Greenon Local School District Stephanie C Ebbs
Wright State University – College of Nursing and Health
The Ohio Department of Health (2014) defines public health nursing as promoting physical and mental health, disease prevention, injury, and disability. The ODH goes on to state public health nursing includes the individual client, family and support system of the client, as well as the community in which the client lives to provide services. Public health services include monitoring health, identifying health problems, educating on health issues, developing partnerships in order to identify and solve problems, developing plans and policies for individuals and communities, providing information on needed personal health services, and evaluating effectiveness, accessibility, and quality of personal and population-based services. (ODH, 2014)
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Carolynn Agresta is the Greenon Local Schools district registered nurse in Enon, Ohio. Carolynn graduated nursing school from the Ohio State University in Columbus, Ohio with a bachelor’s degree in September of 1981. Carolynn’s 33 years of experience includes being a nursing school adjunct and working oncology, neuro-surgical, orthopedic, ICU, and home health nursing settings. In 2000 she began working as a school nurse without school nurse licensure. Primarily Carolynn spends her days with the students in grades 7-12. Two assistants generally tend to kindergarten through grade 6. Both assistants have medical experience and have worked for the Greenon Local School district for the past couple of years. Carolynn is responsible for the entire Greenon school district which currently enrolls 1,838 students.
The Enon, Ohio area is predominately Caucasian with an average age of 48 years of age. A majority of the population (58%) is married. 19% of the population have never married. 12.5% of the population is divorced. 9% are widowed and 2% are separated. Other ethnicities are prevalent in the community, but represent less than 25%. 91% of the Enon community has a high school degree, 28% of the community have a bachelor’s degree, and 13% have a graduate or professional degree. 8.5% of the Enon community is unemployed. Many in the community drive everywhere since a majority of the region is in a rural setting. Crime rates are below the national and state average and are mostly property related. (U.S. Department of Education Institute of Education Sciences and Advameg Inc., 2014)
Struggles Carolynn faces includes the repercussions of multiple failed levees leaving tough necessary budget cuts on the school district. Teachers have not received a raise for the past three to four years and one of the four buildings open in 2013 has been closed. Carolynn reports the Enon, Ohio population to be many retired individuals who cannot pay any more than they already do for the district. She explained she is sad and happy at the same time for the merging of buildings as she moved from the now closed building into the Grennon Jr/Sr High School building this year. Carolynn states most of the buildings in the Greenon district need replaced and offers a metaphor of budgeting of the school buildings as placing a band-aid over a hemorrhaging wound. The buildings are just not in good enough condition to be continually repaired anymore. She reports pipes burst every winter and ruin the teachers’ classrooms. It forces the teachers to rebuild the classroom and shuffling the students to other rooms while repairs are being made.
Many students require medical attention throughout the day at Greenon Jr/Sr High School. Most students come with minor requests of a band-aid for a minor cut, an ice pack, or feeling ill. Carolynn reports five students have Epi-Pens in the locked cabinet in the school nurse office in case of an emergent allergic reaction. One student reports having hypoglycemia and visits the school nurse’s office for a granola bar a few times during the week. One student has severe migraines. Two students are currently being monitored for type two diabetes.
Three type one diabetics are present in the high school building and are Carolynn’s admitted biggest worry most days. She advocates independence of diabetic students, takes action during hypo/hyperglycemic episodes, and reports concerns to the student’s parent(s). One student is independent in diabetes management. Two students visit the school nurse’s office daily for diabetes management. One student in particular is poorly controlled and recently reported a hemoglobin (Hgb) A1C score of 13. It is a very poor score indicating the student’s diabetes is out of control. Carolynn shows genuine concern regarding the student’s long-term health. She reaches out to the student’s parents with concerns over constant hyperglycemia episodes. She is constantly helping the student try and understand how to manage carbohydrates in the diet effectively. Fears of amputation, vision and nerve damage, and a shortened life span for the student worries Carolynn. (ADA, 2014)
Carolynn must keep up with Ohio department of health (ODH) guidelines, Ohio state laws, HIPAA, and Greenon Local School district rules. Keeping up with compliance is no easy feat. Caring to a continuous steady stream of students needing attention, documenting care, calling parents, updating state required vaccination records of students, and instructing voluntary staff members how to tend to emergencies in her absence requires a lot of time, patience, multi-tasking, and skill.
