Archive for the ‘school nurses’ Category

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Caring for Suicidal Children in the ED

September 1, 2011

By Sylvia Foley, AJN senior editor

Emergency lights #5, by DrStarbuck via Flickr

Suicidal children and adolescents are often first seen in EDs. At Children’s Hospital Boston (CHB) recently, a boy we’ll call J.J. was one of them. Still in elementary school, he had just started a new school year. J.J. has Asperger’s syndrome (a disorder on the autism spectrum), and new situations are difficult for him. His classmates were teasing him, and it was escalating: one boy reportedly threatened to kill J.J. for being “weird.” Despite efforts by J.J.’s parents and the school to address the situation, J.J. became increasingly depressed and fearful. As September CE authors Alexis Schmid and colleagues explain,

On the morning of the ED visit, as the family members were starting their day, J.J. had gone into the kitchen, found a butcher knife, and held it to his throat. His mother walked in and saw him. Although J.J. willingly surrendered the knife to her, she said she was “rattled to the core.”

Schmid was the ED nurse on J.J.’s case that day (all three authors work at CHB). In “Care of the Suicidal Pediatric Patient in the ED: A Case Study,” the authors describe the course of J.J.’s care and what they did to keep J.J., his family, and the hospital staff safe as the day progressed. Read the rest of this entry ?

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Back to School: Team Sports and Concussions

September 1, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Concussions among young athletes are on the rise—are parents and coaches taking them too lightly?

Photo by Dick Rochester, via Flickr

My sons played ice hockey and football in their high school years, what my husband and I referred to as “collision sports.” The unmistakable sound of helmet-hitting-helmet always made me cringe, especially in hockey where a good skater can generate considerable speed (and therefore force) before impact. I’ve witnessed many players being helped off the ice. The coach, who knew I was a nurse, would sometimes signal to me to come to the bench and check out a player. Most of the time, the player was fine; but there were a few times when it was clear that the player was a bit more than just shaken up.

I recall one 12-year-old who had nystagmus and ringing in his ears and kept asking the same question in a slow, sleepy voice. The coach wanted to put him back out on the ice (“He just saw a few stars, right?”), but instead I sent him with his parents to the ED for evaluation. After an overnight stay in the hospital he was released, but was cautioned not to play hockey for two weeks because he’d suffered a concussion. So he waited two weeks and went back to playing, even though he still had frequent headaches. I also remember a girl who was an excellent high school soccer player. She was hoping to play in college, but by the end of her senior year she’d sustained three concussions and was having cognitive issues—she had trouble working with numbers and suffered headaches. Her neurologist told her she shouldn’t play competitively for at least a year, and perhaps permanently. She was resistant, but her parents enforced the neurologist’s ban. Good for them. Read the rest of this entry ?

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Diabetes, Hypertension, Obesity. . .The Case of the Missing School Nurse

August 11, 2010

By Peggy McDaniel, BSN, RN

I was amazed by a MarketWatch article this week about the overall lack of school nurses. According to the article, the National Association of School Nurses recommends that one nurse be available for every 750 well children. Many states operate with ratios greatly exceeding that number. For example, in 2009 Michigan had one nurse for every 4,836 children. To give credit where it is due, that same year Vermont provided one nurse for every 311 students. As a nurse, and a parent, I find this data frightening. Not only are there fewer trained professional nurses available to our children every year, but approximately 30% of American children suffer from chronic conditions such as type 1 or type 2 diabetes, asthma, and high blood pressure.

by woodley wonderworks, via Flickr.

Having more nurses available to patients in an inpatient setting has been proven to promote better patient outcomes. I’m going to go out on a limb and suggest that the same is probably true for school nurses.

