Application of Components of the Massachusetts’ Sports Concussion Regulations to All Students With Concussion: A Survey of School Nurses

Abstract

Appropriate management by schools of all students with a concussion, regardless of the cause, has not received the same attention as sports-related concussions. Focus groups conducted with Massachusetts School Nurses in 2015 found that some had applied protocols required in the state’s sports concussion regulations to all students with concussion, not just student athletes. We surveyed high school nurses in Massachusetts to examine (1) the extent of this practice and (2) the extent to which protocols for all students with concussion are included in school policies. Of 168 (74%) responding, 94% applied the return-to-learn and play, and medical clearance requirements to all students with concussion, regardless of how or where the concussion occurred and 77% reported their school’s policy required these protocols for all students with concussion. A significant association (odds ratio: 13.3, 95% confidence interval [2.4, 72.8], p <.01) existed between the two measures. These findings have important clinical and academic implications.

Perceptions of implementation of Massachusetts sports concussion regulations: results of a survey of athletic directors

“…This finding confirms the interpretation of the previous focus groups with ADs, and is consistent with the interpretations of the focus groups with SNs and ATs. The perceived impact the regulations have on daily workflow was slightly higher (5.5) for ADs than it was for SNs (5.0), when SNs were asked the same question (Hackman et al 2018). It is likely that the impact of the regulations on workload for ADs is largely dependent on whether their school employs one or more AT.…”

“…SNs, ATs, (Howland et al 2018) and ADs felt that school teachers, counselors, athletic coaches, and healthcare providers required more education and training regarding sports concussion management. Interestingly, a subsequent survey of SNs conducted independently by the IPC confirmed a focus group finding that almost all SNs had generalized aspects of the sports concussion regulations to all students, regardless of how or where their head injury occurred (Hackman et al 2018).…”

Evaluation of Implementation of Massachusetts Sports Concussion Regulations: Results of Focus Groups with Athletic Directors

“…Despite a generally high degree of support for the law, SNs and ATs felt that school teachers, counselors, athletic coaches, and healthcare providers could use more education and training regarding sports concussion management [6]. A subsequent survey of SNs confirmed the focus group finding that almost all SNs had generalized aspects of the sports concussion regulations to all students, regardless of how or where their head injury occurred [8].…”

“…In 2015, the MDPH conducted focus groups with SNs and ATs from MA middle and high schools to assess implementation of legislated regulations [6,8]. Four tape-recorded focus groups were conducted by experienced facilitators.…”

Development of a concussion public policy on prevention, management and education for schools using expert consensus

“…However, a major issue is that many concussion public policies were developed without representation and input from all relevant stakeholders. As a result, revisions have been necessary to align policy with community needs that subsequently became apparent from challenges faced in implementation 14–16. For example, Yang et al noted that multiple changes to the American state laws were implemented after introduction to include concussion education for parents, in consultation with the school staff and communities, which had identified shortcomings in the initial iterations of concussion legislation 17.…”