry rabies.
_ Often students are seen by the school nurse for bites that occurred outside of school.
The school nurse should not assume that appropriate care has been given. Notify
parent/guardian and public authorities of animal bites and assess for both student
and animals immunization status.
1. HIPa
2. Wound care
a. Control bleeding.
b. Clean bite area thoroughly with mild antiseptic soap.
c. Irrigate with saline or running water 2-5 minutes.
218
Section C - 57 - 02-2006
NOTE:
Human bites have not been linked with HIV transmission.
1. HIPa
2. Wound care
a. Control bleeding.
b. Cleanse wound thoroughly with mild antiseptic soap.
c. Rinse with copious amounts of normal saline.
d. Apply sterile bandage.
e. Apply cold compress to control swelling and bruising.
3. Refer for immediate medical evaluation if:
_ Skin is broken
_ Tetanus booster is needed
_ Hepatitis B vaccine is incomplete/unknown in either the victim or the biter
4. Notify administrator.
5. Indications for parent/guardian contact:
_ Skin is broken ( This creates potential for bacterial infection.)
_ Need for medical evaluation
_ Need for observation at home
_ Injury occurs at school
_ Need to review wound care
6. Future considerations:
a. Observe for signs of infection.
b. Promote wound healing.
c. Provide health education with student and parent/guardian on ongoing wound care.
INSECT STING (bees, wasps, ants, scorpions, some marine animals)
NIC: Allergy Management; Emergency Care; First Aid; Heat/Cold Application
NOTE:
_ If student has history of allergy to insect stings, follow his/her Emergency Plan.
_ Of particular concern are history of reactions (even local ones), multiple stings or
being stung in the mouth, neck or head.
1. HIPa
2. Observe for signs of anaphylaxis.
3. If insect is potentially poisonous or a known allergen:
a. Limit the students movements, particularly of the involved extremity. Increased
exercise/movement will increase circulation and thus spread.
b. Call 911 for poison or anaphylaxis. Notify parent/guardian and administration.
219
4. If there is a stinger, scrape off stinger with clean, hard surface. A credit card works well.
Do not
use forceps or tweezers as this may squeeze out additional venom.
5. Remove jewelry from areas distal to the sting.
6. Clean with mild antiseptic soap.
7. Apply cold compress or baking soda paste for comfort.
8. If swelling becomes extensive, advise medical care.
9. Notify parent/guardian of sting. Review wound care and signs of anaphylaxis and
infection.
SPIDER BITE
NIC: Emergency Care; First Aid; Heat/Cold Application; Skin Surveillance
NOTE:
_ If known allergy, follow Emergency Action Plan or physicians order.
_ Symptoms may occur for up to 48 hours.
Section C - 58 - 02-2006
_ Student may present without knowledge that a bite has occurred.
1. HIPa
a. Observe and monitor for signs of anaphylaxis.
2. Black widow or brown recluse spider bites can be life-threatening. (For picture, go to
http://www.mayoclinic.com/health/first-aid-spider-bites/FA00048)
a. Call 911 immediately. Notify parent/guardian and administration.
b. Monitor and maintain breathing and circulation.
c. Keep bitten area lower than students heart level.
d. Apply cold compress to area.
e. Keep student calm and inactive.
f. Transport spider with student, if possible, for identification.
3. Other spider bites
a. Cleanse wound well thoroughly with mild antiseptic soap.
b. Apply cold compress.
c. Remove jewelry from areas distal to the bite.
d. Notify parent/guardian.
4. Future considerations:
a. Monitor for several days. Look for flu-like symptoms, rash, infection, abdominal pain or
other.
TICK BITE
NIC: First Aid; Skin Surveillance
NOTE:
_ Tape the tick to a calendar or piece of paper with date inscribed. This will assist for
later identification and provide a record of the date of the bite should symptoms
develop.
_ Deer ticks are approximately 1/8 in length. When engorged, they can be 5-7 times
the original size. More information and pictures of a deer tick are available at
http://www.ent.iastate.edu/ImageGallery/ticks/deertick.html .
1. HIPa
2. Remove tick.
a. Coat with nail polish, petroleum jelly or mineral oil and wait for tick to disengage, or apply
forceps as close to the skin as possible at the attachment site and pull tick backward with a
firm, steady pressure. Take care not to crush or squeeze tick. If the mouth or head of the
tick separate, remove as you would a splinter and refer for medical care. Do not touch the
tick without a barrier.
b. If deer tick, refer for prompt medical attention.
3. Wash wound with mild antiseptic soap and water.
4. Always notify parent/guardian of a tick bite. They will need to observe for fever and other
symptoms, which could indicate Lyme Disease. Prompt medication is needed if these
symptoms
220
occur. While Lyme Disease is the most common illness associated with ticks in Delaware,
ticks
can carry other illnesses.
NOTE:
For more information on Lyme Disease, see
http://www.cdc.gov/ncidod/dvbid/lyme/lyme_brochure.pdf.
The symptoms of Lyme Disease usually occur within 4-20 days. Symptoms include: skin
rash,
developing into reddish circle with a clearing center. Non-specific flu-like symptoms such as
headache, stiff neck, fatigue, joint and muscle aches may also appear. A blood test to detect
Lyme
Disease is available, but results will not reflect infection until 2-4 weeks after the tick
exposure.
Section C - 59 - 02-2006
Late stage symptoms of Lyme Disease include muscle aches, joint pain, and nervous system
symptoms such as numbness or pain.
5. Future considerations:
a. Monitor for Lyme Disease or other infection.
b. Encourage wearing long sleeves and high socks/footwear when in the woods, along with
the
proper use of a pesticide for humans.
PENETRATING/PUNCTURE WOUND
NIC: Bleeding Reduction: Wound; Emergency Care; First Aid; Hemorrhagic Control; Vital Signs
Monitoring; Wound Care
NOTE:
_ Penetrating wounds may be caused by such things as an impaled object (ex. pencil)
or a gunshot wound.
_ A penetrating wound to the abdomen or chest is a medical emergency.
_ There may be minimal bleeding at the site. This is not indicative of the seriousness
or extent of the injury.
1. Maintain ABCDs of emergency care. Consider possible head, neck and spinal trauma.
2. HI
3. Do not insert anything into the wound area, including topical medication.
4. Do not attempt to remove an impaled object unless the object is obviously only in the
superficial
skin layer. Stabilize the object.
5. Call 911. Notify parent/guardian and administration. Do not leave student unattended by
nonmedical
personnel.
6. Keep student calm, comfortable and NPO.
7. Monitor vital signs and level of consciousness continually.
8. Special considerations:
a. Abdomen
(1) If abdominal contents protruding from wound, cover with sterile gauze moistened
with sterile saline.
(2) Do not attempt to replace organs in abdomen.
b. Chest
(1) Do not remove object from wound. Immobilize penetrating object.
(2) Cover wound with dry sterile gauze. Make an airtight seal over gauze with plastic
wrap or aluminum foil.
(3) If sucking chest wound, cover wound with dry sterile gauze, but seal only on three
sides.
c. Extremity
(1) Monitor pulse and neuro-vascular status of any affected extremity.
9. Determine tetanus status and share with emergency responders.
221
Section C - 60 - 02-2006
b. If deep, do not attempt to remove.
c. Soaking affected part in warm soapy water for 20 minutes may help to loosen and soften
the
splinter for easier removal.
d. After removal, thoroughly clean the wound.
4. Determine tetanus status.
5. Indications for medical referral:
_ Large splinter
_ Deep insertion
_ Tetanus booster needed
_ Dirty wound or splinter
_ Break or suspected break of splinter during removal
6. Notify parent/guardian. Review signs/symptoms of infection and indications for seeking
medical
evaluation.
* Uphold and Graham (2003): CLINICAL GUIDELINES IN FAMILY PRACTICE, FOURTH EDITION. Gainesville:
Barmarrae Books, Inc.
FEVER
Get extra rest and eat light meals.
Drink extra fluids every 15 to 60 minutes.
Ask your healthcare provider to recommend an over-the-counter medication to reduce the
fever. DO NOT TAKE ASPIRIN! CAN CAUSE REYES SYNDROME.
If fever persists for more than 2 days, increases to over 102, or symptoms continue to
worsen, contact your healthcare provider.
No school until fever-free for 24 hours.
UPPER RESPIRATORY INFECTION (COLD SYMPTOMS)
Ask your healthcare provider to recommend an over-the-counter medication to ease
symptoms. DO NOT TAKE ASPIRIN! CAN CAUSE REYES SYNDROME.
Drink plenty of fluids.
Use moist air from vaporizer to help relieve congestion.
Contact your healthcare provider if:
a.) breathing difficulties occur
b.) you cough up green or yellow phlegm that has a bad odor
c.) fever persists; or
d.) you feel sicker each day instead of feeling better
NAUSEA AND VOMITING
No solids for 8 hours.
Clear liquids only (not milk) until 4 hours have passed without vomiting. Start with one
tablespoon every 10 minutes. If vomiting does not occur, double the amount every hour. If
vomiting does occur, allow the stomach to rest for 1 hour and then start again. Key is to
gradually increase the amount of fluid until taking 8 oz. every hour.
222
Section C - 62 - 02-2006
Injury Illness
Nursing Intervention/Comments:
223
Section C - 63 - 02-2006
DELAWARE HEALTH
AND SOCIAL SERVICES 2004
Division of Public Health
224
Primary Contact:
Section C - 66 - 02-2006
School District Letterhead
2004
Delaware
[ date ]
Dear Parent:
RE: School Incident
On [ date ], a student brought a concealed sharp object to school. Several
students claim they
were stuck with the device. Please discuss this incident with your child. If
your child was
involved in the incident, contact your family doctor immediately and notify
the school by the
close of the next school day. Our phone number is [ number ].
We have been in contact with the Division of Public Health. Public Health
recommends the
following steps for your childs protection if your child was stuck:
If your child is previously vaccinated against hepatitis B (3 doses) NO
treatment is
necessary for protection against hepatitis B infection.
226
The School Nurse assists the physical education teacher with the program
modifications for the
student who is restricted in physical education activities due to health
problems.
Recommendations from the student's licensed healthcare provider should be
obtained in writing
and based on the activities in which the student can participate.
Temporary excuses for up to three consecutive days of modification in
physical education
classes for minor illness and injury may be issued by the school nurse.
Temporary Medical Excuse for Physical Education Modification
School District School Name
Student's Name Grade
Address
Student Referred by Date
(School staff member and title)
Nature of disease or injury
Length of time for modification
Will re-examination be necessary? Date
Student is able to do the following activities:
No physical activity Moderate Calisthenics
Non-vigorous physical activity Moderate running
Vigorous physical activity
Exercises such as
Beginning (date), this student would benefit from exercises such
as , which may be taken during physical education class.
Date Name of Physician (M.D. or D.O., N.P. or School Nurse)
Address
Section C - 69 - 02-2006
228
student maintain the highest level of wellness and thus maximize his/her
learning
potential. When providing specialized care, the school nurse should consider
the
students privacy, the amount of intrusion to the students learning
environment and
possible disruption to the educational process. Additionally, the school nurse
should
assure that current techniques and protocols are followed.
General Guidelines
The following guidelines are applicable to all students requiring specialized
nursing
procedures or management during school hours. All specialized procedures
require a
physicians order, which should include specific directions.
Physicians orders must be renewed annually (minimally) and when there
are any
changes. Examples would include, but are limited to:
gastrostomy/jejunostomy
feeding, tracheostomy suctioning, blood glucose testing, oxygen
administration and
catheterization.
All procedures must have written parent permission, which is renewed
annually
(minimally) and when there are any changes.
Emergency Plans from the physician should be available for any student
with a lifethreatening
condition. They should be updated and renewed annually (minimally).
Nursing care techniques should follow evidence based practice and
protocols, as are
presented in current, accepted pediatric nursing texts* or hospital/physician
guidelines.
Medical equipment should be used, maintained and cleaned according to
manufacturers directions.
Current directions and information should be available for school nurse
substitutes.
Recommended Texts
* Pediatric Nursing Procedures
Bowden, V. & Greenberg, C. (2003). Pediatric Nursing Procedures.
Philadelphia, PA:
Lippincott.
Hootman, J. (2004). Quality Nursing Interventions in the School Setting:
Procedures,
Models, & Guidelines, 2nd Edition. Scarborough, ME: NASN.
General Nursing
229
Section C - 72 - 02-2006
Date
Section C - 73 - 02-2006
Students Name
Individual Daily Prescribed Medication/Treatment
Date Time Medication/Treatment Comments/Reactions Initials*
*
Initials Full Name Initials Full Name
Initials Full Name Initials Full Name
Section C - 74 - 02-2006
Emergency Healthcare Plan
Name: DOB:
Teacher: Grade:
Medical Condition:
Symptoms of Condition:
Action/Treatment:
Parent/Guardian/Relative Caregiver: Phone:
Parent/Guardian/Relative Caregiver: Phone:
Physician: Phone:
Emergency Contact: Phone:
If symptoms of health problems above occur, the school nurse will assess the student and
institute the
prescribed action/treatment. The school nurse or designee will contact the
parent/guardian/Relative Caregiver
of the student. If a parent/guardian/Relative Caregiver cannot be reached, the emergency
contact person will be
called. Emergency personnel may be given a copy of this form.
Parent/Guardian/Relative Caregiver Signature: Date:
Physician Signature: Date:
Place
Students
Picture
Here
Section C - 75 - 02-2006
What is SNAP? SNAP identifies children with special health care needs in the
community for
emergency medical services (EMS) providers. SNAP encourages families to meet
with EMS staff in
their home before they have to make a 911 call. The program educates EMS
providers about the
unique needs of the child. Any child (0-21 years) with special emergency care needs
may enroll. No
231
family will be excluded if they feel they would benefit from SNAP. Participation is
strictly on a
voluntary basis. You may cancel enrollment at anytime.
How to enroll a child
1. Call the Emergency Medical Services for Children (EMSC) Office at 302-744-5415
and ask to
enroll in the SNAP program or you may also go to:
http://www.familyvoices.org/st/DE.htm to
download the forms in English or Spanish.
2. Complete the following documents:
_ Enrollment Form
_ Consent Form signed by parent or guardian
_ Emergency Information Form signed by the childs physician or licensed
healthcare provider.
3. Mail or fax completed SNAP documents to:
Special Needs Alert Program
Attention: Beth MacDonald, SNAP Coordinator
Office of Emergency Medical Services
Blue Hen Corporate Center
655 South Bay Road, Suite 4-H
Dover, DE 19901
4. EMSC will contact the local county EMS agency and complete the enrollment
process.
A SNAP call to 911
The family calls 911. Their address is flagged in the 911 system when the call is
placed from
the home phone. All responding units are notified that this is a SNAP child. The
emergency
medical responders can review the childs special information and prepare for
arrival in the
home.
When an emergency call is placed from school, you may identify the child as a
SNAP child.
SNAP children are identified by county according to their home address.
EMS providers are able to be more prepared to provide special care for children in
the
program.
For questions or more information contact Beth MacDonald at:
Phone: (302) 744-5415
Fax: (302) 744-5429
E-mail: beth.macdonald@state.de.us
DELAWARE HEALTH AND
SOCIAL SERVICES
Division of Public Health
This project was supported in part by grant number 1 H33 MC00112-03 from the
Department of Health and
Human Services, Health Resources and Services Administration, Maternal and Child Health
Bureau.
Section C - 76 - 02-2006
Allergy - Food
I. General Guidelines
232
233
Gaudreau, J. (2000) 1. The Challenge of Making the School Environment Safe for
Children with
Food Allergies. Journal of School Nursing, 16(2), 5-10.
The Food Allergy Network
10400 Eaton Place, Suite 107
Fairfax, VA 22030-2208
www.foodallergy.org
Section C - 77 - 02-2006
Dear Parent/Guardian:
This year, your childs class has a child with a life-threatening food allergy to
__________. I
am notifying parents/guardians/Relative Caregivers so that we can ensure a safe
and worry-free year
for the student and his/her family.
It is important that you understand an allergic reaction can occur from any contact
with the food
that causes the allergy. The child with a food allergy can be in danger if food is
spilled onto his/her
snack or lunch, or if the food is transferred unknowingly to an object the child may
touch.
Attached is a list of foods that may contain the food to which this child has an
allergy. Please
try to avoid sending in any foods from that list. If your child eats any of the foods
from the list during
the school day, please remind him/her that it is very important to wash his/her
hands thoroughly.
There will be a table in the cafeteria where no one eating the food causing the
allergy will be
permitted to sit. If your child brings food from the list or chooses those foods from
the cafeteria
menu, he/she will need to sit away from the special table.
Lets help our children to have a safe, happy and healthy school. If you have
questions or
concerns, please contact me. Thank you for your help.
Sincerely,
(School Nurse)
Allergy-Food developed 4-2001
Section C - 78 - 02-2006
Allergy - Latex
I. General Guidelines
A. What is latex?
Natural latex is produced from the rubber tree Hevea basiliensis. More than 400
medical
products contain latex including: stethoscopes, latex gloves, surgical masks,
adhesive
bandages, tape, syringe plungers, blood pressure cuffs, catheters and tourniquets.
Many
household items also contain latex such as balloons, dishwashing gloves, nipples for
baby
234
bottles and pacifiers, tires, bicycle handlebar grips, condoms, waistbands in clothing
and
swimming goggles. In addition, school items include: rubber bands, erasers, rubber
balls
and playground/track surfaces. It is important to know that many of these products
contain both latex and other chemicals. An individual may have a reaction to either
the
latex or the chemicals.
B. How latex allergy develops
The protein in latex acts as a sensitizer and the amount needed to cause a reaction
varies
from individual to individual. Those individuals that are at higher risk of becoming
sensitized include:
persons with history of multiple allergic conditions particularly to potatoes,
bananas,
papaya, tomatoes, kiwi, avocado and chestnuts
persons who have had multiple surgeries
persons who frequently use latex gloves or other latex-containing products.
Latex protein adheres to the powder in powdered latex gloves and each time these
are
donned and removed, the protein is released in the air and inhaled causing
exposure.
Washing hands before using gloves is important since any dirt can cause a possible
irritation and skin breakdown, increasing the risk of latex exposure. Prior hand
washing
removes oil-based ointments, gels and products that can combine with the proteins
and
increase the potential of exposure. Likewise, it is essential to wash your hands
thoroughly after removing the latex gloves since the proteins may have adhered to
your
skin. If hand lotion is applied prior to washing the hands then the proteins will more
tightly bond to the skin.
C. Types of skin irritation
Three types of skin irritation are associated with use of latex.
1. Irritant contact dermatitis
This is characterized by dry, itchy, irritated skin. It is not a true allergy and
develops over time. It can be caused by repeated hand washing, inconsistent
drying, use of cleaners and powders added to gloves.
2. Chemical sensitivity dermatitis
This is characterized as poison ivy-like blisters that appear 24-48 hours after
contact. This is not caused by the latex, but from the chemicals used to process it.
3. Latex allergy (immediate hypersensitivity)
This is characterized by itchy eyes and scalp, scratchy throat and respiratory
involvement. Hives and redness may result. Symptoms will usually occur within
minutes of exposure.
Expect sensitization if the following symptoms develop immediately after exposure
to
latex:
redness
hives (urticaria)
235
Section C - 79 - 02-2006
Section C - 80 - 02-2006
Asthma
Description
Asthma is a chronic inflammation of the airways (bronchioles). People with asthma
have hyperresponsive
airways that may over-react to specific asthma triggers for that person. The
inflammation
236
237
difficulty speaking in sentences, and decreased peak expiratory flow rate. Not all
people with asthma
may exhibit all of these symptoms.
It should be noted that the absence of wheezing upon auscultation may be
symptomatic of severe
respiratory depression.
1
2
http://www.aafa.org/display.cfm?id=9&sub=42
http://www.clevelandclinicmeded.com/diseasemanagement/pulmonary/asthma/asthma.htm
Section C - 81 - 02-2006
Preventative Measures
The person with asthma should have a thorough physical examination done by their
healthcare
provider. Additional testing may include lung function test, chest x-rays and/or sinus
x-rays. The
primary care provider may refer to an allergist, pulmonary specialist or internist.
Once a diagnosis is
made, the person should:
1. Know his/her asthma triggers and try to minimize exposure
2. Take the prescribed medication, which will likely include:
a. Maintenance medication, which is taken daily to decrease inflammation and limit
the
production of mucous
1. Inhaled corticosteroids
2. Cromolyn and Nedocromil
3. Theophylline, Sustained Release
4. Leukotriene Modifiers
5. Long-Acting Beta Agonists
b. Quick relief medication for prompt treatment of acute airflow obstruction and its
accompanying symptoms
1. Short-Acting Beta Agonists
2. Systemic Corticosteroids
3. Monitor the asthma through the use of a peak flow meter. A peak flow meter is a
device that
measures expiratory air flow. It can provide the earliest signs that an asthma is
changing and
determine which medication to take, how much to take, when to take it, when to call
your
doctor or to seek emergency care.
4. Know what to do when asthma symptoms continue to worsen. (Refer to the
Asthma Action
Plan.)
5. Follow an Asthma Action Plan, which is developed by the doctor,
parent/guardian/Relative
Caregiver and student.
Nursing Assessment and Intervention
Routine Procedures/Equipment
1. Review Asthma Action Plan with student at the beginning of each year.
2. Determine if the student knows his/her asthma triggers.
3. Have student demonstrate use of their peak flow meter and recording their peak
expiratory
238
Section C - 82 - 02-2006
239
http://www.mainehealth.org/mh_about/
Section C - 83 - 02-2006
model and advocate for students, their care and community issues such as Clean
Air, a safe environment, no smoking
policies and pollution control.
The school nurse serves as a liaison. The students case management involves
communication with the students
parent/guardian/Relative Caregiver, healthcare provider, educational staff, support
staff such as bus drivers, and
community agencies.
The school nurse must be a promoter of health and a healthy school environment in
order to increase awareness of what
constitutes the best learning environment and conditions for an optimum learning
experience. Normal activity levels for
students with asthma are encouraged and promoted.
240
Lastly, the school nurse serves as a resource person. He/she must be able to answer
questions from students, families,
healthcare providers, teachers, staff and the administration he/she serves. In order
to provide accurate and current
information, the school nurse must be aware of community resources that are
available for different ages and groups.
Resources
American Academy of Allergy Asthma and Immunology (AAAAI),
http://www.aaaai.org
American Lung Association (ALA), http://www.lungusa.org
Asthma Allergy Network Mothers of Asthmatics (AANMA), http://www.aanma.org
Asthma and Allergy Foundation of America (AAFA), http://www.aafa.org
Centers for Disease Control and Prevention (CDC) Healthy Youth! Asthma,
http://www.cdc.gov/HealthyYouth/asthma/index.htm
Maine Health, http://www.mainehealth.org
Medical Society of Delaware, http://www.msdhub/com, Clinical Guidelines for
Asthma
National Asthma Education and Prevention Program, National Heart, Lung, and
Blood Institute, http://www.nhlbi.nih.gov
Epi-Pen and Epi-Pen Jr. manufactured by Dey, Meridian Medical Technologies, Inc.,
http://www.epipen.com/pdf/PatientInsert.pdf
References
American Lung Association of Delaware, http://www.lungusa.org
Kavuru, M.D.; Mani S.; David M. Lang, M.D.; Serpil C. Erzurum. Asthma, The
Cleveland Clinic, Published January 22,
2003, Revised February 28, 2005.
http://www.clevelandclinicmeded.com/diseasemanagement/pulmonary/asthma/asth
ma.htm
Guidelines for the Diagnosis and Management of Asthma, NIH Publication No. 974051, July 1997, National Institutes of
Health, National Heart, Lung and Blood Institute.
NASN. Issue Brief, Role of the School Nurse, (2002).
http://www.nasn.org/briefs/2002briefrole.htm.
Update to Nurses: Partners in Asthma Care, NIH Publication No. 95-3308, October
1998, National Institutes of Health,
National Heart, Lung and Blood Institute.
http://www.nhlbi.nih.gov/health/prof/lung/asthma/nurs_upd.pdf.
General Information:
_ Name
_ Emergency contact Phone numbers
_ Physician/Health Care Provider Phone numbers
_ Physician Signature Date
_ Mild Intermittent _ Moderate Persistent _ Colds _ Smoke _ Weather 1. Pre-medication (how much and
when)
_ Mild Persistent _ Severe Persistent _ Exercise _ Dust _ Air pollution
241
242
Section C - 85 - 02-2006
243
The NASN has developed seven role concepts relative to working with children with
ADHD. It is the
professional school nurse that incorporates these standards while working with the
family and the
child with ADHD. The school system may be the first to identify symptoms that
necessitate
evaluation by a healthcare provider. The school nurse should not diagnose or
recommend
medication, but is responsible for making appropriate referrals.
Section C - 86 - 02-2006
As a provider of direct health care, the school nurse must have a sound knowledge
of ADHD. Many
of these children are risk takers, which may result in frequent injuries from
playground mishaps to
car accidents. School nurses provide care not only to the physical injuries of these
children, but also
to their emotional needs as they often make hurried and careless mistakes.
As a leader, the school nurses role extends beyond the classroom. The nurse is
often the only health
professional in the educational setting. Educating staff members and students about
ADHD is
necessary to assure that all persons have a sound understanding of this condition.
Communication
should also include the availability of outreach programs and support groups within
the community to
be a part of the educational understanding of ADHD.
