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The Relentless School Nurse: The Ripple Effect - When Community Violence Comes to School

 

 

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Elizabeth (Liz) Clark, MSN, RN NCSN is a school nurse's school nurse. Her leadership skills were honed as President of the CO Association of School Nurses. She served on the national level as the CO NASN Director, completing her term in 2017. Liz has a prominent presence on Twitter and uses the social media platform to elevate school nursing practice. Liz is a natural teacher and you can find her sharing the most recent peer-reviewed articles with colleagues to promote health and learning.

A few weeks ago, Liz shared a story on Twitter about two kindergarten students whose lives were tragically intertwined through community violence. As we know, what happens at home comes to school, and what happens at school follows our students home. When I read Liz's heartwrenching story, I asked her to share it with the readers of this blog. I thank Liz for her leadership and for her professional generosity. Liz is a truly a Relentless School Nurse.

Screen Shot 2018-12-30 at 4.19.06 PM Elizabeth Clark, MSN, RN, NCSN

"I could hear the crying before they arrived in the school health office. It had the ring of a serious injury.  As an experienced school nurse, I automatically jumped up and put on my gloves. It was Monday morning recess and I was wondering if it was a head injury or possible fractured bone. The principal entered the office holding the hands of two kindergarten students, one on each side of her. She quickly set the boys down on separate cots, on opposite sides of the office. One student had a bloody nose and the other was holding his cut lip, and of course, both were crying.  Ok, it was a fight. I started my duties to assess and care for the students as the principal walked out shaking her head sending me a knowing look. I asked the first boy; let’s call him Joe, the million dollar question, What happened? Between tears, he told me while pointing at the other boy, “His Dad killed my Dad.” Wow! How do you respond to that explanation? I recalled a news story over the weekend involving a shooting that killed a man as he walked out of his apartment building in the neighborhood. As I worked providing nursing care, I told Joe that I was sorry. I then turned my attention to the other student; let’s call him Steve. Steve told me his story, how the police came and took his Dad away. How he was scared and he and his Mom cried and begged them not to take him away. I told Steve that I was sorry. Both boys were hurting deeply, not only from their physical wounds, but also from their hearts. The principal came back into the office with the school counselor and school psychologist. The school team, administration, nursing, and behavioral health was in place to support the students.

Students bring their burdens and attempt to problem solve in the way that they see as best. Acts of physical violence are common occurrences in schools. School Nurses are often the first school staff to interact with student injuries and students exhibiting anxiety and stress masked as headaches, stomachaches, and other non-specific health complaints. The school health office is a safe space, and students frequently seek the school nurse to obtain acceptance and comfort, even when they are not able to articulate their worries.

Many students are in conflict every day from life events that occur inside and outside of the school environment. Gun violence has affected the lives of children both inside and outside of school. In 2018, 24 school shootings across the US resulted in injury and death. There were 28 students killed and 7 school employees or other adults (Education Week, 2018b). As responsible adults, we must reduce gun violence for our children. Will 2019 be another record year for gun violence in schools? Can we be the change to reduce this horrific trend?" - Liz Clark, MSN, RN, NCSN

Disclaimer:  To protect their identities, the names and details of the incident and the children involved were changed.

References:

Education Week, December 18, 2018. The School Shootings of 2018: What’s Behind the Numbers.  Retrieved from: https://www.edweek.org/ew/sect...f71850bfb073dea1fe02

 

Bio: Elizabeth Clark MSN, RN NCSN has over 20 years of experience in school nursing practice and school health services administration. She received her Master’s Degree in the Nursing Care of Children from the UCHSC in 1991. She was elected to the National Association of School Nurses Board of Directors from 2013 – 2017. Ms. Clark is a member of the American Nurses Association, the National Association of School Nurses, and a Past President of the Colorado Association of School Nurses.  She presents at state and national conference annually on school health leadership. She is currently a trainer for School Emergency Triage Training and Youth Mental Health First Aid.

 

Come and visit the Relentless School Nurse by clicking here

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Cissy White (ACEs Connection Staff) posted:

This is such a sad story, Robin. If it were fiction it would be hard to believe.

It astounds me how much kids are carrying and feeling and dealing with.

I appreciate your sharing not only your own views and experiences but that of so many other school nurses. This line:

"As we know, what happens at home comes to school, and what happens at school follows our students home," is clear and powerful. 

Thanks for all you do!
Cissy

Thank you for sharing your reflections after reading this blog post. I appreciate your comments and on-going support. 

Cissy White (ACEs Connection Staff) posted:

This is such a sad story, Robin. If it were fiction it would be hard to believe.

It astounds me how much kids are carrying and feeling and dealing with.

I appreciate your sharing not only your own views and experiences but that of so many other school nurses. This line:

"As we know, what happens at home comes to school, and what happens at school follows our students home," is clear and powerful. 

