Wednesday, August 18, 2021

Concussions in the School Setting


Concussions and The School Nurse

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Hopefully Helpful School Nurse Tip: Each year thousands of student athletes are diagnosed with a concussion. These blog posts were written to help the school nurse help those students.

What is a concussion?

It won't take long before a student enters your school nurse office and notifies you they have been diagnosed with a concussion. It is important that your student understands what this diagnosis means and as a school nurse you have the opportunity to educate your student.  A textbook definition from the Centers for Disease Control and Prevention is: 

"A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells." (CDC, 2021)

However, that is a very technical and medical definition- will your student understand what that actual means?  It is OK to give an actual medical definition, but then follow it up with easy to use words and terms that your student will understand. This will depend on the grade level, age, and compression level of your student. 



What are common symptoms of a concussion?

Although school nurses are not allowed to diagnose a concussion, they should be able to recognize and refer for signs and symptoms of a potential concussion caused by a recent head injury. As a school nurse you'll want to know your school district's protocol when dealing with a student who has suffered a head injury at school or comes to school with a concussion diagnosis.  Do you know what signs and symptoms to look for?  For a review of signs and symptoms related to a concussion read this CDC article titled Concussion Signs and Symptoms. 

Are concussions serious?

Although concussions might not be life threatening, the side effects can be serious. Many students recovery within a few weeks, but others might need a few months or even longer to make a complete recovery!

                                     

What classroom accommodations can be made to support a student with a concussion?

There are many appropriate and suggested classroom accommodations that can be made when a student is diagnosed with a concussion. Sometimes the physician or athletic trainer might even provide you or the classroom teachers with accommodations when they provide the diagnosis. Other times the school nurse will only receive the written diagnosis. When this happens, what are you accepted to do?  Is the school nurse supposed to notify the student's classroom teacher/s or the student's school counselor?  Each school or school district should have a written concussion protocol to follow in this situation. 

A brief concussion protocol example might be something like this:
  1. School Nurse receives documentation that student has been diagnosed with a concussion
  2. School Nurse notifies classroom teachers and school counselor that the "concussion protocol" has been started
  3. School Nurse asks for or receives updates from students, parents, classroom teachers, and/or school counselor as needed
  4. School Nurse might need to inform athletic trainer or physician of received updates
  5. School Nurse receives documentation the Return To Learn is complete
  6. School Nurse notifies classroom teachers and school counselor that the "return to learn" has been completed
  7. School Nurse asks for or receives updates from students, parents, classroom teachers, and/or school counselor as needed
  8. School Nurse might need to inform athletic trainer or physician of received updates
  9. School Nurse receives documentation the Return To Play is complete
  10. School Nurse notifies classroom teachers and school counselor that the "return to play" has been completed
  11. School Nurse asks for or receives updates from students, parents, classroom teachers, and/or school counselor as needed
  12. School Nurse might need to inform athletic trainer or physician of received updates
The above are only brief suggestions ... as a school nurse you'll want to check on your school district's specific policies and procedures regarding concussion.  If your district doesn't have one, then you might want to work on creating one to use at your school when needed.

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NEED HELP CREATING A CONCUSSION PROTOCOL / POLICY / PROCEDURE? 

These Google Slides are Available For Purchase and 100% Editable

THREE CONCUSSION PROTOCOL / CLASSROOM SUGGESTION SLIDES

Instant Google drive access. 100% editable.

  • 3 fully editable slides for the following concussion situations:
    • Concussion Protocol Starting
    • Return To Learn
    • Return To Play
  • Edit to make each slide specific to your school / students
  • Save as PNG or JPG in order to insert into the body of an email




School Nurse Concussion Resources:







Sunday, August 8, 2021

Digital Student Health History Form

 

Digital Health History Form for Students

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Digital Health History Form for Students

Keeping student health information up to date is an important part of school nursing practice. Knowing your students' current health conditions can help you plan for their needs, identify students who may need an Individualized Healthcare Plan (IHP) or Emergency Action Plan (EAP), and provide appropriate care throughout the school day.

A digital student health history form can provide an easy and organized way for parents and guardians to share updated health information with the school nurse.

Health History Purpose

The purpose of this digital student health history form is to provide an easier, yet formal way, for the school nurse to gather (collect data) on medical conditions for current students. Although this digital form is 100% editable, it currently offers parents a way to inform the nurse of the following:

  • Current health concerns
  • Explanation of the health concern
  • Description of how the health concerns impacts the student's school day
  • Requested accommodations the might benefit the student throughout the school day
  • Doctor contact information

As you can see, this digital health history form provides parents a chance to subjectively provide the school nurse with an overview of their child's current health conditions. The school nurse can then ask for needed / required follow up information from the student's parents and/or physician.


How To Collect A Student Health History

Have you ever had a parent call with an important health update—or had a student casually mention something you didn't previously know?

Those conversations can provide valuable information, but having updated health information documented in writing can make follow-up much easier.

A digital health history form can be shared with families at the beginning of the school year, during registration, when a student enrolls, or anytime a student's health status changes.

If you're using a Google Form, remember to review your notification and response settings so you have a reliable process for knowing when new information has been submitted.

