A Day with a School Nurse – Nursing Reflective Essay

My experience with school health nurse in the Office of School Health Nurse (OSH) was educative, offering some invaluable experience. The experience was educative as it provided me with an opportunity to observe, listen, learn and reflect upon the nursing events that took place on that day. The paper provides a description of the events that occurred and the application of Carper’s (1979) ways of knowing in describing the insights and understandings that were enhanced through the reflection.

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Description of the School Nurse Assessment of Health Complaints

My encounter with a school health nurse proved to be so informative and educative. Initially, I had no idea as to what the real experience a school nurse undergoes in a school. When I visited my local school, I hoped to find a nurse attending to patients and offering nursing interventions. However, little did I know that their roles vary day to day and involves more than provision of assessment of illnesses to include nursing education for the children and parents. When I entered the school nurse’s office, I got an opportunity to observe and learn one of the roles of a school nurse in screening and assessment of students who were presented with complaints.

            “Apart from the home of the child, the school presents the other most influential environment in the life of a child.  It is the school nurse who is a healthcare representative responsible for the health of the students”. This information is what I had gathered from my learning research. However, I needed to know and experience more in order to be more informed. Hence, my local school visit, allowed me to observe Perry (the local school nurse) make student assessments. This allowed me to make an observation of the procedural framework for student assessment. I also had an opportunity to learn the scope of roles of the school nurse from Perry.

            Though I had hoped to find a school nurse offer clinical interventions such as assessment and administration of medication, I was made to learn that a majority of Perry’s work was assessments of complaints and provision of appropriate first aid (if need be) and making of referrals to physicians. As I stood in her room, I witnessed several students get in with different complaints. Perry would make assessments through physical examination to obtain subjective and objective information on assessing the student complaints.  Compiling all these with the student medical history, Perry would make a decision that would help the student’s parents to take appropriate medical interventions.

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The Key Features

            The school nurse plays an important role in the delivery of healthcare outcomes and ensures a coordinated care. According to (Ivanov & Blue, 2008) the roles of a school nurses extends to that of a health educator, case manager and other roles such as health promoter, researcher, advocate, health policy expert and collaborator. The authors further notes that school nurses are in a good position to promote the components of a coordinated school health that include health services, nutrition, health education, physical education and activity, school environment, mental health and social services and family and community involvement. It was during my local school visit that I witnessed the roles of a nurse in fulfillment of the component of health services during the assessment of student complaints.

            One of the important components that were observed during my visit of the school nursing was the collection of information regarding the student complaint. On the material day of the visit, several complaints were received. However, my visit would coincide with the assessment of a student who was suffering from a headache. The student’s name was Bill (real name withheld for confidentiality purposes) who reported to the nurse’s office at around midday. Bill was welcomed by Perry and ushered to a seat in front of the nurse. What proceeded would turn to be very educative and invaluable experience to future nursing role.

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            The nurse proceeded to collect subjective data by asking the student’s name and obtaining his health record. Perry would proceed to ask Bill if there had been any previous head injury and proceeded to examine the student’s head for any signs such as bleeding, bruises, lacerations or bumps. The nurse would also ask for the location of the headache, severity, how long it had persisted and associated symptoms such as difficulty with vision, vomiting or stiff neck. Moreover, Perry would collect data regarding the any other chronic medical disorders, the frequency of the headache, the recently eating habits of the student and any other forms of illness such as stomachache and chills.

            Once the subjective data collection was complete, Perry proceeded to collect objective data. Perry did this by making several assessments that include checking student temperature, checking neck for tenderness or pain when on motion, checking the student eyes and checking the head for any bruises or lacerations. In all these I noticed that Perry became relaxed and when I later inquired from her he pointed “the student assessment revealed that the headache was that of acute onset, which may be associated with cold (Perry, 2018).”

            The other key feature observed in the nurse’s office was her close dedication to her work and the desire to help the students. It was observed that Perry exhibited close attention to the answer to the questions when assessing the student. She would assure the student that all would be well, which created optimism among the students, who left the room in high spirits. I guessed that she must have been in love with her job. True to my intuition, Perry would later assert that she loved to help young children, ensuring that they completed their studies in the best health possible.

Ways of Knowing

            Carper (1978) identified four major ways of knowing in nursing; empirical knowing, personal knowing, ethical knowing and aesthetic knowing. These patters of knowing are critical for the creation of an understanding and method of observation for every client interactions. According to (Videbeck, 2010) the creation of an understanding on where the knowledge comes from and the way it affects behavior is critical in the development of self-awareness.

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Ethical Knowing

            Ethical knowing, according to (Smith, Turkel & Wolf, 2013) encompass the philosophical system examination, normative actions and judgment in particular situations. Although I was often pressed to ask some questions to the student or the nurse during the assessment process, I felt I had an ethical responsibility to remain silent till appropriate moment arose. Owing to my understanding and greater influence of the nursing code of ethics, I knew respect for the student’s rights was important. As a nurse, I had the obligation to consider the student and his right for self-determination.

Esthetic Knowing

            Esthetic knowing helps to illuminate the art of nursing. Carper (1978) describes it as an experience that involves the creation of a particular singular subjective expression of imagined possibilities that resist projection into discursive form (p.16). Through my observation, I would create some artistic imaginations of the student care process, where I envisioned a successful care delivery from the nurse. During one of Perry’s assessments, I would place myself in such an imagination, which further enhanced my learning process.

Personal Knowing

            That nursing is an interpersonal process, for it to be effective; it needs self-awareness and that of others (Smith, Turkel & Wolf, 2013). Elements of personal knowing were evident from Perry, as outlined earlier in the paper. Perry’s expression feelings of concern on receiving the students for assessment reiterated her desire and understanding on what the students were undergoing. She was more willing to know more about her student clients. If found this to be invaluable in enhancing my observation and learning experience.

Reflexivity

            My observation of the school nurse doing student assessments provided huge and invaluable lessons. As a nurse I hold the highest responsibility to provide the best care whenever needed. Before the observation, I had not imagined that a school nurse had the same care delivery responsibility as a nurse in a healthcare organization. I also learned that it demands more flexibility as the role involves dealing with students of different age groups and different levels of abilities. In addition, the role involves a lot of record keeping, which makes it demanding and challenging. All these insights were not only educative but also increased my interest in the role since I love working in challenging environment.

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Conclusion            

The school provides one of the most influential areas in the development of a child. In order for children to enjoy their studies, there is need for coordinated levels of care in schools. The school nurse plays a critical role in providing coordinated levels of care through student health assessments, healthcare promotion, education and nutrition. These critical school nurse roles were evident during the observation of Perry’s student assessment and an interview that was done with her. The whole observation process proved invaluable and a good source of learning experience for my future nursing roles.

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