Original Research: Concussions at School: The Experiences and Knowledge of School Nurses

Abstract

Background: School nurses' knowledge about and confidence in managing concussions are important to ensure continuity of care between a student's school and home environments. This mixed-methods study explored concussion-related knowledge, confidence, and management experiences among urban and rural school nurses in Washington State. Methods: Public school nurses, identified via state educational service district websites and recruited by e-mail, completed an online survey assessing their concussion knowledge and confidence levels. Following the survey, a subset of respondents participated in semistructured interviews aimed at exploring their confidence in managing concussions. Results: Of the 945 school nurses to whom the survey was sent, 315 responded (33% response rate). Most survey respondents held an RN license (89.6%) and were from urban areas (90.8%). Overall, the respondents exhibited accurate concussion knowledge; only one significant difference was noted based on rural–urban status. Correct responses were given for most questions (67.4% to 98.7% correct responses). In interviews with a subset of six school nurses, emergent themes pertained to communication, assessment, and monitoring, and the nurse's role in postconcussion management. Barriers can include a lack of relevant school policies, low concussion awareness among teachers and parents, and limited resources. Conclusions: The study findings suggest that school nurses possess high levels of concussion knowledge and confidence in managing concussions. Continuing education remains important to ensure that current research and evidence inform practice regarding ongoing concussion management among school-age children.

Understanding Baseline Concussion Testing: A Resource for School Nurses as Members of Concussion Management Teams

“…BCT is one available tool that can be used to offer guidance for the student athlete's safe return to learn and return to play after an SRC has occurred (CDC, 2020). Findings from the literature (Halstead et al, 2018;Pietz et al, 2021;Weber et al, 2019;Wing et al, 2016) as well as this project, demonstrate that consistent education regarding BCT and the role of the school nurse should be provided for all members of the concussion management team to ensure consistency in the care for the concussed studentathlete. Furthermore, information about concussion symptom identification, proper use of BCT and management of the student with an SRC would be beneficial to include in new school nurse orientation programs, as well as continuing education for school nurses in current practice.■…”

“…Additionally, only 48% of the school nurses were able to correctly recognize all the strategies to help concussed students in the school setting. Similarly, Pietz et al (2021) surveyed 315 public school nurses and found that while 70% of school nurses felt comfortable managing a student’s return to learn, only 48% of these nurses felt confident in managing an athlete’s return to play postconcussion. These findings demonstrate the need for ongoing concussion management education for school nurses.…”

“…Therefore, it is necessary for school nurses to be knowledgeable about postconcussion care and BCT administration. Since school nurses come from diverse professional backgrounds, BCT knowledge and training lack consistency (Pietz et al, 2021;Sarmiento, Donnell, et al, 2019;Worley, 2019). Wing et al (2016) surveyed 151 elementary, middle, and high school nurses.…”

Factors associated with continuing education needs in medication administration among school nurses

“…Linear multiple regression with a fixed model, effect size of 0.15, power of 0.95 and alpha of 0.05 was employed to calculate the minimum sample size, which was found to be 129 participants. Considering the response rates from previous online research conducted with school nurses which averaged around 33.0% (Pietz et al., 2021), a total of 391 schools were invited to participate. This ensured sufficient responses for robust research analysis and meaningful conclusions.…”

“…Considering the response rates from previous online research conducted with school nurses which averaged around 33.0% (Pietz et al, 2021), a total of 391 schools were invited to participate. This ensured sufficient responses for robust research analysis and meaningful conclusions.…”