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THE SCHOOL NURSE AND VISION SCREENINGS

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the school nurse and vision screenings linda s. kimel, rn, ms, il-csn rockford, illinois school nurse s role ensure adequate vision for learning and safety see ... – PowerPoint PPT presentation

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Title: THE SCHOOL NURSE AND VISION SCREENINGS


1
THE SCHOOL NURSE AND VISION SCREENINGS
  • Linda S. Kimel, RN, MS, IL-CSN
  • Rockford, Illinois

2
SCHOOL NURSES ROLE
  • ENSURE ADEQUATE VISION FOR LEARNING AND SAFETY
  • SEE ADEQUATELY TO READ, WRITE, COPY, FILL IN
    SCANTRON SHEET ACCURATELY
  • PREVENT PHYSICAL DISCOMFORTS DUE TO VISION
    DIFFICULTY (HEADACHES, DIZZINESS, FACE / NECK /
    SHOULDER TENSION)
  • PREVENT INJURIES DUE TO VISION DIFFICULTIES
    (TRIPPING, BUMPING INTO OBJECTS, HIT BY THROWN
    ITEMS)
  • FACITITATE OBTAINING NEEDED EXAMS / SERVICES
  • COORDINATE SCHOOL VISION SCREENINGS
  • MAKE REFERRALS FOR NEEDED EXAMS / CARE
  • ASSIST FAMILIES IN OBTAINING RESOURCES TO ACCESS
    SERVICES (FUNDING, TRANSPORTATION, USE OF A
    PHONE)
  • EDUCATE FAMILIES WHY VISION CARE IS IMPORTANT
  • PROMOTE PROPER USE OF GLASSES, CONTACTS
  • NOTIFY TEACHERS OF STUDENTS WHO SHOULD BE WEARING
    GLASSES / CONTACTS
  • ENCOURAGE TEACHERS AND PARENTS TO REPORT STUDENTS
    WITH VISION CONCERNS, BROKEN GLASSES
  • Instruct students on proper care of glasses

3
VISION SCREENING IN ILLINOIS
  • ILLINOIS DEPARTMENT OF PUBLIC HEALTH TRAINS AND
    CERTIFIES VISION SCREENING TECHNICIANS
  • MANDATORY ANNUAL SCREENINGS
  • PRESCHOOL MICHIGAN PRESCHOOL BATTERY
  • KINDERGARTEN (OR SCHOOL ENTRY) MICHIGAN
    PRESCHOOL BATTERY OR MASSACHUSETTES BATTERY
  • 2ND GRADE MASSACHUSETTES BATTERY INCLUDING
    COLOR
  • 8TH GRADE NEAR AND FAR BINOCULAR VISION
  • SPECIAL EDUCATION APPROPRIATE TEST FOR
    ABILITIES
  • EACH SCHOOL DISTRICT DETERMINES WHO DOES THEIR
    SCREENINGS
  • SCHOOL NURSES
  • HEALTH OR SPECIAL SERVICES AIDES / TECHNICIANS
  • LOCAL HEALTH DEPARTMENT
  • MANDATORY ANNUAL REPORT BY SCREENING AGENCIES
    INDICATING NUMBERS OF SCREENINGS AND REFERRALS
    AND OUTCOME OF REFERRALS

4
THE PROBLEM
  • POOR COMPLIANCE WITH RECOMMENDED FOLLOW-UP EXAMS
    AFTER FAILED SCREENINGS
  • PARROTT ET AL (1999) KENTUCKY 32-37
  • PRESLAN NOVAK (1998) BALTIMORE - lt 33
  • YAWN ET AL (1996) AVERAGE DELAY FROM FIRST
    FAILED SCREENING UNTIL EXAM WAS 4 YEARS
  • MARK MARK (1996) N. CAROLINA 80-90 ONLY
    AFTER MULTIPLE FAILED SCREENINGS AND REFERRALS
    OVER 2 YEARS
  • ROCKFORD PUBLIC SCHOOLS - lt40 IN A COMMUNITY
    WITH ADEQUATE AMOUNTS OF AFFORDABLE CARE