The school nurse needs to have a sound knowledge of the legal aspects of public
laws relating to
education especially The Individual with Disabilities Act (IDEA) and Section 504 of
the Vocational
Rehabilitation Act of 1973 (Public Law 93-112; Public Law 101-476). These laws
provide the basis
for the childs right to a yearly individual education plan and may also reflect on the
childs
individualized healthcare plan. Screening updates, medication changes, and input
from the student
and family should also formulate the students health plan.
As a client teacher for a healthy school environment, the school nurses
responsibility is to create an
environment to achieve optimal wellness within the school community. Selecting
educational
materials for school libraries and media centers can assist staff and students on
recognizing signs and
symptoms of ADHD and medical, educational and psychological resources that are
available to these
students. Activating public resources for ADHD such as Children and Adults with
Attention Deficit
Disorder (CHADD) and local physicians and nurses who are experts on this subject
helps to educate
the community on ADHD.
244
The school nurse can enhance care by maintaining current knowledge of ADHD
literature and
research. Grants for research can contribute to the future of school nursing and
supplies direction for
the care of children in the school setting.
As the health care expert within the school system, the school nurse takes a
leadership role in the
development and evaluation of school health policies, making them appropriate for
a child with
ADHD or any other health condition. The school nurse represents all children by
participating in and
providing leadership to the coordinated school health program, crises/disaster
management teams, and
school health advisory councils.
The school nurse is a liaison who communicates with the family through telephone
calls, assures
them with written communication and serves as a representative of the school
community. Learning
successful techniques used in other school settings can assist the school nurse. The
school nurse also
communicates with community health providers and community healthcare
agencies while ensuring
appropriate confidentiality, developing community partnerships and serving on
community coalitions
to promote the health of the community. Participation in state and national
organizations serves to
provide collaboration, personal growth and knowledge of national and state
standards.
Resources
Attention Deficit Information Network, Inc.
475 Hillside Avenue
Needham, MA 02194
Tel: (617) 455-9895
Fax: (617) 455-5466
Section C - 87 - 02-2006
245
Section C - 88 - 02-2006
DiabetesHypoglycemia/Hyperglycemia Reaction
Hypoglycemic Reaction (Insulin Shock)
2. Observe student closely for improvement, check blood glucose in about 10-15
minutes.
3. If student shows no improvement, repeat previous steps, or if becomes
unconscious,
immediately call 911 for transport to hospital. Follow procedure for shock:
a. Keep warm
b. Elevate feet
c. Maintain patent airway
4. Notify parent/guardian/Relative Caregiver, physician, and administration.
*If unsure of insulin shock or hyperglycemia, the carbohydrates will not worsen
situation
(condition); so if in doubt, give carbohydrate.
Hyperglycemic Reaction
Section C - 89 - 02-2006
Section C - 90 - 02-2006
What to do in an Emergency
Hypoglycemia
Hyperglycemia
Diabetic Ketoacidosis
Section C - 92 - 02-2006
Hearing Aid
Recommended Protocol for Monitoring Students with a Hearing Aid
Description
Hearing aids amplify sounds and improve hearing. A hearing aid has a significant
impact on the
childs classroom participation, peer socialization, and overall educational
achievement. One that is
improperly used, malfunctioning, ill fitting or poorly equipped can compromise the
childs wellbeing.
Preventative Measures
It is recommended that the student have a weekly hearing aid check by the school
nurse, teacher,
speech pathologist, or other appointed school professional.
Nursing Assessment and Intervention
Maintain a list of students with hearing aids that includes:
1. Student: name, grade, classroom
2. Instrument: make, model, battery number, receiver number (if applicable), and
ear to which aid is
fitted
249
Section C - 93 - 02-2006
2. Battery compartment: If the hearing aid is not operating, check for proper battery
insertion.
Check to assure the +is placed next to the + on the battery compartment. If
battery
compartment is corroded, gently wipe with swab lightly dampened with rubbing
alcohol to
clean compartment and contacts.
Reinsertion
Have student reinsert hearing aid and make sure all switches are on to determine if
it is functioning.
Insert the earmold by pulling pinna back to enlarge the ear canal. With the mold
twisted slightly to
250
the rear of its seating position, insert in canal and twist forward to release pinna.
Referral:
If any problems are detected, notify parent/guardian/Relative Caregiver promptly in
order to address
the situation.
Role of the School Nurse
The school nurse provides a valuable support to students with hearing impairment.
Without periodic
monitoring, maintenance and compliance, the hearing aid can become ineffective
and compromise the
childs academic success and well-being.
Resources
American Speech-Language-Hearing Association website at
http://www.asha.org/default.htm.
Delaware Division of Public Health,
http://www.dhss.delaware.gov/dhss/dph/dpc/diabetes/html.
References
Galludet University (n.d.). Support services handout series number 5003 audiology
sheet: Hearing
aids and other listening devices. Retrieved July 11, 2005 from
http://clercenter.galludet.edu/SupportServices/series/5003.html
Galludet University (n.d.). Support services handout series number 5004 audiology
sheet: How to
check a hearing aid. Retrieved July 11, 2005 from
http://clercenter.galludet.edu/SupportServices/series/5004.html
Section C - 94 - 02-2006
251
252
Section C - 95 - 02-2006
253
Section C - 96 - 02-2006
Oxygen Administration
Description
Oxygen is a licensed drug under FDA standards, complete with indications,
contraindications, dosage
254
ranges and potential for toxicity. As a drug, its dosage and administration must be
directed by the
prescription of a licensed healthcare provider.
Symptoms
The decision of how much oxygen to administer to a patient is based on several
factors. The first
considerations are the directives within the healthcare providers standing order.
When the order is
PRN, the following should be considered:
Respiratory rate, pulse rate and blood pressure
Level of consciousness
Skin color and condition
Oxygen saturation (pulse Oximetry)
Presenting complaint/history of the chief complaint
Pre-existing condition (asthma, cardiac, etc.)
Age and size of patient
Nursing Assessment and Intervention
Routine Procedures Maintenance
Safe usage requires following the healthcare providers directions and the
manufacturers
recommendations, instructions or operating manual. Individuals who assume the
responsibility for
oxygen equipment and its use must be familiar with the hazards of oxygen, the
operational
characteristics of the equipment, and the precautions to be observed while using
oxygen. Some areas
to be aware of include:
a. If using a disposable cylinder, do not refill under any circumstances.
b. Oxygen cylinders in use must be secured in an upright position.
c. All oxygen cylinders not in use must be stored in a well ventilated area and safe
from
environmental hazards, tampering, or the chance of accidental damage to the stem.
If stored
upright, the cylinders need to be secured. If stored horizontally, the cylinders must
be on a level
surface where they will remain stationary.
d. The content indicator should be checked at least monthly to determine amount of
oxygen in the
cylinder. This should be documented.
e. Common hazards associated with oxygen are ignition or heating sources. Friction
toys can create
sparks that can ignite oxygen. Cylinders must be kept away from these hazards.
f. Oxygen cylinders are required to have an expiration date. Equipment will need to
be recertified
periodically.
Emergency Equipment/Procedures
a. Have a standing order or PRN for emergency oxygen.
b. Select appropriate size mask or cannula.
c. Check tubing and cannula to be sure it is not twisted or kinked.
255
d. Attach cannula and tubing to oxygen source securely. (Some units also have
humidification
attachments.)
e. Set flow, if possible, to ordered rate.
f. Check for oxygen coming out of source.
g. Apply cannula or face mask to patient. When using nasal cannula, instruct patient
to breath
through the nose.
h. Monitor patients respiratory status.
i. Report signs and symptoms to medical personnel.
j. Document incident in student/staff file.
Role of the School Nurse
The need for oxygen administration may be a frightening time for the patient. The
placement of a
mask or nasal cannula may add additional fear to a patient who is already
experiencing breathing
difficulties. Clearly the role of the school nurse during oxygen administration is
providing
continuous medical assessment of vital signs and physical assessment of
respiratory status while
reassuring the patient.
References
Guide for the Safe Storage, Handling and Use of Liquid Oxygen in Health Care
Facilities, 2nd Edition,
(2000). Compressed Gas Association (CGA), Pamphlet CGQ p 2-7.
AARC Clinical Practice Guideline: Selection of an Oxygen Delivery Device for
Neonatal and
Pediatric Patients. (2002). Respiratory Care. 47(6), 707-716.
Guidance for Industry, May 2003. Retrieved at FDA:gov/cder/guidance/3823dft.pdf
on 7/21/05.
Seizure Management
Description
Epilepsy is a chronic, neurological condition that is characterized by the repeated,
unprovoked
occurrence of seizure activity. It is the main cause of seizure activity in the schoolaged student.
Approximately 2.3 million individuals are affected by epilepsy. Annually 181,000
Americans
develop epilepsy each year.
An Emergency Plan should be on hand for any student with known seizures.
Physicians orders
related to procedure should be in place.
Etiology
Seizures occur from malfunctions of the brains electrical systems. Conditions
resulting in a single
seizure or epilepsy include such things as genetic/congenital disorders, trauma,
fever, infection,
electrolyte imbalance or hormonal changes.
256
Symptoms
Seizure Classification
A. Absence Seizure brief lapses of consciousness (1-4 seconds) that look like
daydreaming, but
begin and end abruptly.
1. Partial Seizure either type may evolve into a generalized tonic-clonic seizure.
2. Simple Partial activity begins in and is usually limited to one part of either the
right or left
cerebral hemisphere and occurs without loss of consciousness; can present as
limited motor
activity, emotions, feelings, or sensations
B. Complex Partial seizure occurs with impairment in the level of consciousness.
Produce
automatic movements and a period of confusion. Movements may look purposeful,
but are not.
C. Generalized Tonic-Clonic Seizure affects the whole brain and body. There is loss
of
consciousness with stiffening and jerking. May fall. May have loss of bladder and/or
bowel.
Lasts an average of 1-2 minutes.
Preventative Measures
Triggering factors may be identified through careful and detailed documentation
that highlights a
pattern. Avoidance of triggers can reduce the incidence of the seizure. The goal in
epilepsy
management is to reduce the frequency and severity of seizures. Treatment
includes drug therapy,
surgical intervention, vagus nerve stimulatus and ketogenic diet.
Nursing Assessment and Intervention
A. Emergency Nursing Interventions for Generalized Tonic-Clonic Seizure
1. Lower the student to the floor and remove any objects in the area to prevent
injury. Leave the
student where he/she was when the seizure began as long as there is no
environmental
danger.
2. Turn the student to the side to prevent aspiration.
3. Loosen tight clothing.
4. Stay with the student and do not try to restrain movements, but protect the head.
5. Never put anything into the students mouth.
257
Please complete all questions. This information is essential for the school nurse and
school staff in
determining your students special needs and providing a positive and supportive
learning
environment. If you have any questions about how to complete this form, please
contact your childs
school nurse.
258
Effective Date
Students Name: Date of Birth: Classroom:
Parent/Guardian/Relative Caregiver: Phone: Cell:
Treating Physician: Phone:
Medical History:
Seizure Information:
1. When was your child diagnosed with seizures or epilepsy?
2. Seizure type(s):
Seizure Type Average length Description
1.
2.
3.
Students Name
Emergency Response:
A seizure emergency for this student is defined as:
11. What emergency/rescue medications are prescribed for your child?
Name Dosage Administration instructions
(timing* & method**)
What to do after
administration:
1.
2.
* After 2nd or 3rd seizure, for cluster of seizure, etc. ** Orally, under tongue, rectally, etc.
Seizure Emergency Protocol: (Check all that apply and clarify below)
_ Contact school nurse at
_ Call 911 for transport to
_ Notify parent or emergency contact
Telephone number
_ Notify doctor
Telephone number
_ Administer emergency medications as indicated
_ Other
Does student have a Vagus Nerve Stimulator (VNS)? YES NO
If YES, describe magnet use
Special Considerations & Safety Precautions:
(regarding school activities, sports, trips, etc.)
259
STUDENT
AURA: Yes No If yes, Type: _ auditory _ tactile
_ olfactory _ visual
Date: Time:
DID STUDENT MAKE ANY NOISES? Yes No
DURATION (length of time):
DESCRIPTION OF MOVEMENT & BEHAVIORS (stiffness, shaking, repetitive behaviors,
other)
LOSS OF CONSCIOUSNESS: Yes No If yes, how long:
ONSET: Face: Rt. Arm: Rt. Leg: Left Arm: Left Leg:
Spreading: Generalized at Onset:
Turning of Eyes: Turning of Body: Direction:
POSTICTAL STATE: A) Sleepiness Yes No
B) Drowsiness Yes No
C) Confusion Yes No
D) Psychotic Behavior Yes No
If answer to D) is Yes, Describe:
DESCRIBE INJURIES, IF ANY:
INCONTINENCE: Bowel - Yes No
Bladder - Yes No
EXCESSIVE SALIVATION: Yes No
CYANOSIS: Yes No
COMMENTS:
Witnessed by:
Signature Title
Contacted: _ Parent/Guardian/Relative Caregiver Date: Time:
_ Licensed healthcare provider Date: Time:
_ Other Date: Time:
261
The NASN Position Statement, Nursing Classification Systems: NANDA, NIC & NOC,
provides an
overview. It can be accessed at http://www.nasn.org/positions/2001psnursing.htm.
1
Section D.
School Programs and Resources
I. The Delaware Education Support System (DESS)
II. Connections to Learning
A. Overview
B. The Role of the School Nurse
III. Connections to Learning Subdomains
A. Health, Nutrition and Physical Activity
1. Dental Health
2. Driver Education
3. Health Education
4. Nutrition
5. Physical Activity
B. School Climate
1. School Crisis Plans/ Emergency Preparedness
2. Staff Wellness/ Back Protection
3. Recommended Space and Supplies/Equipment in the School Nurses
Office
C. Social and Emotional Health
1. Caregivers Law
2. Child Abuse and Neglect
3. Domestic Violence
4. Homeless Students
5. Mental Health
6. Safe Arms for Babies
262
To promote the highest quality education for every Delaware student by providing
visionary
leadership and superior service.
DESS provides a framework for building district capacity to address Leadership for Learning, Teaching
and
Learning, and Connections to Learning through a wide range of services to Delaware public school
districts,
schools, early childhood programs, and interagency collaborative projects. The individual student (birth to
age
21) is at the center of each domain of the DESS model.
Leadership for Learning strengthens administrative leaders within districts and schools. Teaching and
Learning addresses curriculum and teaching strategies. Connections to Learning brings together
support
systems and those areas that influence the childs overall social, emotional and physical well-being. By
increasing communication and focusing on connecting areas that support student learning, school teams
will
work more efficiently to improve student success. Health Services is a part of Connections to Learning.
Connections to Learning is a strategy to support student learning by supporting the whole child.
Within this
domain are three interconnected subdomains that identify critical areas of focus that impact student
learning:
1. Health, Nutrition, and Physical Activity
2. School Climate
3. Social and Emotional Health
Connections
to
263
Learning
Teaching
and
Learning
Leadership
for
Learning
Section D - 4 - 9-2008
CONNECTIONS TO LEARNING
Character Development Family & Community
Collaboration
Diversity
264
Most nurses are familiar with a Coordinated School Health Program (CSHP), which is a
multidimensional
program that increases the probability of having a healthy student who is ready to learn
and one who will learn to his/her potential. There are many similarities between Connections to
Learning and a CSHP Program model. It is a school-based program with a broad spectrum of
activities
and services which take place in schools and the surrounding communities to enable all members
of
the school community to enhance their physical, mental and social well-being. For many years
the
literature referred to a school health program as being comprised of three components - health
education, health services, and a healthy school environment. The CDC model, which appeared
around
1990, created a broader context of the school health program to include the physical education
program, counseling and psychological services, food service programs, health promotion for the
faculty and staff, and integrated efforts of the school, community, and parents to address the
health of
students. The rationale for an expanded model was simple - by coordinating the efforts and
resources
of programs designed to improve the health of students and staff, the result could produce greater
effectiveness than if delivered in isolation.
Schools with any sort of student support teams already in place (CSHP, Positive Behavior
Support,
Student Assistance, Wellness Policy, etc.) will find the Connections to Learning philosophy
parallels
their foundational concepts. Building on an existing team, additional members will need to be
added to
ensure every subdomain is represented.
The Connections to Learning book, which provides more details is available at the following
link:
http://www.doe.k12.de.us/programs/DESS/connections_to_learning.shtml
School
Climate
Social & Emotional
Health
Health, Physical
Activity & Nutrition
Section D - 7 - 9-2008
265
services and screening for potential health problems. School nurses advocate for, plan, and
implement
diverse programs to meet identified needs. The rising numbers of chronic illness among children
has
initiated new programs and strategies for school nurses to use with students, schools, and
families.
Working with community partners and national programs, school nurses provide health
education and
connect families with necessary resources.
School Nurses are known experts in the area of school health, making them key players in the
integration of Connections to Learning. Possessing excellent collaboration skills, school nurses
can
easily facilitate the development of meaningful partnerships among school staff, families and
communities to maximize student health and well-being. Together they can help students gain
the
knowledge, skills and awareness of resources to help them grow up to be healthy and productive
adults. The dual roles and the many responsibilities that school nurses possess make their
practice
instrumental in promoting a positive school climate, increasing academic achievement,
enhancing
lifelong wellness among students, families, educators, and communities. As a Connections team
member, the school nurse contributes by sharing health information (statistics, trends, etc.),
analyzing
health data in conjunction with other data sets, and contributing to school and student success
planning.
Resources:
Centers for Disease Control (CDC) Healthy Youth: http://www.cdc.gov/HealthyYouth/index.htm
National Association of School Nurses: www.nasn.org
U.S. Department of Health and Human Services: www.healthypeople.gov
Section D - 8 - 9-2008
the dental health program and makes appropriate referrals. In 2006 a Sealant Program was
initiated for
all second graders to meet underserved areas.
Objectives:
To assist the student in assuming responsibility for his/her dental hygiene.
To include dental health activities with the total school health program.
Activities:
Emphasize early and regular periodic examination.
Assist families in accessing local dental services.
Contact the state service center for referrals to the dental clinic (current list of Medicaid
dentist list is provided on the following pages).
Participate in health education regarding dental hygiene.
Encourage appropriate nutritional choices.
Encourage the use of mouthguards in contact sports to prevent injury and loss of teeth.
Discourage the use of all tobacco products.
Contact the Delaware State Dental Society (www.delawarestatedentalsociety.org) for more
information.
