School Nurses on the Front Lines of Medicine: The Approach to a Student After a Syncopal Event: Don’t “PASS OUT”

2018 ◽  
Vol 33 (4) ◽  
pp. 222-227 ◽  
Author(s):  
Gretchen Hackett ◽  
Jodi Brady ◽  
Robert P. Olympia
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
School Setting ◽  
School Nurses ◽  
Initial Assessment ◽  
Level Of Care ◽  
Primary Health ◽  
Life Threatening ◽  
Medical Emergencies

Students presenting with syncope and/or seizure occur occasionally in the school setting. Several studies have shown that seizures as well as respiratory distress are the most common medical emergencies that prompt school nurses and staff to contact emergency medical services (EMS) to transport students to the closest emergency department (Knight 1999, Olympia 2005). It is important to develop a differential diagnosis for syncope, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary health care provider’s office, or directly to the closest emergency department via EMS). This article describes the initial assessment and management of two students presenting after syncopal events.

School Nurses on the Front Lines of Medicine: Take a BREATH: The Approach to a Student With Respiratory Distress

2017 ◽  
Vol 33 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Morgann Loaec ◽  
Robert P. Olympia
Keyword(s):  
Emergency Department ◽  
Respiratory Distress ◽  
Respiratory Symptoms ◽  
School Setting ◽  
School Nurses ◽  
Initial Assessment ◽  
Level Of Care ◽  
Primary Health ◽  
Life Threatening

Students presenting with varying degrees of respiratory symptoms and distress occur commonly in the school setting. It is important to develop a differential diagnosis for respiratory distress, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary health care provider’s office, or directly to the closest emergency department via Emergency Medical Services). This article describes the initial assessment and management of a student presenting with respiratory distress.

Distress in My Chest: The Approach to a Student Presenting With “Chest Pain”

2018 ◽  
Vol 33 (6) ◽  
pp. 366-371
Author(s):  
Timothy Gay ◽  
Robert P. Olympia
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Emergency Medical Services ◽  
Primary Healthcare ◽  
School Setting ◽  
Initial Assessment ◽  
Level Of Care ◽  
Life Threatening

Occasionally, students present with chest pain in the school setting. Therefore, it is important to develop a differential diagnosis for chest pain, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider’s office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of a student presenting with chest pain.

scholarly journals LO23: Reducing time to disposition for treat & release patients in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S14-S14
Author(s):  
V. Woolner ◽  
S. Ensafi ◽  
J. De Leon ◽  
L. George ◽  
L. Chartier
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Providers ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Care Providers ◽  
Patient Disposition ◽  
Forcing Function

Introduction: Treat and Release (T&R) patients are seen and discharged home from the emergency department (ED), and asked to return within 12-72 hours for follow-up care (e.g., ultrasound, repeat blood work). Our two academic teaching hospitals see approximately 2,000 T&R patients per year. Handover of care for T&R patientsdone through charting only and therefore dependent on the charts adequacy and completenessis crucial to the safety and quality of care they receive. An 18-month retrospective chart audit at our sites identified quality gaps, including suboptimal documentation that ultimately impedes patient disposition. Our projects aim was to reduce the time-to-disposition (TTD; time spent by patients between provider initial assessment and discharge from the ED) by a third (from 70min) in 6-months time (March 2017), a target felt to be both meaningful and realistic by our stakeholder team. Methods: Our primary outcome measure was the TTD (in minutes). Our process measure was the quality of documentation, using a modified version of QNOTE, a validated tool used to assess the quality of health-care documentation. PDSA cycles included: 1) Involvement of stakeholders for the creation and refinement of an improved T&R handover tool to cue more specific documentation; 2) Education of health-care providers (HCPs) about T&R patients; 3) Replacement of the previous T&R handover tool with a newly designed and mandatory tool (i.e. a forcing function); 4) Refinement of the process for T&R patients and chart hold-over. Results: Run charts for both the median TTD and median modified QNOTE scores over time demonstrate a shift (i.e., run chart rule) associated with the second and third clustered PDSA cycles. After the first three clusters of PDSA cycles (i.e., before-and-after), mean TTD was reduced by 40% (70min to 42min, p=0.005). The quality of documentation (mean modified QNOTE scores) was also significantly improved (all results p<0.0001): patient assessment from 81% to 92%, plan of care from 58% to 85% and follow-up plan from 67% to 90%. Conclusion: We reduced the time-to-disposition for T&R patients by identifying gaps in the quality of documentation of their chart. Using iterative PDSA cycles, we improved their time-to-disposition through improved communication between health-care providers and a new T&R handover tool working as a forcing function. Other centers could use similar assessment methods and interventions to improve the care of T&R patients.