Lousy timing. This acute shortage of school nurses could not come at a worse time. With more families than ever feeling the pinch of the recession, children are not immune to the oft-reported outcomes related to our current overall economic condition. Less money can translate into fewer visits to health care providers and dentists, greater family stress, and even hunger, among many other things. School nurses not only help kids with cuts and bruises but also make referrals to dentists and other needed services. The article I mentioned above didn’t discuss the number of children with mental health issues in our public school system, but this factor adds another level of complexity to the care of our nation’s children, one that nurses are prepared to assist with.

As a parent of healthy kids, I didn’t worry too much about the availability of a school nurse. My daughters actually regretted the fact that I was not only a pediatric nurse, but also owned a medical grade thermometer—needless to say, you didn’t stay home at our house unless you were truly sick! My good friend has a daughter who was diagnosed with type 1 diabetes just prior to entering first grade. Read the rest of this entry ?

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Shortage of School Nurses Means Greater Student Vulnerability to H1N1

September 28, 2009

By Alison Bulman, AJN senior editorial coordinator

the school bus routine by woodley wonderworks, via Flickr.

the school bus routine by woodley wonderworks, via Flickr.

On Friday the New York Times reported that a shortage of school nurses is making students more vulnerable to the pandemic (H1N1) 2009 virus, stating that  “[m]any districts have few or no nurses to prevent or respond to outbreaks, leaving students more vulnerable to a virus that spreads easily in classrooms and takes a heavier toll on children and young adults.”

The article acknowledges the key role played by school nurse Mary Pappas, who we interviewed for this blog shortly after she’d helped identify the first U.S. cases of H1N1 at a school in Queens. As AJN reported in June, school nurses  have been and will continue to be on the front lines of efforts to prevent or manage outbreaks. But the school nursing shortage is acute, with just one nurse for every 1,155 students nationally, a ratio that the American Federation of Teachers has called “dangerous.” With a new school year underway, the Times reports, school districts are relying more heavily on non–health care personnel to identify and isolate sick kids and monitor absences.

For more on issues related to school nurses and nursing, see these recent posts:

Can School Nurses Help Prevent Heat Stroke Fatalities in High School Football?

Nurse Organizations Oppose Move to Allow Non-Licensed Personnel to Give Insulin to Students


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Can School Nurses Help Prevent Heat Stroke Fatalities in High School Football?

September 17, 2009

Shawn Kennedy, MA, RN, AJN editorial director & interim editor-in-chief

by Bludgeoner86, via Flickr

by bludgeoner86/via Flickr

Earlier this month, Diana Mason, AJN’s editor-in-chief emeritus, wrote here about head injuries in soccer. A related news story about high school sports should make all school nurses, coaches, and parents take notice: student athletes suffer—and sometimes die—from heat stroke during intense workouts in hot weather.

According to an Associated Press report, Fred Mueller, director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina, attributes 39 deaths since 1995 to heat-related causes. And that doesn’t count three deaths this past summer that he notes may also be associated with heat stroke.

Most of the deaths are associated with football preseason training in August. My middle son played high school football and every August he went to “preseason camp.” He and his teammates slept on air mattresses in the non-air-conditioned high school gym, and spent the last week of summer vacation in grueling drills and practices, wearing shorts, T-shirts, shoulder pads, and helmets. One year he arrived home looking thin and gaunt. He related stories of teammates vomiting on the sidelines during practices and of restricted water breaks. It took a player fainting during one session and an onslaught of parent complaints and pressure on school administrators (the word “lawsuit” does get attention) for coaches to change their methods. Read the rest of this entry ?

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Nurse Organizations Oppose Move to Allow Non-Licensed Personnel to Give Insulin to Students (Despite ADA Testimony Supporting the Practice)

August 25, 2009

By Shawn Kennedy, MA, RN, editorial director and interim editor-in-chief

By Mel B./via Flickr

By Mel B./via Flickr

A scenario is playing out in California that may have far-reaching consequences for nursing and for school children with diabetes. At issue is a move by the California Department of Education to allow non-nurse, unlicensed school personnel—teachers, aides, administrators, and others—to administer insulin to children while at school or at school functions if licensed personnel are unavailable. Read the rest of this entry ?