Section D - 10 - 9-2008
267
Section D - 11 - 9-2008
Brafman Kevin General/Family/Pediatric S 31381 DOGWOOD ACRES
RD
UNIT 2 Dagsboro DE 19939 302-732-3852 Dagsboro
Brafman Wendy General/Family/Pediatric S 31381 DOGWOOD ACRES
RD
UNIT 2 Dagsboro DE 19939 302-732-3852 Dagsboro
Bragan Georgette General/Family/Pediatric N 625 BARKSDALE RD SUITE 115-117 Newark DE 19711 302-731-4907 Newark
Brenner Charles Pedodontist MD 145 EAST CARROLL
STREET
SUITE 201 Salisbury MD 21801 410-749-0133 Salisbury,
MD
Bresler David General/Family/Pediatric PA 6801 RIDGE AVENUE Philadelphia PA 19128 215-483-6633 Philadelphia,
PA
Bright Jeffrey General/Family/Pediatric N 600 NORTH BROAD STREET SUITE 7 Middletown DE 19709 302-376-7882 Middletown/
Odessa
Broder Michelle General/Family/Pediatric N 2300 PENNSYLVANIA AVE SUITE 5C Wilmington DE 19806 302-652-1533 Wilmington
Broomall Pediatric Dentistry
and Orthodontics PC
General/Family/Pediatric PA 1999 SPROUL ROAD SUITE 14 Broomall PA 19008 610-356-1454 Broomall,
PA
Bunting Lucinda General/Family/Pediatric K 615 N DUPONT Milford DE 19963 302-424-7976 Milford
Burke John General/Family/Pediatric N 3105 LIMESTONE ROAD SUITE 305 Wilmington DE 19808 302-995-7128 Wilmington
Burns Christopher Prosthodontics K 871 SOUTH GOVERNORS
AVENUE
SUITE #1 Dover DE 19904 302-674-8331 Dover
Cahoon Michael Oral Surgeon S KINGSWAY
PROFESSIONAL BLDG
750 KINGS
HIGHWAY STE 107
Lewes DE 19958 302-644-4171 Lewes
Calhoon Charles General/Family/Pediatric N 17 POLLY DRUMMOND CTR
102
Newark DE 19711 302-731-0202 Newark
Capodanno John Oral Surgeon K 1001 S BRADFORD ST SUITE 2 Dover DE 19904 302-674-4450 Dover
Carr Suk Young Endodontist K 850 SOUTH STATE STREET Dover DE 19901 302-736-6631 Dover
Carroccia Richard General/Family/Pediatric N 1415 FOULK ROAD SUITE 200 Wilmington DE 19803 302-477-4900 Wilmington
Cha Moon General/Family/Pediatric N 344 E. MAIN STREET NEWARK DENTAL
ASSOCIATES
Newark DE 19711 302-737-5170 Newark
Chodroff Richard Periodontist N 3105 LIMESTONE ROAD SUITE 203 Wilmington DE 19808 302-995-6979 Wilmington
Chou Joseph General/Family/Pediatric N 344 E. MAIN STREET NEWARK DENTAL
ASSOCIATES
Newark DE 19711 302-737-5170 Newark
Christian Paul General/Family/Pediatric N 423 EAST MAIN STREET ASHLEY PLAZA Middletown DE 19709 302-376-9600 Middletown/
Odessa
Christiana Care
Department of Dentistry
General/Family/Pediatric N 501 WEST 14TH STREET PO BOX 1668 Wilmington DE 19899 302-428-4850 Wilmington
Christiana Care
Department of Dentistry
Specialist N 501 WEST 14TH STREET PO BOX 1668 Wilmington DE 19899 302-428-4850 Wilmington
Section D - 12 - 9-2008
Cicorelli Connie General/Family/Pediatric N 1401 SILVERSIDE ROAD SUITE 2A Wilmington DE 19810 302-798-5797 Wilmington
Clay Rosemary General/Family/Pediatric N 533 MAIN STREET Wilmington DE 19804 302-998-0500 Wilmington
Cole Jeffrey General/Family/Pediatric N 2396 LIMESTONE ROAD Wilmington DE 19808 302-633-2900 Wilmington
Collins Dale Pedodontist N 5500 SKYLINE DRIVE Wilmington DE 19808 302-239-3655 Hockessin
Collins Gary Orthodontist N 5500 SKYLINE DRIVE Wilmington DE 19808 302-239-3531 Wilmington
Collins Lynn Pedodontist N COLLINS DENTAL ASSOC 38 PEOPLES PLAZA Newark DE 19702 302-834-4000 Newark Sees children
up to age 14
Collins Lynn Orthodontist N COLLINS DENTAL ASSOC 38 PEOPLES PLAZA Newark DE 19702 302-834-4000 Newark Sees children
up to age 14
Collins Robert General/Family/Pediatric N 5500 SKYLINE DRIVE Wilmington DE 19808 302-239-3655 Hockessin
Collins Ron Pedodontist N COLLINS DENTAL ASSOC 38 PEOPLES PLAZA Newark DE 19702 302-834-4000 Newark Sees children
up to age 14
Collins Ron Orthodontist N COLLINS DENTAL ASSOC 38 PEOPLES PLAZA Newark DE 19702 302-834-4000 Newark Sees children
up to age 14
Conaty Thomas General/Family/Pediatric N 2003 BRANDYWOOD LANE Wilmington DE 19810 302-478-5269 Wilmington
Conley Thomas General/Family/Pediatric S 55 RT 24 Lewes DE 19971 302-645-6671 Lewes
268
Coope Robert General/Family/Pediatric K 863 BUTTNER PLACE STE 203 Dover DE 19904 302-741-2044 Dover
Cornatzer Joseph General/Family/Pediatric N 7197 LANCASTER PIKE Hockessin DE 19707 302-239-5917 Hockessin
D'Amico Eugene Oral Surgeon N B92 OMEGA DR Newark DE 19713 302-292-1600 Newark
Daniels V.J. General/Family/Pediatric N 2300 PENNSYLVANIA AVE SUITE 2C Wilmington DE 19806 302-655-8387 Wilmington
D'Antonio Richard General/Family/Pediatric N 1415 FOULK ROAD SUITE 201 Wilmington DE 19803 302-477-4900 Wilmington
D'Arro Carmelina General/Family/Pediatric N 601 NEW CASTLE AVENUE Wilmington DE 19801 302-655-6187 Wilmington
Deakyne David General/Family/Pediatric K 27 DEAK DRIVE Smyrna DE 19977 302-653-6661 Smyrna
Deakyne, Jr. David General/Family/Pediatric K 27 DEAK DRIVE Smyrna DE 19977 302-653-6661 Smyrna
Dearing Gregory Endodontist N 112 SAINT ANN'S CHURCH
RD
Middletown DE 19709 302-285-0350 Middletown/
Odessa
DeCouto Douglas General/Family/Pediatric N 1290 PEOPLES PLAZA Newark DE 19702 302-836-3750 Newark
Section D - 13 - 9-2008
Del Tech Dental Health Center General/Family/Pediatric N 333 N. SHIPLEY STREET Wilmington DE 19801 302-571-5364 Wilmington
Delmarva Rural Ministries General/Family/Pediatric K 26 WYOMING AVENUE Dover DE 19904 302-678-2000 Dover
Derenzo George Pedodontist N 2000 FOULK ROAD SUITE C Wilmington DE 19810 302-475-3110 Wilmington
Diecidue Robert Oral Surgeon PA 834 CHESTNUT STREET,
STE 311
C/O JUP CNTRL
ENROLLMENTS
Philadelphia PA 19107 215-955-9628 Philadelphia,
PA
Director Robert Endodontist N 1110 NORTH BANCROFT
PKWY
Wilmington DE 19805 302-658-7358 Wilmington
Ditty Douglas Oral Surgeon K 1001 S BRADFORD ST SUITE 2 Dover DE 19904 302-674-4450 Dover
Dougherty Thomas Oral Surgeon N 5317 LIMESTONE ROAD Wilmington DE 19808 302-239-2500 Hockessin
Dover Junior General/Family/Pediatric N 1290 PEOPLES PLAZA BEAR-GLASGOW
DENTAL
Newark DE 19702 302-836-3750 Newark
Dunhoft Korie General/Family/Pediatric N COLLINS DENTAL ASSOC 38 PEOPLES PLAZA Newark DE 19702 302-834-4000 Newark Sees
children
up to age 14
Ehrenfeld David General/Family/Pediatric N 710 GREENBANK ROAD Wilmington DE 19808 302-994-2582 Wilmington
Elkington Isaac Kent General/Family/Pediatric S 218 PENNSYLVANIA
AVENUE
Seaford DE 19973 302-629-3008 Seaford
Ettinger David Oral Surgeon N 850 LIBRARY AVE SUITE 102 Newark DE 19711 302-369-1000 Newark
Fagioletti Lisa General/Family/Pediatric N 850 LIBRARY AVE SUITE 102 Newark DE 19711 302-366-8668 Newark
Farhi Adeline General/Family/Pediatric N 301 SOUTH DUPONT ROAD ELSMERE DENTAL
ASSOCIATES
Wilmington DE 19804 302-998-9244 Wilmington
Farhi Parham General/Family/Pediatric N 301 SOUTH DUPONT ROAD ELSMERE DENTAL
ASSOCIATES
Wilmington DE 19804 302-998-9244 Wilmington
Fay Brendan General/Family/Pediatric N 1802 W 4TH ST Wilmington DE 19805 302-655-5822 Wilmington
Fay Bruce General/Family/Pediatric N 900 FOULK ROAD SUITE 203 Wilmington DE 19803 302-778-3822 Wilmington
Fidance Ernest General/Family/Pediatric N 1415 FOULK ROAD SUITE 201 Wilmington DE 19803 302-656-8219 Wilmington
Fink Daniel General/Family/Pediatric N 3600 SILVERSIDE RD STE A Wilmington DE 19810 302-479-7111 Wilmington
Fink Fred Orthodontist N 3518 SILVERSIDE ROAD 23 THE COMMONS Wilmington DE 19810 302-478-6930 Wilmington
Fink Gregg General/Family/Pediatric N ONE CENTURIAN DRIVE SUITE 213 Newark DE 19713 302-998-6300 Newark
Fisher Bruce Oral Surgeon K 33718 WESCOATS ROAD SUITE A Lewes DE 19958 302-644-2977 Lewes
Section D - 14 - 9-2008
Fiss Mark Orthodontist N 4901 LIMESTONE ROAD Wilmington DE 19808 302-239-4600 Wilmington
Fontana John General/Family/Pediatric N 1701 LOVERING AVENUE STE 101 Wilmington DE 19806 302-656-2434 Wilmington
Fortunato Mark General/Family/Pediatric N 1415 FOULK ROAD SUITE 201 Wilmington DE 19803 302-656-8219 Wilmington
Friz William General/Family/Pediatric N 1415 FOULK ROAD SUITE 200 Wilmington DE 19803 302-477-4900 Wilmington
Ganfield Timothy General/Family/Pediatric N 12 POLLY DRUMMOND
HILL ROAD
Newark DE 19711 302-731-4225 Newark
Ganjavian Syamack General/Family/Pediatric N 828 N. UNION ST. Wilmington DE 19805 302-777-4121 Wilmington
Gaz David John General/Family/Pediatric N 106 ST ANNES CHURCH RD Middletown DE 19709 302-378-8600 Middletown/
Odessa
Gerber Danielle General/Family/Pediatric N 1290 PEOPLES PLAZA BEAR-GLASGOW
DENTAL
Newark DE 19702 302-836-3750 Newark
Giles Howard General/Family/Pediatric N 1415 FOULK ROAD SUITE 200 Wilmington DE 19803 302-477-4900 Wilmington
Gioffre Dominic General/Family/Pediatric N 4901 LIMESTONE ROAD Wilmington DE 19808 302-239-0410 Hockessin
269
Gioffre, Jr. D. Michael General/Family/Pediatric N 1708 LOVERING AVENUE SUITE 102 Wilmington DE 19806 302-652-5312 Wilmington
Giordano Lawrence Oral Surgeon N 1601 MILLTOWN ROAD SUITE 17 Wilmington DE 19808 302-995-1870 Wilmington
Gladnick Dann General/Family/Pediatric N 1104 N BROOM STREET Wilmington DE 19806 302-654-7243 Wilmington
Gladnick Mark General/Family/Pediatric N 5513 KIRKWOOD HIGHWAY KIRKWOOD
MILLTOWN
PROFESSION
Wilmington DE 19808 302-994-2660 Wilmington
Goldfeder Allan General/Family/Pediatric N 2415 MILLTOWN ROAD Wilmington DE 19808 302-994-1782 Wilmington
Goleburn Glen General/Family/Pediatric N 1290 PEOPLES PLAZA BEAR-GLASGOW
DENTAL
Newark DE 19702 302-836-3750 Newark
Goleburn Stanley General/Family/Pediatric N 1290 PEOPLES PLAZA BEAR-GLASGOW
DENTAL
Newark DE 19702 302-836-3750 Newark
Gonce William General/Family/Pediatric N 530 SCHOOL HOUSE ROAD SUITE F Hockessin DE 19707 302-235-2400 Hockessin
Goodwill James Oral Surgeon N 1304 N BROOM STREET Wilmington DE 19806 302-998-0331/
655-6183
Wilmington
Grandison Dawn General/Family/Pediatric N 1290 PEOPLES PLAZA BEAR-GLASGOW
DENTAL
Newark DE 19702 302-836-3750 Newark
Granite Edwin Oral Surgeon N 2101 FOULK ROAD Wilmington DE 19810 302-475-1122 Wilmington
Gregory Victor General/Family/Pediatric N 5301 LIMESTONE ROAD SUITE 211 Wilmington DE 19808 302-239-1827 Hockessin
Section D - 15 - 9-2008
Hansen Greg General/Family/Pediatric N 1415 FOULK ROAD SUITE 201 Wilmington DE 19803 302-378-8600 Middletown/
Odessa
Harris Jay General/Family/Pediatric N 220 CHRISTIANA MED CTR Newark DE 19702 302-453-1400 Newark
Hazuda Michael General/Family/Pediatric N 5301 LIMESTONE RD STE
212
STONEY BATTER
OFFICE BLDG
Wilmington DE 19808 302-239-8230 Hockessin
Henrietta Johnson Medical
Center
General/Family/Pediatric N 601 NEW CASTLE AVENUE Wilmington DE 19801 302-655-6187 Wilmington
Herb Kathleen Oral Surgeon PA 834 CHESTNUT STREET,
STE 311
C/O JUP CNTRL
ENROLLMENTS
Philadelphia PA 19107 215-955-9628 Philadelphia,
PA
Holley James Periodontist VA 446 EFFINGHAM STREET Portsmouth VA 23704 757-393-2401 Portsmouth,
VA
Honig Gordon Orthodontist N 2707 KIRKWOOD HIGHWAY Newark DE 19711 302-737-6333 Newark
Hounsell Jill General/Family/Pediatric N 38 PEOPLES PLAZA Newark DE 19702 302-834-4000 Newark Sees children
up to age 14
Isaacs David General/Family/Pediatric N ISAACS & ISAACS FAMILY
DEN
707 FOULK ROAD Wilmington DE 19803 302-654-1328 Wilmington
Isaacs Milton General/Family/Pediatric N 707 FOULK ROAD Wilmington DE 19803 302-654-1328 Wilmington
Jacobs Laurie Pedodontist N 708 FOULK ROAD Wilmington DE 19803 302-764-7714 Wilmington
Jain Arvind General/Family/Pediatric MD 123 W COLLEGE AVE Salisbury MD 21804 410-546-5900 Salisbury,
MD
Jolly Jeena General/Family/Pediatric K 26 WYOMING AVENUE DELMARVA
RURAL MNISTRIES
Dover DE 19904 302-678-2000 Dover
Jones Blair General/Family/Pediatric S 34359 CARPENTERS WAY Lewes DE 19958 302-645-8993 Lewes
Jones Donald General/Family/Pediatric N 1 WINSTON AND
MARYLAND AVE
Wilmington DE 19804 302-656-8266 Wilmington
Kacmarcik Robert General/Family/Pediatric N 5301 LIMESTONE ROAD SUITE 122 Wilmington DE 19808 302-235-7645 Hockessin
Kelly, Jr. Joseph General/Family/Pediatric N 2205 SILVERSIDE RD SUITE 2 Wilmington DE 19810 302-475-5555 Wilmington
Kim Jung Endodontist N 1815 W 13TH STREET #7 Wilmington DE 19806 302-652-3556 Wilmington
King David Oral Surgeon N 1304 N BROOM STREET Wilmington DE 19806 302-998-0331/
655-6183
Wilmington
Kionke Cathy General/Family/Pediatric N JAMES V TIGANI III DMD 1021 GILPIN AVE
STE 205
Wilmington DE 19806 302-571-8740 Wilmington
Klassman Bradford Periodontist N 1110 NORTH BANCROFT
270
PKWY
Wilmington DE 19805 302-658-7871 Wilmington
Kremer Michael Oral Surgeon N 1304 N BROOM STREET 10 HERITAGE
PROF. PLAZA
Wilmington DE 19806 302-998-0331/
655-6183
Wilmington
Section D - 16 - 9-2008
Kreshtool Daniel Endodontist N 1815 W 13TH STREET #7 Wilmington DE 19806 302-652-3556 Wilmington
Kuon Thomas General/Family/Pediatric S 34539 CARPENTERS WAY Lewes DE 19958 302-645-8993 Lewes
Kwon Myochul General/Family/Pediatric N 1802 W 4TH ST Wilmington DE 19805 302-655-5822 Wilmington
Labin Charles General/Family/Pediatric S 34359 CARPENTERS WAY Lewes DE 19958 302-645-8993 Lewes
Lemper Jian Ying
Chen
General/Family/Pediatric PA 207 NORTH GUERNSEY
ROAD
West Grove PA 19390 610-869-0991 West Grove,
PA
Levin Lawrence Oral Surgeon PA 34th & CIVIC CENTER BLVD CHILDREN'S
SURGICAL
ASSOCIATES, LTD
Philadelphia PA 19104 215-590-8794 Philadelphia,
PA
Levine Alan General/Family/Pediatric N 2018 NAAMANS ROAD SUITE #2 Wilmington DE 19810 302-475-3743 Wilmington
Lippman Norman Oral Surgeon K 712 S GOVERNORS
AVENUE
Dover DE 19904 302-674-1140 Dover
Liu Grace General/Family/Pediatric N 1415 FOULK ROAD STE 201 Wilmington DE 19803 302-477-4900 Wilmington
Lynch John General/Family/Pediatric S 543 SHIPLEY ST SUITE E Seaford DE 19973 302-629-7115 Seaford
Maguire Charles General/Family/Pediatric N 1401 PENNSYLVANIA
AVENUE
UNIT 106 Wilmington DE 19806 302-654-0566 Wilmington
Maher Rachel Pedodontist N 2036 FOULK RD SUITE 200 Wilmington DE 19810 302-475-7640 Wilmington
Marsico Franklin General/Family/Pediatric N 625 BARKSDALE ROAD SUITE 117 Newark DE 19711 302-731-4907 Newark
Matthews Bruce General/Family/Pediatric N 1403 SILVERSIDE RD STE A SILVERSIDE PROF
PARK
Wilmington DE 19810 302-475-9220 Wilmington
Matthews Daniel General/Family/Pediatric N 1403 SILVERSIDE RD STE A SILVERSIDE PROF
PARK
Wilmington DE 19810 302-475-9220 Wilmington
Matthias Michael General/Family/Pediatric N 3844 KENNETT PIKE POWDERMILL SQ
SUITE 206
Wilmington DE 19807 302-575-0100 Wilmington
Maxwell Clyde General/Family/Pediatric N 303 LEA BLVD Wilmington DE 19802 302-765-3373 Wilmington
May Betsy General/Family/Pediatric N 850 LIBRARY AVE SUITE 102 Newark DE 19711 302-366-8668 Newark
McAllister Brian General/Family/Pediatric N 200 CLEAVER FARM ROAD SUITE 101 Middletown DE 19709 302-376-0617 Middletown/
Odessa
McAneny Neil General/Family/Pediatric N 625 BARKSDALE RD SUITE 115-117 Newark DE 19711 302-731-4907 Newark
McCann Judith General/Family/Pediatric N 625 BARKSDALE RD, 101 BARKSDALE PROF
CTR
Newark DE 19711 302-368-7463 Newark
Section D - 17 - 9-2008
McKelvey James General/Family/Pediatric N 4901 LIMESTONE ROAD Wilmington DE 19808 302-239-0303 Hockessin Sees
adolescents
12 years and
older
McSpadden H. Dean General/Family/Pediatric N 1801 ROCKLAND ROAD SUITE 204 Wilmington DE 19803 302-654-1242 Wilmington
Medlin Tawana General/Family/Pediatric S 544 S. BEDFORD STREET GEORGETOWN
STATE SERVICE
CENTER
Georgetown DE 19947 302-856-5240 Georgetown DPH Dental
Clinic
Mercer Sean General/Family/Pediatric N 600 NORTH BROAD ST SUITE 7 Middletown DE 19709 302-678-2942 Middletown/
Odessa
Mercer Thomas A. General/Family/Pediatric K 77 SAULSBURY ROAD Dover DE 19904 302-678-2942 Dover
Mercer Thomas W. General/Family/Pediatric K 77 SAULSBURY ROAD Dover DE 19904 302-678-2942 Dover
Mitchell Albert General/Family/Pediatric N 828 N UNION ST Wilmington DE 19805 302-777-4121 Wilmington
Mukkamala Neena General/Family/Pediatric K 95 WOLF CREEK
BOULEVARD
271
Section D - 18 - 9-2008
Ralston William General/Family/Pediatric N 344 E. MAIN STREET NEWARK DENTAL
ASSOCIATES
Newark DE 19711 302-737-5170 Newark
Rautio Erin General/Family/Pediatric N 708 FOULK ROAD Wilmington DE 19803 302-762-6400 Wilmington
Recktenwald William General/Family/Pediatric N 330 CHRISTIANA MEDICAL
CTR
CHRISTIANA
DENTAL CENTER
Newark DE 19702 302-369-3200 Newark
Reddy Veena General/Family/Pediatric N 537 STANTON CHRISTIANA
ROAD
STE 211 Newark DE 19713 302-998-0304 Newark
Roberts Kevin General/Family/Pediatric N 344 E. MAIN STREET NEWARK DENTAL
ASSOCIATES
Newark DE 19711 302-737-5170 Newark
Rocheleau Norman General/Family/Pediatric N 1415 FOULK ROAD SUITE 200 Wilmington DE 19803 302-477-4900 Wilmington
Rodriguez Janette General/Family/Pediatric S 543 SHIPLEY ST SUITE E Seaford DE 19973 302-629-7115 Seaford
Rodriguez Marieve General/Family/Pediatric N GENTLE CARE FAM
DENTISTRY
1021 GILPIN AVE
STE 200
Wilmington DE 19806 302-655-5862 Wilmington
Rohrbaugh Edward General/Family/Pediatric N 5317 LIMESTONE ROAD SUITE 2 Wilmington DE 19808 302-239-6677 Hockessin
Rose Karen General/Family/Pediatric N 446A S. NEW STREET ACCESS DENTAL,
LLC
Dover DE 19904 302-674-3303 Dover
Roseman Barry Oral Surgeon N 708 FOULK ROAD Wilmington DE 19803 302-764-7714 Wilmington
Rosen Michael General/Family/Pediatric N 2601 ANNAND DRIVE SUITE 2 Wilmington DE 19808 302-994-0979 Wilmington
Ryan Michael General/Family/Pediatric N 1415 FOULK ROAD SUITE 201 Wilmington DE 19803 302-378-8600 Middletown/
Odessa
Rybinski John General/Family/Pediatric N 2601 ANNAND DRIVE SUITE 6 Wilmington DE 19808 302-999-9277 Newark
Savani Bhaskar General/Family/Pediatric PA 402 MIDDLETOWN BLVD SUITE 200 Langhorne PA 19047 215-757-4400 Langhorne,
PA
Savani Niranjan General/Family/Pediatric PA 35 B WOODLAND AVENUE ADV FAMILY
DENTISTRY
MORTON PA 19070 610-544-3630 Delaware
County, PA
Savani Niranjan General/Family/Pediatric PA 402 MIDDLETOWN BLVD SUITE 200 Langhorne PA 19047 215-757-4400 Langhorne,
PA
Scanlon Martin General/Family/Pediatric N 5507 KIRKWOOD HIGHWAY Wilmington DE 19808 302-994-3093 Wilmington
Schmitt Margaret General/Family/Pediatric N 1601 CONCORD PIKE Wilmington DE 19806 302-655-1228 Wilmington
Schnelle Marissa General/Family/Pediatric N 4901 LIMESTONE ROAD Wilmington DE 19808 302-239-0303 Hockessin
272
Section D - 19 - 9-2008
Sklut Richard General/Family/Pediatric K 26 WYOMING AVENUE DELMARVA
RURAL MNISTRIES
Dover DE 19904 302-678-2000 Dover
Smith Patricia Pedodontist N COLLINS DENTAL ASSOC 38 PEOPLES PLAZA Newark DE 19713 302-834-4000 Newark
Spera Joe Oral Surgeon N 2101 FOULK ROAD Wilmington DE 19810 302-475-1122 Wilmington
Stiles Marlind General/Family/Pediatric PA 834 CHESTNUT STREET,
STE 311
C/O JUP CNTRL
ENROLLMENTS
Philadelphia PA 19107 215-955-9628 Philadelphia,
PA
Stout Edmond General/Family/Pediatric N 344 E. MAIN STREET NEWARK DENTAL
ASSOCIATES
Newark DE 19711 302-737-5170 Newark
Subach Peter Oral Surgeon N 1601 MILLTOWN ROAD SUITE 17 Wilmington DE 19808 302-995-1870 Wilmington
Syed Sattar General/Family/Pediatric N 5507 KIRKWOOD HIGHWAY KIRKWOODMILLTOWN
PLAZA
Wilmington DE 19808 302-994-3093 Wilmington
Tai Christopher General/Family/Pediatric N 2101 FOULK ROAD STE 201 Wilmington DE 19803 302-477-4900 Wilmington
Taub Daniel Oral Surgeon PA 834 CHESTNUT STREET,
STE 311
C/O JUP CNTRL
ENROLLMENTS
Philadelphia PA 19107 215-955-2440 Philadelphia,
PA
Tetzner Emil Periodontist K 804 S STATE STREET SUITE 1 Dover DE 19901 302-744-9900 Dover
Thomas Glavin Hope General/Family/Pediatric N 5317 LIMESTONE ROAD SUITE 2 Wilmington DE 19808 302-239-6677 Hockessin
University of PA Oral Surgery
Associates
Oral Surgeon PA 3400 SPRUCE STREET 5TH FLOOR WHITE
BLDG.
Philadelphia PA 19104 215-662-6035 Philadelphia,
PA
Usmani Sohaib General/Family/Pediatric N 201 CARTER DR STE A Middletown DE 19709 302-285-7645 Middletown/
Odessa
Usmani Sohaib General/Family/Pediatric N 900 FOULK ROAD STE 203 Wilmington DE 19803 302-778-3822 Wilmington
Vattilana Anthony General/Family/Pediatric N 2309 PENNSYLVANIA
AVENUE
Wilmington DE 19806 302-654-6915 Wilmington
Vaughn Francis Pedodontist N 613 PHILADELPHIA PIKE Wilmington DE 19809 302-764-8000 Wilmington
Vaughn Nadine General/Family/Pediatric N 2018 NAAMANS ROAD SUITE #2 Wilmington DE 19810 302-475-3743 Wilmington
Vickers Susan Pedodontist MD 11029 RACE TRACK ROAD Berlin MD 21811 410-749-0009 Berlin, MD
Wahl Jean General/Family/Pediatric N 1601 CONCORD PIKE Wilmington DE 19803 302-655-1228 Wilmington
Wahl Michael General/Family/Pediatric N 1601 CONCORD PIKE Wilmington DE 19803 302-655-1228 Wilmington
Wahl Patrick General/Family/Pediatric N 1601 CONCORD PIKE Wilmington DE 19803 302-655-1228 Wilmington
Walker Kelly General/Family/Pediatric N 4901 LIMESTONE ROAD SUITE 305 Wilmington DE 19808 302-239-0410 Hockessin
Section D - 20 - 9-2008
Welsh Sharon General/Family/Pediatric N 1400 PEOPLES PLAZA STE 207 Newark DE 19702 302-836-3711 Newark
Westside Health Center General/Family/Pediatric N 1802 W 4TH ST Wilmington DE 19805 302-655-5822 Wilmington
Wieczorek Mark General/Family/Pediatric N 1229 QUINTILLO DRIVE Bear DE 19701 302-838-3384 Bear
Woloshin Neil General/Family/Pediatric N 1290 PEOPLES PLAZA BEAR-GLASGOW
DENTAL
Newark DE 19702 302-836-3750 Newark
Wright Bruce General/Family/Pediatric S 55 ROUTE 24 Lewes DE 19971 302-645-6671 Lewes
Wright Steven General/Family/Pediatric S 55 ROUTE 24 Lewes DE 19971 302-645-6671 Lewes
Wu Lavinia General/Family/Pediatric N 3105 LIMESTONE ROAD SUITE 305 Wilmington DE 19808 302-995-7128 Wilmington
Zaayenga Wayne General/Family/Pediatric PA DEVEREUX FOUNDATION
DENTAL
1300 SHIP ROAD West
Chester
PA 19380 610-431-9651 West
Chester, PA
273
Zawislak Thaddeus General/Family/Pediatric PA 161 E BISSELL AVENUE Oil City PA 16301 814-677-1341 Oil City, PA
Section D - 21 - 9-2008
2. Driver Education
At the beginning of the school year, driver education teachers are required to ask the school
nurse for
assistance in obtaining vision screening results that should be completed within a year prior to
their car
driving hours and also assistance in working with physically and mentally handicapped pupils. A
roster of all driver education pupils will be presented to the school nurse for review with
particular
emphasis on identifying those pupils with extreme visual difficulties including color-blindness,
physical and/or1 mental handicaps. If the nurse is aware of any condition that will affect a pupils
ability to drive, he/she should assist the driver education teacher in a follow-up of the case. This
cooperation has been most helpful to the driver education teachers, pupils, parents, and the
Motor
Vehicle Department. The Medical Report of Physicians findings is on the following pages.
Regulation # 815: Physical Examinations and Screening
This regulation states Driver Education students shall have a vision screening within a year prior
to
their in car driving hours.
http://regulations.delaware.gov/AdminCode/title14/800/815.shtml#TopOfPage
Delaware Code for License qualifications:
http://delcode.delaware.gov/title21/c027/sc01/index.shtml#TopOfPage
Section D - 22 9-2008
DELAWARE DEPARTMENT OF PUBLIC SAFETY
DIVISION OF MOTOR VEHICLES
DRIVER IMPROVEMENT UNIT MEDICAL RECORDS SECTION
PO BOX 698 - DOVER, DE 19903-0698
Page 1 of 2
MEDICAL REPORT OF PHYSICIANS FINDINGS
Name: DOB ____/___/____ License Number
Address:
I hereby authorize Doctor to perform any medical examination necessary
for the purpose of determining my fitness to operate a motor vehicle. Also I understand that this authorization includes permission for
the Director of Motor Vehicles and/or their designee to have this information reviewed by a Medical Board of unidentified physicians
for the purpose of giving him/her a medical opinion on my case for a guidance in determining my medical capabilities to operate a
motor vehicle safely. The information contained in this report is confidential and will be used solely for the purpose of drivers
license considerations.
274
Section D - 23 9-2008
Page 2 of 2 Patient Name: DOB:____/___/____
If YES, the treating physician must attest to one of the two below listed statements, as may be applicable, for any
person who is subject to loss of consciousness due to disease of the central nervous system.
I hereby certify that I am the treating physician duly, licensed to practice medicine and surgery, for the above named individual
and that I have been the treating physician for him/her for a period of at least three months, that I am aware of his/her medical history,
including his/her history with respect to diseases of the central nervous system, and that such persons infirmity is under sufficient
control to permit him/her to operate a motor vehicle with safety to person and property.
I hereby certify that I am the treating physician, duly licensed to practice medicine and surgery, for the above named individual
and that I have been the treating physician for him/her for a period of at least three months, that I am aware of his/her medical history,
including his/her history with respect to diseases of the central nervous system, and that such persons disease no longer requires
treatment and that such person can reasonably expect to suffer no further losses of consciousness on account of such disease.
