Nursing Notes

The school nurse is a key player in ensuring a successful school experience for a student with a chronic illness. The nurse is the "glue" that connects the student, family, school and hospital. The school nurse is integral in:  creating a smooth transition from hospital to school; alleviating the fears of the parents and the student; addressing the concerns of peers, siblings, teachers and other parents; and being a support to all of these stakeholders. It is obvious, therefore, that the role of the nurse is significant and should not be underestimated.

Ongoing communication is essential

Nurses confering.

When a student is diagnosed with a chronic illness or experiences an exacerbation of an existing illness, effective and ongoing communication among all personnel is essential. The nurse should meet with the parents to understand the child's health issues. Sufficient time should be set aside to meet with the child and the parents.

Additional meetings might be needed to include all school personnel involved with the child. These meeting should include the hospital educator, nurse clinician or hospital social worker, the child's teachers and other key persons who will interact with the student at school. Preferably, this meeting should occur with all parties in attendance. If that is not possible, a telephone conference is recommended.

Checklist

The following checklist may assist the school nurse in developing a plan for academic reentry and reintegration of the student with a chronic illness. Each point in this list should be carefully considered and weighed.

  1. The child's current medical status and prognosis; the hospital educator, nurse clinician or social worker should present information about the diagnosis and treatment.
  2. Nurse examining patient.
  3. Any physical restrictions that have been recommended.
  4. Information about any implanted devices, surgical sites or other issues that might need special attention or precautions.
  5. The child's current psychological or emotional status; how does the child feel about the diagnosis and its long-term impact.
  6. Provide ample opportunity for the child and parents to voice any concerns they might have regarding re-integration into classes and social structure upon return to school.
  7. The family's desires regarding sharing information with other students and parents. A signed consent should be obtained before sharing any information.
  8. The development of an Emergency Health Care Plan or Individualized Health Care Plan for the child in school. Most districts have a form for this purpose. If your district does not have such a form, an example is available on this site. This plan will enable you to prevent many problems, and to have a good plan of action in case there is an emergency at school.
  9. Give the family ample time to present any additional concerns that they may have.

It does not end here

Although this list seems to be fairly comprehensive, it is merely a beginning for the dialogue between the school nurse, family, and health care providers. A chronic illness is not a stagnant condition, so it is vital to maintain ongoing communication to ensure that current issues are addressed. The child with cancer, for example, might have weekly blood tests to determine whether the platelet count is high enough to participate in physical education and recess, or whether the white blood count is high enough to prevent potentially life-threatening infections.

As the school nurse, you are an essential link to provide the student's teachers and other educational staff with pertinent information. As the person who addresses health care issues when the child is at school, you enable the educators to do their job:  teaching students. In this way, the student is more likely to enjoy success at school, and all involved will relish the experience!