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Kentucky nurses and their allies seek a mandate for a nurse in every school

By Melissa Patrick

May 9, 2017

– Advocates say move would improve learning outcomes

 

Kari Hall, Certified Medical Assistant, with a Madison County student

Putting a full-time nurse in every Kentucky school would not only provide health care, but improve education outcomes, say advocates of the idea.

 

“We need a nurse in every school because we need to quit thinking about health and education as separate entities, because they are not,” said Eva Stone, an advanced-practice registered nurse and co-chair of the school-nurse initiative being mounted by nurses’ groups and their allies.

 

One of their strongest allies is retired educator Terry Brooks, executive director of Kentucky Youth Advocates, says he is “absolutely convinced that the non-cognitive issues that kids face, like health, have as much to do with their capacity to learn as a teaching method.”

 

Brooks added, “There is only so much blood that you can wring out of a turnip when it comes to teaching methods. You always want great teaching methods, but my goodness, we have been working on that for decades with results that are a whole lot more the same than they are different. So if it is not producing significant change, we’ve got to look for something else. . . . You are not hearing me say that this is a silver bullet, that, boy, a school nurse is going to fix everything, but I think the presence of a school nurse not only impacts kids’ health, but it impacts the kids’ capacity to learn.”

 

Those assertions are supported by research, including a recent study that looked at the association between school nurses and academic outcomes of high-school students. It showed that when there was a nurse in a public high school on a full time, every-day basis, graduation rates were higher, absentee rates were lower and ACT scores were higher,” Teena Darnell, assistant professor of nursing at Bellarmine University, said about her research.

 

“And traveling nurses showed no significance on any level. So if you had a part-time nurse, there was no significant difference on academic performance,” said Kathy Hager, a Bellarmine nursing professor and president of the Kentucky Nurses Association.

 

Hager is also a member of the “Every School Needs a Nurse, Every Day” initiative that is advocating mandates for a full-time nurse in every public school, as recommended by the American Academy of Pediatrics.

 

The National Association of School Nurses supports a ratio of one nurse for every 750 healthy students. This was the recommendation of the pediatrics academy until just last year, when it changed its recommendation to a nurse in every school, saying that “The use of a ratio for workload determination in school nursing is inadequate to fill the increasingly complex health needs of students.”

 

Kentucky has one nurse for every 1,254 students, according to a 2011 KYA report, the latest data available. The Kentucky Department of Education only records nurses hired by school boards (187 this year) and does not include any hired by different funding streams.

 

Darnell’s research found that 42 percent of Kentucky’s high schools had a full-time nurse, 37 percent had a part-time nurse and 20 percent of them didn’t have one at all. Among all schools, 44 percent had full-time registered nurses; 48 percent had either RNs or licensed practical nurses.

 

State law requires schools to “make any necessary arrangement” to provide for the immediate health needs of students. Stone said they “do that for the most part, but . . . there is no system of monitoring in place.”

 

When a nurse isn’t available, student health services are often provided by school employees who are trained to provide those services. Many students have conditions that need frequent attention.

 

Out of 655,475 students enrolled in Kentucky’s public schools last year, 20,711 were diagnosed with attention deficit hyperactive disorder, 14,054 with allergies, 55,897 with asthma, 1,142 with Type 1 diabetes and 5,259 with a seizure disorder, according to the KDE.

 

Vicki Williams, RN, Calloway County

Vicki Williams, school-health coordinator and one of three school nurses in Calloway County, which has about 3,400 students, said the school system has about 150 employees who have completed medication training, and others who know certain medical procedures, like blood-sugar testing, taking blood pressure and using g-tubes to the stomach.

 

And though she is allowed to delegate administration of insulin to other employees, Williams said she isn’t comfortable doing that. “That is where I will draw the line,” she said. “I will not train anybody to give insulin except myself and any other licensed nurse in my building.”

 

She said schools have many distractions and “Too much insulin is life threatening, and I don’t feel comfortable putting that on somebody who has not had more training than a quick diabetes training after school one day.”

 

Hager didn’t question that unlicensed employees can be trained to provide such services, but said what they don’t have are the assessment skills of a school nurse. “It takes years of experience to recognize what a person looks like with a low blood sugar reaction,” which often occurs with young diabetics, she said.

 

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Melissa Patrick

What Does It Take to Improve Societal Health?

By Kenya V Beard

May 4, 2017

 


Chances are you have or you know someone who has asthma, hypertension or diabetes. These are serious illnesses that raise morbidity and mortality rates. Medicine alone is not enough to manage these conditions. To start, individuals should eat healthy foods, avoid cigarette smoke, have access to jobs, health care, and safe communities.

 

But what if you live in a community where there is no grocery store, the air quality is poor, or the unemployment and poverty rates are so high, health is no longer a priority? These conditions are just a few of the realities that impact health for so many individuals. For example, the Morrisania section of the Bronx was once called a “food desert”; a place where grocery stores did not exist and access to fresh fruits and vegetables was inadequate. So exactly how could one eat healthier? In New York, there are some midtown districts where the air quality is at unacceptable levels. What affect does that have on individuals who have asthma and work in those areas? Lastly, there is a direct relationship between poverty and health. Individuals in poor households tend to have worse health outcomes for reasons beyond their control.

