We got this student who has ADHD and maybe something else, he used to be worse in behavior but after his parents got him his medication approved to be given twice a day instead of once a day, he has been getting better in behavior. He's a very sweet Kinder student and he's extremely lovable.
But we had an issue last Friday, he was not wanting to cooperate in taking his medication. Usually he's a champ about it and does it, no questions asked. But that day, he was clearly upset and wouldn't listen. I kept asking him what's going on, but he kept just moaning and acting like a little animal (And I mean literally, when he's off his medications, he's speech and all his normal behavior disappears and acts like a small little animal, not speaking and gets into a small ball and refuses to come out.) I thought maybe his mother forgot to give his morning dose, but not that day, he did get his first dose, but he was upset about a situation before I came in. He got a stamp and he was stamping all his classmates and it got taken up. He got mad and that's why he was acting like this.
We kept trying to cohort him out and to listen to me. But he kept just saying "No!" and this kept going to an HOUR. At one point, the elementary coach came and grabbed his hands and was playing it off as she was hugging him, so I took the opportunity to give the medication, but he turned as I pushed the syringe and spit the medication back at my face. I was livid, but I tried to play it off so he can come with me, but he still refused. As I said, this took an HOUR and I was suppose to do my last group of Kinder of Hearing and I wasn't able to.
I'm just at a loss right now, what we should do? The medication has a 4 hour lifespan, (Procentra 5mL solution), and when he gets the medication, he's a good kid, but now I'm not so sure if it's working at all. And not only that, I'm not sure what I should be doing myself, because I'm pretty sure I can't handle him and only a few teachers have the training to handle the children, so I'm not sure what I can do if this happens again.
Yea, you work in a school, not a psych unit, so forcing a student to take a medicine isn't in your job scope. I will try to convince an unwilling child to take their medicine, I will sit with them and try to re-direct them, etc., I will walk away and return a few times to give them the opportunity to take the med but if that doesn't work I report to the parent that the child is refusing to take the medication and leave it at that.
Along these lines...I do not participate in restraining a student unless I perceive there is imminent danger to themselves or someone else.
There is more to this than ADHD. I'm surprised a diagnosis of ADHD was even made at such a young age.
Restraining is not appropriate in the school (unless, as OD said, there is imminent danger).
That behavior sets off all sorts of warning bells.
So many good responses here that I stopped quoting them . . .
We have some of the same issues with some kids in our district as well. This child certainly does not sound like it is only ADHD. Or even ADHD at all.
My experience with the local psychiatrist is that he is quick to label a kid and then medicate. But that's another story . . .
I'd call the parents as well.
And your school needs more training for times like you've described as some of the other school nurses here have mentioned.
One large issue with being a school nurse has always been the admin/teachers expect to be able to tell the nurse how to do his/her job. We are usually the only medical authority on campus and being second-guessed all the time is frustrating.
Again, not in this extreme situation, but I would look at what is going on in the classroom leading up to medication time. My first year, I had a kiddo that has meds twice a day and he would take his am med with no problem, but the afternoon one was alway difficult. I found out the teacher was making comments about how his medication must be wearing off and other snide thing leading up to him seeing me, so she was setting him up to feel bad. just a thought.
I do believe he has something else because of his sister who is a year older than him. She is autistic and the same behaviors she displays when she's going off the edge is the same as he is, but it's only when he's off his medication.
We don't have much space here at our school, like at all, so I'm not exactly sure what do you mean by "safe space".
A safe place for a child who exhibits self-injurious behavior (like head banging) could be a little area off to the side of a classroom with gym mats on the floor and propped up on the walls, for example.
HOWEVER, this could also act as seclusion if you're blocking him from exiting. This little guy needs a behavioral plan that everyone - parents, every teacher, and you - needs to implement consistently. If there is no 504/IEP/behavioral plan, I thinks it's time for a meeting. You can request one as part of his team.
I feel badly for the little tyke. To explode like that; it must've felt terrible.
OP, I looked at your profile, and if I am understanding correctly, you are not a licensed nurse, but are a CMA (which is fine). Is that correct? Is there an RN or an NP that covers several schools and is just not there full time? If so, I think that it may be time to get them involved so that you have some help in advocating for this child. Someone, somewhere needs to get everyone together (parents, school, physician) to make a better plan for this kid.
Specializes in Cardiology, School Nursing, General.
No. I didn't restrain him. I tried to take the opportunity of the teacher holding him and hugging him and tried to give him his medication but he spit it out.
Specializes in Cardiology, School Nursing, General.
