Case Study: School Nurse Urges an Early Start to Prevent Long-Term Illness

March 18, 2013

Today we’re featuring a case study from Health in Mind, a new report from HSC and Trust for America’s Health (TFAH), which details immediate solutions that can help close the achievement gap and create a healthy future for all children. Here, we learned about how a school nurse leverages her role to make meaningful, lasting change in schools.

Today we're featuring a case study from Health in Mind, a new report from HSC and Trust for America’s Health (TFAH), which details immediate solutions that can help close the achievement gap and create a healthy future for all children. Here, we learned about how a school nurse leverages her role to make meaningful, lasting change in schools. 

By Kadesha Thomas

The patients that Saria Lofton attended as a  bedside nurse ran the gamut.  There was the charming man who was admitted for  uncontrolled high blood pressure—at age 30.  Then, there were the seniors who struggled with  multiple chronic conditions, such as strokes, heart  attacks and diabetes, plus additional complications  with dementia and limited mobility. After eight years
in patient care, Lofton decided to act on a powerful realization: These health issues didn’t just appear. They started decades prior.

In 2006, Lofton earn her certification as a school  nurse and completed a graduate degree in community  health nursing. Months later, she joined Chicago  Public Schools, rotating among five elementary  schools on the city’s West Side. Children in the  predominantly African-American and Latino area face  chronic disease health disparities and socioeconomic  disadvantages.

“As a child, I wasn’t taught how to eat healthy, but as  an adult, I like to eat healthy and exercise,” said Lofton,  RN, MSN, CSN. “I wanted to have an impact and  serve as an example for kids like me.”

As a school nurse, Lofton is the go-to health expert  for more than 1,200 students ages preschool through  eighth grade. Each day, she juggles tasks that extend  far beyond a school nurse’s stereotypical first-aid  responsibilities. Her crunched schedule starts with  evaluating the preschool or early childhood students  who have been flagged for possibly needing additional  health services, for both physical and mental health  conditions.

When a case manager or teacher points out a child  who may need additional health services, Lofton  conducts an in-depth interview with the parents and  personally observes the child in class and at play.

She is scrutinizing motor skills, social interactions  with other students, eating habits, coordination and  evidence of pain or discomfort. Signs like limping,  poor walking coordination, or the inability to eat can  all indicate that the child may need to see a specialist or medical attention. In that case, Lofton switches  to case management mode, coordinating with the  child’s primary care provider or offering referrals. She  knows—by memory—which insurance types are  accepted at health care providers throughout the city,  as well as the hospitals and physicians that best serve  specific medical conditions.

“You won’t get medical attention with this level of detail  in a fifteen-minute doctor’s appointment,” Lofton said.  “We get to see the kids in their natural setting. They’re  at school so much of the time. We have so many opportunities to give pearls of wisdom throughout the day about eating habits and physical activity. That can  make a difference in how they approach what they eat. Even with those in preschool, three  and four years old, I’m talking to them  about healthy snacks. Everything we do  should be intentionally directed towards improving and preserving their health.”

In 2008, Lofton attended three days of training with the Healthy Schools Campaign’s School  Nurse Leadership Program. The training program  is designed to build on school nurses’ direct care  abilities and equip them to take on more leadership  responsibilities. Nurses review best practices  in childhood chronic disease prevention and  management, learn about laws and regulations related  to school health, and discover how to create a culture  of wellness at their schools.

Lofton put the information to use immediately. In  2010, she earned the prestigious Albert Schweitzer  Fellowship, aimed at health initiatives in underserved  communities. She combined the fellowship’s funding  with an additional grant from Weight Watchers to  plant a community garden.

“When I first started, it was  like pulling teeth,” Lofton recalled. But she was able to  recruit about 25 fourth- and seventh-grade students  and their parents from one of the schools she attends to fill a 16-by-16-foot plot. “We had everything—herbs, wheatgrass, onions, tomatoes, peppers. We had so  much that it was kind of crowded out.” The next year,  the students and parents told Lofton they wanted to get the garden going again.

Lofton has also added advocacy to her school nurse duties. Three children at the same school needed constant nursing care to manage their severe type 1 diabetes. Struggling to manage the new diagnosis,  they had constant issues with high blood sugar and  repeat trips to the ER for symptoms like abdominal pain, headaches and vomiting. “They’d get under control, then they’d be out of control,” Lofton said. She was able to get a nurse at their school five days a week to  educate the children and parents, and help manage their condition during the day.

“School nurses are underutilized, and we have so much to offer,” Lofton said in a speech at a Healthy Schools Campaign School Nurse Leadership event. “We deal with every aspect of health in addition to the physical. We try to help people before things happen.”