School Nurse Perspectives
Thoughts, Tools, Resources and Inspiration For School Nurses
Gerri Harvey, RN, MEd
Frequent Flyer Plans
Dear Gerri:
I am finding myself with more and more "Frequent Flyers" and often I find there is no real health problem when I do a nursing assessment. It seems to be the same kids over and over and I suspect they are just trying to get out of class, I don't know why the teachers can't see this. Do you have any good ideas for dealing with the kid and the teacher in a way that doesn't reflect the frustration I feel when the same kid comes in again and again?
Thanks for any thoughts you can share.
LM
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Dear LM,
I agree that the kids who keep showing up with no findings are a challenge to school nurses, and it can be frustrating. I think the solution lies in a three-point approach:
1. View the Frequent Flyer (FF) as a kid who is in need of something and may be getting or trying to get that need met by coming to you.
Although the need might not be a real health problem per se, the problem is still a real one, creating tension and discomfort in the child. Here's where making a mind shift yourself will help. Traditionally, school nurses have worked within a framework of the Medical Model, ie health is the absence of disease, illness or injury. In our overly busy offices, it can be tempting to send the child with no physical signs of illness back to class, and to get tough if the child becomes an FF, considering him or her a "faker". School nurses who practice in this "old school" nursing model still do many good things for kids, but could miss out on important opportunities to prevent stress-related problems from developing into health issues down the road. They might also miss opportunities to teach kids health-enhancing coping skills in the face of stress: part of wellness promotion and whole-person nursing care.
It is now well-known that unresolved, ongoing stress and distress can lower immunity and resistence to disease. Children today face many stresses, from fractured relationships due to divorce to having to be home alone after school before they are ready to manage the aloneness. Sometimes the source of the stress is school itself; academic difficulties, problems with peers, even a mismatch between the child and the teacher. Whether the child is coming to you because he wants to avoid work he finds too hard, a teacher he finds too rigid, or because he is in desperate need of one-on-one attention from somebody is a child experiencing stress. Feeling sick may be the knots-in-the-stomach or pounding head feeling that results from stress. Only your assessments will help the child and the teacher to figure out what is really going on so a negative coping pattern can be changed. Everyone experiences stress, it's what you do about it that impacts how it will affect you.
2. Try to determine the real need.
Some kids use claiming illness as a way to get their real, less apparant needs met, temporarily reducing the stress. For many people, including adults, their experience has taught them that illness and injury elicits concern, attention and comfort,and a legitimate reason to seek care from others. Learned helplessness results and hypochondia becomes a way of life, with the person unconsciously choosing illness. Many researchers in the field of mind/body medicine think that this sets the stage for the later development of real illness. Let kids know that they do not have to be sick to come to see you. Give wellness appointments and let kids know you enjoy social calls (preplanned of course).
3. Once you have made an assessment, work with the rest of your team to create a plan for that child and implement and assess your interventions, modifying if need be.
Your overall goal is to meet the real need without the child having to get ill or injured in order to meet that need. A FF Plan might include regular visits to the school counselor, lunch once a week with you, daily check-in visits with you, and communication with the teacher and other staff if the child is expressing distress over academic or classroom issues. Parents may not be aware of the stress their children may be under due to issues at home. Some of these interventions fall under psycho/social and emotional, but they can still have a huge impact on the child's health.
The field of body-mind medicine is just bursting with data and support around the importance of teaching children to consciously choose wellness by getting to the real source of the frequent complaint, "I don't feel good. "
Children fortunate enough to learn how to get what they need without getting sick are less likely to develop a host of ailments as adults.
Here's a tidbit from one of my favorite reference books, The Well Child Book by Mike Samuels, MD and Nancy Samuels, Summit Books:
How Sress Causes Illness
When people perceive they are under stress, their bodies react with tension
1. their brain sends out impulses to the nervous system that
2. directly stimulate the heart, muscles and stomach to tense and
3. the adrenal glands secrete harmones that increase the general level of tension, thereby
4. causing direct tissue damage, like tears in artery walls
When people perceive they are under stress, their immune systems become less effective:
1. their brains send impulses out to the nervous system that
2. lower the thymus' and spleen's ability to produce lymphocytes and
3. the adrenal glands secrete harmones that lower the lymphocytes' ability to produce antibodies, thereby
4. lowering the body's ability to detect and eliminate bacteria,viruses and cancer cells.
Looked at this way, helping FF's figure out what they really need and how to get it without becoming sick ultimately saves lives. Not as flashy as ER, but a more gentle, steady and consistent kind of nursing that is but a small piece of what school nursing is all about.
If you are interested in more information here are a few articles:
Gerri
