"Headache Tools to Stay in School”: An Educational Guide for Nurses and Students With Headache

In recent years, there has been a significant push towards increased inclusion of students with chronic illness or complicated symptomology in mainstream schools (Jackson, 2013). This reentry process is often complicated by transition barriers and challenges, including absences due to illness and doctors’ visits, and difficulties with classroom accommodations (Jackson, 2013). Collaboration between the student, their family, school officials, and health care professionals is necessary to ensure a smooth transition back to school, with school nurses at the forefront of implementing those health care accommodations within school premises. Many chronically ill students have legally enforced school accommodations that require the school nurse’s regular and substantial involvement, but this involvement is also necessary and valuable in cases without Individualized Education Plans (Pufpaff et al., 2015). Thus, school nurses’ roles and responsibilities have evolved significantly to accommodate these students and their individualized education plans, with increased expectations to evaluate, treat, and manage new and complicated cases previously managed outside of school.

One such chronic illness is pediatric headache, including diagnoses of new daily persistent headache, tension-type headache, and migraine. A review and analysis of recent literature found that 60% of children and adolescents are prone to episodic or acute headaches (Abu-Arafeh et al., 2010), with that percentage increasing upon the including of chronic headaches. School nurses must be proficient in a variety of health care related skills in order to most effectively address chronic and acute headaches. Assessing headaches through collecting the student’s headache history and pertinent health information and performing a thorough physical exam comprise the fundamentals of the school nurses’ practice. Specifically, school nurses must provide brief, yet adequate assessment and treatment, and determine when to encourage a child to remain in school versus dismissing the child early (American Nursing Association, 2010). As school nurses work in educational rather than medical settings, their care of pediatric headache should prioritize reducing students with headache’s school failure and absenteeism.

Compared to providers in health settings with full access to colleagues and a medical team on site, the semi-autonomous nature of the school nurse, serving students and families in a uniquely isolated clinical context often necessitates independent development of methods of assessment and treatment (Smith and Firmin, 2009). Clinical guidelines must be delivered directly to school nurses in ways that acknowledge and account for their unique needs and resources. There are too few resources available to school nurses with information on providing efficient and effective care to students with headache.

Based on our review of available headache resources for school nurses, we developed a two-armed study addressing the necessity, implementation, and favorability of an educational tool designed for school nurses in supporting the complex needs of headache patients. Through the development and installment of a tailored, evidence-based educational tool available to school nurses, this study seeks to bridge the gap between the schools and medical and psychological care provided by outside providers by facilitating school nurses’ delivery of effective and efficient care.

To fill this need, we created a clinical practice and educational guide for school nurses treating pediatric headache, “Headache Tools to Stay in School: An Educational Collaboration and Tool for School Nurses and their Students with Headaches, Migraines, and Concussions ©.” This tool was developed by the nurses, neurologists, psychologists, researchers, and clinical support staff at a tertiary headache clinic in a large, urban northeast pediatric hospital, and includes sections on (1) lifestyle factors that may contribute to the presentation of headache; (2) checklists of suggested treatment plans and accommodations for managing students’ headaches in school settings; (3) cautionary advice on when a child should seek further care; (4) medication overview charts to be used for education and reference; and (5) additional lists of apps, books, equipment, and websites for pain management and relaxation resources for students, parents, and school administrators. The guide contains documents intended for use by the school nurse as well as handouts and documents that can be used to facilitate collaboration between the school nurse, the student, the student’s family, and outside healthcare providers.

The guide was implemented and evaluated over a three-month trial period by 31 school nurses. The participating school nurses gave the guide an overall rating of 4.46 out of 5, and nearly 2 out of every 3 respondents “agreed” or “strongly agreed” that the guide was helpful to their understanding and practice of managing headaches. These results may indicate the guide’s potential for successful dissemination and implementation by other school nurses. Qualitative feedback was also collected and was instrumental in the updated version of the guide, presented in this presentation.

The results of this study reinforce the need for more readily accessible and comprehensive EBP guidelines, like “Headache Tools to Stay in School,” to be available to school nurses. As greater numbers of children with complex medical conditions, including chronic pain conditions such as chronic pediatric headache, are attempting to reintegrate into typical school settings, school personnel must be properly prepared to handle the physical and psychological challenges that may arise. Continued dissemination of this guide may improve students’ headache management under the informed care of school nurses, and may encourage the development of more evidence-based guides across a multitude of medical conditions.