With the end of the school year rapidly approaching, what do you normally do to close up the Health Room? What information do you share with the students and their parents? When are routine physicals done? When are Sports Physicals done? How do you notify parents to pick up the medications left in the Health Rooom? Inhalers? Medications? Epipens? Do you have end of the year statistics?

This topic has been hit by spammers of late. We are now requiring posters to sign in before posting messages. Very sorry for any inconvenience but all the junk mail has been making it very hard to continue the discussion.

With the number of diabetics increasing in the school setting, are you finding compliance and therapeutic blood sugars especially with Middle School aged students? How are Field Trips handled for nursing coverage? How many students are switching over to pumps? Do you find these students are better regulated and have more control over their readings? What preparations are given to the staff and faculty in regards to dealing with the diabetic student?

Hi, I am looking for any RN that might be interested in working 2-3 weeks at a sleep-a-way camp this summer. If you have camp age children, then they can come to camp for free. I am there for 7 weeks and I come back every year because I love it. We have 4 nurses and a doctor for less than 300 kids. Once you do camp, you will never want to do anything else in the summer. You don’t have to cook, clean, do laundry, drive your kids anywhere or food shop the whole time you are there. Nurses have their own rooms in the upstairs of the infirmary. Please look at the camp website at www.camptioga.com or call me at 631-592-3751 for more info. Please pass this on to any nurses who you think might benefit from this fun summer opportunity. Thanks so much…Kim Conway

Hi Heather. I finished the Food Allergy course at Framingham State, and found the online experience very enjoyable. It was great sharing information with people who work in other disciplines as well as School Nurses. We covered a lot of material and it was helpful and exercise/stress absolutely influences reactions to foods. I think the most important fact I discovered was the fact that there currently is not a cure so extreme vigilance will save lives. On the horizon, there are many studies being done to get control of these life threatening allergies. Some of these exciting potential cures involve Allergen Immunotherapy or Allergy Shots. Methods to decrease the amount IgE circulating in the body along with developing a DNA vaccine and genetic engineering are some of the current attempts to find a cure.
It's also important to remember that anaphylaxis can take place immediately or up to 2 hours after the initial exposure to the allergen. When in doubt, it's always better to give the Epipen and fatalities occur when it is delayed.
How does your district handle field trips and Epipen training? Is this required of teachers? Who does the training?

I was wondering how the food allergies course kwiater is taking is going?? Have they covered anything that was new to you?? The entire topic is kind of interesting but scary. I have had a student who had environmental allergies resulting in anaphylaxis 3x while riding a bike with all the allergy testing being negative. A student had anaphylaxis after strenuous exercise. Another was transported to the hospital in anaphylaxis from stress during a custody battle. I have always wondered if food could have played a part in those allergic reactions with the exercise/stress increasing the metabolism and there fore heightening a mild allergy. Please let us know if you learn any interesting tidbits.

Our School system has the nurses using the SNAP computer program. All the nurses except myself and my supervisor (the old timers) are doing all their charting...including medications on the computer. I know how but much prefer documenting by hand and charting my meds by hand. I find it much easier to have the hard copies...especially when I need to refer to them. We have a Paraprofessional who does all the data entry of medical information. All our referral forms are on the computer and really save time as they "spit" the referrals out and the address labels. All of the letters we send home (ie...missing physical exams, missing emergency cards) are in the computer and are easily generated. My problem initially was that the nurses were given old computers that just were not reliable and at one point my computer was down for over four months. I now have an old but reliable computer which I use every day. We are scheduled to get new computers next year...if they are not cut from the budget again. I think my computer phobia is
generational in that it is a very radical change for a person who has done things by hand for 26 years. The younger nurses really embrace using their computers. I still use a log book and each student and staff member has their own clinic page that I document on.

We are very strict about everyone having a current emergency card. A copy goes to the emergency room with a student if that is neceassary. The medical lists are reviewed with each team (including survey team...art, music, etc). We try to break it down for them...Critical Alerts, Food allergies, individual health care plans, and the general medical list. It isn't a perfect system because everyone doesn't always remember...but we try to keep everyone updated on changes..I also suggest that if a student has a major problem that somehow you document that with a red mark or something in their grade book. Our gym teachers put an A in front of asthmatics, S for seizures, D for diabetic as reminders when they take attendance at each class.




