Area Evaluation for District Registered Nurse

Area Evaluation for District Registered Nurse Greenon Local School District Stephanie C Ebbs Wright State University College of Nursing and Health School Nursing 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) 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. Population 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) Standards 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. Care 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. 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. References Advameg, Inc. (2014). Enon, Ohio Statistics. http://www.citydata.com/city/EnonOhio.html#ixzz3DorjZSUU American Diabetes Association (ADA). (2014). Diabetes, complications, and safe at school. http://www.diabetes.org Legislative Information Systems (2014). House Bill 296 http://www.legislature.state.oh.us/bills.cfm?ID=130_HB_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=1DistrictID=3904623ID=390462302475

The Civil Rights Movement :: African-American Civil Rights Movement

The first massive direct action in the civil rights movement came in Montgomery, Alabama in 1955. Under SCLC leadership, the black community boycotted the city’s bus system, which required them to ride at the back of the buses. After many months of boycotting, the U.S Supreme court declared that segregation on public buses was unconstitutional, and the boycott was bought to an end. This was a very significant event for the civil rights movement. It caught the attention of the entire nation. People around the country were made aware of the event because it was launched on such a massive scale and lasted for more than a year. It also set the tone for the civil rights movement, which led to more struggles and protest. There was the school integration in Little Rock, Arkansas in 1957, where nine black students were admitted to Little Rock’s Central High School. President Dwight Eisenhower sent federal troops to enforce desegregation. There were public accommodation sit-ins in North Carolina and Georgia in 1960, when four black college students began protesting racial segregation in restaurants by sitting at â€Å"white only† lunch counters and waiting to be served. There were the freedom riders who traveled around the South in buses to test the effectiveness of the 1960 Supreme Court decision of illegal segregation in bus stations. There was also education and voter registration drives in Mississippi in 1961, which organized voter registration campaigns in black counties. Many of these protests where organized by the student affiliate of SCLC, many northern white liberal supporters, and the SNCC which stands for Student Nonviolent Coordinating Committee. The SNCC was founded in Raleigh, North Carolina in April 1960 to help organize and direct the student sit-in movement. They also concentrated on voter registration, believing that voting was a way to empower blacks so that they could change racist policies in the South. Southern whites counter mobilized by reviving the infamous Ku Klux Klan who used violence or threats against anyone suspected of favoring desegregation or black civil rights. There was also the start of a new organization called White Citizens Councils. There goal was to maintain segregation. One of the last meetings between civil rights demonstrators and southern whites came in Montgomery, Alabama in 1963.

Attitudes Toward Life

Attitude Toward Life I have always heard it said that people are the same under the skin, and in many ways it's true. People have similar impulses, hopes, and dream. However, people vary widely in their attitudes toward life. A person with a negative attitude puts a pessimistic twist on life even when good things happen. If she has a front-row center seat at the concert, she complain the her neck hurts from sitting so close or that the music is too loud. if he has a new job, he complains that the hours are too long and the benefits inadequate. When I congratulated my friend tim on his new job, his response was typically negative. It's okay, I guess. † he said,†but the money and the chance for advancement aren't that great. I'm just binding my time until some thing else comes along. â€Å"negative people can turn even good fortune into bad luck. A positive person, on the other hand, can find the good in almost anything. my coworker mario always says, â€Å"Something good is going to happen today. â€Å"At first, I thought Mario's good cheer was just a false front. But I have worked with him for a wile now and I have begun to see that there is nothing fake about his optimism . He really does look for good things to happen, and he sees failure as an incentive to work harder.Any doubt I had about Mario's attitude evaporated when he confided that his wife has cancer . â€Å"It's made me realize what's important in my life, â€Å"He said, â€Å"and its made me closer to her than ever before. † Even tragedy has its positive side to a positive person like mario. The person with a wait-and-see attitude withholds judgment on everything. if you ask him how he is today, he may cautiously reply, â€Å"So far, so good. † he sees no point in committing himself when unexpected disaster or great good fortune may befall him at any time. My elderly neighbor is a classic example of the wait-and-see person. he last time I saw her, I asked about her ch ildren and grandchildren. she told me that her daughter and son-in-law had just celebrating their Twenty-fifth anniversary. When I commented on how long their marriage had lasted, my neighbor shrugged. Yes, I quasi its a good marriage, she said. â€Å"Time will tell. † Attitude toward life shape the way we see the weld. S negative perso finds the bad in everything, while a positive person looks for good. and the person with a wait-and-see attitude, like someone watching a play, sits back and wait for the next act to unfold.