After reviewing a response, follow up with the family as needed to:

  • Clarify health information
  • Request additional medical documentation or healthcare provider orders
  • Discuss school accommodations or supports
  • Determine whether an IHP, EAP, 504 Plan, or other documentation may be appropriate
  • Discuss how relevant health information will be communicated to appropriate school staff


Why a Health History Is Important

Accurate student health histories are important. Knowing what to do with that information is even more important.

Digital Health Records

Many schools use electronic student information systems to maintain student records. Determine how health information should be documented within your district's system and whether health conditions can be entered, tracked, and reported.

Taking the time to maintain accurate records throughout the year can make reviewing student needs—and preparing end-of-year reports—much easier.

Health Condition Lists

Many moons ago, I created Excel spreadsheets to track student health concerns because that was the best option I had!

Thankfully, today's student information systems often make this much easier. Depending on your system, you may be able to generate reports by health condition, grade level, graduation year, teacher, or other criteria.

These reports can help you understand the health needs within your school population and provide valuable data when preparing reports for administrators, supervisors, or your school board.

Individualized Healthcare Plans

Information gathered through a health history can help identify students who may need an Individualized Healthcare Plan (IHP). 

Review each student's individual needs along with your district policies, state requirements, nursing standards, and professional nursing judgment when determining appropriate health planning and documentation.

Emergency Action Plans

Students with health conditions that have the potential to become a medical emergency during the school day may require an Emergency Action Plan (EAP).

The health history can help identify students who need additional follow-up with their parent/guardian and healthcare provider to ensure appropriate emergency plans, orders, medications, and supplies are available at school.

Medication Forms

Knowing which medications a student takes can help the school nurse understand the bigger picture of the student's health.

If medication needs to be administered during school hours, follow your state requirements and district policies regarding healthcare provider orders, parent/guardian authorization, medication documentation, and administration.

Nursing Procedures

Health history information may also identify students who require nursing procedures during the school day, such as tube feedings, catheterization, suctioning, dressing changes, or other skilled nursing care.

Follow applicable state requirements, district policies, provider orders, and nursing standards when developing an appropriate plan of care for these students.

One Form Can Be the Starting Point

A student health history form doesn't replace nursing assessment or individualized follow-up. Instead, it gives the school nurse a starting point.

The information families provide can help you identify students who need additional assessment, documentation, healthcare provider orders, emergency planning, accommodations, or other school health support.

And having a consistent system for collecting that information can make the process much more manageable—especially at the beginning of a busy school year.

Looking for an easier way to collect student health information?

My editable Digital Student Health History Form can be customized for your school and shared electronically with families.

              

ILLINOIS SCHOOL NURSE REFERENCES:

Illinois General Assembly (Full Article)
Illinois General Assembly Codes (Child Health Examination Code, 77 Ill. Adm. Code 665) https://www.ilga.gov/.../admincode/077/07700665sections.html
Illinois State Board of Education: Health Requirements
Each state has rules listing the minimum health requirements students must meet in order to attend school. 
Try searching your state + school health requirements to locate your specific state school health requirements.

OTHER SCHOOL NURSE REFERENCES:

2015 DOASN Lillian Wald Blog Post: http://diaryofaschoolnurse.blogspot.com/search...
Complete List of Department of State Health Websites: https://www.cdc.gov/.../healthdire.../healthdepartments.html
Lillian Wald - Henry Street Settlement https://www.henrystreet.org/about/our-history/lillian-wald/
NCSL State Vaccination Policies: Requirements and Exemptions for Entering School https://www.ncsl.org/.../state-vaccination-policies...
Schools & Health: Our Nation's Investment https://www.ncbi.nlm.nih.gov/books/NBK232693/
State School Nurse Associations


Thursday, July 29, 2021

FREE EPI PENS FOR SCHOOLS!

Back To School : FREE Epi Pens

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Every school nurse should be prepared to respond to an allergic reaction—whether the student has a known allergy or not. As you prepare for a new school year, here are several important steps to help keep students safe.

Obtain (FREE) Undesignated Epinephrine

If you've been reading this blog for a while then you already know that Mylan Pharmaceuticals  & BioRidge Pharma offer 2 two packs of  FREE epi pens, replenishment epi-pens, and epi-pen trainers to qualifying schools each calendar year! I've been taking advantage of this program for many, many years and saving my school districts many, many dollars too! 

To say this is a wonderful and valuable service is an understatement. 

This is a potentially LIFE SAVING offer they continue to provide for FREE!

As with most undesignated prescription medication offers, there is required paperwork, but it is very self explanatory and easy to complete.  FYI- you will need to have your school district physician or a local physician willing to sign an order or provide a standing order.  

Having epinephrine at each school could literally save the life of a student, staff member, or visitor.  You can read all about their program & apply for your free doses HERE.  

I'm curious if there are any school nurses reading this post who have needed to use one of the free epi-pens at some point throughout a school year?  If so, please comment so the rest of us can learn from your experience. 

I'm also curious if there are any school nurses reading this post who live in a state with undesignated emergency medication laws who also have a state health department who provides the physician orders for those medications?  If so, please comment your state.   