Ohio House Bill 264, safe at school, keeps children with diabetes medically safe at school. The bill allows volunteer school staff to be trained in assisting diabetic children with insulin administration and glucagon in an emergency situation. The safe at school bill also allows children to self-manage their diabetes while at school if able and capable. (ADA, 2014)
One student is independent in diabetes management at Greenon. One student requires privacy to inject insulin at lunch time which is why Carolynn bought a divider for the school nurse office. One diabetic student requires a great deal of supervision and monitoring.
Another law, House Bill 296 recently passed highly recommending and allowing schools to stock Epi-Pen in case of an emergency on a student not previously identified with anaphylaxis. This law will help save lives of students unaware of severe allergic reactions. House bill 296 also authorizes middle and high school students to carry an epinephrine pen with them at all times (with proper documentation from physician and parents turned into the district school nurse). Greenon Local School district does not currently stock Epi Pens, but eventually will. Carolynn states she wants to apply for a grant or at least investigate how to get the school buildings donated Epi Pens. She states she just has not been able to as of yet since the bill passed in April of 2014. (Legislative Information Systems, 2014)
Five students have epinephrine auto injectable pens in the school nurse office. Most of the five students keep another Epi Pen on their person at all times in case of emergency. Students requiring epinephrine pen injection are required to be transported to the hospital and parental contact. No student is required to self-administer the epinephrine and volunteering staff are trained to assist students in case of an anaphylaxis.
The Ohio Department of health has requirements of students regarding vaccinations. Polio, MMR (measles, mumps, and rubella), and Varicella (chickenpox) are required vaccinations before children begin kindergarten school. DTaP//DT/Tdap/TD are a required set of vaccinations for diphtheria, tetanus, and pertussis required before kindergarten and once before entering seventh grade. Every fall Carolynn must document and send letters to parents in order to have the proper documentation for students to remain in school. (ODH, 2014)
Carolynn abides by the ODH standards of infection control prevention guidelines. She constantly is hand washing, changing paper bed linen after each student, changing thermometer probe covers with each student, cleans her stethoscope with alcohol before and after use, and never allows students to share ice packs, blood glucose monitors, band-aids, or ace wraps. Carolynn strives to protect herself, students, and staff from infection and illness and maintains high standards for herself in care of students.
Carolynn provides a non-biased and supportive environment for all students. She listens intently to each student as they come to her office. Students always refer to Carolynn by Mrs. Agresta. She has a 700 dollar a year budget for the school nurse’s office and uses it on food and supplies. She provides free granola bars, juice, water, graham crackers, and fruit snacks to students upon request or diabetic need. Since the Greenon Local School district is public spirituality is limited. She can pray with students and families if requested, but not impede upon spiritual beliefs by federal law.
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Parents must be contacted to provide non-prescription medication at the school. Carolynn contacts parents daily for cough, cold, and allergy medications for students. Remaining in a supportive attitude and complying with parental wishes regarding care is a necessary component of school nursing. Giving parents an educated report of a student’s condition is required in communicating. Sometimes parents will take the student home to rest with or without recommendation of the Carolynn acting as school nurse.
Carolynn is responsible for maintaining privacy in her clinic while caring for students. She requests students wait in the hall outside her office momentarily while she tends to another student. She has a nurturing motherly style approach to each student and treats each student with respect, attentiveness, and compassion as if each student were her own child. Carolynn is a dedicated nurse who tries to provide the best quality care possible in an economically struggling school district. She wishes she had more resources to help. Carolynn does reach out to local area school nurses, the Clark County Combined Health District, and the ODH for help and reference.
Carolynn provides training to voluntary staff members on insulin, glucagon, and epinephrine auto-injector pens. She also answers any questions with educated research and provides additional information. She hangs health information in her office and around the school on bulletin boards to keep the student and staff population educated on their health.
Advameg, Inc. (2014). Enon, Ohio Statistics.
American Diabetes Association (ADA). (2014). Diabetes, complications, and safe at school.
Legislative Information Systems (2014). House Bill 296
Ohio Department of Health (ODH). (2014). Immunization summary for child care, head start,
pre-school, and school attendance: ohio. http://www.odh.ohio.gov
U.S. Department of Education Institute of Education Sciences National Center for Education
Statistics. (2014). Greenon Local Schools: Greenon High School. http://nces.ed.gov/ccd/schoolsearch/school_detail.asp?Search=1&DistrictID=3904623&ID=390462302475
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