On 2/26/08, QT - Katie Wiater <qtopic-40-6C5Scr8cehcM@quicktopic.com> wrote: >
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The emergency lists are a great way of finding out the pertinent information and, as with anything, it's consistency using them that makes the difference. What do you use in the Health Room for a daily log of visits? Do you use a computer program for documentation?

Our emergency sheets (telephone numbers, emergency contact numbers, current addresses and phone numbers, e-mail addresses) have a place where parents/gaurdian lists all current diagnosis, daily meds, frequent prn meds. Our teachers are trained to share any new medical information, including med changes, with me. I keep the original of these forms in a binder in my clinic and update these forms and the students records accordingly. At the beginning of the year new information is transcribed onto the student's health record. The office, academic team and Central administration also has a copy of these forms. In this way we try to keep current but often are not kept up to date by the parents/gaurdians.

I think you raise some very serious concerns regarding the use of meds on growing children. They are frequently prescribed medications that we are never made aware of and the side effects can be misinterpreted by teachers. To be a real team player and contribute some pertinent information regarding the behavior and learning ability of these students, we need to be in the loop when these meds are prescribed. At my school, when students need the ADHD evaluation forms filled out, I have them go through my office. This provides me with good information for these students.
I'm also seeing an increase in the administration of medications for mental health issues, but unless it is given during the school day or unless an evaluation is sent to the school, I have no way of knowing what medications these students are on. Does anyone have a form seeking such information from the parents? Perhaps an update can be sent out periodically to gather this kind of medical information. How do other School Nurses handle these situations? Does anyone know of any studies being done regarding the risks associated with off-label medications? What effects will these medications have on our children’s creativity? Are we shutting down our student’s greatest traits so they can comply with educational requirements?

One of my concerns as a school nurse are the number of prescribed medications students are taking for mental health issues. It is not unusual for individual students to be on numerous meds with some of these meds having an "off label" use. I actually went to a conference that was about all of these meds and what I came away with is that "off label" use drugs have side effects that have been found to be benificial in the treatment of some illnesses and that many of these meds are meant to put a person in a place that makes them receptive to therapy...but unfortunately the therapy part of the treatment is often hard to get, too expensive, not covered by insurance or just not available so the person stays on the medications indefinitely. With all that said- how do we monitor these students for deleterious side effects of the many medications they are on??...in particular the "off label" meds. I also worry about the effects of long term use of all these meds on growing bodies. Any thoughts on these issues?

Heather,you make some very good points and your school is working very hard to track the absent students and increase attendance. I think everyone is frustrated with the casual approach parents take by using school time for vacations. I can understand their view in that, rates are cheaper, not as crowded and it's still an educational experience. However, with the pressure on the schools for better attendance, we're in a "Catch-22". I understand administratively, in that, if we can get them to school, we can better educate them. With "No Child Left Behind", the bar is being raised. The movement to lengthen the school day continues to gain momentum. The bottom line is, I think teachers are working extremely hard and putting in a lot of time and effort to help the students succeed. They can't be the only ones trying this hard. If it "Takes a Village to Raise a Child", we have to have the support of the students, the parents , the community, the court system and the teachers. Perhaps there should be a minimum number of days in order to pass each grade. Perhaps we should offer after school programs or Saturdays to make up the missed work. Perhaps this should be paid for by the parents. The general work ethic in this country needs to improve for this to succeed. Any ideas?

Great Questions! I find the attendance isues interesting. We have a strict attendance policy, district attendance meetings,building attendance meetings (I am on the building attendance committee), letters sent home after 7 absences and 14 absences. Referrals are made to the youth officer. The secretary calls all unexcused absences every day to confirm the reason and that parents are aware of their students absence. All of this is quite successful in keeping kids in school. My biggest frustration is that a great majority of our absences are planned vacations. So far this year we have had 78 students out on vacation trips which, of course, is more than a one day at a time loss of school days. The school policy states that vacations must be approved by the building administrater. There are always good reasons for trips. I have to say that the majority of the students going away are doing well in school and the vacation doesn't seem to impact their grades but I can't help feel it undermines the work ethic of having to be in school every day responsible for each days work. Our attendance numbers are not great at times but truency is not the problem.

