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.”