 

How do we improve the health of our society when we know that a prescription for medication does not translate to healthier food on the table, better air quality or employment? What are the lessons learned from our past that can be used to inform our future?

 

In the book, Out in the Rural: A Mississippi Health Center and Its War on Poverty, Dr. Thomas J. Ward takes us back to the early 1960’s to explore the triumphs and challenges faced by Dr. H. Jack Geiger and others who established the first rural community health center in the United States, the Tufts-Delta Health Center. The Center was established during a time when many African Americans were denied access to health care. When health care was accessible, they had to use the back door, wait in separate rooms or were expected to tell the doctor what their problem was because some doctors refused to touch them. In addition, since emergency care required immediate payment, some died on the hospital steps. Some communities in Mississippi faced astonishing health care challenges that led to the highest infant and maternal mortality rates in the country. But that was all about to change.

 

Tune in to HealthCetera to hear the conversation with Diana Mason, Kenya Beard, and the author of Out in the Rural: A Mississippi Health Center and Its War on Poverty, Dr. Thomas J. Ward. Find out how the Tufts-Delta Health Center addressed the social determinants of health, provided comprehensive health care, and improved the health of a community. Indeed, the lessons learned 50 years ago could still be used today. So tune in on Thursday, May 11th at 1:00 PM to WBAI, 99.5 FM in NYC or streaming at www.wbai.org. 

Kenya V Beard

Nurse Tina Carlson’s Poems on the Generational Consequences of War

By Joy Jacobson

April 28, 2017

It’s National Poetry Month for another minute or two, and since you probably haven’t dedicated as much time to memorizing poems as the month might suggest, I offer you absolution in the form of a poem composed by a woman whose work concerns itself with absolution.

 

Tina Carlson, Ojo Caliente, NM

Tina Carlson, a psychiatric nurse practitioner, released her first book of poems, Ground, Wind, This Body, through University of New Mexico Press in March. The book is a chronicle of sorts, one that winds through the wretchedness wrought by war and the deep, lifelong impression it leaves in the lives of a returning soldier’s children.

Tina is a dedicated nurse who works with the homeless in Albuquerque and a true poet—and what a combination: a carer both of human beings and of the language we use to shape and reshape our experience—who is also one of my dearest friends.

 

Try reading this poem aloud. It comes about midway through her book (offered here with the poet’s permission): 

Summer Nights

 

After rain, the earth shines in gratitude. We are nine,

awake on wet grass and the sky, a vast cup of stars.

Because our lives are small fires buried under dry fields,

the muddy homes of childhood, auditoriums of weeds, and trees.

Even discomfort glistens here.

The whole world breathes together, watches messages

pass across the wide face of the moon. We were born into wildness

after the war. Each year, watch the hillsides burn aspen yellow,

then the wind changes everything to brown.

For you, I am an arsonist.

Our fathers take aim at us behind doors with imaginary weapons,

still living in battle. Almost criminal, our desire to thrive in this world.

Our futures arrested, like the cat’s gift in the doorway:

birdlike, perfectly curled into the shape of an egg, gelatinous.

Even after several re-readings I am left breathless by that last image.

 

With the astonishing opening lines we begin in thankfulness for a thirst quenched, for the simplicity of wet grass and cupped stars—a childlike sweetness that gives way immediately to an underground fire. By line 3 we know we are in hell, navigating atemporally a place that by some unnamed grace makes even pain beautiful.

 

The poem doesn’t let on who “we” are, and so it allows me to step as a nine-year-old into that space. “For you, I am an arsonist,” the speaker says, implicating me in the near-criminality of a “desire to thrive,” despite our aborted future that has been left uncannily as a “gift.”

 

When the speaker states “We were born into wildness / after the war” she means the Second World War, but she could also be referencing our current landscape of perpetual War on Terror. Regardless, wildness in this poem’s universe is a two-headed thing, both a natural and a manmade chaos, one that helps us survive our wounded fathers and also nearly annihilates us.

 

Such antipodal tensions abound in this poem, as throughout the book. Redemption is almost always at hand, as in these brilliant lines, in which it seems that the entire world is being born and dying at the same time:

The whole world breathes together, watches messages

pass across the wide face of the moon.

Yesterday was Poem in Your Pocket Day, but it’s not too late to print this one out, or another of her poems from the book, “Ojo Caliente: Metamorphoses,” that recently appeared on Verse Daily. Carry it with you. Give it to a colleague. Read it to a friend over lunch.

 

I asked Tina what it’s been like to have this book published. She said by email: “Having this book out in the world was initially terrifying. So much was never supposed to be spoken. But the book itself, like a child, has its own life now, and wants the secrets to be over and the war wounds to be healed.”

 

Poetry has often served to bear witness and to speak the unspeakable.

 

I’ve been reading Tina Carlson’s numinous poems for more than 20 years. It thrills me that now you can read them, too.

Joy Jacobson
Joy Jacobson is the CHMP’s poet-in-residence and cofounder of our Writing Reflective Narratives for Clinicians program.