(K) How long have you been treating this patient? Date of last examination:_____/____/_____
(L) Additional comments:
Physicians Name (Printed or typed) Physicians Signature
Address Phone Number
Date:
Please mail form to: MEDICAL RECORDS SECTION DRIVER IMPROVEMENT UNIT PO Box 698 Dover, DE 19903-0698
The form may be transmitted by facsimile to: (302) 739-5667 ATTN: MEDICAL RECORDS SECTION
FORM MV-346 Document No. 45-07-93-03-01
Section D - 24 - 9-2008
3. Health Education
Effective health education curricula should reflect the growing body of research that emphasizes
teaching functional health information (essential concepts); shaping personal values that support
healthy behaviors; shaping group norms that value a healthy lifestyle; and developing the
essential
health skills necessary to adopt, practice, and maintain healthenhancing behaviors. Less
effective
curricula often overemphasize teaching scientific facts and increasing student knowledge. CDC
identifies the characteristics of effective health education curricula at:
www.cdc.gov/HealthyYouth/SHER/characteristics/index.htm
Delaware Health Education Standards
1. Students will understand essential health concepts in order to transfer knowledge into healthy
actions for life.
2. Students will analyze the influence of family, peers, culture, media, technology and other
factors on
health behaviors.
3. Students will demonstrate the ability to access information, products and services to enhance
health.
275
4. Students will demonstrate the ability to use interpersonal communication skills to enhance
health
and avoid or reduce health risks.
5. Students will demonstrate the ability to use decision-making skills to enhance health.
6. Students will demonstrate the ability to use goal-setting skills to enhance health.
7. Students will demonstrate the ability to practice health-enhancing behaviors and avoid or
reduce
health risks. (self-management)
8. Students will demonstrate the ability to advocate for personal, family and community health.
Regulation # 851: K-12 Comprehensive Health Education Program
This regulation mandates the program requirements for Health Education in schools.
http://regulations.delaware.gov/AdminCode/title14/800/851.shtml#TopOfPage
Resources:
DDOEs Health Education webpage and resources:
http://www.doe.k12.de.us/programs/ci/cont_areas/health.shtml
Health Teacher - A K-12 health curriculum that delineates knowledge and skill expectations
that are consistent with the Assessment Framework and National Health Education Standards
for each grade level: www.healthteacher.com
Nemours Foundation Kidshealth: www.kidshealth.org
Section D - 25 - 9-2008
4. Nutrition
The health and well-being of children is directly impacted by their overall nutritional status. The
types
of foods eaten and the meal patterns are linked to both academic performance and the overall
long term
health. Poor nutrition and inactivity can negatively impact both academics and social skills
among
students. Breakfast is often described as the most important meal of the day, but many students
do not
eat anything before classes begin each day. Children who eat breakfast show improved cognitive
function, attention, and memory. Participating in school breakfast can attract children to school,
improve standardized achievement test scores, and lower absence and tardiness rates.
Childhood obesity is an ever increasing problem in schools across America. Delaware is no
exception
with 36% of the students classified as overweight or at-risk to be overweight (Nemours.org).
Childhood obesity is not just a health issue, it also impacts academic achievement and social and
emotional health. To help reverse current trends schools need to consider modified and/or new
approaches to partnering with communities, families and students. Quality school nutrition
programs,
the availability of healthy snacks in vending machines and policies that eliminate the sale of junk
foods
for fund raisers are all basic steps that districts and schools can adopt. Nationally, it is recognized
that
schools did not create the obesity epidemic; however, it is also recognized that schools present
the
greatest opportunities for systemic solutions as a vested stakeholder. The U.S. Department of
276
Education has produced a list of effective strategies to help stakeholders target behaviors that
lead to
improve health. These strategies include: making healthy foods more readily available,
influencing
food and beverage contracts to require healthy items only, developing comprehensive wellness
policies, increasing opportunities to teach nutrition education and offering physical activity in
afterschool
programs, making physical activity and nutrition a part of every day life, creating fundraising
activities and student reward programs that support health, and developing nutrition standards for
the
entire school environment . The U.S. Department of Education also provides research based
documentation that supports the effectiveness of these strategies. Students will purchase healthy
foods,
parents and staff can influence behavior, and schools can make maintain or increase revenues
with
healthy foods selections. Even though healthy food choices are sometimes more expensive, data
shows
that revenues will more than support the increased costs. Delaware has regulatory requirements
to
ensure quality programs and participates in USDA programs that provide healthy meals and
snacks to
children.
Regulation #852: Child Nutrition
This regulation mandates child nutrition policies in schools.
http://regulations.delaware.gov/AdminCode/title14/800/852.shtml#TopOfPage
Resources:
Action for Healthy Kids: www.actionforhealthykids.org
Food Research and Action Center: www.frac.org
Nemours Foundation: www.nemours.org/department/nhps.html
School Nutrition Association (Includes self-assessment tool): www.asfsa.org
United States Department of Agriculture (USDA) Food and Nutrition: www.usda.gov
Section D - 26 - 9-2008
5. Physical Activity
Physical activity is any bodily movement produced by skeletal muscles that result in an
expenditure of
energy.* Physical activity has both benefits and risks. Regular physical activity promotes
cardiovascular health. The benefits of exercise are related to frequency, intensity and duration.
Planning for physical activity needs to consider a variety of factors, including personal fitness
levels,
overcoming barriers and protecting the body from exposure to the elements. The use of proper
protective equipment helps prevent injuries during certain activities. The most widely accepted
recommendation is for children to accumulate at least 60 minutes of physical activity on all or
most all
days of the week, both in and out of school.
Quality physical activity programs promote the physical growth and development of children and
277
youth while contributing to their general health, well-being, and fitness. Physical activity events
that
include families and collaborate with community members directly relate in an interactive
manner with
the other areas and domains addressed by Connections to Learning. Constructive use of time,
including leisure hours, keeping fit and enjoying physical forms of recreation during the school
years
and continuing throughout adult life is addressed.
Physical activity is critical to the development and maintenance of good health. A goal of
Physical
Education is to develop physically educated individuals who have the knowledge and skills to
enjoy a
lifetime of healthful physical activity. Physical activities can promote each students optimum
physical, mental, emotional and social development when utilized with the proper nutritional,
and
other protective factors. Physical activity is paramount in addressing mobility, stamina, and
student
attention span; thus, improving the level of academic success.
Resources and Citations:
Comprehensive School Physical Activity Programs A Position Statement from the National
Association for Sport and Physical Education, May 2008 National Association for Sport and
Physical Education, an association of the American Alliance for Health, Physical Education,
Recreation and Dance; http://iweb.aahperd.org/naspe/
*CCSSO SCASS Health Education Assessment Project 1998
Fitnessgram
In 2006, Delaware House Bill 372 was passed requiring each school district and charter school to
assess the physical condition of each student at least once in grades K-5, 6-8 and 9-12 with
results to
be provided to parents, guardians or relative caregivers. House Bill 471 created a pilot program
to
determine the best practices and assessment that could be implemented in schools statewide for
physical education/physical activity. The Fitnessgram was chosen by the DDOE the assessment
tool
for determining the physical fitness of each student. Learn more about the Fitnessgram and
DDOEs
physical education resources at:
http://www.doe.k12.de.us/programs/ci/content_areas/phys_ed_resources.shtml
Section D - 27 - 9-2008
B. School Climate
Overview
The CDC describes a healthy school environment as: The physical and aesthetic surroundings
and the
psychosocial climate and culture of the school. Factors that influence the physical environment
include
the school building and the area surrounding it, any biological or chemical agents that are
detrimental
to health, and physical conditions such as temperature, noise, and lighting. The psychological
278
environment includes the physical, emotional, and social conditions that affect the well-being of
students and staff.
The goal of School Climate and Discipline programs in Delaware is to promote necessary
components
of a healthy school climate: to support learning and contribute to students health by minimizing
distractions and physical, psychological, and social hazards; to create a climate in which students
and
school staff do their best work; to expect that all students can succeed; and to implement
supporting
policies. This goal is accomplished by having in place collaborative relationships, an effective
evaluation process, technical assistance and resources to ensure that schools are designed to
provide a
safe, healthy, and supportive environment that fosters learning.
School climate relates to the Connections to Learning process. Strategies to improve the school
climate
by teaching conflict resolution and social skills can also be multi-tiered and include curriculum
with
teaching and modeling positive social interactions. Schools that implement programs such as
Positive
Behavior Support (PBS) incorporate proactive strategies at the building, class, and individual
level.
Schools whom adopt PBS establish a safe school climate that promotes academic, social, and
emotional development. Other strategies and tools include the Delaware School Climate Survey,
an
evaluation measure given to parents, school staff, and students to examine the needs and
effectiveness
of efforts to improve school climate. Using such an evaluation measure, allows all parties
involved in
the school to give input about the practices and environment of the school and will in turn, help
foster a
positive school climate. A positive school climate can also include anti-bullying strategies and
drop out
prevention that can be implemented at any age level.
Resources:
DDOEs School Climate and Discipline webpage:
http://www.doe.k12.de.us/programs/climate/default.shtml
Positive Behavior Support: www.pbis.org
National Drop-out Prevention Network: www.dropoutprevention.org
Delaware Positive Behavior Support: www.delawarepbs.org
Delaware School Climate Survey: www.udel.edu/cds/pbs/survey.html
Section D - 28 - 9-2008
279
emergencies at school. Students who have special health care needs are at greater risk for a
medical
emergency and they should have an individualized Emergency Care Plan (NASN, 2008).
There are checklists and guidelines from DDOE for school emergency preparedness. According
to the
DDOE Regulation # 620, all schools must have plans and review and exercise them annually.
These
guidelines represent an all hazards approach and include any emergency event, including a major
communicable disease event such as a Pandemic Influenza Outbreak that may occur in the
school
community.
Regulation # 620: School Crisis and Response Plans.
This regulation discusses the requirements of school crisis and response plans.
http://regulations.delaware.gov/AdminCode/title14/600/620.shtml#TopOfPage
Resources:
American Red Cross: http://www.redcross.org/
DDOEs DE School Climate and Discipline webpage:
http://www.doe.k12.de.us/programs/climate/default.shtml.
Delaware Emergency Management Agency (DEMA): http://dema.delaware.gov/
Delaware Health and Social Services School Preparedness page:
http://dhss.delaware.gov/dhss/dph/php/prepschool.html
Disaster Preparedness: School Nurse Role: http://www.nasn.org/Default.aspx?tabid=221
Emergency Care Plans for Students with Special Health Care Needs:
http://www.nasn.org/Default.aspx?tabid=220
FEMA for Kids Federal Emergency Management Agency (FEMA):
http://www.fema.gov/kids/
Facing Fear: Helping Young People Deal with Terrorism and Tragic Events Red Cross
Curriculum: http://www.redcross.org/disaster/masters/facingfear/
Masters of Disaster- Red Cross Disaster Preparedness Curriculum:
http://www.redcross.org/services/prepare/0,1082,0_63_,00.html
Preparing for School Emergencies: http://www.nasn.org/Default.aspx?tabid=238
Section D - 29 - 9-2008
Caring for students may require having to move or lift them. It is important to use proper
technique to
protect your back to prevent injury. OSHA (U.S. Department of Labors Office of Safety and
Health
Administration) defines Ergonomics as:
Ergonomics is the science of fitting the job to the worker. When there is a mismatch between
the
physical requirements of the job and the physical capacity of the worker, work-related
musculoskeletal
disorders (MSDs) can result. Ergonomics is the practice of designing equipment and work tasks
to
conform to the capability of the worker, it provides a means for adjusting the work environment
and
work practices to prevent injuries before they occur. Health care facilities especially nursing
homes
have been identified as an environment where ergonomic stressors exist.
(www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html)
Section D - 30 - 9-2008
Remember to Protect Your Back*
Factors Contributing to Back Pain
Stress
Poor nutrition
Poor body mechanics
Poor posture
Seven Rules to Lifting
Plan the lift.
Face the load.
Lift with legs.
Get as close to the load as possible.
Come full upright.
Pivot, don't twist or jerk as you lift.
Seek assistance if someone else is available.
Back Exercises
Our backs work very hard all throughout the day. The exercises are designed to strengthen your lower back and encourage
flexibility of
your spine.
1. PELVIC TILT
Lay on your back with knees bent. Flatten your lower back as if you are trying to make every single vertebra touch the floor.
Pull in abdominal muscles.
2. KNEE TO CHEST
Begin as in #1, on your back with your knees bent. Bring one leg up to your chest and hold. Let it down slowly and repeat
with other leg.
3. DOUBLE KNEE TO CHEST
Begin as in #1, on your back with your knees bent. Bring both legs up to your chest, hold your knees. Slowly raise your head
and hold for count of 5, slowly lower your head and legs.
4. PRONE KNEELING
Begin on your hands and knees. Lower your head and arch your back toward the ceiling, as a cat stretches.
*Exercises developed with the assistance of Alison Malone, R.P.T. and Sam Cronis, R.P.T. Taken from earlier Delaware School
Nursing
Manual.
Section D - 31 - 9-2008
282
gauze 2 6 7 10 12 13
Bleach, 1 gallon 1 1 1 1 1
Cotton balls (5000 per box) 1 1 1 2 2
CPR
mask, adult 1 1 1 1 1
mask, child 1 1 1 1 1
airway 1 1 1 1 1
Dental floss 1 1 1 1 1
Diphenhydramine liquid (ex. Benadryl), dye-free 1 1 1 1 1
Drinking cups, 4 oz. 1000s 5 6 9 11 14
Epinephrine, injectable (doctor/standing order required) 1 1 1 1 1
Exam table, paper 18 x 24 pkg. 1 1 1 2 2
Gauze
pads, 2 x 2 box 100 1 1 1 2 2
pads, 2 x 2 box 100, non-stick 1 1 1 2 2
Gauze continued:
pads, 3 x 3 box 100 1 1 1 2 2
pads, 3 x 3 box 100, non-stick 1 1 1 2 2
roll, 4 wide, 15 yds. 1 1 1 1 1
Gloves, examination, non-latex 5 bx 7 bx 10 bx 12 bx 16 bx
Glucose Gel 1 1 1 1 1
Hydrogen Peroxide 3 3 4 4 5
Ice bag 1 1 1 1 1
Ipecac 1 1 1 1 1
Kleenex, box 9 12 14 16 20
Medicine cups, 100 3 3 3 4 4
Oxygen, with mask/cannula (doctor/standing order required) 1 1 1 1 1
Safety pins, mixed sizes 1 1 1 1 1
Saline 3 3 4 4 5
Sanitary pads, box 24 (age appropriate) 4 4 5 5 6
Sheeting, paper 18 x 24 pkg. 1 1 1 2 2
Slings, appropriate sizes 2 2 2 2 2
Soap, liquid 16 oz. bottle 6 7 8 10 12
Splints 3 3 3 3 3
Sterile water, 1 gallon 1 1 1 1 1
Thermometers, sheaths 1 1 1 1 1
Tongue depressors 1 1 1 2 2
Vaseline 1 1 1 1 1
Wax, dental 1 1 1 1 1
Section D - 33 - 9-2008
Tentative List of Durable Equipment for School Health Services
Equipment Items per school
Audiometer 1
Basin 1
Blanket, twin 2
Bucket, plastic, utility 1
Cabinet, medicine with lock 1
Cabinet built around the sink 1
Chairs (side chairs) 6
Computer, with internet access 1
Couch (plastic) 1
Desk 30 x 55 1
Desk Chair 1
Drinking cup dispenser (optional) 1
Eye chart or vision screening machine 1
Eye cup 1
Examination table 1
File cabinet 4 drawer 1
File drawer for 3 x 5 cards 1
Flashlight/penlight 1
Glasses repair kit 1
Heating pad 1
283
Section D - 34 - 9-2008
academic success as physical well-being. School nurses play a vital role in the school community
by promoting
positive mental health development in students through school/community-based programs and
curricula. As
members of interdisciplinary teams, school nurses play a vital role in supporting early
assessment, planning,
intervention, and follow-up of children in need of mental health services. In addition, school
nurses serve as
advocates, facilitators and counselors of mental health services both within the school
environment and in the
community.
(NASN, 2008 http://www.nasn.org/Default.aspx?tabid=231.)
Included in this section are a variety of resources and programs that foster positive social
and emotional
health.
Section D - 35 - 9-2008
1. Caregivers Law
Caregivers: School and Medical Authorization Affidavits
What is the Caregivers Law?
(School 14 Del. Code 202-203, medical 13 Del. Code 707-708)
The Caregivers School Authorization law (13 Del. Code 202, 707, 708, see Section A) allows
a caregiver,
raising a relatives child without custody or guardianship, to register that child for school. The
Caregivers
School Authorization law applies to all public schools in Delaware without exception.
What is the difference between a School and Medical Authorization Affidavit?
When properly completed and notarized, both Affidavits allow a relative caregiver who does not
have custody
or guardianship of a child to register that child for school and to approve his or her medical
treatment. Since
these Affidavits are part of the Delaware Code, all public schools and providers of medical care
must accept
them. In some circumstances a parent, custodian, or guardian may sign the Affidavit permitting
the caregiver to
take medical or school responsibilities for the child.
Where can one get a copy of the Affidavits?
The Caregivers School Authorization Affidavit is available at all school district offices. The
Caregivers
Medical Authorization Affidavit is available at many State Service Centers and all Public Health
sites that
provide health services. Samples of both Affidavits are available on-line at the Division of
Services for Aging
and Adults with Physical Disabilities (DSAAPD) web site www.dhss.delaware.gov/dsaapd
under Support for
Grandparents Raising Children.
What responsibilities does the Caregivers School Authorization affidavit place on the
caregiver?
285
Once the affidavit completed and approved by the school district, the caregiver is responsible for
enrolling the
student in school, being the legal contact for the school regarding, but not limited to, truancy and
discipline,
making school-based decisions, regarding but not limited to special education; and giving
medical approval for
health care administered by the school.
How long can the Caregivers School Affidavit be used?
The School Affidavit can be renewed for up to two years of school or longer if the school
district decides it is
appropriate. After two years the caregiver is required to begin filing legal papers for
guardianship.
The Medical Affidavit is valid for one year from the date it is notarized and may also be
renewed. For more
information contact your school district office or the Division of Services for Aging and Adults
with Physical
Disabilities at 1-800-223-9074, on-line at www.dhss.delaware.gov/dsaapd, or via internet e-mail
at
DSAAPDinfo@state.de.us.
Section D - 36 - 9-2008
as they have specialized training to do so. Additionally, schools should not notify parents that
they made a
report. All information is to remain strictly confidential.
When you call in a report, be prepared to provide the following information, if known. A lack of
information
does not mean that DFS will not accept the report, but more information will assist DFS in
making a decision
about the urgency of the needed response.
Name, age (date of birth if possible), gender of the child and other family members and the
names of
the parents/caretakers if available
Address, phone numbers, and/or directions to the familys home or location of the child
Description of the suspected abuse or neglect
Current condition of the child (e.g., whether medical treatment appears necessary)
Any other pertinent information which may assist DFS in investigating abuse or neglect
When making a report you will not have to give your name (anonymous report); however, if you
do give your
name it will allow the caseworker to call you for further information about the family and you
will have
documentation that you have followed the mandatory reporting law. By Delaware statute, there is
no liability
for making a report. It is DFS policy to never divulge the name of the reporter without the
reporters consent
or, as required federally, to cooperate with investigatory entities such as law enforcement or the
Department of
Justice.
Once a report is received, the Report Line worker will review the facts of the case with a
supervisor. In most
instances, you will be informed at the conclusion of making the report that if you do not receive
a call back, the
report was accepted for investigation after supervisory review. If a decision is made not to
investigate, you will
be contacted by Report Line staff. If you have additional information or believe strongly that the
case should be
investigated, you should ask to speak to the Report Line Supervisor for further discussion.
Section D - 37 - 3-2009
287
Mandatory Child Abuse and Neglect Reporting form. All persons are required by law to report
child
abuse or neglect. * Please note, a call to the Reportline must be accomplished when using this
form.
[2pg] PDF format Revised 2007, 2p, 417kb
DSCYF/School District Program Collaboration Matrix [rev. 08/28/2002, 6pg]
PDF format 121kb
State of Delaware Domestic Violence Advocate Pilot Project 2002-2004: An Overview and
Evaluation
PDF format (12/14/2004, 50p, 482k)
The Professionals' Guide to Reporting Child Abuse and Neglect
A DSCYF Division of Family Services brochure.[25pg] PDF format 622kb
Parent Handbook / Manyl pou paran / Manual de los Padres
This handbook was designed with parents in mind. It is intended to provide an overview of our
services
and should answer many common questions. Your caseworker can explain and provide answers
to
questions you may have which do not appear in this handbook.
o Creole version:PDF format [05/2004, 11pg, 256kb]
o English version:PDF format [05/2004, 11pg, 256kb]
o Spanish version:PDF format [05/2004, 11pg, 256kb]
o French version:PDF format [08/22/2005, 12pg, 208kb]
Section D - 38 - 9-2008
Physical and Behavioral Indicators of Child Abuse and Neglect
Obtained from the Department of Services for Children, Youth and Their Families
Type CA/N Physical Indicators Behavioral Indicators
Physical Abuse Unexplained bruises and welts:
on face, lips, mouth
on torso, back, buttocks, thighs
in various stages of healing
clustered, forming regular patterns
reflecting shape of article used to inflict
(electric cord, belt buckle)
on several different surface areas
regularly appear after absence, weekend or
vacation
Unexplained burns:
cigar, cigarette burns, especially on soles,
palms, back or buttocks
immersion burns (sock-like, glove-like,
doughnut shaped on buttocks or genitalia)
patterned like electric burner, iron, etc.
rope burns on arms, legs, neck or torso
Unexplained fractures:
to skull, nose, facial structure
in various stages of healing
multiple or spiral fractures
Unexplained lacerations or abrasions:
to mouth, lips, gums, eyes
to external genitalia
Wary of adult contacts
Apprehensive when other children cry
Behavioral extremes:
288
aggressiveness, or
withdrawal
Frightened of parents
Afraid to go home
Reports injury by parents
Physical
Neglect
Consistent hunger, poor hygiene, inappropriate dress
Consistent lack of supervision, especially in dangerous
activities or long periods
Unattended physical problems or medical needs
Abandonment
Begging, stealing food
Extended stays at school (early arrival and late departure)
Constant fatigue, listlessness or falling asleep in class
Alcohol or drug abuse
Delinquency (e.g. thefts)
States there is no caretaker
Sexual Abuse Difficulty in walking or sitting
Torn, stained or bloody underclothing
Pain or itching in genital area
Bruises or bleeding in external genitalia, vaginal or anal
areas
Venereal disease, especially in pre-teens
Pregnancy
Unwilling to change for gym or participate in physical
education class
Withdrawal, fantasy or infantile behavior
Bizarre, sophisticated, or unusual sexual behavior or
knowledge
Poor peer relationships
Delinquent or run away
Reports sexual assault by caretaker
Emotional
Maltreatment
Speech disorders
Lags in physical development
Failure-to-thrive
Habit disorders (sucking, biting, rocking, etc.)
Conduct disorders (antisocial, destructive, etc.)
Neurotic traits (sleep disorders, inhibition of play)
Psychoneurotic reactions (hysteria, obsession, compulsion,
phobias, hypochondria)
Behavior extremes:
compliant, pensive
aggressive, demanding
Overly adaptive behavior:
inappropriately adult
inappropriately infant
Developmental lags (mental, emotional)
Attempted suicide
Section D - 39 - 3-2009
MEMORANDUM OF UNDERSTANDING
BETWEEN
THE DEPARTMENT OF EDUCATION/PUBLIC SCHOOL
DISTRICTS AND THE DEPARTMENT OF SERVICES FOR CHILDREN,
YOUTH AND THEIR FAMILIES DIVISION OF FAMILY SERVICES
A Memoranda of Understanding exists that describes specific reporting procedures, protocol for
289
interaction between agencies, criteria for sharing of information, problem resolution and
designate
liaisons for each agency. A statewide committee has convened to update the MOU.
Link to MOU
Section D - 40 - 9-2008
3. Domestic Violence
Domestic violence is a pattern of assaultive and coercive behaviors, including physical, sexual,
and
psychological attacks, as well as economic coercion, that adults or adolescents use against their
intimate partners. Examples of domestic violence are physical assault, sexual assault,
psychological
assault, economic coercion and using children to control an adult victim.
Domestic violence is a learned behavior. It is learned through observation,
experience/reinforcement,
in the family, communities (schools, peer groups, etc.) and culture. It is not caused by genetics,
illness,
alcohol and drugs, anger, stress and behavior of the victim or problems in the relationship.
Domestic violence has a great effect on children of all ages. An important resource in Delaware
is The
Domestic Violence Coordinating Council (DVCC). This state agency was legislatively created
in
1993 to improve Delawares response to domestic violence. Information about the Council, its
activities and other resources is available on the DVCC website at www.dvcc.delaware.gov.
Facts on Children Witnessing Domestic Violence
Domestic violence is a pattern of assaultive and coercive behaviors, including physical, sexual,
and
psychological attacks (including stalking) that adults or adolescents use against their intimate
partners.
Domestic violence is a learned behavior. It is learned through observation,
experience/reinforcement
in the family, communities (schools, peer groups, etc) and culture. It is not caused by genetics,
illness,
alcohol and drugs, anger, stress, the behavior of the victim or problems in the relationship.
Seeing or hearing violence among family members hurts children in many ways. In general,
children
can experience a sense of danger, chaos, confusion, anxiety, isolation, fear, tension, and/or
hopelessness. They do not have to be hit to feel the pain of violence. Children who witness
domestic
violence are at special risk for emotional and developmental problems.