Edited by author 02-07-2008 08:44 PM
 Are we as educators called upon to teach more and more to our children? Does it seem like our purpose has evolved into teaching social skills as well as educating them. Much of our day includes teaching character traits, personal hygiene, peer mediation, etc. This used to be the responsibility of the parents. Our society has gone through many changes and the family unit is not what it was in the 50’s. Are we doing a disservice to our students by trying to be everything to them? Should we put the burden of teaching these social skills back on the parents? The work ethic in this country is reflected in the increase in absenteeism of our students. Should there be repercussions for parents who fail to send their child to school? How have other schools dealt with the problem of poor attendance?

I think you made a good point, Heather, about needing to investigate a little into the issue before just assuming the kid does not WANT to smell or appear good to other students and staff. Too often it seems to me that this is what the teachers assume... when really there is usually a lot more going on.

  You're doing a great job Heather! It is a very difficult situation to handle and the way you deal with it varies depending on their age/grade. I actually forgot about showers in school. When I attended High School, it was mandatory and the teacher would make sure everyone had taken a shower before reporting back to class. Often the students would just splash water on their hair to appear as though they had showered. (This, of course, was one of my personal favorite tricks). Times have certainly changed and social norms have evolved in such a way that EVERYTHING needs to be antibacterial. There is some evidence that this may be the reason for increased food allergies. Because we're not allowing our bodies to produce antibodies, we have little or no natural immunity.

I found this to be very difficult on the elementary level because the little kids were so dependent on parental cooperation and help. I remember one little boy (4th grade) who asked me to provide him with a wash cloth, soap, shampoo tooth brush , toothpaste and towel. Every morning he came to my clinic and stripped down in the bathroom and gave himself a good wash. He was already doing his laundry at home. His clothes were wrinkled but he felt so much better and full of confidence with his hair combed and feeling clean. I remember many times with students that DCF had to be called in to deal with problems of which personal hygiene was just one of the
problems...which is often a very painful way to address life issues.
I have been much more successful on the middle school level. (As life would have it...since I have started this response, I have been called to the 8th grade special education resource room to talk to five boys about their personal hygiene and a teacher stopped and asked me to address the issue with another student) The approach that I find the most effective is total honesty. I meet with them individually as they are referred (usually). We discuss the reason for the referral and talk about the social ramifications of being dirty or smelling badly. We talk at great length about their issues with doing what they need to do to have success. We make a deal and they are usually able to take care of the problem on their own as that is the first option. The second step is to bring in a parent/parents to assist us. I often provide deodorant and powder samples, new toothbrushes and tooth paste. There is usually some backsliding as time goes on but they respond to a gentle reminder. At first I thought this would alienate the students but it has actually opened up great lines of communications between the students and I. After you have talked about their body odor problems there is not much they don't feel comfortable talking to me about.

In my dealing with this issue we have come across some interesting situations. Sometimes it takes a little investigating. I can remember the dilemma of having three students who appeared to be very clean and clothes neat and clean but smelled "badly". All three did not want parents brought in on the issue. I discovered one of the student's pet ferrets was sleeping in their clothes drawers. The student quickly started using the ferrets cage with only supervised outings. Another time we discovered the students cat was wetting on their clean clothes laundry basket. It became a really good lesson in putting clothes away immediately and a decision they came to on their own. The last student's parents were from India and it was the curry in all their cooking that gave her body an odd odor. When we discovered this she was actually able to incorporate that information into a presentation she did in Social Studies on the Smells of Different Cultures.

We had a number of years at our middle school where the female gym teacher made towels, soap and shampoo available in the locker rooms and it was surprising how many students took advantage of that opportunity. She did a load of towels in the home ec room every day. Showers are no longer required and now nobody showers after PE which I think is a missed opportunity on the teaching of personal hygiene.