5
THE STUDY
  • DURING THE SUMMER OF 2004 FAMILIES OF ENGLISH
    SPEAKING, PUBLIC SCHOOL KINDERGATEN 5TH GRADERS
    WHO FAILED SCHOOL VISION SCREENINGS AND HAD NOT
    REPORTED FOLLOW-UP VISION EXAMS WERE INTERVIEWED.
  • THE PURPOSE WAS TO DETERMINE WHY AN EYE EXAM HAD
    NOT BEEN OBTAINED IDENTIFY BARRIERS TO CARE
  • 66 FAMILIES PARTICIPATED
  • 11 OBTAINED EYE EXAMS BUT HAD NOT INFORMED THE
    SCHOOL
  • 11 OBTAINED EYE EXAMS DURING THE SUMMER
  • 44 DID NOT OBTAIN EYE EXAMS
  • 41 SINGLE PARENTS
  • 42 CAUCASIAN 49 AFRICAN AMERICAN
  • 85 ON FREE OR REDUCED LUNCH
  • 62 MEDICAID PARTICIPANTS

6
IDENTIFIED BARRIERS TO FOLLOW-UP CARE
  • FINANCIAL
  • COST AND MONEY CONCERNS
  • NO INSURANCE COVERAGE
  • WAITING FOR INSURANCE TO BEGIN
  • LOGISTICAL
  • APPOINTMENT PROBLEMS
  • CANT PLAN AHEAD
  • NO PHONE
  • NO CAR
  • SOCIAL / FAMILY
  • ALL ADULTS WORK
  • FAMILY ISSUES
  • LARGE FAMILY
  • PARENT DISABLED
  • CHANGE IN RESIDENCE
  • PERCEPTUAL
  • DO NOT BELIEVE RESULTS
  • NOT A PRIORITY
  • NO NEED FOR AN EXAM

7
PRAGMATIC BARRIERS
8
PSYCHO-SOCIAL BARRIERS
9
RESULTS
  • DIFFICULTY PLANNING AHEAD IS A BARRIER NOT
    PREVIOUSLY IDENTIFIED. THE LOWER SOCIOECONOMIC
    POPULATION IS NOT COMFORTABLE USING CALENDARS FOR
    PLANNING AHEAD
  • 31 REPORTED FINANCIAL BARRIERS, BUT WHEN PAYMENT
    SOURCES WERE EXAMINED ALL BUT 11 ACTUALLY HAD
    ACCESS TO PAYMENT FOR VISION CARE
  • FEW PARTICIPANTS KNEW THAT SCHOOL NURSES COULD
    ASSIST WITH SIGHT FOR STUDENTS VISION CARE
    VOUCHERS OR LIONS CLUB REFERRALS
  • PSYCHO-SOCIAL BARRIERS NEEDED TO BE ADDRESSED
    BEFORE FAMILIES WOULD ACCEPT ASSISTANCE WITH
    PRAGMATIC BARRIERS
  • MOST EXISTING PROGRAMS ADDRESS ONLY PRAGMATIC
    BARRIERS
  • VERBAL COMMUNICATION WITH THE PARENT IS THE MOST
    EFFECTIVE METHOD TO ENCOURAGE FOLLOW-UP CARE.
    ALTHOUGH LABOR INTENSIVE, IT MAY SAVE TIME IN THE
    LONG RUN

10
FACTORS INCREASING COMPLIANCE WITH FOLLOW-UP EYE
EXAMS
  • PARENT WEARS GLASSES
  • PARENT HAS AT LEAST A HIGH SCHOOL DIPLOMA OR
    G.E.D.
  • AT LEAST ONE NON-WORKING ADULT IN THE HOME
  • FAMILY INCOME ABOVE 200 OF FEDERAL POVERTY LEVEL
  • FAMILY HAS BOTH A CAR AND PHONE
  • PARENT UNDERSTANDS THE VISION CONCERN
  • APPOINTMENTS ABVAILABLE WITHIN 1-2 WEEKS
  • TRUST IN PERSON DOING THE SCREENING / REFERRING