I think I need to address this. I did not restrain him in any way. The Gym teacher saw I was struggling, as someone said, everyone expects me to be able to handle situations like this but I'm not trained in this. She went to give him a hug and was holding him in away that seemed easier to for me to give his medication. I took the opportunity to give his medication, but as I pushed the syringe he spit it out and in my face. We did not grab him by force or anything in that matter. He got more upset because the teachers started to threaten him with phone calls to the admin and his parents, once the teacher got enough and actually did call his parents, he got extremely mad and ran behind the door and started to do that behavior I said he was doing and hurting himself. I spent the whole hour trying to get him out of the door and out with us because he was self-harming himself. Eventually mom came and picked him up because of his behavior.
I am planning to talk to the admin about this behavior and if he's under a 504. As for the safe place idea, I like that better than having him bang his head that hard on the door instead.
I think I need to address this. I did not restrain him in any way. The Gym teacher saw I was struggling, as someone said, everyone expects me to be able to handle situations like this but I'm not trained in this. She went to give him a hug and was holding him in away that seemed easier to for me to give his medication. I took the opportunity to give his medication, but as I pushed the syringe he spit it out and in my face. We did not grab him by force or anything in that matter. He got more upset because the teachers started to threaten him with phone calls to the admin and his parents, once the teacher got enough and actually did call his parents, he got extremely mad and ran behind the door and started to do that behavior I said he was doing and hurting himself. I spent the whole hour trying to get him out of the door and out with us because he was self-harming himself. Eventually mom came and picked him up because of his behavior.
I am planning to talk to the admin about this behavior and if he's under a 504. As for the safe place idea, I like that better than having him bang his head that hard on the door instead.
For the record, I don't think you did anything wrong. I think your administration is not handling any of this situation correctly. You were, I'm sure, just trying to give his medication because everyone around you feels like that is the magic answer. You saw a calm moment and gave it a go, I can't say I wouldn't have done the same thing when I first started. The way the school is handling this kiddo, just isn't working. I'm so glad that I have a new team of admin and counselors this year because my first year we had a very similar situation which was handled very poorly and put everyone at risk. You are not responsible for his behavior and the school needs to insure his safety-not you alone. Everyone needs to understand that his safety must come before anything else. His safety is more important than his medication. I know they hate to hear this but single dose of anything isn't going to fix whatever is going on with this poor kid; that is the reality of it. Your admin needs to get it together, you just keep trying and advocating for him when you can!
The thing that keeps rewinding through my mind is, all this was not that important. I would have called the parents to pick up the child and kept him safe, and I believe you see that now, too. I have had decades of dealing with these types of scenarios, this was your first. I didn't handle my first correctly, that's how you learn. I had an ADHD kid who didn't take her AM med, she was like the Chipmunks on caffeine. Immediately called her parents, the day was a wash. Other students' learning should not be impacted by one student, no matter what the root cause.
If sister is on the spectrum, his behavior sounds like it could be the same. Spectrum kids, once they are upset, can be very difficult to calm down. An ODD child would have this behavior more frequently. I am surprised there is not an RN in charge of the CMA's - who do you report to?
Specializes in Cardiology, School Nursing, General.
To our medical aide supervisor and she's not an RN either.
It's a public charter school, so I'm not sure if the same rules apply as public schools.
And I get this idea, I seriously do believe we need to do something about this because I'm tired of getting the blame because of his behavior. "You didn't give his medication on time, that's why he's acting up." When it's not that, I think there's other ways we can control his behavior and just medicating is not right. I do believe that because I used to be the same as him as a kid. I used to get in trouble for the same things, and not understand why I was always in trouble. But when I got the care and right attention, everything changed. I seriously think we do need to do something but the thing is I'm under the admin's supervision and if they all agree it's just the medication, then I can't really put my input unless he's under a 504 and we get this situated. I honestly want to make things okay for him because as I said he's a wonderful sweet little boy and I really like him and seeing him acting like this and hurting himself just breaks my heart.
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Spidey's mom, ADN, BSN, RN
11,305 Posts
So many good responses here that I stopped quoting them . . .
We have some of the same issues with some kids in our district as well. This child certainly does not sound like it is only ADHD. Or even ADHD at all.
My experience with the local psychiatrist is that he is quick to label a kid and then medicate. But that's another story . . .
I'd call the parents as well.
And your school needs more training for times like you've described as some of the other school nurses here have mentioned.
One large issue with being a school nurse has always been the admin/teachers expect to be able to tell the nurse how to do his/her job. We are usually the only medical authority on campus and being second-guessed all the time is frustrating.
I'm glad he took the medication today.