ALLERGY EDUCATATION & PLAN

You will also want to spend some time thinking about how you will educate your staff members and maybe even the other students in your school.  The following is a list of questions that you should have answers to... these questions might even help you think of more questions that you'll need answers to.
  1. Who needs to know how and when to use an epi-pen.
  2. How will those people be taught signs/symptoms and medication administration techniques?
  3. Does your school district require a medication form or action plan?
  4. Who needs to know which students have potentially life threatening allergies?
  5. How are students with severe allergies identified? 
  6. Do students have permission to carry their own emergency medications?
  7. How will you gather more information from the parents? View this easy to use & editable digital Health History form HERE.
  8. ... and many more questions depending on your school/s and school district


Preparing Your School Team

Once you've gathered the necessary medical orders and met with the family, it's time to prepare your school team. Every school is different, but taking a few minutes to develop a plan before the first day of school can help everyone respond quickly and confidently during an allergic emergency.

Consider questions like these as you prepare for the school year:

  • Who needs to know about this student's allergy?
  • Who should be trained to recognize the signs and symptoms of an allergic reaction?
  • Who will be responsible for administering epinephrine if you're unavailable?
  • Does your district require an Allergy Action Plan, Individualized Healthcare Plan (IHP), or medication authorization form?
  • Will the student self-carry their emergency medication?
  • How will substitute teachers receive important health information?
  • What is the plan for field trips, after-school activities, and athletic events?
  • How will emergency medications be stored so they are quickly accessible?
  • How will you communicate important allergy information to staff while protecting student privacy?

Every student, school, and district is a little different, so use these questions as a starting point when developing your own systems.

Questions to Ask Parents Before School Starts

Parents are the experts on their child. While the Allergy Action Plan provides the healthcare provider's medical orders, a conversation with the parent or guardian often provides valuable information that isn't written on the form.

Consider asking questions such as:

✔ Tell me about your child's allergy. When was it first diagnosed?

✔ Has your child ever experienced anaphylaxis?

✔ Has your child ever needed an EpiPen?

✔ What symptoms usually appear first when your child is having an allergic reaction?

✔ Does your child recognize when they're beginning to have a reaction?

✔ Does your child self-carry emergency medication?

✔ Are there any classroom, cafeteria, or transportation concerns I should know about?

✔ What accommodations have worked well in previous schools?

✔ What would you like me to know before the first day of school?

Helpful Tip

The best allergy care happens when school nurses, families, students, and healthcare providers work together. Parents are the experts on their child, while the student's Allergy Action Plan provides the medical orders that guide care at school. Use your first conversation to build trust, learn about the student's individual needs, and always provide care according to the student's current healthcare provider orders.

School Staff Health Concern Notifications

Every school nurse develops communication systems that work for their building. Personally, I rely on email and Skyward to make sure those who "need to know" have the information they need. 

I always invite staff to stop by my office, call, or email with specific questions they might have too.  Teacher Tips digital cards are how I notify teachers and this is my how to guide- if it works for you that is great, if not then just take the pieces that work and switch up the rest.

Why Staff Communication Matters

As nurses, we often take our knowledge for granted and might even assume that others we work with understand or have a similar knowledge base regarding certain health conditions.


However, as school nurses, we are often viewed as the medical expert within the school setting. One of the roles of a school nurse is to educate others we work with so they understand what they need to know about certain medical conditions. Does that make sense?


Teacher Tips cards provide an opportunity to educate others within the school on a specific health condition. These teacher tips give broad information on a health condition and invite school staff to ask you for specific details as needed.


HOW TO NOTIFY TEAHCERS & STAFF


Way back when, I used to print information sheets and hand deliver them to teachers or put them inside their teacher mailbox; I’m dating myself, right?!  Now, I include these digital Teacher Tips digital health information cards within the body of an email message to teachers and/or add them as an IHP attachment in Skyward for a specific student.



EMAIL:  Since the Teacher Tips cards offer broad information, I have the option of including more student specific details within the body of the email; information staff would need to know. I can also include a copy of the 504 Plan or ask teachers to reference the 504 Plan for even more specific information. 


SKYWARD: Use Skyward to your advantage! If you have access to the Skyward Health module then consider uploading the teacher tips cards within the Health tab of Skyward Student Management.  How you wonder? Follow these steps:

  1. Open the student screen within the Health tab of the Skyward Student Management System
  2. Select IHP
  3. Then “Add File”
  4. Enter a form description and then Choose the Teacher Tips file you want to attach (download as a PDF from Google prior to attaching in Skyward)
  5. Use the Comment box to add student specific information or more detailed information you want to the teacher to be aware of.
This is an excellent communication tool and resource between you and the teachers; especially at the 6-8 or 9-12 grade levels when student schedules change mid year or without notice. Make sure you utilize the Health Condition tab in Skyward too (great information for another blog post!)

The Teachers Pay Teachers items discussed in this blog post are items I actual use- or very close variations of those items! These items are created and designed to offer consistency when working with multiple students and sometimes at multiple schools.




SCHOOL NURSE RESOURCES




HEALTH CONCERN LABELSSEVERE ALLERGYASTHMA