11
RECOMMENDATIONS
  • SIMPLIFY REFERRAL LETTERS / PARERWORK. USE NO
    MORE THAN A 6TH GRADE READING LEVEL
  • EXPLAIN THE VISION SCREENING PROCESS AND THE PART
    OF THE SCREENING WITH WHICH THE CHILD HAD
    DIFFICULTY
  • USE VERBAL COMMUNICATION FOR FOLLOW-UP CONTACTS
    REGARDING REFERRALS
  • ENCOURAGE CARE PROVIDERS TO MAKE APPOINTMENT
    REMINDER CONTACTS WITH FAMILIES
  • ENCOURAGE CARE PROVIDERS TO OFFER SOME
    APPOINTMENTS AVAILABLE ON SHORT NOTICE (SAME DAY,
    NEXT DAY)
  • ENCOURAGE SCHOOLS TO TEACH TO TEACH THE USE ON
    MONTHLY CALENDARS FOR PLANNING AHEAD
  • DURING FOLLOW-UP CONTACTS EXPLORE PRAGMATIC AND
    PSYCHO-SOCIAL BARRIERS. BE PREPARED TO OFFER
    ASSISTANCE OR REFERRALS FOR OVERCOMING IDENTIFIED
    BARRIERS.

12
SAMPLE VISION REFERRAL LETTER
  • School Vision Screening Results
  • Date___________________
  • To The Parent of__________________________________
    _
  • Your child recently failed the school vision
    screening. He / she had difficulty with
  • _____ seeing clearly with _____right eye
    _____left eye _____ both eyes
  • _____ eye muscles working together for
    _____near vision _____ far vision
  • _____ far vision (looking at the board)
  • _____ teacher notices _____ squinting
    ____moving close to things to see
  • _____ frequent headaches
  • _____ complains of blurred vision / difficulty
    seeing clearly
  • _____ glasses not at school - unable to pass
    screening without his / her glasses
  • Your child needs a professional eye exam.
  • Please take your child to an eye doctor as soon
    as possible.
  • Call the school nurse if you would like help
    with
  • -finding affordable eye care
  • -finding eye care for children with special
    needs

13
THOUGHTS ON VISION SCREENING
  • IT IS HELPFUL IF THE PERSON DOING THE SECOND
    SCREENING IS FAMILIAR WITH THE CHILD AND HIS/HER
    INDIVIDUAL SITUATION (ADHD, INSECURITIES, HEARING
    PROBLEMS, LANGUAGE DIFFICULTIES)
  • IT IS EASIER TO GIVE SPECIFIC INFORMATION AND
    ANSWER PARENT QUESTIONS WHEN THE PERSON MAKING
    THE REFERRAL IS THE PERSON WHO DID THE SECOND
    SCREENING
  • ASK ABOUT CONTACTS AS WELL AS GLASSES. ENCOURAGE
    TEACHERS TO NOTIFY THE SCREENER OF STUDENTS WHO
    HAVE N OT BEEN WEARING THEIR GLASSES.
  • ENCOURAGE TEACHERS AND PARENTS TO NOTIFY THE
    PERSON COORDINATOR OF SCREENINGS OF STUENTS THEY
    FEEL MIGHT HAVE A VISION PROBLEM.
  • NOTIFY PARENTS WHEN SCREENINGS WILL BE DONE AT
    SCHOOL AND WHEN TO EXPECT TO RECEIVE RESULTS

14
The full report of the study is published Lack
of Follow-up Exams After Failed School Vision
Screenings An Investigation of Contributing
Factors Linda S. Kimel, RN, MS, IL-CSN The
Journal of School Nursing Volume 22, number 3,
June 2006, pp. 156-162
  • How to contact me
  • Linda S. Kimel, RN, MS, IL-CSN
  • Rolling Green School
  • 3615 Westgate Pkwy
  • Rockford, Illinois 61108
  • 815-229-2881
  • frogkimel_at_aol.com
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