How Was Stegosaurus Discovered

Yet another of the classic dinosaurs (a group that also includes  Allosaurus and Triceratops) that were discovered in the American west during the late 19th-century Bone Wars, Stegosaurus also has the honor of being the most distinctive. In fact, this dinosaur had such a characteristic appearance that any fossils vaguely attributable to it wound up being assigned as separate Stegosaurus species, a confusing (though not unusual) situation that took decades to sort out! First things first, though. The type fossil of Stegosaurus, discovered in Colorados stretch of the Morrison Formation, was named in 1877 by the famous paleontologist Othniel C. Marsh. Marsh was originally under the impression that he was dealing with a gigantic prehistoric turtle  (not the first paleontological blunder he ever made) and he thought the scattered plates of his roof lizard lay flat along its back. Over the next few years, though, as more and more Stegosaurus fossils were discovered, Marsh realized his mistake, and properly assigned Stegosaurus as a late Jurassic dinosaur. The March of Stegosaurus Species A low-slung, small-brained dinosaur with characteristic triangular plates and sharp spikes protruding from its tail: this general description of Stegosaurus was broad enough for Marsh (and other paleontologists) to include numerous species under its genus umbrella, some of which later turned out to be dubious or deserving assignment to their own genera. Heres a list of the most important Stegosaurus species: Stegosaurus armatus (armored roof lizard) was the species originally named by Marsh when he coined the genus Stegosaurus. This dinosaur measured about 30 feet from head to tail, possessed relatively small plates, and had four horizontal spikes jutting out from its tail. Stegosaurus ungulatus (hoofed roof lizard) was named by Marsh in 1879; oddly enough, given the reference to hooves (which dinosaurs definitely did not possess!), this species is known only from a few vertebrae and armored plates. Given the lack of additional fossil material, it may well have been a juvenile S. armatus. Stegosaurus stenops (narrow-faced roof lizard) was identified by Marsh 10 years after he had named Stegosaurus armatus. This species was only three-quarters as long as its predecessor, and its plates were also correspondingly smaller--but its based on far more abundant fossil remains, including at least one fully articulated specimen. Stegosaurus sulcatus (furrowed roof lizard) was also named by Marsh in 1887. Paleontologists now believe that this was the same dinosaur as S. armatus, though at least one study maintains that its a valid species in its own right. S. sulcatus is best known for the fact that one of its tail spikes may actually have been located on its shoulder. Stegosaurus duplex (two-plexus roof lizard), also named by Marsh in 1887, is notorious as the Stegosaurus that supposedly had a brain in its butt. Marsh hypothesized that the enlarged neural cavity in this dinosaurs hip bone contained a second brain, to make up for the unusually small one in its skull (a theory that has since been discredited). This may also have been the same dinosaur as S. armatus. Stegosaurus longispinus (long-spined roof lizard) was about the same size as S. stenops, but was named by Charles W. Gilmore rather than Othniel C. Marsh. Not one of the better attested Stegosaurus species, this may actually have been a specimen of the closely related stegosaur Kentrosaurus. The teeth of Stegosaurus madagascariensis (Madagascar roof lizard) were discovered on the island of Madagascar in 1926. Since, as far as we know, the genus Stegosaurus was restricted to late Jurassic North America and Europe, these teeth may well have belonged to a hadrosaur, a theropod, or even a prehistoric crocodile. Stegosaurus marshi (which was named in honor of Othniel C. Marsh in 1901) was reassigned a year later to a genus of ankylosaur, Hoplitosaurus, while Stegosaurus priscus, discovered in 1911, was later reassigned to Lexovisaurus (and later became the type specimen of an entirely new stegosaur genus, Loricatosaurus.) The Reconstruction of Stegosaurus Stegosaurus was so strange, compared to the other dinosaurs discovered during the Bone Wars, that 19th-century paleontologists had a difficult time reconstructing what this plant-eater looked like. As mentioned above, Othniel C. Marsh originally thought that he was dealing with a prehistoric turtle--and he also suggested that Stegosaurus walked on two legs and had a supplementary brain in its butt! The earliest illustrations of Stegosaurus, based on the knowledge available at the time, are virtually unrecognizable--a good reason to take the reconstructions of any newly discovered dinosaurs with a big grain of Jurassic salt. By far the most puzzling thing about Stegosaurus, which is still being discussed by modern paleontologists, is the function and arrangement of this dinosaurs famous plates. Lately, the consensus is that these 17 triangular plates were arranged in alternating rows down the middle of Stegosaurus back, though occasionally there have been other suggestions out of left field (for example, Robert Bakker hypothesizes that Stegosaurus plates were only loosely attached to its back, and could be flopped back and forth to deter predators). For further discussion of this issue, see  Why Did Stegosaurus Have Plates?