Children growing up witnessing domestic violence may perpetuate violence in their adolescent
relationships.
An important resource in Delaware is the Domestic Violence Coordinating Council (DVCC).
This
state agency was legislatively created in 1993 to improve Delawares response to domestic
violence.
Information about the Council, its activities and other resources is available on their web site:
www.dvcc.delaware.gov.
290
4. Homeless Students
Regulation # 901: Education of Homeless Children and Youth
This regulation provides information about the education of homeless children and youth
consistent
with the provisions of the McKinney-Vento Homeless Education Assistance Improvement Act, as
amended by the No Child Left Behind Act of 2001.
http://regulations.delaware.gov/AdminCode/title14/900/901.shtml#TopOfPage
Enrollment of Homeless Students
Homeless Students lack the required (by regulation) medical documentation of immunizations,
tuberculosis (TB) screening, a current physical and lead screening (age-dependent) for
enrollment in
school. DDOEs School Nursing Partners newsletter (March 2003) states:
School nurses are typically assigned by districts to monitor and assure that students meet the
regulatory
requirements for school entry. Additionally, they are responsible for reducing the risk of the
entire
school to communicable disease. Because of this, they often have questions regarding how the
school
entry requirements relate to the McKinney-Vento statute.
The following are points to be considered when working with homeless students:
McKinney-Vento requires the school to assist the family in meeting all school enrollment
requirements.
o In the case of a child without a shot record, the school needs to assist the family in
locating the record. The child should not be denied school entry during this time. In the
event the record is never found, the school can follow the Lost Records section of the
regulation if it is believed that the record was lost.
o In the case of a child missing an immunization or a required booster, the school must
assist the child in getting the vaccination. This may mean arranging for a doctors visit,
providing transportation, etc. It may be less interruptive to the family to address this on
the day that the child enrolls and prior to getting to the classroom; however, if this can
not be arranged immediately the child should not miss class time while waiting for an
appointment.
Any child or staff member exhibiting signs of active communicable disease must be excluded
from participating in school activities.
o In the case of TB, a child may have multiple risk factors for TB and need to have a
Mantoux skin test; however, unless the child has symptoms of disease (ex. night sweats,
pallor, coughing, fever, etc.) he/she should not be excluded from school.
Section D - 43 - 9-2008
5. Mental Health
Division of Child Mental Health Services
Department of Services for Children, Youth and Their Families
Who is DCMHS?
The Division of Child Mental Health Services (DCMHS) is part of the Delaware Department of Services
for
Children, Youth, and Their Families (DSCYF).
Child Mental Health Services Contact Information:
Mailing Address: 1825 Faulkland Rd, Wilmington, DE 19805
292
If an infant is surrendered under the law, the hospital will place a numbered identification bracelet on the
baby
as an aid in linking the person and the medical questionnaire to the baby. The baby will receive a medical
screening examination and any necessary medical care. The hospital will take temporary emergency
protective
custody of the baby and immediately notify the Division of Family Services and the State Police that a
baby has
been surrendered under the law. The Division of Family Services will request ex parte custody of the baby
from
Family Court and the State Police will submit an inquiry to the Delaware Missing Children Information
Clearinghouse. The baby will be placed with a family willing to adopt the child if parental rights are
terminated.
Can the birth parent(s) be reunited with their baby?
If a parent changes their mind and wants their baby back, they can call the Division of Family Services
hotline
at 1-800-292-9582 and say they wish to be reunited with their baby. The Division of Family Services shall
seek
to terminate parental rights unless the parent seeks reunification within 30 days of the date of surrender. It
is
important to note that the identification number given the baby at the time of surrender is an identification
aid
only and does not permit the person possessing the identification number to take custody of the baby on
demand. Once the baby has been surrendered to the hospital, the baby will not be returned by the hospital
until
the Division of Family Services and Family Court determines that the baby can be cared for safely.
Who can I call for more information?
To speak with someone directly 24-hours a day about the Safe Arms for Babies, call the toll-free 24-hour
hotline.
Go to the Safe Arms for Babies Locations in Delaware Page
Section D - 46 - 9-2008
7. Health Counseling
Introduction
Health appraisal has very limited value unless followed by a planned program to give each
student the
care he/she needs. Parents/guardians and teachers need to be informed concerning the problems
discovered and how these problems are related to the health, growth, and welfare of the student
a
task that may be aided by written notices or letters, but is best achieved through individual
conferences. Parents/guardians need to formulate a plan of action, and in some instances, need to
be
informed of community resources which can provide needed assistance. Some types of problems,
such
as speech defects, markedly impaired vision, or severe hearing impairment, indicate the need for
the
school to provide special or modified programs.
The term health counseling includes all of the activities of school nurses, classroom teachers and
others
directed toward helping the student to secure the professional services and special
accommodations
295
2. Accept the students statement as a valid report on how he/she feels at present. Students may
become ill under stress. Family changes can also initiate illnesses.
3. Try to identify factors that may be affecting the individuals health. Use open-ended questions
that do not suggest or limit the answers.
4. Involve the student in the management of his/her health, providing him/her with possible
alternatives and avenues of assistance.
Section D - 48 - 9-2008
8. Substance Abuse
Regulation # 612: Possession, Use or Distribution of Drugs and Alcohol
This regulation addresses possession, use or distribution of drugs and alcohol in the school
setting:
http://regulations.delaware.gov/AdminCode/title14/600/612.shtml#TopOfPage
Regulation # 877: Tobacco Policy
This is regulation addresses tobacco policy in an effort to improve the health of students and
school
personnel:
http://regulations.delaware.gov/AdminCode/title14/800/877.shtml#TopOfPage
Guidelines for Students who Appear to be Under the Influence of Drugs or Alcohol
Students who become involved in substance abuse may be unstable or seriously disturbed youths
whose plight deserves treatment not censure. Note: Some medical conditions can present with
similar
symptoms and should be considered during the nursing assessment.
1. A student whose behavior and appearance seem inappropriate for that particular individual to
the
teacher, administrator, or other school personnel should be sent to the school nurse.
2. The teacher or staff member should accompany the student to the health room. If the teacher is
unable to leave his/her area, his/her observation should be written and sent to the health room.
3. The principal or school administrator should be notified of the observation made by the
teacher and
school nurse.
4. The nurse will determine through her observation and the information supplied by the teacher
if
immediate medical attention is or is not needed.
a. For emergency situations (based on vital signs and threat of danger to self):
(1) Nurse or school administrator should follow School Emergency Procedures as outlined on
the Emergency Card (see Section B).
b. For non-emergency situations:
(1) Inform the parent/guardian of students symptoms.
(2) Request parent/guardian to come to school.
(3) Inform parent/guardian of observations and suggest examination by family physician.
If the school has a physician on call, he/she should be requested to examine the student.
5. The procedure for treating and excluding students under the influence of drugs or alcohol are
basically the same as those used in the school district for any student showing signs of illness.
6. Keep accurate, objective and detailed records of such incidents.
Section D - 49 - 9-2008
Appendix A
I. Peer Review Tool
II. Self Evaluation Tool
III. Resources for the School Nurse
Appendix - 2 - 04-2008
299
Appendix - 6 - 04-2008
SECTION 3 To be completed following a half-day observation by peer
reviewer.
What personal/professional strengths that you observed promote the overall
health and
wellness of students and staff served by the School Nurse?
What professional area/s for improvement would allow this nurse to more
effectively
serve health and wellness of students and staff?
Comments of the Peer Reviewer:
Comments of the School Nurse:
Signatures:
300
NIC
Nursing Intervention Classification
Definition and Activities
Copyrighted materials used with permission by Elsevier
INTRODUCTION
Quality school nursing documentation depends upon the individual school nurse accurately recording
his/her
nursing assessments, plans, interventions and client outcomes. Use of the nursing process assures that all
aspects of care are considered, addressed and written in a uniform manner. The challenge is to document
in
an efficient way that is easily comprehended by the nursing community. While medical terminology is
universally understood, it is insufficient to describe nursing aspects of client care. The need for school
nurses
to communicate in a common language has never been more vital than today as we begin to focus on
student
outcomes, build a body of research, and break down the walls of isolation between school nurse
colleagues.
To this end, standardized language amongst school nurses is essential.
303
In January 2004, Delaware School Nurse district representatives were invited to join the School Nurse
Advisory Group (SNAG). Eighteen School Nurses provided input into a pilot computer documentation
system and the development of standardized documentation. SNAG determined that identifying reasons
for
student visits to the nurse, interventions by the school nurse and outcomes from those interventions
should be
core components. Because the Nursing Intervention Classification System (NIC) had the most
comprehensive list of nursing actions, it was selected for use in Delaware. The Department of Education
(DOE) then obtained permission to use the copyrighted terminology of NIC and NOC (Nursing Outcome
Classification) in the statewide computerized program.
NIC is a unique vocabulary that describes actions performed by a nurse. Interventions can be independent
or
collaborative, direct or indirect, and individual or group oriented. NIC was initially created for hospital
use.
Use in school settings, to date, has been rare. Thus, the challenge was to narrow the over 450 NIC terms
to a
reasonable list and then to customize definitions and activities to reflect potential Delaware use.
This document contains the Delaware selected NIC terms, along with their definitions, activities and
related
readings. Where these have been altered, is noted within the text.
Terms: All NIC have been linked to Medicaid reimbursement, if appropriate. Some administrations
activities, such as seizure precautions, are not billable, but are included because of their importance in
providing comprehensive nursing services. Few terms are changed from the original NIC.
Definitions: Due to Medicaid billing requirements, some changes were made to distinguish between
a group or individual intervention or to establish a link to an injury or illness. In some cases new
definitions
and terms were created to articulate the type of care typical in Delaware schools (e.g. specific health
screenings).
Activities: These lists are neither exhaustive nor exclusive. It is likely other school nurse activities
could be added and others could be removed, based upon a particular student population.
The lists herein have removed activities that are:
clearly hospital in nature (e.g. providing blood transfusions, monitoring electrolytes); and/or
inappropriate for the school setting (e.g. limit visitors).
Some activities, which remain in the list:
may require special skills (e.g. applying a cervical collar);
are unlikely to be used in the school setting, except in special instances (e.g. obtaining a stool for
culture; monitoring skin in the perianal area);
may require written orders from a healthcare provider (e.g. insert rectal suppository);
should only be used AFTER an evaluation by a healthcare provider (e.g. initiate suicide precautions
should not be the first intervention for a client who threatens suicide. The first response should be an
immediate call to 911; later the school nurse may initiate suicide precautions as directed by the
discharging entity.)
Finally, some additions were needed (e.g. inform individual/family of available healthcare insurance).
The reader is cautioned that this list should not replace doctors orders or established protocols for an
individual client; rather, this list compiles possible nursing activities for consideration.
The introduction of NIC into Delaware documentation is an important step towards assuring quality
and standardized documentation. This document is a beginning.
Table of Contents
Nursing Intervention Classification (NIC) Codes ..........................................................................
1
304
305
306
307
308
Determine whether the family has an intact social support network to assist with family problems, respite child care, and crisis child care
Identify infants/children with high-care needs (e.g., prematurity, low birth weight, colic, feeding intolerances, major health problems in the first
year of
life, developmental disabilities, hyperactivity, and attention deficit disorders)
Identify caretaker explanations of childs injuries that are improbable or inconsistent, allege self-injury, blame other children, or demonstrate a
delay in
seeking treatment
Determine whether a child demonstrates signs of physical abuse, including numerous injuries in various stages of healing; unexplained bruises &
welts;
unexplained pattern, immersion, & friction burns; facial, spiral, shaft, or multiple fractures; unexplained facial lacerations & abrasions; human
bite
marks; intracranial, subdural, intraventricular, & intraoccular hemorrhaging; whiplash shaken infant syndrome; & diseases that are resistant to
treatment and/or have changing signs & symptoms
Determine whether the child demonstrates signs of neglect, including poor or inconsistent growth patterns, failure to thrive, wasting of
subcutaneous
tissue, consistent hunger, poor hygiene, constant fatigue and listlessness, bald patches on scalp or other skin afflictions, apathy, unyielding body
posture, and inappropriate dress for weather conditions
Determine whether the child demonstrates signs of sexual abuse, including difficulty walking or sitting; torn, stained, or bloody underclothing;
reddened
or traumatized genitals; vaginal or anal lacerations; recurrent urinary tract infections; poor sphincter tone; acquired sexually transmitted diseases;
pregnancy; promiscuous behavior or prostitution; a history of running away, sudden massive weight loss or weight gain, aggression against self,
or
dramatic behavioral or health changes of undetermined etiology
Determine whether the child demonstrates signs of emotional abuse, including lags in physical development, habit disorders, conduct learning
disorders,
neurotic traits/psychoneurotic reactions, behavioral extremes, cognitive developmental lags, and attempted suicide
Monitor child for extreme compliance, such as passive submission to invasive procedures
Monitor child for role reversal, such as comforting the parent, or overactive or aggressive behavior
Listen to pregnant womans feelings about pregnancy and expectations about the unborn child
Monitor new parents reactions to their infant, observing for feelings of disgust, fear, or disappointment in gender
Monitor for a parent who holds newborn at arms length, handles newborn awkwardly, asks for excessive assistance, & verbalizes or
demonstrates
discomfort in caring for the child
Monitor for repeated visits to clinics, emergency rooms, or physicians offices for minor problems
Determine parents knowledge of infant/child basic care needs and provide appropriate child care information as indicated
Instruct parents on problem solving, decision making, and childrearing & parenting skills, or refer parents to programs where these skills can be
learned
Help families identify coping strategies for stressful situations
Provide parents with information on how to cope with protracted infant crying, emphasizing that they should not shake the baby
Provide the parents with noncorporal punishment methods for disciplining children
Provide pregnant women and their families with information on the effects of smoking, poor nutrition, & substance abuse on the babys and their
health
Engage parents and child in attachment-building exercises
Provide parents and their adolescents with information on decision making & communication skills & refer to youth services counseling, as
appropriate
Provide older children with concrete information on how to provide for the basic care needs of their younger siblings
Provide children with positive affirmations of their worth, nurturing care, therapeutic communication, and developmental stimulation
Refer families to human services and counseling professionals, as needed
Provide parents with community resource information that includes addresses and phone numbers of agencies that provide respite care,
emergency child
care, housing assistance, substance abuse treatment, sliding-fee counseling services, food pantries, clothing distribution centers, health care,
human
services, hot lines, and domestic abuse shelters
Refer a parent who is being battered and at-risk children to a domestic violence shelter
Refer parents to Parents Anonymous for group support, as appropriate
Background Readings:
Campbell, J., & Humphreys, J. (1993). Nursing care of survivors of family violence (2nd ed.). St. Louis: Mosby.
Campbell, J., & Humphreys, J. (1984). Nursing care of victims of family violence. Reston, VA: Reston Publishing.
Cicchetti, D., & Carlson, V. (Eds.). (1990). Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect. New York:
Cambridge
University Press.
Cowen, P.S. (1994). Child abuseWhats nursings role? In J.C. McCloskey & H.K. Grace (Eds.), Current issues in nursing (4th ed.) (pp. 731-741). St. Louis: Mosby.
Cowen, P.S., & Van Hoozer, H. (1993). Family violence computer assisted instruction programs. Chapel Hill: Health Sciences Consortium.
Dove, A., & Kobryn, M. (1991). Computer detection of child abuse. Nursing Standard, 6(10), 38-39.
Dykes, L.J. (1986). The whiplash shaken infant syndrome: What has been learned? Child Abuse & Neglect, 10, 211-221.
Rosenberg, D.A. (1987). Web of deceit: A literature review of Munchausen syndrome by proxy. Child Abuse & Neglect, 11(4), 547-563.
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definition; NIC definition reads identification of high-risk dependent relationships and actions to prevent further infliction of physical or emotional harm.
definition; NIC definition reads facilitating entry of a patient into a health care facility
Background Readings:
Barnes, C., & Kirchhoff, K.T. (1986). Minimizing hypoxemia due to endotracheal suctioning: A review of the
literature.
Heart & Lung, 15, 164-176.
Craven, R. F., & Hirnle, C. J. (2000) Fundamentals of nursing: Human health and function (3rd ed.) (pp. 825-827).
Philadelphia: Lippincott.
Nelson, D.M. (1992). Interventions related to respiratory care. In G.M. Bulechek & J.C. McCloskey (Eds.),
Symposium on Nursing Interventions. Nursing Clinics of North America, 27(2), 301-324.
Stone, K., & Turner, B. (1988). Endotracheal suctioning. Annual Review of Nursing Research, 7, 27-49.
Stone, K.S., Preusser, B.A., Groch, K.F., Karl, J.I., & Gronyon, D.S. (1991). The effect of lung hyperinflation and
endotracheal suctioning on cardiopulmonary hemodynamics. Nursing Research, 40(2), 76-79.
Titler, M.G., & Jones, G. (1992). Airway management. In G.M. Bulechek & J.C. McCloskey (Eds.), Nursing
interventions: Essential nursing treatments (2nd ed.) (pp. 512-530). Philadelphia: W.B. Saunders.
Background Readings:
Hendry, C., & Farley, A.H. (2001). Understanding allergies and their treatment. Nursing Standard, 15(35),
4753.
Hoole, A., Pickard, C., Ouimette, R., Lohr, J., & Greenberg, R. (1995). Patient care guidelines for nurse
practitioners (4th ed.). Philadelphia: J.B. Lippincott.
Lemone, P., & Burke, K. (1996). Medical surgical nursing: Critical thinking in client care. Menlo Park,
CA:
Addison-Wesley.
Trzcinski, K.M. (1993). Update on common allergic diseases. Pediatric Nursing, 19(4), 410-415.
Smith, C.E. (1987). Using the teaching process to determine what to teach and how to evaluate learning.
In
C.E. Smith (Ed.), Patient education: Nurses in partnership with other health professionals (pp. 61-95).
Philadelphia: W.B. Saunders.
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314
Background Readings:
Boggs, R.L., & Woolridge-Kim, M. (1993). AACN procedural manual for critical care (3rd ed). Philadelphia: W.B.
Saunders.
Craven, R.F., & Hirnle, C. J. (2000) Fundamentals of Nursing: Human Health and Function (3rd ed.) (pp. 819-824).
Philadelphia: Lippincott
Goodnough, S.K.C. (1988). Reducing tracheal injury and aspiration. Dimensions of Critical Care Nursing, 7, 324331.
McHugh, J.M. (1985). Airway management. In S. Millar, L.K., Sampson, & M. Soukup (Eds.), AACN Procedural
Manual for Critical Care (pp. 203-239). Philadelphia: W.B. Saunders.
Nelson, D.M. (1992). Interventions related to respiratory care. In G.M. Bulechek & J.C. McCloskey (Eds.),
Symposium
on Nursing Interventions. Nursing Clinics of North America, 27(2), 301-324.
Titler, M.G., & Jones, G. (1992). Airway management. In G.M. Bulechek & J.C. McCloskey (Eds.), Nursing
Interventions: Essential Nursing Treatments (2nd ed.) (pp. 512-530). Philadelphia: W.B. Saunders.
wide- and narrow-bore nasogastric feeding tubes. Heart & Lung, 20(1), 75-80.
Schwartz-Cowley, R., & Gruen, A.K. (1988). Swallowing dysfunction in patients with altered mobility. In
P.H. Mitchell, L.C. Hodges, M. Muwaswes, et al. (Eds.), AANNs Neuroscience Nursing (pp. 345-357).
Norwalk, CT: Appleton & Lange.
Taylor, T. (1982). A comparison of two methods of nasogastric tube feedings. Journal of Neurosurgical
Nursing, 14(1), 49-55.
316
National Asthma Education and Prevention Program. Second Expert Panel. (1997). Guidelines for Diagnosis and Management of
Asthma. NIH Publication No. 97-4051.
Silkworth, C.K. (1993). IHP: Asthma. In M.B. Haas, M.J.V. Gerber, W.R. Miller, K.M. Kalb, C.K. Silkworth, R.E. Leuhr, &
S.I.S.
Will. (Eds.), The School Nurses Source Book of Individualized Healthcare PlansVolume 1. (pp. 133-150). North Branch, MN:
Sunrise River Press.
Szilagyi, P. & Kemper, K. (1999). Management of chronic childhood asthma in the primary care office. Pediatric Annuals, 28(1),
4352.
University of Michigan Health System. (2000). Asthma: Guidelines for clinical care. Available online: http://www.cme.med.
umich.edu/ pdf/guideline/asthma.pdf
Yoos, H.L., & McMullen, A. (1999). Symptom monitoring in childhood asthma: How to use a peak flow meter. Pediatric Annals,
28(1), 31-39.
Definition: Limitation of the blood loss from a wound that may be a result of trauma,
incisions,
or placement of a tube or catheter.
Activities:
Identify the cause of the bleeding
Monitor the patient closely for hemorrhage
Monitor the amount and nature of blood loss
Monitor trends in blood pressure and hemodynamic parameters, if available (e.g., central venous
pressure and pulmonary capillary/artery wedge pressure)
Monitor fluid status, including intake and output, as appropriate
Instruct the patient and/or family on signs of bleeding and appropriate actions (e.g., notify the
nurse),
should further bleeding occur
Instruct the patient on activity restrictions, if appropriate
Instruct patient and family on severity of blood loss and appropriate actions being performed
Perform proper precautions in handling blood products or bloody secretions
Apply direct pressure or pressure dressing, if appropriate
Background Readings:
Cullen, L.M. (1992). Interventions related to circulatory care. In G.M. Bulechek & J.C. McCloskey
(Eds.),
Symposium on Nursing Interventions. Nursing Clinics of North America, 27(2), 445-476.
Jennings, B. (1991). The hematologic system. In J. Alspach (Ed.), AACNs core curriculum for critical
care
nursing (4th ed.) (pp. 675-747). Philadelphia: W.B. Saunders.
Johanson, B.C., Wells, S.J., Hoffmeister, D., & Dungca, C.U. (1988). Standards for critical care (3rd ed.).
St.
Louis: Mosby.
Thompson, J.M., McFarland, G.K., Hirsch, J.E., & Tucker, S.M. (1998). Mosbys clinical nursing (4th
ed.). St.
Louis: Mosby.
Instruct patient about need for correct posture to prevent fatigue, strain, or injury
Instruct patient how to use posture and body mechanics to prevent injury while performing any
physical activities
Determine patient awareness of own musculoskeletal abnormalities and the potential effects of
posture and muscle tissue
Instruct to use a firm mattress/chair or pillow, if appropriate
Instruct to avoid sleeping prone
Assist to demonstrate appropriate sleeping positions
Assist to avoid sitting in the same position for prolonged periods
Demonstrate how to shift weight from one foot to another while standing
Instruct patient to move feet first and then body when turning to walk from a standing position
Assist patient/family to identify appropriate posture exercises
Assist patient to select warm-up activities before beginning exercise or work not done routinely
Assist patient to perform flexion exercises to facilitate back mobility, as indicated
Instruct patient/family regarding frequency and number of repetitions for each exercise
Monitor improvement in patients posture/body mechanics
Provide information about possible positional causes of muscle or joint pain
Background Readings:
Craven, R.F., & Hirnle, C.J. (2000) Fundamentals of nursing: Human health and function (3rd ed.). (pp.
738739). Philadelphia: Lippincott.
Glick, O.J. (1992). Interventions related to activity and movement. In G.M. Bulechek & J.C. McCloskey
(Eds.), Symposium on Nursing Interventions. Nursing Clinics of North America, 27(2), 541-568.
Lewis, C.B. (1989). Improving mobility in older persons. Rockville, MD: Aspen.
Sheahan, S. (1982). Assessment of low back pain. Nurse Practitioner, 7, 15-23.
Sweezey, S. (1988). Low back pain. Geriatrics, 43(2), 39-44.
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Turn off the tube feeding 1 hour prior to a procedure or if the patient needs to be in a position with the head less than
30
degrees
Irrigate the tube every 4 to 6 hours as appropriate during continuous feedings and after every intermittent feeding
Use clean technique in administering tube feedings
Check gravity drip rate or pump rate every hour
Slow tube feeding rate and/or decrease strength to control diarrhea
Monitor for sensation of fullness, nausea, and vomiting
Check residual every 4 to 6 hours for the first 24 hours, then every 8 hours during continuous feedings
Check residual before each intermittent feeding
Hold tube feedings if residual is greater than 150 cc or more than 110% to 120% of the hourly rate in adults
Keep cuff of endotracheal or tracheostomy tube inflated during feeding, as appropriate
Keep open containers of enteral feeding refrigerated
Change insertion site and infusion tubing according to agency protocol
Wash skin around skin level device daily with mild soap and dry thoroughly
Check water level in skin level device balloon according to equipment protocol
Discard enteral feeding containers and administration sets every 24 hours
Refill feeding bag every 4 hours, as appropriate
Monitor for presence of bowel sounds every 4 to 8 hours, as appropriate
Monitor fluid and electrolyte status
Monitor for growth (height/weight) changes monthly, as appropriate
Monitor weight 3 times weekly initially, decreasing to once a month
Monitor for signs of edema or dehydration
Monitor fluid intake and output
Monitor calorie, fat, carbohydrate, vitamin, and mineral intake for adequacy (or refer to dietitian) 2 times weekly
initially,
decreasing to once a month
Monitor for mood changes
Prepare individual and family for home tube feedings, as appropriate
Monitor weight at least three times a week, as appropriate for age
Background Readings:
Fellows, L.S., Miller, E.H., Frederickson, M, Bly, B., & Felt, P. (2000). Evidence-based practice for enteral feedings and
aspiration
prevention: Strategies, bedside detection and practice change. MEDSUR6 Nursing, 9(1), 27-31.