Thanks for all you do!
Cissy

My first year working primarily in one [predominantly Rural] county as an 'Outreach Worker' with NH's statewide Homeless Outreach Intervention Project, 30% of my 'caseload' involved 'Domestic/Sexual Violence. I had the good fortune to have some great community allies, including one elementary School Nurse, an Elementary School Principal, A High School Vice-Principal, Planned Parenthood General Primary Care (for free Vaccinations-to be eligible to register for school)....

Last edited by Robert Olcott
Robin M Cogan posted:
Robert Olcott posted:

In 2000, I attended a 'Grand Rounds' presentation at [then Dartmouth, now] Geisel Medical School, by an Epidemiologist, entitled: "52% of Detroit Metropolitan Area Schoolchildren met the DSM-IV criteria for PTSD". Similar numbers of Schoolchildren have subsequently been reported in Philadelphia, Baltimore, Atlanta, and in June of last year [2018], at 5 charter schools in New Orleans. What is the customary 'response time' for addressing an Epidemic ? ? ?

The USA is currently the only 'Non-Signatory [developed] Nation' to the UN Convention on Children's Rights, and ranked only 25th in the World Health Organization's 2013 assessment of the world's healthiest children. Fortunately, the World Health Organization's ACE screening tool [used in the 2013 assessment], based in part on the US CDC/Kaiser-Permanente ACE screening tool (the WHO ACE International Questionnaire), but includes sources of 'Community Violence' not included in the US CDC/Kaiser ACE Screening tool.

Thank you for your informative comment. I have spent the last 18 years as a school nurse in an urban NJ district. I follow the work of Wendy Ellis from George Washington University, who along with Dr. W. Dietz have coined the term "Pair of ACEs" the combination of both Adverse Childhood Experiences and Adverse Community Environments. They amplify each other and certainly community violence is front and center. https://publichealth.gwu.edu/d...esilient-communities

I first had a chance to 'witness' an 'Adverse Community Environment' in the early 1970's in the Southeast Bronx of NYC, where a nearly overwhelmed physician spoke of an eight year old male patient, brought into the ER with a gunshot wound in his thigh--accompanied by two older fellow gang members, to make sure he didn't cry while the bullet was removed. 85% of the housing in that 'neighborhood' was considered 'substandard' or 'deteriorated'. and the population included 100,000 Heroin addicts there too....  Robin M. Cogan: I appreciate your A Comm. Envir. note re: "Pair of ACEs", and the attached link. Thank You!

Last edited by Robert Olcott

This is such a sad story, Robin. If it were fiction it would be hard to believe.

It astounds me how much kids are carrying and feeling and dealing with.

I appreciate your sharing not only your own views and experiences but that of so many other school nurses. This line:

"As we know, what happens at home comes to school, and what happens at school follows our students home," is clear and powerful. 

Thanks for all you do!
Cissy

Robert Olcott posted:

In 2000, I attended a 'Grand Rounds' presentation at [then Dartmouth, now] Geisel Medical School, by an Epidemiologist, entitled: "52% of Detroit Metropolitan Area Schoolchildren met the DSM-IV criteria for PTSD". Similar numbers of Schoolchildren have subsequently been reported in Philadelphia, Baltimore, Atlanta, and in June of last year [2018], at 5 charter schools in New Orleans. What is the customary 'response time' for addressing an Epidemic ? ? ?

The USA is currently the only 'Non-Signatory [developed] Nation' to the UN Convention on Children's Rights, and ranked only 25th in the World Health Organization's 2013 assessment of the world's healthiest children. Fortunately, the World Health Organization's ACE screening tool [used in the 2013 assessment], based in part on the US CDC/Kaiser-Permanente ACE screening tool (the WHO ACE International Questionnaire), but includes sources of 'Community Violence' not included in the US CDC/Kaiser ACE Screening tool.

Thank you for your informative comment. I have spent the last 18 years as a school nurse in an urban NJ district. I follow the work of Wendy Ellis from George Washington University, who along with Dr. W. Dietz have coined the term "Pair of ACEs" the combination of both Adverse Childhood Experiences and Adverse Community Environments. They amplify each other and certainly community violence is front and center. https://publichealth.gwu.edu/d...esilient-communities

In 2000, I attended a 'Grand Rounds' presentation at [then Dartmouth, now] Geisel Medical School, by an Epidemiologist, entitled: "52% of Detroit Metropolitan Area Schoolchildren met the DSM-IV criteria for PTSD". Similar numbers of Schoolchildren have subsequently been reported in Philadelphia, Baltimore, Atlanta, and in June of last year [2018], at 5 charter schools in New Orleans. What is the customary 'response time' for addressing an Epidemic ? ? ?

The USA is currently the only 'Non-Signatory [developed] Nation' to the UN Convention on Children's Rights, and ranked only 25th in the World Health Organization's 2013 assessment of the world's healthiest children. Fortunately, the World Health Organization's ACE screening tool [used in the 2013 assessment], based in part on the US CDC/Kaiser-Permanente ACE screening tool (the WHO ACE International Questionnaire), but includes sources of 'Community Violence' not included in the US CDC/Kaiser ACE Screening tool.

Last edited by Robert Olcott
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