Good community health link found in school nurses
Good community health link found in school nurses
Education good way to enhance disease management
Working with school nurses throughout Georgia is a key element of community health outreach at Children’s Healthcare of Atlanta.
The link is made in several ways, but one of the most unique methods is the School Nurse Liaison Consultant Program, which covers 28 school districts within the Atlanta area.
"Our nurse liaisons and consultants work with any chronic disease, illness, or injury that is complex when families request assistance in communicating with the school. We are really focused on the health care the child needs during the school day," says Joyce Allers, RN, manager of illness prevention and management at Children’s Healthcare of Atlanta.
She says some programs have liaisons to help children with cancer return to school or children who are burn victims, but she has never come across a generalized liaison program like the one she supervises.
Four registered nurses with pediatric experience are available to manage cases. Some are nationally certified school nurses. Because the liaisons operate from home-based offices, they have flexible schedules and can move about their region according to client need. For example, they may have to meet with school officials before the first class begins or in the evening when parents are free.
Families are connected via the service lines at the Children’s Healthcare system. Also, they receive referrals from specialty physician offices and clinics. When a family is interested in working with a liaison, a form is completed that authorizes the liaisons to give personal health information to the school.
One of the most common referrals is children with new onset Type I diabetes. That is because children have to coordinate food, insulin, exercise, and activity during the school day. "We get the discharge orders and go over it with the school nurse so they know how the child is being handled at home and what they need at school," says Allers.
Diabetes educators at Children’s Healthcare of Atlanta always recommend parents use a school nurse liaison following a diagnosis of Type I diabetes.
The school nurse liaison often is able to help school staff understand the complexity of health issues.
Allers says in one case, school staff became concerned when a child with atopic dermatitis, an intense swelling of the skin, did not seem to be getting better. Therefore, the principal reported the family to the department of children and family services.
To help clear up the issue, a school nurse liaison met with the family and accompanied the mother and child to a dermatology appointment.
"We were able to educate the teachers and administrative staff explaining what the disease is and how it is treated, letting them know it is a chronic disease and the child would have flare-ups.
We also spoke with the social worker from children and family services," says Allers.
The liaison had the freedom to accompany the parent and child to a physician’s visit to make sure the child was receiving the proper care. Then it was a matter of having all parties communicate, she says.
Parents often ask for the liaison’s help when staff don’t seem to understand the urgency of a situation. For example, liaisons have interceded on behalf of children with life-threatening allergies such as a peanut allergy. They help administrators, cafeteria workers, and teachers understand what they need to do to protect the child from hidden peanuts and educate the school nurse on how to respond should the child have an allergic reaction.
An inservice for school staff would include a short lecture on peanut allergies followed by a video on allergies. A question-and-answer session would end the workshop.
The school nurse liaisons are available to help with any problem that impacts a child’s health. That includes helping underserved families apply for low-cost medical insurance.
In 2004, schools contacted liaisons 2,084 times to provide advice on illnesses; 233 children were referred to a specialist, agency, or community resource for medical care; 537 children admitted to Children’s Healthcare of Atlanta were assisted in transitioning back to school with a medical problem; and 6,832 professionals were educated through conferences and presentations.
All services are free to schools and families, and the program is funded by donations. This year, Kohl’s Department Stores foundation provided the funding. Allers says she does not know from year to year how the program will be funded and must work at obtaining money to support it.
While school nurse liaisons can only work directly with schools within the Atlanta metropolitan area, the program aids school nurses throughout the state of Georgia.
"We have contacts in every school district in Georgia by telephone," Allers explains.
Information can be faxed to a school nurse within minutes of an inquiry because Allers can contact the medical library, a specialist, or use the medical software she has on her computer. "We have access to a huge health care system. We are a doorway for the folks on the outside of the hospital to get the information right away," says Allers.
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To help school nurses prepare for the variety of medical issues and emergencies they encounter each day, Children’s Healthcare of Atlanta also publishes a 419-page school health resource manual in partnership with the Georgia Association of School Nurses.
"When we first started the program six years ago, we went to school nurses and asked what Children’s Healthcare of Atlanta could do to help and they said they wanted to standardize school nursing in Georgia and needed a resource manual," says Allers.
The manual covers procedures, chronic illness, emergency care, medication administration, clinic setup, community resources, and how to work within a school setting. This resource is distributed to all public schools in Georgia and to private schools that have more than 200 students enrolled. (The manual is available via the Internet at www.gasn.org.)
In addition, Children’s Healthcare of Atlanta publishes a biannual newsletter for school nurses titled "Building Bridges Connection." Each issue features a case study with questions to ask and steps to take when a child appears at the school clinic with a certain complaint. Also included are "quick clues" or symptoms that would give reason to investigate further or indicate that a call to emergency medical services might be in order. (This newsletter can be reviewed at www.choa.org/ buildingbridges.)
Special work on asthma management education is another component aimed at school nurses. A statewide conference is held annually. In addition, Children’s Healthcare of Atlanta assists families in communicating with school nurses concerning a child’s asthma management plan.
"Asthma is our No. 1 hospital admission. We have focused on the school day because our families get their education at the hospital from the providers but the children are going to spend up to seven hours a day at school and be in the care of someone else," says Allers.
The first choice for this education is the school nurse, the second is the classroom teacher, and the third is the physical education teacher or coach.
Education good way to enhance disease management Working with school nurses throughout Georgia is a key element of community health outreach at Childrens Healthcare of Atlanta.Subscribe Now for Access
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