Mahan, K.L., & Escott-Stump, S. (2000) In Krauses food, nutrition & diet therapy (9th ed.). Philadelphia: W.B. Saunders.
Methany, N.A. & Titler, M.G. (2001). Assessing placement of feeding tubes. American Journal of Nursing, 101(5), 6-45.
Perry, A.G., & Potter, P.A. (2002). Clinical nursing skills and techniques (5th ed.) (pp. 559-616). St. Louis: Mosby.
325
Assist individual to schedule regular periods for the exercise program into weekly routine
Perform exercise activities with individual, as appropriate
Include family/caregivers in planning and maintaining the exercise program
Inform individual about health benefits and physiological effects of exercise
Instruct individual about appropriate type of exercise for level of health, in collaboration with physician
and/or
exercise physiologist
Instruct individual about desired frequency, duration, and intensity of the exercise program
Monitor individuals adherence to exercise program/activity
Assist individual to prepare and maintain a progress graph/chart to motivate adherence to the exercise
program
Instruct individual about conditions warranting cessation of or alteration in the exercise program
Instruct individual on proper warm-up and cool-down exercises
Instruct individual in techniques to avoid injury while exercising
Instruct individual in proper breathing techniques to maximize oxygen uptake during physical exercise
Provide reinforcement schedule to enhance individuals motivation (e.g., increased endurance estimation;
weekly weigh-in)
Monitor individuals response to exercise program
Provide positive feedback for individuals efforts
Background Readings:
Allan, J.D., & Tyler, D.O. (1999). Exercise promotion. In G.M. Bulechek & J.C. McCloskey (Eds.), Nursing
interventions: Effective nursing treatments (3rd ed.) (pp. 130-148). Philadelphia: W.B. Saunders.
Glick, O.J. (1992). Interventions related to activity and movement. In G.M. Bulechek & J.C. McCloskey (Eds.),
Symposium on Nursing Interventions. Nursing Clinics of North America, 27(2), 541-568.
NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. (1996). Physical activity and
cardiovascular health. Journal of the American Medical Association, 276 (3), 241-246.
Rippe, J., Ward, A., Porcari, J. et al. (1989). The cardiovascular benefits of walking. Practical Cardiology, 15(1).
Sorenson, S., & Poh, A. (1989). Physical fitness. In P. Swinford & J. Webster (Eds.), Promoting wellness: A nurses
handbook (pp. 101-140). Rockville, MD: Aspen.
Timmermans, H., & Martin, M. (1987). Top ten potentially dangerous exercises. Journal of Physical Education,
Recreation and Dance, 58, 29.
Topp, R. (1991). Development of an exercise program for older adults: Pre-exercise testing, exercise prescription
and
program maintenance. Nurse Practitioner, 16(10), 16-28.
1 Delaware definition differentiates between individual or group intervention.
Feeding (FEED)
Definition1: Feeding of patient with oral motor deficits.
Activities:
Identify prescribed diet
Set food tray and table attractively
Create a pleasant environment during mealtime (e.g., put bedpans, urinals, and suctioning
equipment
out of sight)
Provide for adequate pain relief before meals, as appropriate
Provide for oral hygiene before meals
Identify presence of swallowing reflex, if necessary
Sit down while feeding to convey pleasure and relaxation
Offer opportunity to smell foods to stimulate appetite
Ask patient preference for order of eating
327
definition; NIC definition reads providing nutritional intake for patient who is unable to feed self.
Jr. (Eds.), Cecil textbook of medicine (19th ed.) (pp. 1568-1571). Philadelphia: W.B. Saunders.
Thompson, J.M., McFarland, G.K., Hirsch, J.E., & Tucker, S.M. (1993). Mosbys clinical nursing (3rd
ed.). St.
Louis: Mosby.
Activities:
Target high-risk groups and age ranges that would benefit most from health education
Target needs identified in Healthy People 2000: National Health Promotion and Disease Prevention Objectives or other local,
state, and
national needs
Identify internal or external factors that may enhance or reduce motivation for healthy behavior
Determine personal context and social-cultural history of individual, family, or community health behavior
Determine current health knowledge and lifestyle behaviors of individual, family, or target group
Assist individuals, families, and communities in clarifying health beliefs and values
Identify characteristics of target population that affect selection of learning strategies
Prioritize identified learner needs based on client preference, skills of nurse, resources available, and likelihood of successful goal
attainment
Formulate objectives for health education program
Identify resources (e.g., personnel, space, equipment, money) needed to conduct program
Consider accessibility, consumer preference, and cost in program planning
Strategically place attractive advertising to capture attention of target audience
Avoid use of fear or scare techniques as strategy to motivate people to change health or lifestyle behaviors
Emphasize immediate or short-term positive health benefits to be received by positive lifestyle behaviors rather than long-term
benefits
330
Background Readings:
APHA Technical Report. (1987). Criteria for the development of health promotion and education programs. American Journal of Public Health,
77 (1),
89-92.
Bastable, S.B. (2003). Nurse as educator: Principles of teaching and learning for nursing practice. Boston: Jones and Bartlett Publishers.
Clark, M.J. (1992). Nursing in the community. The health education process (pp. 126-141). Norfolk, CT: Appleton & Lange.
Damrosch, S. (1991). General strategies for motivating people to change their behavior. Nursing Clinics of North America, 26(4), 833-843.
Department of Health and Human Services. (1991). Healthy People 2000: National health promotion and disease prevention objectives (DHHS
Publication No. PHS 91-50213). Washington, DC. U.S. Government Printing Office.
Green, L.W., & Johnson, K.W. (1983). Health education and health promotion. In D. Mechanic (Ed.), Handbook of health, health care, and the
health
professional (pp. 744-765). New York: The Free Press, Macmillan Publishing Co.
Somas Job, R.F. (1988). Effective and ineffective use of fear in health promotion campaigns. American Journal of Public Health, 78(2), 163-167.
Pahnos, M.L. (1992). The continuing challenge of multicultural health education. Journal of School Health 62(1), 24-26.
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Background Readings:
Arnold, E., & Boggs, K. (1989). Interpersonal relationships: Professional communication skills for nurses.
Philadelphia:
W.B. Saunders.
Dunne, P.J. (1998). The emerging health care delivery system. American Association of Respiratory Care (AARC)
Times
22(1), 24-8.
Matthews, P. (2000). Planning for successful outcomes in the new millennium. Topics in Health Information
Management 20(3), 55-64.
Viscardis, L. (1998). The family-centered approach to providing services: A parent perspective. Physical &
Occupation
Therapy in Pediatrics 18(1), 41-53.
Zarbock, S.G. (1999). Sharing in all dimensions: Providing nourishment at home. Home Care Provider 4(3), 106107.
332
Screen for contraindications to cold or heat, such as decreased or absent sensation, decreased circulation,
and
decreased ability to communicate
Select a method of stimulation that is convenient and readily available, such as waterproof plastic bags
with
melting ice; frozen gel packs; chemical ice envelope; ice immersion; cloth or towel in freezer for cold; hot
water bottle; electric heating pad; hot, moist compresses; immersion in tub or whirlpool; paraffin wax;
sitz
bath; radiant bulb; or plastic wrap for heat
Determine availability and safe working condition of all equipment used for heat or cold application
Determine condition of skin and identify any alterations requiring a change in procedure or
contraindications
to stimulation
Select stimulation site, considering alternate sites when direct application is not possible (e.g., adjacent to,
distal to, between affected areas and the brain, and contralateral)
Wrap the heat/cold application device with a protective cloth, if appropriate
Use a moist cloth next to the skin to increase the sensation of cold/heat, when appropriate
Instruct how to avoid tissue damage associated with heat/cold
Check the temperature of the application, especially when using heat
Determine duration of application based on individual verbal, behavioral, and biological responses
Time all applications carefully
Apply cold/heat directly on or near the affected site, if possible
Inspect the site carefully for signs of skin irritation or tissue damage throughout the first 5 minutes and
then
frequently during the treatment
Evaluate general condition, safety, and comfort throughout the treatment
Position to allow movement from the temperature source, if needed
Instruct not to adjust temperature settings independently without prior instruction
Change sites of cold/heat application or switch form of stimulation, if relief is not achieved
Instruct that cold application may be painful briefly, with numbness about 5 minutes after the initial
stimulation
Instruct on indications for, frequency of, and procedure for application
Instruct to avoid injury to the skin after stimulation
Evaluate and document response to heat/cold application
Background Readings:
Herr, K.A., & Mobily, P.R. (1992). Interventions related to pain. In G.M. Bulechek & J.C. McCloskey (Eds.),
Symposium on Nursing Interventions. Nursing Clinics of North America, 27(2), 347-370.
McCaffery, M., & Beebe, A. (1989). Pain. Clinical manual for nursing practice (pp. 145-154). St. Louis: Mosby.
Perry, A.G., & Potter, P.A. (1998). Clinical nursing skills and techniques (pp. 1113-1132). St. Louis: Mosby.
Ridgeway, S., Brauer, D., Cross, J., Daniels, J.S., & Steffes, M. (1998). Application of heat and cold. In M. Snyder
& R.
Lindquist. (Eds.), Complementary/alternative therapies in nursing (3rd ed.) (pp. 89-102). New York: Springer
Publishing Company.
Sorensen, K., & Luckmann, J. (1986). Basic nursing: A psychophysiologic approach (2nd ed.) (pp. 966-981).
Philadelphia: W.B. Saunders.
1 Delaware definition limits to injury.
Background Readings:
Association of Womens Health, Obstetric, and Neonatal Nurses. (1993). Didactic content and clinical skills verification for
professional nurse providers of basic, high-risk and critical-care intrapartum nursing. Washington, DC: AWHONN.
335
Field, P.A., & Marck, P. (1994). Uncertain motherhood: Negotiating the risks of the childbearing years. Newbury Park, CA: Sage
Publishing.
Gilbert, E.S., & Harmon, J.S. (1998). Manual of high risk pregnancy and delivery. (2nd ed.). St. Louis: Mosby.
Mandeville, L.K., & Troiano, N.H. (Eds.). (1992). High-risk intrapartum nursing. Philadelphia: J.B. Lippincott.
Mattson, S. & J.E. Smith (Eds.). (1993). Core curriculum for maternal-newborn nursing. Philadelphia: W.B. Saunders.
Background Readings:
American Diabetes Association. (1995). Intensive diabetes management. Alexandria, VA: Author.
American Diabetes Association. (1994). Medical management of insulin-dependent (type I) diabetes. (2nd ed.).
Alexandria, VA: Author.
Ahern, J., & Tamborlane, W.V. (1997). Steps to reduce the risks of severe hypoglycemia. Diabetes Spectrum, 10(1),
3941.
Cryer, P.E., Fisher J.N., & Shamoon, H (1994). Hypoglycemia. Diabetes Care, 17(7), 734-755.
Havlin, C.E., & Cryer, P.E. (1988). Hypoglycemia: The limiting factor in the management of insulin-dependent
diabetes
337
Background Readings:
Centers for Disease Control. (1997). Recommended childhood immunization schedule: United States 1997. Mortality and
Morbidity
Weekly Report, 46(2), 35-40.
338
Centers for Disease Control. (2002). Recommended adult immunization schedule: United States, 2002-2003. Mortality and
Morbidity
Weekly Report, 51(40), 904-908.
Lambert, J. (1995). Every child by two. A program of the American Nurses Foundation. American Nurse, 27(8), 12.
Lerner-Durjava, L. (1998). Nurses guide to immunizations. Nursing 28(7), 32hn10-12.
Scudder, L. (1995). Child immunization initiative: Politics and health policy in action. Nursing Policy Forum, 1 (3), 20-29.
Scarbrough, M.L., & Landis, S.E. (1997). A pilot study for the development of a hospital-based immunization program. Clinical
Nurse
Specialist, 11(2), 70-75.
West, A.R., & Kopp, M. (1999). Making a difference: Immunizing infants and children. American Nurse Foundation, A1-A6.
Pottinger, J., Burns, S., & Manske, C. (1989). Bacterial carriage by artificial versus natural nails.
American
Journal of Infection Control, 17, 340-344.
Pugliese, G., & Lampinen, T. (1989). Prevention of human immunodeficiency virus infection: Our
responsibilities as health care professionals. American Journal of Infection Control, 17(1), 1-22.
Thompson, J.M., McFarland, G.K., Hirsch, J.E., & Tucker, S.M. (1998). Mosbys clinical nursing (4th
ed.). St.
Louis: Mosby.
Strome, T., & Howell, T. (1991). How antipsychotics affect the elderly. American Journal of Nursing,
91(5),
46-49.
Contact patient and family after discharge, as appropriate, to answer questions and discuss concerns
associated
with the medication regimen
Encourage the patient to have screening tests to determine medication effects
Background Readings:
Le Sage, J. (1991). Polypharmacy in geriatric patients. Nursing Clinics of North America, 26(2), 273-290.
Malseed, R.T. (1990). Pharmacology drug therapy and nursing considerations (3rd ed.). Philadelphia: J.B. Lippincott.
Mathewson, M.J. (1986). Pharmacotherapeutics: A nursing approach. Philadelphia: F.A. Davis.
Weitzel, E.A. (1992). Medication management. In G.M. Bulechek & J.C. McCloskey (Eds.), Nursing interventions: Essential nursing treatments
(2nd
ed.) (pp. 213-220). Philadelphia: W.B. Saunders.
Background Readings:
Fessele, K.S. (1996). Managing the multiple causes of nausea and vomiting in the patient with cancer. Oncology Nursing Forum, 23(9), 14091417.
Grant, M. (1987). Nausea, vomiting, and anorexia. Seminars in Oncology Nursing, 3(4), 227-286.
Hogan, C., M. (1990). Advances in the management of nausea and vomiting. Nursing Clinics of North America, 25(2), 475-497.
Hablonski, R.S. (1993). Nausea: The forgotten symptom. Holistic Nursing Practice, 7(2), 64-72.
Larson, P., Halliburton, P., & Di Julio, J. (1993). Nausea, vomiting, and retching. In V. Carrier-Kohlman, A.M. Lindsey, & C.M. West (Eds.),
Pathophysiological phenomena in nursing human responses to illness. Philadelphia: W.B. Saunders Company.
Rhodes, V.A. (1990). Nausea, vomiting, and retching. Nursing Clinics of North America, 25(4), 885-900.
Background Readings:
Ackerman, L.L. (1992). Interventions related to neurological care. In G.M. Bulechek & J.C. McCloskey (Eds.), Symposium on Nursing
Interventions.
Nursing Clinics of North America, 27(2), 325-346.
Allan, D. (1986). Management of the head injured patient. Nursing Times, 82(25), 36-39.
Alspach, J.G. (Ed.). (1991). Core curriculum for critical care nursing (4th ed.). Philadelphia: W.B. Saunders.
Ammons, A.M. (1990). Cerebral injuries and intracranial hemorrhages as a result of trauma. Nursing Clinics of North America, 25(1), 23-34.
Cammermeyer, M., & Appeldorn, C. (Eds.). (1990). Core curriculum for neuroscience nursing (3rd ed.) (pp. Val-Val8 & Vbl-Vb5). Chicago:
American
Association of Neuroscience Nurses.
Crosby, L., & Parsons, L.C. (1989). Clinical neurologic assessment tool: Development and testing of an instrument to index neurologic status.
Heart &
Lung, 18(2), 121-125.
Hickey, J.V. (1992). The clinical practice of neurological and neurosurgical nursing (3rd ed.). Philadelphia: J.B. Lippincott.
Mitchell, P.H., & Ackerman, L.L. (1992). Secondary brain injury reduction. In G.M. Bulechek & J.C. McCloskey (Eds.), Nursing interventions:
Essential nursing treatments (2nd ed.) (pp. 558-573). Philadelphia: W.B. Saunders.
Price, M.B., & Vroom, H.L. (1985). A quick and easy guide to neurological assessment. Journal of Neurosurgical Nursing, 17(5), 313-320.
Titler, M.G. (1992). Interventions related to surveillance. In G.M. Bulechek & J.C. McCloskey (Eds.), Symposium on Nursing Interventions.
Nursing
Clinics of North America, 27(2), 495-516.
definition.
Whitney, E.N. & Cataldo, C.B. (1991). Understanding normal and clinical nutrition (3 rd ed.). St. Paul,
MN:
West Publishing.
Background Readings:
Acute Pain Management Guideline Panel. (1992). Acute pain management: Operative or medical procedures and trauma. Clinical practice guideline. AHCPR Pub. No.
92-
348
0032. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services.
Herr, K.A., & Mobily, P.R. (1992). Interventions related to pain. In G.M. Bulechek & J.C. McCloskey (Eds.), Symposium on Nursing Interventions. Nursing Clinics
of North
America, 27(2), 347-370.
McCaffery, M., & Pasero, C. (1999). Pain. Clinical manual for nursing practice (2nd ed.). St. Louis: MosbyYear Book.
McGuire, L. (1994). The nurses role in pain relief. Medsurg Nursing, 3(2), 94-107.
Mobily, P.R., & Herr, K.A. (2000). Pain. In M. Maas, K. Buckwalter, M. Hardy, T. Tripp-Reimer, M. Titler, & J. Specht (Eds.), Nursing diagnosis, interventions, and
outcomes for elders (2nd ed.). Thousand Oaks, CA: Sage Publications.
Perry, A.G., & Potter, P.A. (2000). Clinical nursing skills and techniques (pp. 84-101). St. Louis: MosbyYear Book.
Rhiner, M. (1999), Managing breakthrough pain: A new approach. American Journal of Nursing, March Suppl., 3-12.
Titler, M.G., & Rakel, B.A. (2001). Nonpharmacologic treatment of pain. Critical Care Nursing Clinics of North America, 13(2), 221-232.
Victor, K. (2001). Properly assessing pain in the elderly. RN, 64(5), 45-49.
Positioning (POSI)
Definition: Deliberative placement of the patient or a body part to promote physiological
and/or psychological well-being.
Activities:
Place on an appropriate therapeutic mattress/bed
Provide a firm mattress
Explain to the patient that he/she is going to be turned, as appropriate
Encourage the patient to get involved in positioning changes, as appropriate
Monitor oxygenation status before and after position change
Premedicate patient before turning, as appropriate
Place in the designated therapeutic position
Incorporate preferred sleeping position into the plan of care, if not contraindicated
Position in proper body alignment
Immobilize or support the affected body part, as appropriate
Elevate the affected body part, as appropriate
Position to alleviate dyspnea (e.g., semi-Fowler position), as appropriate
Provide support to edematous areas (e.g., pillow under arms and scrotal support), as appropriate
Position to facilitate ventilation/perfusion matching (good lung down), as appropriate
Encourage active or passive range-of-motion exercises, as appropriate
Provide appropriate support for the neck
Avoid placing a patient in a position that increases pain
Avoid placing an amputation stump in the flexion position
Minimize friction and shearing forces when positioning and turning the patient
Apply a footboard to the bed
Turn using the log roll technique
Position to promote urinary drainage, as appropriate
Position to avoid placing tension on the wound, as appropriate
Prop with a backrest, as appropriate
Elevate affected limb 20 degrees or greater, above the level of the heart, to improve venous return, as
appropriate
Instruct the patient how to use good posture and good body mechanics while performing any activity
Monitor traction devices for proper setup
Maintain position and integrity of traction
Elevate head of the bed, as appropriate
Turn as indicated by skin condition
Develop a written schedule for repositioning, as appropriate
Turn the immobilized patient at least every 2 hours, according to a specific schedule, as appropriate
Use appropriate devices to support limbs (e.g., hand roll and trochanter roll)
Place frequently used objects within reach
Place bed-positioning switch within easy reach
Place the call light within reach
349
Background Readings:
Metzler, D., & Finesilver, C. (1999). Positioning. In G.M. Bulechek & J.C. McCloskey, (Eds.), Nursing
interventions:
Effective nursing treatments (3rd ed.). Philadelphia: W.B. Saunders.
Sundberg, M.C. (1989). Alterations in mobility. In M.C. Sundberg, (Ed.), Fundamentals of nursing: With clinical
procedures (2nd ed.) (pp. 767-807). Boston: Jones & Bartlett.
Titler, M.G., Pettit, D., Bulechek, G.M., McCloskey, J.C., Craft, M.J., Cohen, M.Z., Crossley, J.D., Denehy, J.A.,
Glick,
O.J., Kruckeberg, T.W., Maas, M.L., Prophet, C.M., & Tripp-Reimer T. (1991). Classification of nursing
interventions for care of the integument. Nursing Diagnosis, 2(2), 45-56.
definition.
Check periodically with the patient to ensure that the muscle group is relaxed
Have the patient tense the muscle group again, if relaxation is not experienced
Monitor for indicators of nonrelaxation, such as movement, uneasy breathing, talking, and
coughing
Instruct the patient to breathe deeply and to slowly let the breath and tension out
Develop a personal relaxation patter that helps the patient to focus and feel comfortable
Terminate the relaxation session gradually
Allow time for the patient to express feelings concerning the intervention
Encourage the patient to practice between regular sessions with the nurse
Background Readings:
McCaffery, M., & Beebe, A. (1989). Pain: Clinical manual for nursing practice. St. Louis: Mosby.
Scandrett, S., & Uecker, S. (1992). Relaxation training. In G.M. Bulechek & J.C. McCloskey (Eds.),
Nursing
interventions: Essential nursing treatments (2nd ed.) (pp. 434-461). Philadelphia: W.B. Saunders.
Snyder, M. (1998). Progressive muscle relaxation. In M. Snyder & R. Lindquist. (Eds.),
Complementary/alternative therapies in nursing (3rd ed.) (pp. 1-13). New York: Springer Publishing
Company.
Note chest movement, watching for symmetry, use of accessory muscles, and supraclavicular
and
intercostal muscle retractions
Monitor for noisy respirations, such as crowing or snoring
Monitor breathing patterns: bradypnea, tachypnea, hyperventilation, Kussmaul respirations,
CheyneStokes respirations, apneustic breathing, Biots respiration, and ataxic patterns
Palpate for equal lung expansion
Percuss anterior and posterior thorax from apices to bases bilaterally
Note location of trachea
Monitor for diaphragmatic muscle fatigue (paradoxical motion)
Auscultate breath sounds, noting areas of decreased/absent ventilation and presence of
adventitious
sounds
Determine the need for suctioning by auscultating for crackles and rhonchi over major airways
Auscultate lung sounds after treatments to note results
Monitor mechanical ventilator readings, noting increases in inspiratory pressures and decreases
in
tidal volume, as appropriate
Monitor for increased restlessness, anxiety, and air hunger
Monitor patients ability to cough effectively
Note onset, characteristics, and duration of cough
Monitor patients respiratory secretions
Monitor for dyspnea and events that decrease and worsen it
Monitor for hoarseness and voice changes every hour in patients with facial burns
Monitor for crepitus, as appropriate
Open the airway, using the chin lift or jaw thrust technique, as appropriate
Place the patient on side, as indicated, to prevent aspiration; log roll if cervical aspiration is
suspected
Institute resuscitation efforts, as needed
Institute respiratory therapy treatments (e.g., nebulizer), as needed
Background Readings:
Capps, J.S., & Schade, K. (1988). Work of breathing: Clinical monitoring and considerations in the
critical
care setting. Critical Care Nursing Quarterly, 11(3), 1-11.
Carrol, P. (1999). Evolutions/revolutions: Respiratory monitoring: Revolutions: continuous spirometry.
RN,
62(5), 72-74, 77-78.
Carroll, P. (1999). Evolutions/revolutions respiratory monitoring: Evolutions: capnography. RN, 62(5),
68-71,
78.
Lane, G.H. (1990). Pulmonary therapeutic management. In L.A. Thelan, J.K. Davie, & L.D. Urden (Eds.),
Textbook of critical care nursing (pp. 444-471). St. Louis: Mosby.
Nelson, D.M. (1992). Interventions related to respiratory care. In G.M. Bulechek & J.C. McCloskey
(Eds.),
Symposium on Nursing Interventions. Nursing Clinics of North America, 27(2), 301-324.
Rest (REST)
Definition1: Providing environment and supervision to facilitate rest/sleep after nursing
evaluation.
Activities:
Perform nursing assessment
Provide space and supervision for patient to rest or sleep during school hours
Monitor/evaluate response to rest
1 Delaware
Background Readings:
Frantz, R.A., & Gardner, S. (1994). Management of dry skin. Journal of Gerontological Nursing, 20(9), 15-18.
Hardy, M.A. (1992). Dry skin care. In G.M. Bulechek & J.C. McCloskey (Eds.), Nursing interventions: Essential
nursing
treatments (2nd ed.) (pp. 34-47). Philadelphia: W.B. Saunders.
Kemp, M.G. (1994). Protecting the skin from moisture and associated irritants. Journal of Gerontological Nursing,
20(9),
8-14.
Titler, M.G., Pettit, D., Bulechek, G.M., McCloskey, J.C., Craft, M.J., Cohen, M.Z., Crossley, J.D., Denehy, J.A.,
Glick,
O.J., Kruckeberg, T.W., Maas, M.L., Prophet, C.M., & Tripp-Reimer, T. (1991). Classification of nursing
interventions for care of the integument. Nursing Diagnosis, 2(2), 45-56.