And then again....we had a year when we had a group of 5 boys in 8th grade who called themselves "the dead squirrels". Part of their passive Resistance to the "Norms of society" as grown ups/people in power know it was to not bathe often. The powers to be tried everything especially parent involvement and we were not very successful.

As School nurses are well aware...life goes on....and it is very
interesting!!!!


On 1/30/08, QT - Angela Fiandaca <qtopic-40-6C5Scr8cehcM@quicktopic.com> wrote:
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Thanks Angela! It's very difficult approaching these sensitive subjects, and I know on some level, the students "get it". Unfortunately when you have a limited budget for clothes with no heat or hot water in the house, it's pretty tough taking showers and washing your hair and changing into clean clothing. I have to remind myself, "It’s a process". I do what I can do and the teachers do what they can do but bottom line is it’s up to the student to do what he needs to do. You can also argue that these are our standards. That, of course, is a whole other discussion!

I like your approach of updating the health card and asking about a number of things, not just pointing out bad hygiene. I'm sure it helps the students to feel more comfortable talking about this sometimes difficult subject.

Angela, this is an excellent question and I'm sure it's a universal problem. First let me explain how I initially deal with the hygiene issue. I call the student down to review their Health Card. I find out who their doctor is, who their dentist is and when did they last see these people? I ask about immunizations. I update their emergency information and then I begin to educate them on their personal hygiene. I tell them about bathing, deodorant, washing their hair, brushing their teeth and I suggest they get a lesson on how to wash their own clothes. I give out samples for them to use. I try to follow up in a week or so. I will refer them to the SAC or Peer Mediator or any other friendly face in the building ready to take a stab. But as you said, it's often a familial problem, perhaps cultural. To attempt to teach in a classroom setting with this situation is difficult at best. It is often quite disruptive. Ultimately, we do what we can and when the student knows better, he'll do better.

I have a question for all of you skilled nurses out there! In our school we have several students who have serious hygiene concerns. Teachers email me constantly about these students who quite frankly smell, appear to not have showered in a while, and overall are just poorly taken care of. It becomes more than an issue of foul odor, but rather an issue of other kids starting to make comments about these students, which of course leads to low self esteem and lack of friends.

We refer these students to the nurse, who speaks to the students and does her best to work with the families. However, most times the issue does not improve because it is really a life situation that we cannot control no matter how much we wish to make it better for our students. Teachers sometimes do not understand this, as they continue to refer the student despite us saying we have done all we can do at that point.

I'm seeking other ideas that have worked in situations like this. Nurses, any advice?

I just registered for an online course at Framingham State College for "Exploring Food Allergies". I'm really excited to get involved with this course and I will be happy to share the ideas with everyone here. It's a complicated issue with serious ramifications if not handled properly in the school setting. Please feel free to post any specific questions you may want me to bring to that forum.

It's obvious from your discussion posting that you're a "seasoned" School Nurse. The numbers of students who have life threatening allergies, as well as the number of students who have been mainstreamed with serious medical issues continues to climb. With sufficient education, encouragement and administrative support, it seems your district has learned to change and adapt quite nicely. It would be impractical to send School Nurses out of the building every time a class went on a field trip. With the severe nursing shortage in the United States currently, it’s difficult enough hiring and maintaining nurses, let alone getting substitute nurses to cover Field Trips. Unfortunately, it also seems unfair to ask faculty to accept yet another responsibility and be Epipen trained as well so that Field Trips can take place. I'm also impressed with the positive attitude you express. The bottom line is, for the portion of the day that we are in charge of these students, we have a responsibility to do what needs to be done through the various ways you mentioned.

