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 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.

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?

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.

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?

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?

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?

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.

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 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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< replied-to message removed by QT >

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.

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?

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

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?