School Nurses on the Front Lines of Healthcare: Serious Infections in Students and Their Common Presenting Complaints

2020 ◽  
Vol 36 (1) ◽  
pp. 39-44
Author(s):  
Lauren McNickle ◽  
Robert P. Olympia
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Signs And Symptoms ◽  
School Nurses ◽  
Initial Assessment ◽  
Antibiotic Administration ◽  
Serious Infections ◽  
Chief Complaints ◽  
Life Threatening

School nurses occasionally deal with students presenting with serious infections associated with common chief complaints. Although rare, the implications of missing the signs and symptoms of these infections are potentially life-threatening and devastating, with both immediate and long-term complications. Rapid recognition and stabilization, with immediate transfer to the closest emergency department via emergency medical services for antibiotic administration, is the key to reducing morbidity and mortality associated with these serious infections. We discuss three students presenting with febrile illnesses associated with chest pain, headache, and back pain, focusing on the initial assessment and management of these students and their common presenting complaints.

School Nurses on the Front Lines of Healthcare: Getting aHEAD of EmergENT Eye, Ear, Nose, and Throat Infections

2021 ◽  
pp. 1942602X2110191
Author(s):  
Shivam Patel ◽  
Robert P. Olympia
Keyword(s):  
Severe Infection ◽  
Signs And Symptoms ◽  
School Nurses ◽  
Initial Assessment ◽  
Chief Complaints ◽  
Life Threatening ◽  
Regular Practice ◽  
Nose And Throat

School nurses may deal with various common infectious eye, ear, nose, and throat–related chief complaints in regular practice. Recognizing the signs and symptoms of severe infection is paramount to preventing life-threatening complications that can have both acute and long-term implications. Distinguishing urgent and emergent eye, ear, nose, and throat conditions to send to the emergency department is integral to reducing the morbidity associated with these conditions. This article discusses three different students presenting with various chief complaints, from the initial assessment by the school nurse to the appropriate disposition and follow-up.

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

Health Care Access and Follow-Up of Chlamydial and Gonococcal Infections Identified in an Emergency Department

2008 ◽  
Vol 35 (6) ◽  
pp. 583-587 ◽  
Author(s):  
Alia A. Al-Tayyib ◽  
William C. Miller ◽  
Susan M. Rogers ◽  
Peter A. Leone ◽  
Dionne C. Gesink Law ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Access ◽  
Care Access

Supporting Young People at School With High Mental Health Needs

2005 ◽  
Vol 15 (2) ◽  
pp. 137-155 ◽  
Author(s):  
Debra Rickwood
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Young People ◽  
School Environment ◽  
Health Care Services ◽  
Mental Health Problems ◽  
School Setting ◽  
Care Services ◽  
Primary Health

AbstractFor young people still at school, the school setting is vital to their mental health and wellbeing. Not only does the school environment have a direct and indirect impact on mental health, it provides an opportunistic setting in which to identify and respond to emerging mental health problems. To do this effectively, schools and school staff must work in collaboration with the young people themselves, their families, and other support services within the community, particularly primary health care services, including general practice. The importance of developing effective partnerships and care pathways between schools and the primary health care sector is being increasingly acknowledged, and initiatives such as MindMatters Plus GP have advanced our understanding in this area.

scholarly journals Difficulties in nutritional counseling and child growth follow-up: from a professional perspective

2017 ◽  
Vol 70 (5) ◽  
pp. 949-957 ◽  
Author(s):  
Claudia Nery Teixeira Palombo ◽  
Elizabeth Fujimori ◽  
Áurea Tamami Minagawa Toriyama ◽  
Luciane Simões Duarte ◽  
Ana Luiza Vilela Borges
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Medical Model ◽  
Child Growth ◽  
Nutritional Counseling ◽  
Child Feeding ◽  
Professional Experiences ◽  
Primary Health ◽  
Professional Perspective

ABSTRACT Introduction: Nutritional counseling and growth follow-up are priorities when providing care to children; however, these have not been completely incorporated into primary health care. Objective: To know the difficulties for providing nutritional counseling and child growth follow-up, from a professional healthcare perspective. Method: Qualitative study, using Donabedian as theoretical framework, developed by 53 professionals in the field of primary health care. Data was obtained from focal groups and submitted to content analysis. Results: The main difficulties for nutritional counseling were clustered in the category of ‘perceptions and beliefs related to child feeding’. The ‘problems of infrastructure and healthcare’ and ‘maintenance of the hegemonic medical model’ are the main difficulties for following-up growth. Final considerations: Besides investments in infrastructure, healthcare training is indispensable considering beliefs and professional experiences, so in fact, nutritional counseling and child growth follow-up are incorporated in primary health care.

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