Assessing pain in children with special needs presents unique challenges for school nurses, as no evidence-based or clinical standards to guide practices have been established for use in the school setting. Additionally, school nurse staffing has not kept pace with the growth in the population of children with special needs, which has increased by 60% since 2002. The aim of this study was to explore school nurses’ pain assessment practices for students with special needs. A cross-sectional study was conducted via the web. Participants/Subjects: Of 3,071 special needs school nurses invited, 27% participated (n = 825). STATA13 was used to analyze descriptive statistics, while content analysis was performed in NVIVO 10. The majority of participants assessed pain in students with special needs using objective assessments (97.34%) and consultations with teachers (91.09%) and parents (88.64%). School nurses utilize pain assessment methods used previously in other practice areas, and rated pain assessment practices at the low benchmark of adequate. Overall, school nurses assess pain by selecting approaches that are best matched to the abilities of the student with special needs. When assessing students with special needs, nurses should utilize objective clinical assessments, teacher consultations, and parent input scales. In addition to continuing education, policies facilitating lower nurse-to-student ratios are needed to improve pain assessment practices in the school setting. Research to understand the perspectives of nurses, teachers, parents, and students is needed to support the creation of evidence-based policies and procedures.
During her first year at Washington University School of Medicine in St. Louis, Hilary Gallin studied racial and gender disparities in health care. She learned about various physicians’ approaches to community and global medicine. During overviews of medical specialties — from pediatrics to gerontology — Gallin learned about age-specific patient care.However, she felt one important element was missing in her medical education.
“I kept thinking about people with chronic disabilities, whether physical or cognitive,” said Gallin, who will earn her medical degree in May. “And I kept asking myself if I, as a physician, would have the knowledge and skills to best treat a patient with disabilities.”
Her answer was no.
“I also asked myself if, as a physician, I would have access to specialized exam equipment and other resources,” Gallin said.
She didn’t know the answer to that question. The topic wasn’t formally included in medical school training.
Feeling she’d be unprepared as a physician, Gallin decided to create a multiyear curriculum for the School of Medicine that focused on treating patients with disabilities. According to research published in 2016 in the journal Academic Medicine, most medical schools do not offer formal training in caring for people with disabilities; rather, disability often is viewed as an obstacle to overcome, and health-care providers sometimes discount disability’s social, emotional and cultural contexts.
However, physicians nationwide, including at Washington University, say medical schools have started recognizing the need for training students to effectively and compassionately treat patients with disabilities. Some medical schools have implemented various degrees of disability education or have begun the process of considering or developing a disability curriculum.
Gallin witnessed firsthand the struggles facing people with disabilities. The 29-year-old grew up with a friend who navigated life in a wheelchair due to cerebral palsy, an incurable disorder caused by abnormal brain development, often before birth, that impairs motor function. Also, while a young girl, Gallin spent a lot of time in hospitals in her native New York while shadowing her mother, a pediatric ophthalmologist.
“These experiences inspired me to learn more about what I can do, what we can do, to help people with disabilities,” said Gallin, who also is earning a master of business administration this May from Harvard University and formerly worked as an investment banker at Goldman, Sachs & Co. on Wall Street. She believes business skills will make her a better doctor by guiding her through all aspects of the changing health-care system.
“I want to approach medicine from different angles instead of limiting myself to the clinical and research perspective,” said Gallin, whose undergraduate degree in biomedical engineering from Yale University provides an even deeper understanding of the industry as a whole. “A lot of major policy affecting health care is made without a physician in the room.”
Developing a disability curriculum
Academics aside, Gallin values considering patients’ personal backgrounds in evaluation and treatment. For instance, she imagined herself giving a medical exam to her friend with cerebral palsy. She wondered: “How would I weigh her? Would I need a special exam table? What’s it like to go to the doctor when you have a disability?”
So she asked her friend and other people with disabilities. Their insights reflected national findings that people with disabilities often feel that their overall abilities, self-knowledge about their conditions and quality of life are underestimated by health-care providers. Many felt embarrassed to discuss disability-related health concerns such as treating pressure sores or practicing safe sex.
“Physicians may assume the person is not sexually active, and that may not be the case,” said Gallin, who was elected by classmates and faculty to the Gold Humanism Honor Society, which honors those who exhibit compassion in medicine.
“Another example occurred when I was working on cervical cancer screenings, or pap smears, with the National Health Service in the United Kingdom,” Gallin said. “One primary-care physician cited that people with disabilities have lower screening rates, and he admitted that he didn’t feel competent in screening some patients due to lack of training. Physician lack of knowledge increases the risk for negative health outcomes.”
Indeed. “In the medical literature, physician education is cited as a source of health discrepancies in patients with disabilities,” Gallin said. “Formal training in medical school would help to remedy disability as a health disparity.”
A few weeks after Gallin started medical school, she sought guidance on developing a disability curriculum from one of her mentors, Alan I. Glass, MD, assistant vice chancellor for students and director of the Habif Health & Wellness Center, which offers student health services at Washington University.
“Because of her focus, passion and persistence, the project evolved into a mission within the medical school to better care for this large and important population,” Glass said. “Hilary’s work has become an important part of the diversity curriculum for medical students. It serves as a model for other schools.”
