Role of the School Nurse Virginia M. Thompson, RN,MEd, MPH The school nurse is indeed the key t o the control of pediculosis in the school setting. Who else quakes as the principal declares emphatically, “I will not tolerate lice in my school.” Who else faces the irate teacher, who, in a fury, yells, “Get that kid out of my room.” Who else discusses calmly school policy with the friendly neighborhood doctor who mandates, “Admit that child; those nits are dead.” Who else counsels the frustrated mother who says, “I honestly and diligently have tried everything.” Who else consoles the child with tears in her eyes who asks, “DO I have t o go home again?” Who else gulps aspirin and antacids? Unfortunately, this role for the school nurse is taking an inordinate amount of time and effort in schools today. This role involves functioning in health education, health services, and environmental control. The successful pediculosis control program starts with a good plan. The school nurse must take the leadership position in developing policies and procedures. Most administrators with limited knowledge will react to crisis infestation. The school nurse must organize the campaign before that stage is reached. This is not to say that school nurses write policy. It is t o suggest that the school nurse should point out t o her administrator what the problem is o r likely t o become and what might be an effective way t o deal with it. Being a part of the team that formulates policy and procedure implies that the school nurse must be knowledgeable about lice-the life cycle, the mode of transmission, the diagnosis and treatment. Fortunately, symposia such as this are available through the courtesy of pharmaceutical laboratories, local health departments, and medical schools. They can also be arranged at the local level. The literature has been replete with articles about lice from the scientific to the hilarious. The wise school nurse will certainly read and collect them. Again, the pharmaceutical laboratories have been generous with reprints and educational pieces. We assembled an attractive folder of reprints and brochures t o distribute to our staff nurses and t o all 358
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our administrators. It included the school board policy and suggested procedures. School nurses must be informed if they are to have any credibility in planning, in teaching, or in treatment. The real thrust must be in community education. Pediculosis-contrary to all the adverse publicityis not solely a school problem. Were industries to make the kind of inspections that are made in schools, they might also be in the hot seats in which schools have found themselves. Until the community is cognizant of the problem, no school policies will be effective. School nurses must be available and interested outside the school t o work with other professionals who attack the problem from many aspects. A positive informational approach is very helpful in interpreting the school’s position and policies. The school nurse can be effective in faculty inservice. Lice do not jump from head to head, nor are they airborne on the slightest breeze, as many teachers believe. It certainly allays panic when the faculty also understands the nature of pediculosis, when they are behind the school’s preventive o r eradication plan. The school nurse must assume the responsibility for promoting and conducting faculty sessions-not once but frequently. Education of children is the primary responsibility of schools, and it is in this area that school nurses should devote their major efforts. Pupils must be taught t o prevent the transmission of pediculosis. It will take imagination and ingenuity t o change some behavior that definitely contributes t o the spread of lice. Who has not shuddered to see teenagers using a common comb? I know we have taught-or think we have taught-but, somehow or other, students in our schools today have not learned. Does the problem lie in our teaching strategies? The school nurse has to use the best teaching methods t o involve students in the learning process. Of course, she cannot be solely responsible for all the teaching that accompanies a successful program. She can assist teachers by providing ideas and materials and encouraging teachers to be involved. JUNE 1977
