School Nurses Need Education and Support to Care for Students With Sickle Cell Disease

Sickle cell disease (SCD) is a rare but serious disease, and school nurses may not have experience assessing and managing complications in the school setting. A recent article in the International Journal of Environmental Research and Public Health discussed nurses’ self-reported experience, knowledge, and confidence regarding SCD, as well as the types of education and support they need to serve this patient population.

The article was based on a survey administered to more than 400 school nurses working in K-12 schools in Ohio. Most respondents were female (99%), were registered nurses (63%), and had bachelor’s degrees (57%). Many were aged 40–49 years (32.5%).

The nurses worked mostly in public schools (86.8%), often in more than one school building. In fact, about 40% said students do not always have access to a nurse at school. Only 35% of the respondents had experience treating a student with SCD, and 46% rated their ability to identify SCD complications as “below average.” Only 14% of the nurses said they had received continuing education about SCD in the previous three years.

Nurses who responded that they had experience managing SCD received an invitation to participate in a focus group or interview so the researchers could gather more detailed feedback. The authors, led by Lisa Shook of the Cincinnati Comprehensive Sickle Cell Center at Cincinnati Children’s Hospital Medical Center in Ohio, reported the major themes of their research.

According to the findings, the nurses perceived a lack of support and resources to properly manage students with SCD. They reported a low nurse-to-student ratio and inadequate coverage when a nurse is not available. For example, when a nurse is in another building, a secretary might fill in, which can be a problem if a student with SCD has a pain crisis. They said they need more funding, dedicated time, and additional staff.

Nurses also reported limited knowledge and experience with SCD, which affected their confidence and comfort with managing students with the condition. The respondents emphasized the importance of partnerships between the school and the student’s parents or caregivers. They said this could help the nurses understand each individual’s health history, symptoms, complications, medications, needs, and emergency-contact protocol. They said comprehensive communication and documentation could help them make informed decisions and take effective actions. Specifically, they stressed the importance of individual healthcare plans (IHPs) created by parents/caregivers, the SCD healthcare team, and school nurses.

The participants all requested continuing education regarding SCD, specifically on-demand options because of the amount of time that may pass between encounters with students with this rare disease. They also stressed the importance of involving teachers when appropriate.

“School nurses are often faced with managing the complications students may experience in the school setting and should be prepared to treat those emergencies in the most effective way possible,” the authors wrote. “Easily accessible, educational interventions, along with peer networking, can be designed to improve school nurse knowledge and confidence levels in managing SCD. … On-demand interventions are important, as many school nurses reported infrequent exposure to students with SCD.”