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 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
         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 MASSACHUSETTE’S BATTERY
      • 2ND GRADE – MASSACHUSETTE’S 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
                   THE PROBLEM

POOR COMPLIANCE WITH RECOMMENDED FOLLOW-UP EXAMS
  AFTER FAILED SCREENINGS:

-   PARROTT ET AL (1999) KENTUCKY – 32-37%
-   PRESLAN & NOVAK (1998) BALTIMORE - < 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 - <40% IN A COMMUNITY WITH
    ADEQUATE AMOUNTS OF AFFORDABLE CARE
                         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
    IDENTIFIED BARRIERS TO FOLLOW-UP CARE
•   FINANCIAL:
        • COST AND MONEY CONCERNS
        • NO INSURANCE COVERAGE
        • WAITING FOR INSURANCE TO BEGIN
•   LOGISTICAL:
        •   APPOINTMENT PROBLEMS
        •   CAN’T 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
        •   NO INTEREST IN FOLLOW-UP
            PRAGMATIC BARRIERS

45                          45
40                          40                Appt.
                                              problem
35               Cost/      35
30               money      30                Can't
25               No ins.    25                plan
                                              ahead
20                          20
                 waiting                      No
15               for ins.   15                phone
10                          10
                                              No car
5                           5
0                           0
     Financial                   Logistical
           PSYCHO-SOCIAL BARRIERS
                       All
45                     adults
                                  45
40                     work       40                Don't
                                                    believe
35                     Family     35
                       issues
                                                    results
30                                30                Not a
                                  25                priority
25                     Large
20                     family     20                No need
15                                15                for exam
                       Parent
10                     Disabled   10
                                                    No
5                                 5                 interest
0                      Change                       in f/u
                                  0
     Social / Family   in              Perceptual
                       residen.
                        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 LION’S
    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
    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
                   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.
                           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
•           -making appointments
•           -financial assistance with eye care
•   ___________________________________
•               School Nurse
•   ____________________
•          (phone)
•
      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
            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@aol.com