It is interesting that you asked the question "Are teachers required to be trained to give Epipens?" For many years it was in our teachers' contract that they were not to give injections/epipens. During those years we covered field trips with parents and substitute nurses...which was often a problem getting coverage. As the number of Epipens increased in our district along with the increased number of field trips it became an impossibility and teachers asked to be trained (regardless of their contract) so that trips would not be cancelled. Two years ago the wording of the contract changed and teachers may be trained to administer Epipens if they choose. They are not required to. Presently at my middle school every teacher, support person (psychologist, social worker, guidance counselor) and administrator is trained to give Epipens. Our unwritten rule is that we ask the student's parent first. Then we see if a nurse is available. If neither of those people are available the teacher takes the responsibility. Many teachers feel that the parent or nurse are not necessary and take responsibility from the get go. We also encourage older students be trained so that they can carry their epipens and self administer. The teachers are well aware that no student can be deprived of the educational experience of a field trip because of a medical diagnosis and if a student cannot go on the trip because we do not have medical coverage, then no one goes. Knowledge of the law, good training, understanding of the medical conditions, cooperation and a positive attitude help allay fears and boost confidence in everyone's ability to do what needs to be done.

On 1/14/08, QT - kwiater <qtopic-40-6C5Scr8cehcM@quicktopic.com> wrote: >
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I couldn't agree with you more. The number of students with life threatening allergies has skyrocketed. In our Health Room, we have Epipens in stock to use in an emergency but, like you said, it's difficult to get full compliance, whether it's a signature or an undated Epipen, or a doctor’s order. At our Middle School we have 14 students who have sent in Epipens and another 16 who have had an allergic reaction but have not had the need for an Epipen. Does your district require the teachers to be "Epipen Trained"? Who goes on the field trips that can administer an Epipen if necessary? I'd like to hear any suggestions for getting parental compliance. I do realize we live in a very fast paced society and we're all juggling many balls. Is this a DCF referral? Every case is different but after exhausting all other avenues, maybe it is....

In response to your questions regarding food allergies I would like to say that "watching" the evolution of this health problem over my 26 years as a school nurse is almost mind boggling. The allergy/ anaphylaxis situation in schools is a conundrum that reaches out to so many educational settings and issues that there are too many issues to address in one blog. Like all systems we have a detailed school policy that requires very specific health care plans meetings between nurse, parent/gaurdian and teachers. I have always been very lucky in that my parents and teachers are very cooperative with the process and we usually have everything in place for the first day of school. When I go to conferences I speak to colleagues that have the diagnosis of a severe allergy but can't get parents in for meetings, can't get the required Epipens and the Doctor's orders in to school in a timely manner...if at all. We have school Epipens and Adrenalin in the med closet in the nurse's office, but no where near enough to cover field trips and the after school activities of our school population. What can school nurses do to get parents/gaurdians cooperative? Is this a DCF referral??

Thank you for your response. Your reply mirrors how our schools handle the situation. I look on our individual response to each student as a positive way of letting them know that we care, we know they exist and we want to help keep them healthy. I am always amazed at the numbers of coats that are in the lost and found. We are on the coast so that our temperatures are up and down so that winter is not consistently very cold which complicates the immediacy of our message. With all that said...I often long for the days when our principal many years ago announced after a certain date shorts and sandals would not be allowed until spring and that students were expected to dress according to the weather. He used to actually stand in the hall as the kids came in and if it was cold and they did not have a jacket on he would tell them to go call their parents and have them bring in their coat, hats and mittens. Life, priorities, and weather conditions are all different now!!

On 1/8/08, QT - kwiater <qtopic-40-6C5Scr8cehcM@quicktopic.com> wrote: >
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Edited by author 01-08-2008 08:34 PM
I'm afraid this may be a universal problem. Our Principal announces if it is too cold for the students to go out. He bases this on the temperature and windshield conditions of the day. I also know he considers the students who don't come properly dressed to school. Staff members speak to the students individually about wearing warm enough clothing but it often falls on deaf ears and we always have "Lost and Found" articles that go to students who do not have the financial means. I think many times they just come dress inappropriately to get a reaction. There are probably many reasons why some students ignore good, common sense and I guess we should keep trying to help them make the right decisions.