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Nurse Jackie Revisited: Do the Cringes Outweigh the Moments of Recognition?

June 12, 2009
By dailyinvention, via Flickr.

By dailyinvention, via Flickr.

While I agree with Diana Mason that Jackie, the nurse played by Edie Falco on Showtime’s new series, has some admirable qualities, some of her actions caused me to cringe: falsifying an organ donor card; snorting pain medication; cavorting with a coworker while on duty; and yes, flushing the ear of an abusive creep down the toilet (okay, part of me agreed with her—doesn’t the Bible say “an eye for an eye”? Couldn’t that apply here?). Read the rest of this entry ?

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School Nurses Do a Whole Lot More Than Applying Ice and BandAids

May 12, 2009
Photo by adrigu, via Flickr.

Photo by adrigu, via Flickr.

Recently, school nurses have been given a lot of recognition from the media, including AJN (here’s the most recent post, which contains links to several others). I was really happy to see them finally getting the credit they deserve. I was a school nurse for a while and I know firsthand how often they are taken for granted.

The first year, I worked for the New York City Department of Health as a per diem nurse, going to a different school almost every day to fill in for nurses that were out for the day. The following year I worked full-time at a school for the NYC Department of Education. (Department of Health nurses take care of mainstream students and Department of Education nurses are placed in schools to care for children with special needs.) I couldn’t believe how poorly I was treated by administration, students, and teaching staff. I quickly realized that school nurses were considered to be either glorified Band-Aid distributors or the place where children went to avoid classes they didn’t enjoy.  Read the rest of this entry ?

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School Nurses, H1N1, Understaffing, and Public Safety

May 8, 2009

We’ve posted here, here, and here in recent days about the importance of school nurses during the H1N1 outbreak.

Now here’s strong testimony before the U.S. House Committee on Education and Labor from the California State Superintendent of Public Instruction on why school nurses were crucial during the H1N1 outbreak and why understaffing issues must be addressed for the sake of public health.

“At last count, there are approximately 2,844 nurses who serve California’s 6.3 million public school students. That translates to a ratio of 2,227 students to every one school nurse, the largest student-to-nurse ratio in the country. This in no way, shape or form provides effective healthcare for the increasing numbers of students with complex chronic and immediate health needs that require daily care on our school campuses. If we had more school nurses on our campuses, perhaps they could have played an even greater role in early detection and prevention efforts.”

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National School Nurse Day—The Timing Couldn’t Be Better

May 6, 2009
Mary Pappas, BSN, RN, school nurse at St. Francis Preparatory School in NYC, told AJN, "School nurses have been e-mailing me from around the country," since she helped to identify the first H1N1 cases. Photos courtesy of Michael Graziano.

Mary Pappas, BSN, RN, school nurse at St. Francis Preparatory School in NYC, told AJN, "School nurses have been e-mailing me from around the country," since she helped to identify the first H1N1 cases. Photos courtesy of Michael Graziano.

As nurses nationwide celebrate National School Nurse Day AJN decided to check back in with Mary Pappas after our discussion with her last week. She’s the New York City Catholic school nurse who on April 23 alerted public health officials to what would be identified as the first U.S. cases of influenza A (H1N1)—swine flu. img_4700

Students have returned to St. Francis Preparatory School, and things are “calming down,” she said. “We’re still busy because we have to do a screening process. It’s busy work, but no one’s sick.” She has been working closely with the New York State Department of Health.

Yesterday the Centers for Disease Control and Prevention (CDC) said that, because the U.S. cases seen so far have been mild, “School closure is not advised for a suspected or confirmed case of novel influenza A (H1N1).” It seems an appropriate moment to acknowledge the work that Pappas and the 45,000 school nurses are doing on the front lines of assessment nationwide. AJN will continue to follow the work of school nurses in coming weeks and months.—Joy Jacobson, AJN managing editor

(For a more recent post about pandemics, understaffing, and school nurses, click here.)

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