Programs must be varied so that students d o not groan, “Oh, no, not that again!” There are several filmstrips available (free o r inexpensive) from pharmaceutical companies. Filmstrips are particularly effective because you can stop and inject information pertinent on the local level. Some state and local health departments have prepared films and flip charts, and professional-level slides are also available. Unfortunately, the best planning and educational programs have not dealt effectively with pediculosis infestations in the past few years. When preventive programs break down, the nurse becomes involved in detection and treatment. The nurse should work out the procedure of inspection, teaching it carefully t o those who will assist her. Parting the hair in several places with two applicator sticks and examining closely over the ears and at the hairline in strong light will usually reveal any nits. The examiner must not break technique and be the cause of infestation herself. Siblings of all pupils must be examined the same day, and treatment for the whole family must be simultaneous. A distinction between nits and dandruff is easily established-dandruff will shake off o r move; no amount of hair movement will move nits. Pupils found t o have nits or lice should be sent home immediately and should remain out of school until all nits have been removed. This is the point around which the fury rages. In all probability, if effective treatment is instituted, all the nits are dead, but what if a louse lays more nits? Can you then tell which are dead and which are alive on casual examination? What kind of reaction do you get when you send one child home with nits while another, obviously infested with nits (who has had treatment), sits in the classroom? No, there is no way except to insist on the removal of nits. You can, of course, refer pupils t o their physician, in which case a prescription and instructions will be issued. Most physicians in our area have indicated that they really d o not want their offices clogged with children with lice. They feel the school nurse can teach the mother how to deal with the infestation. Although this puts a burden on the school nurse, she is the most effective teacher. She should patiently and thoroughly teach the mother. The family must have a complete understanding of the life cycle and mode of transmission of lice. The
JUNE 1977
mothers must be shown how to treat both the head and environment. This requires a visit to the home. The mother needs to feel that she and the school nurse are partners, not adversaries. Parents should be given a choice of medicated shampoos, and the properties of each should be explained by the school nurse. The technique of combing should be demonstrated. It sounds so simple to say, “Comb o u t the nits,” but like most other things, there is a trick t o it. Nits are actually scraped off with the comb, rather than combed off. The school nurse will undoubtedly often be the object of the mother’s rage or frustration, and she must understand and be prepared for this, handling it effectively and productively and not taking it personally. This implies that she has worked through her own feelings and attitudes about lice. The nurse is the chief epidemiologist in each school. It is her responsibility t o search for any possible source of infestation in the school setting. She should ask the question-Are children transmitting pediculosis in any way in school that can be prevented? Are the earphones and headbands of the listening stations the culprit? Are children lying around on shag rugs? Do the safety patrol members all have their own individual hats? One of my own observations was that the kindergarten room had a lovely mirror and costume rack that included hats and wigs that the children dearly loved! Finally, the school nurse should use her imagination to seek solutions for this problem. Could some kind of headband or barette (like a dog’s flea collar) be an effective preventive measure? What kind of solvent could be marketed t o dissolve the substance that holds nits t o the hair shaft? A permanent wave solution does. What in that solution could be marketed? I urge you to observe what works, and let manufacturers know your ideas. One last encouraging word-the literature tells us that epidemics of lice infestation seem t o occur in regular cycles. So, this, too, shall pass with the generous help of companies such as Pfizer.
Virginia M . Thompson, R N , MEd, MPH, is Director, School Health Services, Houston Independent School District, 3830 Richmond Aue, Houston, TX 7 7027.
