[Emergency health services at the student health service].
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The Student Health Services at Academic Medical Centers group has been aware since its inception in 1997 of the need for standards for health science schools in dealing with the issue of the student infected with a blood-borne pathogen. In view of the absence of such standards, the group organized a small task force of individuals from several student health services at academic medical centers and from key public and private organizations to develop recommendations for institutional responses to the health science student infected with a blood-borne pathogen. This article reviews the current status of relevant position statements of state medical boards, certain professional organizations, and other English-speaking countries, and reviews current literature. A discussion of ethical considerations of the task force's recommendations precedes the specific recommendations, which are divided into four sections: disclosure issues, testing issues, exposure management, and curriculum modification and prevention.
BACKGROUND: Student health services (SHSs) on campuses with academic medical centers (AMCs; schools affiliated with teaching hospitals) often provide clinical services (including occupational health services) for students and staff. There are few aggregate data about the accreditation status of these health services. METHOD: A cross-sectional survey of SHSs at the 124 medical schools in the United States was conducted in spring 1999. SHSs were questioned about their accreditation status. RESULTS: One-hundred three SHSs were included in the survey. Forty-seven (46%) of the SHSs were accredited, 30 (64%) through the Joint Commission on Accreditation of Healthcare Organizations, and the remainder through the Accreditation Association of Ambulatory Health Care (AAAHC). The Joint Commission predominated among private SHSs (13/15 [87%]), but public institutions were more evenly divided. Most of the SHSs accredited as freestanding ambulatory care centers were AAAHC accredited (16/27 [59%]). Nearly all the SHSs accredited as satellites of the AMCs were Joint Commission accredited. CONCLUSION: Although fewer than one-half of SHSs at AMCs are accredited either through the Joint Commission or AAAHC, this is a far higher percentage than of accredited SHSs in general (134/1,500 [9%]). The Joint Commission dominates as the accrediting body for SHSs at AMCs largely because of the high-proportion of services accredited as satellites of the AMCs. Although the accreditation process is costly and time-consuming and may appear daunting, SHSs at AMCs should pursue accreditation to ensure quality in health care processes.
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Principles from public health and community health nursing provide an approach to student health services that enhances interdisciplinary collaboration and advocacy for access to care. Staff participation in the campus community requires administrative support, both in philosophy and in making outreach activities accessible to staff. Student health services at University of Maine's Cutler Health Center in Orono is implementing outreach and community involvement as ongoing aspects of the college health nursing role. Increased collaboration, visibility of nurses on campus, and improved community assessment and intervention are among the outcomes observed during the past 2 years. This article describes the principles that guide this approach and shares some community involvement experiences, including the response to a student suicide attempt, social support for students after a residence hall fire, and case management/consultation services.
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