Does any school system have a definitive policy on Dressing Appropriately for the Weather? We run into this problem every year when the temperature hovers well below freezing and students come to school without coats, short sleeved shirts, shorts and flip flops. We speak to students individually which often has no effect. On occassion we will call parents but that could be someone's full time job making those calls. We try to ascertain that the students family can afford winter wear and in the past have purchased coats as necessary. I would love to hear how other schools handle this problem.

Excellent response to the MRSA question! Your school has taken a proactive stance to maintaining healthy students, fighting germs and improving school attendance. Our ultimate goal is to have students learn and achieve in an academic setting. A frequent motto used by School Nurses is "A Healthy Student is a Better Learner". Congratulations on your efforts! Have a healthy winter season.

All of the publicity on MRSA has made our staff nervous and students frightened. Our entire school community has always worked hard to keep abreast of current health isuues and promoting wellness through continual good health habits.

Handwashing has been emphasized as our primary defense for a very long time. As part of our Osha training before school begins we talk about handwashing technique and keeping hands away from our face as essential in staying well. At specific times and on an ongoing basis homeroom and classroom teachers discuss handwashing, wellness isuues and healthy habits (such as proper rest, daily execise, good personal hygiene, dressing for the weather, making healthy decisions, reducing stress, having fun and laughing everyday!) Our Principal and guidance counselor meet with all the students to talk about team building, creating a positive school experience and character building as we feel happy students are healthier students. The guidance counselor also meets with the fifth grade students to discuss stress reduction as part of their transition to middle school. Our Vice Principal talks to all the lunch blocks regarding the importance of handwashing before eating (one of the acceptable times to bring your hands to your face!) and if you forget he recommends that they use the hand sanitizer dispensers on the wall of the cafeteria.

Our school has alcahol based hand sanitizers in the nurses office and cafeteria. We recommend soap, warm water and lots of friction as the best way to keep hands clean. We recommend Purell only if hands are already fairly clean and soap and water are not available. (We pack small purells in the first aide kits for all field trips). There is nothing healthy about "Purell mud" as students often think it is just easier than "the old fashioned way."

Our health teacher teaches healthy living habits as part of his curriculum. Science teachers addressed MRSA and prevention as part of their Science current events topics. An article from the school nurse appeared in the school newspaper that goes home to parents (As the flu season comes upon us......). The students absolute favorite is when the Principal and a teacher have a serious conversation on the morning live broadcast about staying healthy (while one talks about sneezing/coughing into your elbow the other sneezes into their elbow...while one talks about keeping hands away from face the other rubs their nose...and are told to go wash your hands). It ends with both singing happy birthday to themselves as they demonstrate proper handwashing technique. Everyone has a good laugh but remember the message.

The walls of the clinic are passive lessons as we started the year with a Personal hygiene display. We now have Winning with Wellness, Healthy Living and Developing Your Fitness Four displays up and the posters always lead to very interesting conversations.

I guess this is just a long winded way to say that our philosophy is that germs of all kinds are always there and that we have our emphasis on a consistent, proactive emphasis on prevention through good health habits...
especially handwashing

And with all that...we still get sick staff and students...but maybe not as many as we could have!

Some strains of Staph bacteria are resistant to antibiotics and therefore are termed "methicillin-resistant Staphylococcus aureus"or MRSA...most strains of bacteria are sensitive to antibiotics and infections can be effectively treated...MRSA is often found in 20-30% of the noses of normal healthy people and is also commonly found on people's skin...awareness is key so special treatment can be started but the primary method of prevention for MRSA and many other causes of infection is basic hand washing...this dampens the spread of illnesses in the school setting...with the winter months upon us...it would be in everyone’s best interest to practice good hygiene and encourage all of our students to do so as well...

I have heard a lot lately in the news about MRSA. Could the expert nurses here explain more about this and what it means for us working with students?

Welcome to your world of middle level education. I am thrilled that this group might meet a need that has existed for a long time for a group of very important people in our schools. I look forward to the discussion.
Bob Spear
Executive Director

Currently, communities everywhere are dealing with the serious issue
of "Food Allergies". What are your thoughts on this and how can
we keep these children safe without violating the rights of
others? Do you feel faculty members should be Epipen Trained?