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our administrators. It included the school board policy and suggested procedures. School nurses must be informed if they are to have any credibility in planning, in teaching, or in treatment. The real thrust must be in community education. Pediculosis-contrary to all the adverse publicityis not solely a school problem. Were industries to make the kind of inspections that are made in schools, they might also be in the hot seats in which schools have found themselves. Until the community is cognizant of the problem, no school policies will be effective. School nurses must be available and interested outside the school t o work with other professionals who attack the problem from many aspects. A positive informational approach is very helpful in interpreting the school’s position and policies. The school nurse can be effective in faculty inservice. Lice do not jump from head to head, nor are they airborne on the slightest breeze, as many teachers believe. It certainly allays panic when the faculty also understands the nature of pediculosis, when they are behind the school’s preventive o r eradication plan. The school nurse must assume the responsibility for promoting and conducting faculty sessions-not once but frequently. Education of children is the primary responsibility of schools, and it is in this area that school nurses should devote their major efforts. Pupils must be taught t o prevent the transmission of pediculosis. It will take imagination and ingenuity t o change some behavior that definitely contributes t o the spread of lice. Who has not shuddered to see teenagers using a common comb? I know we have taught-or think we have taught-but, somehow or other, students in our schools today have not learned. Does the problem lie in our teaching strategies? The school nurse has to use the best teaching methods t o involve students in the learning process. Of course, she cannot be solely responsible for all the teaching that accompanies a successful program. She can assist teachers by providing ideas and materials and encouraging teachers to be involved. JUNE 1977
Programs must be varied so that students d o not groan, “Oh, no, not that again!” There are several filmstrips available (free o r inexpensive) from pharmaceutical companies. Filmstrips are particularly effective because you can stop and inject information pertinent on the local level. Some state and local health departments have prepared films and flip charts, and professional-level slides are also available. Unfortunately, the best planning and educational programs have not dealt effectively with pediculosis infestations in the past few years. When preventive programs break down, the nurse becomes involved in detection and treatment. The nurse should work out the procedure of inspection, teaching it carefully t o those who will assist her. Parting the hair in several places with two applicator sticks and examining closely over the ears and at the hairline in strong light will usually reveal any nits. The examiner must not break technique and be the cause of infestation herself. Siblings of all pupils must be examined the same day, and treatment for the whole family must be simultaneous. A distinction between nits and dandruff is easily established-dandruff will shake off o r move; no amount of hair movement will move nits. Pupils found t o have nits or lice should be sent home immediately and should remain out of school until all nits have been removed. This is the point around which the fury rages. In all probability, if effective treatment is instituted, all the nits are dead, but what if a louse lays more nits? Can you then tell which are dead and which are alive on casual examination? What kind of reaction do you get when you send one child home with nits while another, obviously infested with nits (who has had treatment), sits in the classroom? No, there is no way except to insist on the removal of nits. You can, of course, refer pupils t o their physician, in which case a prescription and instructions will be issued. Most physicians in our area have indicated that they really d o not want their offices clogged with children with lice. They feel the school nurse can teach the mother how to deal with the infestation. Although this puts a burden on the school nurse, she is the most effective teacher. She should patiently and thoroughly teach the mother. The family must have a complete understanding of the life cycle and mode of transmission of lice. The
JUNE 1977
mothers must be shown how to treat both the head and environment. This requires a visit to the home. The mother needs to feel that she and the school nurse are partners, not adversaries. Parents should be given a choice of medicated shampoos, and the properties of each should be explained by the school nurse. The technique of combing should be demonstrated. It sounds so simple to say, “Comb o u t the nits,” but like most other things, there is a trick t o it. Nits are actually scraped off with the comb, rather than combed off. The school nurse will undoubtedly often be the object of the mother’s rage or frustration, and she must understand and be prepared for this, handling it effectively and productively and not taking it personally. This implies that she has worked through her own feelings and attitudes about lice. The nurse is the chief epidemiologist in each school. It is her responsibility t o search for any possible source of infestation in the school setting. She should ask the question-Are children transmitting pediculosis in any way in school that can be prevented? Are the earphones and headbands of the listening stations the culprit? Are children lying around on shag rugs? Do the safety patrol members all have their own individual hats? One of my own observations was that the kindergarten room had a lovely mirror and costume rack that included hats and wigs that the children dearly loved! Finally, the school nurse should use her imagination to seek solutions for this problem. Could some kind of headband or barette (like a dog’s flea collar) be an effective preventive measure? What kind of solvent could be marketed t o dissolve the substance that holds nits t o the hair shaft? A permanent wave solution does. What in that solution could be marketed? I urge you to observe what works, and let manufacturers know your ideas. One last encouraging word-the literature tells us that epidemics of lice infestation seem t o occur in regular cycles. So, this, too, shall pass with the generous help of companies such as Pfizer.
Virginia M . Thompson, R N , MEd, MPH, is Director, School Health Services, Houston Independent School District, 3830 Richmond Aue, Houston, TX 7 7027.
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