1 NIC terminology is Skin Care: topical treatments
Activities:
Record current smoking status and smoking history
Determine patients readiness to learn about smoking cessation
Monitor patients readiness to attempt to quit smoking
Give smoker clear, consistent advice to quit smoking
Help patient identify reasons to quit and barriers to quitting
Instruct patient on the physical symptoms of nicotine withdrawal (e.g., headache, dizziness, nausea, irritability, and
insomnia)
Reassure patient that physical withdrawal symptoms from nicotine are temporary
Inform patient about nicotine replacement products (e.g., patch, gum, nasal spray, inhaler) to help reduce physical
withdrawal
symptoms
Assist patient to identify psychosocial aspects (e.g., positive and negative feelings associated with smoking) that influence
smoking behavior
Assist patient in developing a smoking cessation plan that addresses psychosocial aspects that influence smoking behavior
Assist patient to recognize cues that prompt him/her to smoke (e.g., being around others who smoke, frequenting places
where
356
smoking is allowed)
Assist patient to develop practical methods to resist cravings (e.g., spend time with nonsmoking friends, frequent places
where
smoking is not allowed, relaxation exercises)
Help choose best method for giving up cigarettes, when patient is ready to quit
Help motivated smokers to set a quit date
Provide encouragement to maintain a smoke-free lifestyle (e.g., make the quit day a celebration day; encourage selfrewards at
specific intervals of smoke-free living, such as at 1 week, 1 month, 6 months; encourage saving money used previously on
smoking materials to buy a special reward)
Encourage patient to join a smoking cessation support group that meets weekly
Refer to group programs or individual therapists, as appropriate
Assist patient with any self-help methods
Help patient plan specific coping strategies and resolve problems that result from quitting
Advise to avoid dieting while trying to give up smoking because it can undermine chances of quitting
Advise to work out a plan to cope with others who smoke and to avoid being around them
Inform patient that dry mouth, cough, scratchy throat, and feeling on edge are symptoms that may occur after quitting; the
patch
or gum may help with cravings
Advise patient to keep a list of slips or near slips, what causes them, and what he/she learned from them
Advise patient to avoid smokeless tobacco, dipping, and chewing as these can lead to addiction and/or health problems
including oral cancer, gum problems, loss of teeth, and heart disease
Manage nicotine replacement therapy
Contact national and local resource organizations for resource materials
Follow patient for 2 years after quitting if possible, to provide encouragement
Arrange to maintain frequent telephone contact with patient (e.g., to acknowledge that withdrawal is difficult, to reinforce
the
importance of remaining abstinent, to offer congratulations on progress)
Help patient deal with any lapses (e.g., reassure patient that he/she is not a failure, reassure that much can be learned
from this
temporary regression, assist patient in identifying reasons for the relapse)
Support patient who begins smoking again by helping to identify what has been learned
Encourage the relapsed patient to try again
Promote policies that establish and enforce smoke-free environment
Serve as a nonsmoking role model
Background Readings:
Lenaghan, N.A. (2000). The nurses role in smoking cessation. MEDSURG Nursing, 9(6), 298-312.
OConnell, K.A. (1990). Smoking cessation: Research on relapse crises. In J.J. Fitzpatrick, R.L. Taunton, & J.Z. Benoliel (Eds.), Annual Review
of
Nursing Research, 8, 83-100. New York: Springer Publishing.
OConnell, K.A., & Koerin, C.A. (1999). Smoking cessation assistance. In G.M. Bulechek & J.C. McCloskey (Eds.), Nursing interventions:
Effective
nursing treatments (3rd ed.) (pp. 438-450). Philadelphia: W.B. Saunders.
U.S. Department of Health and Human Services. (1997). Smoking cessation: Clinical practice guideline No. 18. Rockville, MD: Agency for
Health Care
Policy & Research.
Wewers, M.E., & Ahijeoych, K.L. (1996). Smoking cessation interventions in chronic illness. In J.J. Fitzpatrick & J. Norbeck. (Eds.), Annual
Review of
Nursing Research, 14, 75-93.
1 Delaware
358
Conduct mouth checks following medication administration to ensure that patient is not cheeking the medications for later
overdose
attempt
Provide small amounts of prescribed medications that may be lethal to those at risk to decrease the opportunity for suicide, as
appropriate
Monitor for medication side effects and desired outcomes
Involve patient in planning his/her own treatment, as appropriate
Instruct patient in coping strategies (e.g., assertiveness training, impulse control, and progressive muscle relaxation), as
appropriate
Contract (verbally or in writing) with patient for no self-harm for a specified period of time, recontracting at specified time
intervals,
as appropriate
Implement necessary actions to reduce an individuals immediate distress when negotiating a no-self-harm or safety contract
Identify immediate safety needs when negotiating a noself-harm or safety contract
Assist the individual in discussing his/her feelings about the contract
Observe individual for signs of incongruence that may indicate lack of commitment to fulfilling the contract
Take action to prevent individual from harming or killing self, when contract is a noself-harm or safety contract (e.g., increased
observation, removal of objects that may be used to harm self)
Interact with the patient at regular intervals to convey caring and openness and to provide an opportunity for patient to talk about
feelings
Use direct, nonjudgmental approach in discussing suicide
Encourage patient to seek out care providers to talk as urge to harm self occurs
Avoid repeated discussion of suicide history by keeping discussions present- and future-oriented
Discuss plans for dealing with suicidal ideation in the future (e.g., precipitating factors, whom to contact, where to go for help,
ways to
alleviate impulses to harm self)
Assist patient to identify network of supportive persons and resources (e.g., clergy, family care providers)
Initiate suicide precautions (e.g., ongoing observation and monitoring of the patient, provision of a protective environment) for
the
patient who is at serious risk of suicide
Place patient in least restrictive environment that allows for necessary level of observation
Continue regular assessment of suicidal risk (at least daily) in order to adjust suicide precautions appropriately
Consult with treatment team before modifying suicide precautions
Communicate risk and relevant safety issues to other care providers
Consider strategies to decrease isolation and opportunity to act on harmful thoughts (e.g., use of a sitter)
Observe, record, and report any change in mood or behavior that may signify increasing suicidal risk and document results of
regular
surveillance checks
Explain suicide precautions and relevant safety, issues to the patient/family/significant others (e.g., purpose, duration, behavioral
expectations, and behavioral consequences)
Facilitate support of patient by family and friends
Refer patient to mental health care provider (e.g., psychiatrist or psychiatric/mental health advanced practice nurse) for
evaluation and
treatment of suicidal ideation and behavior, as needed
Provide information about what community resources and outreach programs are available
Improve access to mental health services
Increase the publics awareness that suicide is a preventable health problem
Background Readings:
Conwell, Y. (1997). Management of suicidal behavior in the elderly. Psychiatric Clinics of North America, 20(3), 667-683.
Drew, B.L. (2001). Self-harm behavior and no-suicide contracting in psychiatric inpatient settings. Archives of Psychiatric Nursing, 15(3), 99106.
Hirschfeld, R.M.A., & Russel, J.M. (1997). Assessment and treatment of suicidal patients. New England Journal of Medicine, 337(13), 910-915.
Potter, M.L., & Dawson, A.M. (2001). From safety contract to safety agreement. Journal of Psychosocial Nursing, 39(8), 38-45.
Schultz, J.M., & Videbeck, S.D. (1998). Lippincotts manual of psychiatric nursing care plans. Philadelphia: Lippincott.
Suicide Prevention and Advocacy Network (1998). Working draft 2National strategy for suicide prevention. Available on-line:
http://www.spanusa.org/draft.htm
Valente, S.M., & Trainor, D. (1998). Rational suicide among patients who are terminally ill. Official Journal of the Association of Operating
Room
Nurses, 68(2), 252-255, 257-258, 260-264.
Surveillance (SURV)
359
Definition: Purposeful and ongoing collection and analysis of information about the patient
and
the environment for use in promoting and maintaining patient safety.
Activities:
Monitor patient for alterations in physical or cognitive function that might lead to unsafe
behavior
Monitor environment for potential safety hazards
Determine degree of surveillance required by patient, based on level of functioning and the
hazards
present in environment
Provide appropriate level of supervision/surveillance to monitor patient and to allow for
therapeutic
actions, as needed
Place patient in least restrictive environment that allows for necessary level of observation
Initiate and maintain precaution status for patient at high risk for dangers specific to the care
setting
Communicate information about patients risk to other nursing staff
Background Readings:
Dougherty, C.M. (1992). Surveillance. In G.M. Bulechek & J.C. McCloskey (Eds.), Nursing
interventions:
Essential nursing treatments (2nd ed.) (pp. 500-511). Philadelphia: W.B. Saunders.
Kanak, M.F. (1992). Interventions related to safety. In G.M. Bulechek & J.C. McCloskey (Eds.),
Symposium
on Nursing Interventions. Nursing Clinics of North America, 27(2), 371-396.
Kozier, B., & Erb, G. (1987). Fundamentals of nursing: Concepts and procedures (3rd ed.). Menlo Park,
CA:
Addison-Wesley.
Nightingale, F. (1969). Notes on nursing: What it is and what it is not. New York: Dover Publications.
363
Hagan, L., Morin, D., & Lepine, R. (2000). Evaluation of telenursing outcomes: Satisfaction, self-care practices, and cost
savings.
Public Health Nursing, 17(4), 305-313.
Larson-Dahn, M. L. (2001). Tel-eNurse practice: Quality of care and patient outcomes. Journal of Nursing Administration, 31(3),
145152.
Poole, S. G., Schmitt, B.D., Carruth, T., Peterson-Smith, A.A., & Slusarski, M. (1993). After-hours telephone coverage: The
application of an area-wide telephone triage and advice system for pediatric practices. Pediatrics, 92(5), 670-679.
Wheeler, S., & Siebelt, B. (1997). Calling all nurses: How to perform telephone triage. Nursing, 97(7), 37-41.
Delaware definition is more narrow in scope by limiting activity to general purpose of updating medical information, which can be an exchange
of
ideas. Activities such as health education and counseling via telephone are documented as health education and counseling.
1
Assist in developing well-balanced meal plans consistent with level of energy expenditure
Background Readings:
National Institutes of Health. (2000). The practical guide: Identification, evaluation, and treatment of
overweight and obesity in adults. NIH Publication Number 00-4084. Washington, DC: US Department of
Health and Human Services.
Thelan, L.A., & Urden, L.D. (1998). Critical care nursing: Diagnosis and management (3rd ed.). St.
Louis:
Mosby.
Whitney, E.N., & Cataldo, C.B. (1991). Understanding normal and clinical nutrition (3rd ed.). St. Paul,
MN:
West Publishing.
Dwyer, F.M., & Keeler, D. (1997). Protocols for wound management. Nursing Management, 28(7), 4549.
Hall, P., & Schumann, L. (2001). Wound care: Meeting the challenge. Journal of the American Academy
of
Nurse Practitioners, 13(6), 258-266.
Thompson, J. (2000). A practical guide to wound care. RN, 63(1), 48-52.
Contact Lens Care EYECL prevention of eye injury & lens damage
Diarrhea Management DIARRprevention & alleviation of diarrhea
Emergency Care (illness) ERILLproviding life-saving measures in life-threatening situations caused
by illness
Enteral Tube Feeding TUBEFEEDdelivering nutrients & water through a gastrointestinal tube
Feeding FEED feeding of patient with oral motor deficits
Fever Treatment FVRmanagement of a patient with hyperpyrexia caused by nonenvironmental factors
First Aid WOUNDFAproviding initial care for a minor injury
Health Care Information Exchange (illness) INFOILLproviding patient care information to other
health professionals related to illness
Health Care Information Exchange (injury) INFOINJproviding patient care information to other
health professionals related to injury
Heat/Cold Application (injury) HTCLDstimulation of the skin & underlying tissues with heat or cold
for the purpose of decreasing pain, muscle spasms, or inflammation
Heat Exposure Treatment HEATXmanagement of patient overcome by heat due to excessive
environmental heat exposure
Hemorrhage Control HMRRreduction or elimination of rapid & excessive blood loss
High-Risk Pregnancy Care PREGidentification & management of a high-risk pregnancy to promote
healthy outcomes for mother & baby
Hyperglycemia Management HYPERGpreventing & treating above-normal blood glucose levels
Hypoglycemia Management HYPOGpreventing & treating low blood glucose levels
Medication Administration MEDADMpreparing, giving, & evaluating the effectiveness of prescription
& nonprescription drugs
Medication Management MEDMGTfacilitation of safe/effective use of prescription & over-the-counter
drugs
Multidisciplinary Care Conference (illness) CONFILLplanning & evaluating patient care with health
professionals from other disciplines
Multidisciplinary Care Conference (injury) CONFINJplanning & evaluating patient care with health
professionals from other disciplines
370
Positioning POSIdeliberative placement of the patient or a body part to promote physiological &/or
psychological well-being
Referral Management REFMGT arrangement for services by another healthcare provider or agency
Respiratory Monitoring RESPcollection & analysis of patient data to ensure airway patency &
adequate gas exchange
Rest REST providing environment & supervision to facilitate rest/sleep (NON-nursing)
Seizure Management SZRcare of a patient during a seizure & the postictal state
Self-Care Assistance, Nursing SELFNURassisting another to perform activities of daily living
Self-Care Assistance, Non-Nursing SELFNONassisting another to perform activities of daily living
Skin Care SKINapplication of topical substances or manipulation of devices to promote skin integrity &
minimize skin breakdown
Surveillance SURV - purposeful/ongoing acquisition, interpretation, & synthesis of patient data for
clinical decision making
Surveillance: Skin SKINSRVcollection/analysis of patient data to maintain skin & mucous membrane
integrity
Telephone Consultation TCfor purpose of updating medical information
Treatment Administration TXADMpreparing, giving, & evaluating the effectiveness of prescribed
treatments
Treatment Management TXMGTfacilitation of safe & effective prescribed treatments
Tube Care TUBECAREmanagement of a patient with an external drainage device exiting the body
Tube Care, Gastrointestinal TUBECAREGImanagement of a patient with a gastrointestinal tube
Urinary Catheterization CATHinsertion of a catheter into the bladder for temporary or permanent
drainage of urine
Vital Signs Monitoring VScollection/analysis of cardiovascular, respiratory, & body temperature data
to determine/prevent complications
Wound Care (Ongoing) WOUNDONprevention of wound complications & promotion of wound healing
HEALTH EDUCATION
Anticipatory Guidance (individual) AGUIDE preparation of patient for an anticipated
developmental &/or situational crisis
Anticipatory Guidance (group) AGUIDEG preparation of a group of patients for an
anticipated developmental &/or situational crisis
Body Mechanics Promotion (individual) BODY facilitating a patient in the use of posture &
movement in daily activities to prevent fatigue & musculoskeletal strain or injury
371
Body Mechanics Promotion (group) BODYG facilitating a group of patients in the use of
posture & movement in daily activities to prevent fatigue & musculoskeletal strain or injury
Exercise Promotion (individual) EXER facilitation of a patient in regular physical exercise to
maintain or advance to a higher level of fitness & health
Exercise Promotion (group) EXERG facilitation of a group of patients in regular physical
exercise to maintain or advance to a higher level of fitness & health
Health Education (individual) HLTHED developing & providing individual instruction &
learning experiences to facilitate voluntary adaptation of behavior conducive to health in
individuals, families, groups, or communities
Health Education (group) HLTHEDG developing & providing group instruction & learning
experiences to facilitate voluntary adaptation of behavior conducive to health in individuals,
families, groups, or communities
Smoking Cessation Assistance (individual) SMOKE helping the patient to stop smoking
through an individual process
Smoking Cessation Assistance (group) SMOKEG helping the patient to stop smoking in a
group process
Substance Use Prevention (individual) SUBAB prevention of an alcoholic or drug use lifestyle
through an individual process
Substance Use Prevention (group) SUBABG prevention of an alcoholic or drug use lifestyle
through a group process
Weight Management WGTMGT facilitating maintenance of optimal body weight & percent
body fat
HEALTH PROMOTION/PROTECTION
Environmental Management ENVMGT manipulation of the patients surroundings for
therapeutic benefit, sensory appeal & psychological well-being
Health System Guidance HGUIDE facilitating a patients location & use of appropriate health
services
Immunization Management IZMGT monitoring status & facilitating access to immunization
Infection Protection INFPRO prevention & early detection of infection in a patient at risk
Progressive Muscle Relaxation MURELX facilitating the tensing & releasing of successive
muscle groups while attending to the resulting differences in sensation
Seizure Precautions SZRPRE prevention or minimization of potential injuries sustained by a
patient with a known seizure disorder
Suicide Prevention PRESUI reducing risk of self-inflicted harm with intent to end life
Surveillance: Safety SAFE purposeful & ongoing collection & analysis of information about
the patient & the environment for use in promoting & maintaining patient safety
Sustenance Support SUST helping a needy individual/family to locate food, clothing, or
shelter
12/16/08
MEMORANDUM OF UNDERSTANDING
BETWEEN
THE DEPARTMENT OF EDUCATION-LOCAL EDUCATION AGENCIES
AND CHARTER SCHOOLS
AND THE
DEPARTMENT OF SERVICES FOR CHILDREN, YOUTH AND THEIR
FAMILIES-DIVISION OF FAMILY SERVICES, DIVISION OF CHILD MENTAL
HEALTH, AND DIVISION OF YOUTH REHABILITATIVE SERVICES
2
Page
TABLE OF CONTENTS
I. Title of the Agreement ............................................................................... 1
372
(P.L. 104-191)
E. Child Welfare, 31 DE Code, Chapter 3
F. Department of Services for Children, Youth and Their Families, 29 DE
Code, Chapter 90
G. Abuse of Children, 16 DE Code, Chapter 9
H. Education, 14 DE Code, Chapters 2, 13, and 41
I. Education of Homeless Children and Youth, 14 DE Admin. Code 901
J. Education, 14 DE Admin. Code 609
K. Education, 14 DE Admin. Code 611
III. Purpose of the Agreement
This MOU between the DOE; LEAs and Charter Schools; and the DSCYF
(DFS, DCMH, and DYRS) has been jointly developed for the following purposes:
A. To develop a uniform process for all Delaware LEAs and Charter
Schools to report child abuse and neglect;
B. To establish consistent procedures for LEAs and Charter Schools to
follow when the DFS investigates a report of child abuse or neglect or
the DSCYF is providing case management services;
C. To ensure multi-disciplinary collaboration between DOE, LEAs, Charter
Schools, and DSCYF in child abuse and neglect investigations,
2
recognizing the paramount goals of all agencies to ensure the health,
safety, and well-being of children;
D. To address necessary supports for all students and families held in
common by the two departments;
E. To develop a uniform process for Delaware LEAs and Charter Schools
to maintain children who are in the custody of DSCYF in their schools of
origin, or when in their best interest, to promptly enroll them in a new
school;
F. To establish consistent procedures to address when children in foster
care change residence resulting in a new school enrollment or the need
for transportation to their school of origin;
G. To enhance communication and coordination of the McKinney-Vento Act
and 14 DE Code 202;
H. To ensure that in all instances, educational and placement decisions
regarding children and youth in foster care are based on the best
interests of the child;
I. To ensure that all students in foster care have a meaningful opportunity
to meet the challenging state pupil achievement standards to which all
students are held;
J. To establish protocol for transition to/from DSCYF programs and LEAs
and Charter Schools;
K. To establish protocols for communication between DSCYF, LEAs, and
Charter Schools, and
L. To ensure compliance with 14 DE Code 4123.
In addition, to meet the needs of the parties hereto, the MOU will:
1. Define the responsibilities of each organization.
374
Protections).
8. Reports made by other sources:
a. In the event that DFS or the police deem it necessary to
pursue an investigation in the school setting, the DFS
caseworker shall inform the school contact person and
request assistance per the procedures in Section
V.A.3.a.3-8 above.
b. Alleged physical abuse will be directly investigated by the
DFS Investigation caseworker who may request that the
school nurse assist with a physical assessment. No
physical assessment of alleged physical abuse reported by
sources outside the school will be conducted by the school
nurse prior to DFS response to the school.
c. Reports to DFS from a Wellness Center will be handled in
the same manner as external reports. The school will be
notified if it is necessary to obtain information from school
personnel.
d. A report that alleges educational neglect by a home school
will not be investigated by DFS unless the report also
alleges another type of abuse and neglect or dependency.
4. Case Collaboration on Active DFS Investigation Cases
Verbal or written consent of a parent/legal guardian/Relative Caregiver is
not required for DFS to investigate allegations of abuse, neglect or
dependency or to interview a child in connection with the foregoing. 16
DE Code 906 (b)(3) states DFS shall conduct an investigation
involving all reports, which if true, would constitute violations against a
child by a person responsible for the care, custody, and control of the
child... In determining how best to respond, 16 DE Code 906 (b) (2)
mandates that DFS ...shall give priority to ensuring the well-being and
safety of the child.
Once an investigation has begun, LEAs/Charter Schools and DFS
encourage the sharing of information to enhance the investigation,
protect children, prevent further child abuse and neglect, and provide
12
family-focused services. When an investigation is complete and the
need for ongoing treatment services has been identified, information can
be shared with a signed State of Delaware Interagency Consent to
Release Information must be obtained by either agency from the
parents/legal guardian. To expedite the exchange of information, either
agency may fax the signed consent form. (See Appendix C State of
Delaware Interagency Consent to Release Information). Additional
information regarding the sharing of information may be found under
Confidentiality.
a. No Identified DFS Investigation Caseworker
When the DFS Investigation caseworkers name is not known and
a school staff person wants to share information about the case
383
immediately (within three school days during the school year, or five
16
working days in the summer) to a new school for a child in foster care
who is transferring schools.
e. Ensure that the sending school fully transfers credits, including partial
credits. The receiving school shall ensure credits are received and
applied. The receiving and sending schools should determine, for
transferring seniors, which school will provide the diploma.
f. Accept a DSCYF letterhead statement as proof of residency of a
child in foster care with the placement resource identified.
g. Accept registration materials from DSCYF case managers via fax
and schedule a meeting or a teleconference with the caseworker for
a later date, within five business days, to discuss other educational
information that may not have been shared.
h. Host meetings with necessary parties to develop the best educational plan
for a child or youth in foster care, as may be needed from time to time.
i. Host a meeting in May, with all involved parties (district/school liaison,
caseworker, parent, Guardian ad litem, CASA, and child) to determine
whether it is in the best interest of the child to remain in the school of
origin or be transferred to the district in which they are now living for
the subsequent year. The school liaison will schedule the meeting and
be responsible for scheduling other school personnel. The DSCYF
Caseworker will be responsible for scheduling the foster parent,
Guardian ad litem, etc. needed to reach a good decision.
C. Transition from DSCYF to LEAs and Charter Schools
To ensure successful transition from a licensed or contracted provider of
DSCYF, the parties agree to follow the Protocol for Transition to/from
DSCYF Programs to LEA or Charter Schools Chart in Appendix F. The
Protocol was developed based on a System of Care philosophy of
integrated, seamless case planning.
D. Confidentiality
Each Department will comply with the relevant laws and regulations that
govern confidentiality. However, each Department will provide information
to each other which is not specifically protected in order to ensure the
successful support of children and families. Additionally, each Department
will make concerted efforts to ensure that parents/guardians understand the
importance of sharing information for the success of their child.
1. Child Abuse Prevention and Treatment Act (CAPTA)
17
CAPTA was reauthorized on June 25, 2003 by the keeping Children and
Families Safe Act of 2003 (P.L. 108-36). Section 106 (b)(2)(A)
(viii - x) requires:
(viii) methods to preserve the confidentiality of all records in order
to protect the rights of the child, and of the childs parents,
including requirements ensuring that reports and records made
and maintained pursuant to the purposes of this title shall only be
387
made available to
(I) individuals who are the subject of the report;
(II) Federal, State, or local government entities, or any agent
of such entities, as described in clause (ix);
(III) child abuse citizen review panels;
(IV) child fatality review panels;
(V) a grand jury or court, upon a finding that information in
the record is necessary for the determination of an issue
before the court or grand jury; and
(VI) other entities or classes of individuals statutorily
authorized by the State to receive such information
pursuant to a legitimate State purpose;
(VII) provisions to require a State to disclose confidential information
to any Federal, State, or local government entity, or any agent
of such entity, that has a need for such information in order to
carry out its responsibilities under law to protect children from
abuse and neglect;
(VIII) provisions which allow for public disclosure of the findings or
information about the case of child abuse and neglect which has
resulted in a child fatality or near fatality;
2. Education
14 DE Code 4111 provides that all educational records in public and
private schools are confidential. Education records and personally
identifiable information can only be released in accordance with DOE
regulations. DOE has adopted the Federal regulations with two
exceptions which are not applicable.
