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Information For School Nurses
The school nurse plays a central role in the management of concussion injuries for our student athletes. As a leader of health education in the school, the nurse can help ensure that students learn basic information about concussion symptoms, signs, and risks as part of their health curriculum.
It is sometimes in the school nurse's office that symptoms of a concussion are first recognized. A student who has not reported a concussion may be unable to tolerate being in class due to headaches, dizziness, or other post-concussive problems. The nurse who recognizes the relationship between such symptoms and recent head trauma (whether occurring in school activities, outside sports, or other accidents) can begin the process of helping the student. This will include obtaining proper medical evaluation and initiating a communication process with parents and teachers that will continue through the student's recovery.
Once a student-athlete is sidelined from sports with a concussion, the nurse is able to track the student's symptoms in school each day and provide important feedback as to the recovery process. It is the nurse's office that becomes an oasis for many injured students who may have only made it through the school day because of the understanding and support they receive there while taking needed breaks. Students who try to push themselves too much can be counseled by their school nurse to take more time to rest and to use temporary accommodations in their academic work.
The school nurse and athletic trainer have a unique partnership in guiding their educational colleagues through a student's concussion recovery. As Carilyn Raines, RN and Brian Robinson, ATC have pointed out in their September 2010 feature article in the NASN School Nurse ("School Nurses and Athletic Trainers Team up on Concussion Management") "… The school nurse and athletic trainer can work together to impress upon the students, parents, teachers, guidance personnel, and coaches the importance of cognitive rest…" not only with respect to tests, quizzes, and homework, but also in terms of activities outside school such as driving, texting, and video games (p. 237).
In many schools, nurses also participate in neurocognitive testing. They sometimes work with the athletic department to administer baseline testing. School nurses who become experienced in administering post-injury neurocognitive testing, in collaboration with their consulting neuropsychologists, are well-positioned to help recovering students understand the relationship between their test scores and recovery status.
The role of the school nurse has also been highlighted in Dr. McGrath's paper "Supporting the Student Athletes Returned to the Classroom after a Sport Related Concussion," (Journal of Athletic Training, October/November, 2010):
"The school nurse carries out daily medical evaluations and provides a rest and recovery area when the student-athlete becomes more symptomatic during the school day. The nurse's record of daily contacts and symptoms offers a valuable method for tracking the student-athlete's progress and also helps to identify worsening symptoms, which may indicate the need to temporarily reduce the student's academic demands or school attendance to facilitate recovery. Nurses may find it very useful to review a checklist of typical post-concussion symptoms with the student-athlete during each visit because some students, particularly while they are experiencing physical discomfort or the cognitive effects of the injury, may not mention the full range of symptoms they are having. The school nurse should also be sure to communicate periodically with the AT (athletic trainer) about the student-athlete's recovery and to compare symptom reports. This information will be useful in helping the AT to determine the student's readiness to return to athletic activity" (p. 497).
At Sports Concussion New England we have the opportunity to work closely with a great many excellent school nursing professionals in our partner schools. No school concussion management team is complete without a strong school nurse.
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