LPS school nursing embraces trauma informed care

By Julene Lesher, RN, BSN, Arnold Elementary School Nurse, and Megan Lytle, MBA, MSN, RN, Huntington Elementary School Nurse

The National Association of School Nurses (NASN) position statement on the school nurse’s role in behavioral/mental health states, “School nurses, because of their regular access to students, are uniquely qualified to identify students with potential behavioral health concerns.” Over the last couple of years, school nurses at LPS have revamped health offices to better meet emotional and behavioral needs of students by partnering with administration and teachers to provide Tiered Support for students. It's all part of evidence-based Trauma Informed Care.

Health Office Tier 1 examples, designed to support all students to help students meet behavior expectations:

• “When to Visit the Health Office” protocols have been created with input from building administrators and teachers. Protocols were made available to classrooms and posted throughout school buildings. The protocol outlines when it is appropriate to refer students to the health office. Health office passes were also created. The protocol has reduced lost classroom minutes significantly.
• Updated classroom first aid kits were created and provided to classrooms. Simple first aid, such as paper cuts, are handled in the classroom instead of losing instructional minutes for trips to the health office.
• School Nurses are setting health office Trauma-Informed Care goals, such as “Use positive verbal and non-verbal wording, as well as voice tone cues that are positive and supportive of student self-esteem”.

Health Office Tier 2 resources are designed to provide targeted group interventions to students who are needing additional support:    

• Student health office visit data is collected and evaluated. Students who frequent the health office with vague complaints are brought by the school nurse to building Tier meetings. Problem-solving and collaboration with administration, school counselors and school psychologists takes place and a decision is made as to if those students qualify for scheduled daily health office triage/wellness visits.   With the addition of a brief daily health office triage/wellness visit for those students, their visits have been reduced to one per day. This has significantly reduced lost classroom minutes for those students, as approximately 10 minutes of instructional time is lost with each health office visit. During scheduled triage, a temperature is taken and physical/emotional symptoms addressed. Academic focus questions are also reviewed with the student, if needed. For example: “Will you make small problems big or keep them small? - Keep them small,” and, “What goal are you working on?” 
• As we focus on physical and emotional health, additional attention has been given to increase mindfulness in students. Research suggests mindfulness training can reduce stress and improve self-confidence, relationships with others, attention, optimism and self-esteem. Mindfulness-based practices appeal to children because they are self-management techniques and allow them to play a role in their own growth and development. Further, there is a potential for greater self-awareness, improved impulse control and decreased emotional reactivity to challenges (Rempel, 2012). Mindfulness is a free tool that can assist students with self-advocacy and resiliency. Students dealing with trauma and stress often leads to difficulty with self-regulation and self-awareness. The tool is being utilized with students who come to the health office and are struggling emotionally.
• Students are taking scheduled medication by following a Student Medication Procedure, receiving simple rewards as part of building wide good behavior reward systems. This procedure enhances safety practices during medication administration.    

Health Office Tier 3 intense supports, designed to provide individualized interventions:

• Trauma-Informed Care is supported in health offices with care, such as morning triage for students who suffer from anxiety. School Nurses create Individualized Anxiety Action Plans with input from school staff as well as the parent and student. An Anxiety Tool used in health offices outlines green/yellow/red zones and strategies that help move the student from yellow/red zones to their green zone, supporting a state of mind conducive to learning. Strategies to help these students include progressive muscle relaxation, deep breathing, talking with the school nurse, drawing, use of a stress ball, Play Doh, and Take 5 social and emotional program strategies. We also discuss triggers and prevention strategies, including the importance of daily self-care activities such as regular exercise, positive self-talk, and time-management.
• Individualized Health Plans are being created for students learning how to complete their own medical treatments (example: self-catheterization and diabetic care). Sticker charts and small prizes/tickets serve as motivation. Students are reaching success quickly with the use of the positive behavior techniques. These students have chronic diseases and are learning life long self-care.

References:

Rempel, K. D. (2012). Mindfulness for children and youth: A review of the literature with an argument for school-based implementation. Canadian Journal of Counselling and Psychotherapy, 46(3), 201-220.

National Association of School Nurses (NASN:) The School Nurse’s Role in Behavioral/Mental Health of Students, Position Statement: https://www.nasn.org/nasn/advocacy/professional-practice-documents/position-statements/ps-behavioral-health

LPS Classroom Practices are Trauma Informed: https://home.lps.org/studentsupports/classroompracticestrauma/

https://www.take5program.com/

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