3. Family Educational Rights and Privacy Act (FERPA)
Generally, schools must have written permission from the parent/legal
guardian or eligible student in order to release any information from a
students education record. However, FERPA, 20 U.S.C. 1232(g), 34
CFR Part 099, allows schools to disclose educational records, without
consent, to the following parties or under the following conditions (34
CFR 99.31):
1. School officials with legitimate educational interest;
18
2. Other schools to which a student is transferring;
3. Educational authorities conducting audit, evaluation, or
enforcement of education programs;
4. Appropriate parties in connection with financial aid to a student;
5. Organizations conducting certain studies for or on behalf of the
school;
6. Accrediting organizations;
7. To comply with a judicial order or lawfully issued subpoena;
8. Appropriate officials in cases of health and safety emergencies;
9. Parents/legal guardian/Relative Caregiver of a dependent
student; and
388
Caesar Rodney
George E. Stone, Ed.D. Date
Cape Henlopen
Michael D. Thomas, Ed.D. Date
Capital
Lillian M. Lowery, Ed.D. Date
Christina
George M. Meney, Ed.D. Date
Colonial
22
David C. Ring, Ed.D. Date
Delmar
Susan S. Bunting, Ed.D. Date
Indian River
Daniel D. Curry, Ed.D. Date
Lake Forest
John W. McCoy, Ed.D. Date
Laurel
Robert D. Smith, Ed.D. Date
Milford
Steven H. Godowsky, Ed.D. Date
New Castle County Votech
Dianne G. Sole, Ed.D. Date
Polytech
Robert J. Andrzejewski, Ed.D. Date
Red Clay Consolidated
Russell H. Knorr, Ed.D. Date
Seaford
Deborah D. Wicks Date
Smyrna
Patrick E. Savini, Ed.D. Date
Sussex Technical
Kevin E. Carson, Ed.D. Date
Woodbridge
23
Charter Schools
Noel Rodriguez - Principal Date
Academy of Dover
Trish Hermance School Administrator Date
Campus Community
Ronald R. Russo, J.D. - President Date
Charter School of Wilmington
Charles W. Baldwin - Principal Date
Delaware Military Academy
Nita Roberson - Principal Date
Delaware College Preparatory Academy
Dominique Taylor Acting Director Date
East Side Charter
Tennell Brewington Head of School Date
Family Foundations Academy
Sondra Shippen Head of School Date
391
Kuumba Academy
Theopalis Gregory, Sr. Head of School Date
Maurice J. Moyer Academy
Linda J. Jennings, Esquire Head of School Date
MOT
Gregory R. Meece School Director Date
Newark Charter
Anthony Skoutelas Head of School Date
Odyssey
24
Brad Catts Head of School Date
Pencader Business and Finance Charter High School
Edward J. Emmett, Jr. Director Date
Positive Outcomes
Jack Perry - Director Date
Prestige Academy
Charles Taylor - Principal Date
Providence Creek
Patricia Oliphant, Ed.D. - Principal Date
Sussex Academy of Arts and Sciences
Alina Columbus, Ph.D. Principal Date
Thomas Edison
25
DSCYF Division Directors
Susan A. Cycyk, M.Ed. Date
Child Mental Health
Carlyse Giddins Date
Family Services
Margaret J. Timko Date
Management Support Services
Rick Shaw. Date
Youth Rehabilitative Services
26
APPENDIX A MANDATORY REPORTING FORM
27
INSTRUCTIONS: Any physician, and any other medical person in the healing arts including any person licensed to
render services in
medicine, osteopathy, dentistry, any intern, resident, nurse, medical examiner, school employee, social worker,
psychologist, or any
other person who knows or in good faith suspects child abuse or neglect shall make an oral report to the Report Line
using the number
at the top of this page in accordance with 16 Del. C, 903 and 904.
Within 72 hours after the oral report, send a completed Child Abuse / Neglect Mandatory Reporting Form to the
following address:
Please type or print the information and sign the form on the back.
392
State of Delaware
The Department of Services
for Children, Youth, and
Their Families
DIVISION OF FAMILY SERVICES
CHILD ABUSE / NEGLECT MANDATORY REPORTING FORM
(Title 16, Delaware Code, Chapter 9, Subsections 901-914)
Toll Free 24-Hour Report Line: 1-800-292-9582
28
29
APPENDIX B LIST OF VIOLATIONS
Per 16 DE Code 906(b)(3):
The Division may investigate any report, but shall conduct an investigation involving all
reports, which if true, would constitute violations against a child by a person responsible for
the care, custody and control of the child of any of the following provisions of 603, 604, 611,
612, 613, 621, 625, 626, 631, 632, 633, 634, 635, 636, 645, 763, 765, 766, 767, 768, 769,
770, 771, 772, 773, 774, 775, 776, 777, 778, 779, 780, 782, 783, 783A, 791, 1100, 1101,
1102, 1107, 1108, 1109, 1110, 1111, or 1259 of Title 11, or an attempt to commit any such
crimes. The Division staff shall also contact the appropriate law enforcement agency upon
receipt of any report under this section and shall provide such agency with a detailed
description of the report received. The appropriate law enforcement agency shall assist the
Division in the investigation or provide the Division, within a reasonable time, an explanation
detailing the reasons why it is unable to assist. Notwithstanding any provision of the Delaware
Code to the contrary, to the extent the law enforcement agency with jurisdiction over the case
is unable to assist, the Division may request that the Delaware State Police exercise
jurisdiction over the case and upon such request the Delaware State police may exercise such
jurisdiction;
603 Reckless Endangering in the 2nd Degree; Class A Misdemeanor
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30
765 Indecent Exposure in the 1st Degree; Class A Misdemeanor
766 Incest; Class A Misdemeanor
767 Unlawful Sexual Contact in the 3rd Degree; Class A Misdemeanor
768 Unlawful Sexual Contact in the 2nd Degree; Class G Felony
769 Unlawful Sexual Contact in the 1st Degree; Class F Felony
770 Rape in the Fourth Degree; Class C Felony
771 Rape in the Third Degree; Class B Felony
772 Rape in the Second Degree; Class B Felony
773 Rape in the First Degree; Class A Felony
774 and 775 Reserved
776 Sexual Extortion; Class E Felony
777 Bestiality; Class D Felony
778 Continuous Sex Abuse of a Child; Class B Felony
779 Dangerous Crime Against a Child, Definitions, Sentences
780 Female Genitalia Mutilation; Class E Felony
782 Unlawful Imprisonment in the 1st Degree; Class G Felony
783 Kidnapping in the 2nd Degree; Class C Felony
783 A Kidnapping in the 1st Degree; Class B Felony
791 Acts Constituting Coercion; Class A Misdemeanor
1100 Dealing in Children; Class E Felony
1101 Abandonment of a Child; Class A Misdemeanor
1102 Endangering the Welfare of a Child; Class E or G Felony
1107 Endangering Children, Unclassified Misdemeanor
1108 Sexual Exploitation of a Child, Class B Felony
1109 Unlawfully Dealing Child Pornography, Class D Felony
1110 Subsequent Conviction of Sections 1108 And 1109
1111 Possession of Child Pornography; Class F Felony
1259 Sexual Relations in a Detention Facility; Class G Felony
31
APPENDIX C STATE OF DELAWARE INTERAGENCY CONSENT TO RELEASE
INFORMATION (REDUCED TO FIT PAGES)
(ORIGINATING ORGANIZATION NAME)
AUTHORIZATION FOR THE RELEASE OF INFORMATION
CLIENT/STUDENT:
DATE OF BIRTH:
I hereby authorize the following individuals or organizations to release information:
To the following individuals or organizations:
The type of information to be provided is:
The purpose of providing this information is:
This authorization is valid until:
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32
NOTES
Block 1 Client/student and Date of Birth: Please check to be certain name is legible. Please check legibility of birth date.
Block 2 I hereby authorize the following individuals or organizations to release information: Enter the name and
address of organization that is being asked to release information.
Then, on lines below
To the following individuals or organizations: Enter the name and address of organization which will receive the
information.
Block 3 The type of information to be provided is: Be as specific as possible; this entry needs to follow the principle of
minimum necessary. If substance abuse, pregnancy, STD, HIV information is to be released it should be specified and
appropriate signatures provided. Signature of minor required for substance abuse information; others under review but
general advice would be to obtain minors signature for information related to pregnancy, STD, and HIV.
Block 4 The purpose of providing this information is: This should be a simple statement such as to assist in treatment
planning and provision, to determine eligibility and need for services
Block 5 This authorization is valid until: If One year is selected, please verify that a date is given in the signature
box. If The following date or event is selected, please be certain that the date or event is clear and not subject to
different interpretations. It is not likely that a date more than a year after the form is executed would be acceptable; this
option is usually used when the client or representative wishes to restrict future releases to a shorter time period.
Block 6 In signing this authorization I understand: These statements are required by HIPAA.
o This authorization is voluntary and services are not dependent on my authorization. Signing a release to
obtain information from another organization cannot be a requirement for the provision of needed services. We
may require information to establish eligibility for services.
o I have a right to receive a copy of my authorization. Providing a copy to signatory is the simplest way to deal
with this issue and avoid complications later. The original usually goes to the organization from which information
if requested, a copy must remain in our client file. We will explore the possibility of multi-part forms so you will not
need to find a copy machine.
o This authorization may be revoked at any time by writing to the originating agency. The revocation will be
effective on receipt, but will not affect actions taken prior to receiving my revocation. There may be a
conflict of federal regulations here; 42 CFR on substance abuse information does not require a written revocation,
HIPAA does. If you receive an oral revocation, the best course of action may be to write that date on a revocation
form and ask the client/representative to sign it just as soon as possible.
o If I request release of information to individuals or organizations which are not subject to state or federal
privacy regulations, that information could be re-disclosed without privacy protections. This statement
may require some explanation. Essentially, it is meant to warn that if information is released to an individual or
organization not subject to HIPAA or any of the other applicable Delaware or federal confidentiality laws or
regulations, that individual or organization could provide the information to others without restriction or penalty.
Please be sure you are comfortable explaining this to clients or their representatives.
Block 7 signatures: the complications here are:
o Information from Wellness Centers requires student authorization; parent authorization is not required.
(Presumably, information could also not be re-released to parents without minors authorizationbut we need
opinion on this.)
o Substance abuse information requires authorization of minor; parent authorization is not required. Information
cannot be re-released to parents without minors authorizationthis one is very clear. Release of substance
information also requires an accompanying 42 CFR statement.
o Representative must indicate legal basis of representative status, e.g., parent, guardian, legal custodian with
rights to information. If guardian or custodian or some other basis for representative status is indicated, please be
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33
Academic achievement**
Completion of
assignments/homework
** Please attach students current grades/transcripts to this form
Decision Making
396
Problem solving
Socially Acceptable Behaviors
Current Medication:
Compliance to Rules
Anger Management
Self Control/ Self / Self Discipline
Extent of Family Involvement:
This student would benefit from continued counseling in the
following areas:
SIGNIFICANT OCCURRENCE(S):
______________________________________________________________________________
_____
35
FUTURE PLACEMENT RECOMMENDATIONS (Please complete this section once a
decision for transition to
the home school is finalized it should allow for 30 days of planning)
School Placement:
Services that will need to be in place:
Outline of Transition Plan:
This form will not be placed in the cumulative folder
36
APPENDIX E DETERMINING FEASIBILITY OF SCHOOL PLACEMENT FORM
Name of Student:
Date:
According to the McKinney-Vento Homeless Assistance Act, a homeless child
or youth has the right to attend the school of origin or the local attendance
areas school, according to the best interest of the child:
The school of origin is defined as:
The school that the child or youth attended when permanently housed;
OR
The school in which the child or youth was last enrolled
The local attendance area school (local school) is defined as:
Any public school that non-homeless students who live in the attendance
area in which the child or youth is actually living are eligible to attend
This form will assist in determining which placement decision would be in the
students best interest.
Please provide the following information for the attendance options for
the student:
School that the child or youth attended when permanently housed:
Name of school and district:
Dates of attendance:
Living arrangement at the time:
School in which the child or youth was last enrolled:
Name of school and district:
Dates of attendance:
Living arrangement at the time:
Local Attendance Area School:
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38
APPENDIX F TRANSITION TO AND FROM DSCYF PROGRAMS, LEAS, AND
CHARTER SCHOOLS
TIMEFRAME ACTION PARTICIPANTS PARTY RESPONSIBLE FOR
SCHEDULING MTG.
Before Admission* to
DSCYF
School Programs
* Note: Admission to DSCYF
Programs frequently occurs
under emergency or
unexpected circumstances to
ensure the childs safety,
evaluate and stabilize the
child, or as a result of a
398
399
39
TIMEFRAME ACTION PARTICIPANTS PARTY RESPONSIBLE
FOR SCHEDULING MTG.
Initial Educational
Planning Meeting Records Needed: The school district or charter school
representative will bring to the meeting a completed
educational intake/update (EIU) form, prior transcripts, prior
report cards, attendance records, and school schedules. For
students eligible for special education services, the
representative will also bring the eligibility form, IEP, and
psychological evaluations. Any additional or necessary
records will also be provided by the school district
representative. All of the educational records are given to the
DSCYF educational representative.
Discussion of the records may or may not be appropriate at
the time of the meeting, but should be based on the needs of
the student. All educators should be familiar with the students
records prior to attending the meeting.
Educational Planning
Reviews
1. The school representative will be involved in regular
progress reviews which will be documented on the
Educational Intake/Update (EIU) form. (See Appendix D).
A planning meeting will occur no less than two weeks
before discharge. This process as much as possible will
include face to face contact with the school district
representative and may involve school participation in
family sessions/treatment plan reviews. Schools should
NOT be involved In family sessions unless the session is
focusing on school information. DSCYF will notify the
school representative of the review dates.
2. The DSCYF educational representative will provide
information to complete the EIU form prior to face to face
contact with the school district representative.
School District
Representative,
DSCYF Educational
Representative,
Program Therapist (if
applicable), DCMH
Coordinator and/or
YRS/DFS Caseworker
For State run programs,
DSCYF/DMSS will set up
meeting; If contracted
program, DCMH Coordinator
or DYRS caseworker
40
TIMEFRAME ACTION PARTICIPANTS PARTY RESPONSIBLE FOR
SCHEDULING MTG.
Discharge
Planning
from DSCYF
School
Programs
400
1. For mental health facilities, the clinician assigned to the case works
with the DCMH Clinical Services Management Team Leader to
determine which issues and behaviors need to be modified
(decreased or increased).
2. In mental health facilities, the CMH Clinical Services Management Team
leader, after hearing input from the clinician, parents,
schools and other involved parties, decides when a child can be moved to a
less intensive level of mental health services.
3. At each planning meeting with the schools approximate discharge
projections by DCMH or DYRS staff should be conveyed to school
personnel. While these estimates of a discharge date constantly change, it
is helpful for school planning.
4. As a part of the transitioning planning CMH or YRS should relate
information related to the behavior of the student. Such information should
at a minimum reflect function of the behavior, effective responses to the
behavior, slow and fast triggers, and suggested life skill changes.
5. As part of the transition planning, the representatives of the receiving school
will work with the treating/rehabilitating program to identify what services the
school needs to provide to the child as early as possible. Consider 14 DE
Admin Code 609 and 611. This would include evaluating whether the child
qualifies for special education services or, if already qualified, whether any
changes need to be made in the IEP. The early discharge planning process
outlined in this document should enable seamless and timely transitions to
school based on the DCMH/DYRS projected discharge date. If the
projected discharge date is accelerated then the primary case manager will
request a transition meeting as quickly as possible.
6. All agencies involved have more difficulty with summer transitioning. Most
school employees are 10 month employees thus planning could be delayed
during summer months.
School District
Representative,
DSCYF Educational
Representative,
Program Therapist (if
applicable), client,
parents/guardian,
Guardian ad litem,
CASA, educational
surrogate parent,
school district
representative, and
appropriate DSCYF
representatives
For State run programs,
DSCYF/DMSS will set up
meeting; If contracted
program, DCMH Coordinator
or DYRS caseworker
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APPENDIX G SERVICES PROVIDED BY DSCYF
Division of Child Mental Health (DCMH)
1. Crisis Services - A twenty-four hour service providing urgent mental health evaluations in
the community, including brief bed-based stabilizations, and referrals for subsequent
services.
2. Outpatient Services - Traditional face-to-face psychotherapeutic interventions provided in
401
a mental health clinic, which may include medications, and can range in intensity from
several times a week to several times a month.
3. Behavioral Health Aides - Trained paraprofessionals implementing supportive behavioral
treatments under the supervision of the clients therapist.
4. Intensive, In-home Services (Intensive Outpatient) - Home and community-based
behavioral and family interventions provided by at therapist/interventionist team in multiple
sessions a week.
5. Day Treatment - Milieu-based multimodal mental health care including individual, family,
behavioral, and group therapies with educational programming and psychiatric supports.
6. Residential Treatment - Twenty-four hour, milieu-based, multimodal mental health care
including individual, family, behavioral, and group therapies with educational programming
and psychiatric supports.
7. Psychiatric Hospital - Intensive, brief, medically-directed, twenty-four hour psychiatric
evaluation and mental health care including individual, family, behavioral, and group
therapies with educational programming.
Division of Family Services (DFS)
1. Office of Childcare Licensing (OCCL) - OCCL regulates in-home, out-of-home,
residential, and group care facilities, conducts criminal background checks on potential
providers, investigates concerns about child care centers, and provides training for
providers. It is the goal of OCCL to ensure the health and safety of all children receiving
child care services.
2. Office of Childrens Services (OCS) - OCS is mandated to receive and investigate
reports of child abuse, neglect, and dependency. Ensuring the safety of children is a
priority. When necessary, appropriate treatment services are provided to change the
behaviors and conditions which cause abuse and neglect and to promote the well-being of
children. Services may include in-home services, placement, family reunification, or other
permanency options including adoption, guardianship, and independent living.
Division of Management Support Services (DMSS)
Education Programs
1. Ferris School
2. Education is provided on site by certified school personnel to youth in the secure treatment
facility. Students transitioning through Mowlds Cottage either continue in the Ferris
Program or return to the home school. Regular and special education courses are offered
through a schedule which mirrors any local public high school. Electives include art,
technology, media literacy, school to work and JDG classes.
3. New Castle County Detention Center
4. All students attend a full day of courses which include all the Core Courses. GED is
available to youth meeting criteria for entry into the Program. Special education services
are provided in accordance with state and federal law.
5. Grace and Snowden Cottages
6. This program is a residential treatment program for adjudicated males and females.
Students are typically between the ages of 12-18. The program, located on the Wilmington
Campus, is operated directly by the Division of Youth Rehabilitative Services. Education is
provided on site by certified school personnel who are employed by DSCYF.
42
7. Camelot
8. Camelot is a non-secure detention environment for non-adjudicated males ages 12-18.
While in placement youth are required to attend school. The certified educator employed by
Department of Services for Children, Youth, and Their Families, Education Unit works
closely with the youth's "home school" to make sure the on-site education provided while in
placement is aligned with the child's "home school" class assignments. The DSCYF
teacher also ensures compliance with special education regulations as required and assists
in arranging a smooth return to a more conventional school environment upon discharge
from the non-secure detention placement. Education is provided year round, on site, and in
compliance with state and federal regulations. Camelot is located in Wilmington, DE.
9. Terry Children's Psychiatric Center
402
10. This CMH program is a Residential Treatment Center providing inpatient and day hospital
services for youth under the age of 14. Education is provided on-site by certified school
personnel. Special education services are provided in accordance with state and federal
law.
11. Northeast Treatment
12. This program is operated by Northeast Treatment Centers, LKEC (Delaware) Inc. under
contract to the Division of Child Mental Health Services. Students ages 12-17 receive a full
day of education by certified teachers. Special education services are provided in
accordance with state and federal law.
13. Silver Lake Treatment Center
14. This Child Mental Health program provides day treatment and educational services to
youth ages 12-17. Full complement of core courses are provided by teachers certified by
Delaware Department of Education. Special education services are provided in accordance
with state and federal law.
15. Stevenson House Detention Center
16. All students attend a full day of courses which include all the Core Courses. GED is
available to youth meeting criteria for entry into the Program. Special education services
are provided in accordance with state and federal law.
17. People's Place II
18. Peoples' Place II is a non-secure detention environment for non-adjudicated males and
females ages 12-18. While in placement youth are required to attend school. The certified
educator employed by Department of Services for Children, Youth, and Their Families,
Education Unit works closely with the youth's "home school" to make sure the on-site
19. education provided while in placement is aligned with the child's "home school" class
assignments. The DSCYF teacher also ensures compliance with special education
regulations as required and assists in arranging a smooth return to a more conventional
school environment upon discharge from the non-secure detention placement. Education is
provided year round, on site, and in compliance with state and federal regulations. Peoples'
Place II is located in Milford, DE
20. Seaford House Treatment Center
21. This program provides day treatment and educational services at the treatment center
operated by Children and Families First under contract with Division of Child Mental Health
Services. Students ages 12-17 receive a full day of education by certified teachers. Special
education services are provided in accordance with state and federal law.
22. Delaware Day Treatment Center
23. There are two Delaware Guidance programs: one in Kent County and one in Sussex
County. Both programs are operated by Delaware Guidance Inc. under contract to the
Division of Child Mental Health Services. Students ages 6-15 are provided with day
treatment and educational services. Education is provided on site by certified teachers
employed by DSCYF. Special education services are provided in accordance with state
and federal law.
Office of Prevention and Early Intervention (OPEI)
1. K-5 Early Intervention Program - a statewide program which helps children and their
families whose behaviors have impeded their social, emotional and academic success.
This school based program places Family Crisis Therapists in elementary across school
districts and charter schools statewide. The program provides crisis intervention as well as
43
ongoing support to the children and families through groups, individual sessions, parenting
groups, liaison with other agencies, etc.
2. Strengthening Families - a statewide, science-based skills training program for at-risk
families with children between the ages of 3 and 16.
3. Promoting Safe & Stable Families (PSSF) - a statewide family preservation and support
program which provides consultation services to at-risk families.
4. Families and Schools Together (FAST) - a science-based middle school program in five
sites in New Castle and Sussex counties for youth in grades 6-8.
5. Creating Lasting Family Connections (CLFC) - a statewide, science-based 20-week
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44
Level II programs are provided directly through DYRS juvenile probation staff or indirectly
through DYRS contracted programs with community providers.
A juvenile ordered to Level II undergoes a risk and needs assessment by DYRS. The
Division places the juvenile offender in one of two Level II programs:
Back on Track - A contracted community provider who coordinates a rehabilitative program
which includes educational programs and community services. Level II Back on Track
placements are monitored by a DYRS Case Manager.
Level II Probation - DYRS juvenile probation staff meets in regular intervals with the
juvenile offender to monitor progress during the probationary period. Level II Probation can
include outpatient treatment services, educational services and community service.
Level III Intensive Programs
Level III Intensive Programs are the highest level of non-secure community programs.
Level III programs are characterized by close supervision and comprehensive services.
Juveniles are assigned to the Intensive Program level based on an evaluation of their
offense history, indicators of risk for reoffense, and treatment needs.
Level III programs include:
Intensive Probation Services provided by DYRS probation staff and/or contracted
providers. This includes providers from Kingswood Community Center-Project StayFree
ICCP or Day Treatment and VisionQuest Family and Child Intensive Case Management
(FCICM). In addition, Multi-Systemic Therapy (MST) Program in which a DYRS contracted
provider works intensively with the juvenile, family, and community in addressing the root
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45
Level V Locked Secure Programs
Placement at the locked secure program level requires Court-ordered commitment to an
out-of-home placement. Locked Secure Programs are the most restrictive rehabilitative
programs available. A locked secure program is one in which the juvenile offender is under
24 hour supervision in a locked setting.
The Court decision to commit to a Level V program shall be based on an assessment of
the current offense, past delinquency history, probability of the juvenile representing a risk
to society, and the juveniles individual characteristics and needs.
Level IV and Level V programs are indicated for juveniles whose adjudicated offenses
include at least one of the following offenses:
Level V: Felony A, B, and C
Level IV: Violent Felony D, E, and F
Placement at a Level IV or V is also appropriate for lesser offenses such as violations of
probation (1) if the juvenile is not responsive to the continuum of less restrictive
interventions, non-amenable to a less restrictive placement, or (2) with a statement of
reason for a more restrictive placement.
THINK OF THE CHILD FIRST
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APPENDIX H - RESOURCES
Child Abuse 24/7 Report Line: 1(800) 292-9582
Child Mental Health:
Crisis contact
o Northern New Castle County (302) 633-5128
o Southern New Castle County (800) 969-4357
o Kent and Sussex counties (302) 424-4357
Non-crisis intake, referral and information
o New Castle County (302) 633-2571
o Kent and Sussex Counties (800) 722-7710
CONTACT Delaware: New Castle County (302) 761-9100; Kent and Sussex
Counties (800) 262-9800
Delaware Help! Line: (800) 464-4357, or out-of-state (800) 273-9500
405
Domestic Violence:
Abriendo Puertas (Spanish) Sussex County (302) 855-9515
CHILD, INC. New Castle County (302) 762-6110
SAFE Kent & Sussex Counties (302) 422-8058
Early Intervention Program (Childrens Department):
Contact: Joyce Hawkins, Program Support Manager (302) 892-5817
Educational Surrogate Parent Program (Courts):
Contact: Kathy Goldsmith, Coordinator (302) 255-1740
Family Court of the State of Delaware:
New Castle County (302) 255-0300
Kent County (302) 739-6500
Sussex County (302) 855-7400
McKinney-Vento (Department of Education):
Contact: Dennis Rozumalski (302) 735-4260
Office of the Child Advocate (Courts):
Contact: Allison McDowell, Program Administrator (302) 255-1730
Office of Prevention Resource Center (Childrens Department):
(302) 892-4505
Parent Information Center: (302)999-7394; North Wilmington (302) 764-3252
Wellness Centers (Division of Public Health):
Contact: Fred MacCormack, Public Health Treatment Administrator
(302) 741-2980
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APPENDIX I
RELATED EDUCATIONAL MEMORANDA OF UNDERSTANDING (MOU)
INTERNET ADDRESSES
1. Early Intervention
School FCTs
Part H -http://kids.delaware.gov/pdfs/pol_mou_dscyf_Interagency_Agreement_PartH.pdf
2. Truancy MOU
http://kids.delaware.gov/pdfs/pol_mou_dscyf_InteragencyAgreementToReduceTruancy.pdf
406
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