For the White House, too. In 2014 and 2015, Gallin presented her curriculum to the director of the National Council on Disability, the agency responsible for devising national policy for people with disabilities.
“In developing the curriculum, I reached out to leaders to learn what they thought was needed in physician education,” Gallin said. “It was around the 25th anniversary of the Americans with Disabilities Act, and the White House director was curious to learn about what medical schools were doing to improve the care of people with disabilities.”
Washington University’s curriculum continues to evolve and improve, Gallin said.
“What is unique about the School of Medicine’s curriculum is that it builds on itself over time,” she said. “Students at other medical schools may receive informal training during their third year or attend isolated curriculum events over the year.
“But with our curriculum, students begin during the first year and continue throughout their studies,” she said. “They must demonstrate mastery of material through exams or standardized patient encounters, which is when an actor plays the role of patient and the student is scored based on performance.”
Gallin said she will continue to advocate for patients with disabilities — as well as all patients — when she begins her post-graduation residency in anesthesiology at the Harvard-affiliated Massachusetts General Hospital.
“One of a physician’s greatest assets is curiosity,” Gallin said. “With each person I treat, I will ask myself, ‘What are the preconceived assumptions that could hinder patient care?’”
The Community Preventive Services Task Forcerecommends meal interventions and fruit and vegetable snack interventions to increase the availability of healthier foods and beverages provided by schools. This finding is based on evidence that they increase fruit and vegetable consumption and reduce or maintain the rate of obesity or overweight.
The Task Force has related findings for interventions to increase healthier foods and beverages in schools:
Professionals in the fields of education and rehabilitation psychology have long used disability simulations to try to promote understanding and improve attitudes about persons with disabilities. To simulate blindness, for instance, participants might complete tasks while wearing blindfolds or goggles. Others use earplugs to mimic deafness. Others may navigate indoor and outdoor areas in a wheelchair. The idea is to boost empathy by giving people perspective on what it is like to have a disability.
However, a recent study published by Michelle Nario-Redmond, Ph.D., professor of psychology, reveals that disability simulations often result in feelings of fear, apprehension and pity toward those with disabilities, proving Nario-Redmond’s thesis that disability simulations do more harm than good.
Goal Planning Tool Author(s): YouthBuild USA This goal planning tool was designed to engage staff across each program components and the young person in the goal planning and assessment process. This process should be introduced very early in the program year, ideally towards the end of mental toughness or shortly after the completion of mental toughness. It tracks the young person’s academic, career, and personal goals and aspirations while allowing both staff and young people to track assessment scores
Findings from the National Longitudinal Transition Study 2012. Volume 1: Comparisons with Other Youth (Full Report)
Key Findings: Youth with an IEP are more likely than their peers to be socioeconomically disadvantaged and to face problems with health, communication, and completing typical tasks independently. The vast majority of youth with and without an IEP feel positive about school, but those with an IEP experience bullying and are suspended at higher rates, and are less engaged in school and social activities. Youth with an IEP are more likely than youth without an IEP to struggle academically, yet less likely to
Policymakers and educators have long recognized the importance of addressing the needs of youth in special education, who today account for 12 percent of all youth in the United States. Concern that this objective was not being adequately met led Congress to pass landmark legislation in 1975, now known as the Individuals with Disabilities Education Act (IDEA) (U.S. Department of Education, 2010). IDEA mandates that children and youth with disabilities have access to a free appropriate public education.
A Young-Persons-Guide-to-Health-Care-Transition is about making the transition from pediatric to adult health care. This brief will review topics youth should consider around transitioning to adult health care, living a healthy lifestyle, and paying for health care. Youth need to be a part of conversations about health care. Most youth rely on their parents to handle decisions about their health care and health coverage. Before you know it, you may be expected to make these decisions on your own, if you are not doing so already. This brief will provide some information and help you think about ways you can start planning now for your transition from pediatric to adult health care.
Taking charge of your health care transition goes hand in hand with helping you achieve your career and life goals. Managing your health and wellness as a young person is the first step necessary for going to school, transitioning to work, and living the life you want. To make your dreams and career goals a reality, start learning about your health, health insurance, and health care transition planning at a young age. Make it a habit to manage your health and well-being as a young person, and you will carry this skill throughout your life.
The National Center on Improving Literacy is a partnership among literacy experts, university researchers, and technical assistance providers, with funding from the United States Department of Education.
To increase access to, and use of, evidence-based approaches to screen, identify, and teach students with literacy-related disabilities, including dyslexia. Download our handout.
This NHeLP fact sheet provides information about health services for children, under age of 21, in schools. Many of the services are provided in schools, and some these services are provided Medicaid and/or the Individuals with Disabilities Education Act, or IDEA.
Services provided in schools can play an important role in child and adolescent health care.
Many services are already provided in schools: through school-based health clinics, school nurses, or through special education programs. This includes services such as mental health services and physical, occupational, and speech therapies.
Some of these services can be covered by Medicaid.
This article presents a ‘‘call to action’’ for nurse educators to identify and implement best practices supporting the success of students with disabilities given recent federal legislative changes. Best practices for educating students with disabilities in nursing education are discussed. Increasing our understanding of disability from a variety of models—not just the medical model—will promote greater diversity and inclusivity within the nursing profession, which will enhance patient care.