Asthma death in Philly school

[Stitchy's mom]

I was just wondering what everyone thought about the little girl who died from an asthma attack in Philly. The parents are saying that the reason she died was because there wasn't a nurse at her school that day. I guess I'm wondering why the school didn't call 911 if she was having trouble breathing. I've got about 20 -30 kids with asthma at my school and I feel that if there's any doubt (inhaler/neb isn't working, meds aren't at school) I'm just calling 911. I would hope that if I'm not there (sometimes I leave a bit early to get to a class) that our staff would just call 911. The surgeons say "When in doubt, cut it out." I say "When in doubt, ship them out." I would much rather have a parent chew me out because I just cost them X dollars at the ER than to have a child die on me!

[SassyTachyRN]

Access to primary care is undoubtedly lacking in many inner cities but I disagree that it was a factor in this case. Laportia was diagnosed, had medications and was skilled in using them, which is evidence that for her, primary care was not the issue. Parental responsibility was. [/quote']

We don't know if she was diagnosed in an ER and simply given a rescue inhaler and nebulizer. Maybe she never did have access to primary care, we don't know that. I had that happen with a student just recently. Went to ER doc said you have asthma here's a rescue inhaler and sent them on the way. I work with inner city kids. The girl has had continued issues at school with her asthma. Asthma has to be controlled with daily meds, not just rescue meds. Unfortunately when you are in and out of ER's parents and students just don't get the education they need regarding asthma. This is where having a school nurse in the building could have played a large role in the scenario.

[Jolie, BSN]

What kind of education is necessary to teach a parent to pick up a sick child from school? Especially a parent who is home napping?

[LadyFree28, BSN, LPN, RN]

What kind of education is necessary to teach a parent to pick up a sick child from school? Especially a parent who is home napping?

Since we don't know what communication transpired; Again, NOT discussing the details of the actuals; we don't know if the father made assumptions and made a misjudgment; again, kids feel sick, and they get left in school; father could have been getting ready for work; etc, again, extraneous and Monday morning quarterbacking.

I don't know how many times I need to reiterate that I am discussing there is a serious issue of not having enough nurses; in my OP, and subsequent issues about the lack of school nurses; this is going to add fuel to many; that is what I'm addressing; and because of parents like the father in this article IS a good example of why a nurse is needed in these communities; it involves cultural and socioeconomic issues in regards to illness and other issues at hand; again, since we really DON'T know; like I already reiterated; there are still children that are going to school today without nurses, and that is a HUGE issue, to people who work in nursing in this community as well as the nurses who are still working.

Again, I'm discussing the drastic cuts of the school nurses; lack of proper emergency training and the other issues posted in the link I attached; if anything that this tragedy did was shine a light on how school nurses were cut, and the responsibility that educators and parents and the community put on the importance of school nurses, in this community; that's the issue that I'm discussing; NOT the father.

[NutmeggeRN, BSN]

"Believing the girl too ill to walk home, a school staffer gave her a ride."

This is where the school district may get in trouble. Assuming she was having symptoms (wheezing/cough), if they felt she could not get home safely then IMHO they should have called 911.

Putting a kid in a car is not a good practice. If she was having no symptoms but still not well enough to get home, they needed to insist the parent get her or make an arrangement.

BUT that does not negate the parents responsibility to:

1) notify the school of her condition/diagnosis

2) provide her with a rescue inhaler-along with a parental medication form with the doctors order

3) pick her up

or

4) ask that 911 be called

What a sad day that his first course of action is legal......

[Madras]

I really hope that something can be worked out in Philly, this is just sad all around and as LadyFree said, IT'S THE KIDS that are LOSING!!

In my neighboring district, they employ school nurses in all of their buildings. The nurses hold inservices a few times a year where parents are invited to come and discuss health issues and talk about management of things like asthma, autism spectrum disorders, diabetes, STD and safe sex in the high schools, etc. EDUCATE!! What a difference it makes.

My school district employs health aides.

I work in the local hospital that serves these communities; we see wayyyy more kiddos from my district rather than the neighboring district in the ER for these illnesses. Maybe there's a correlation, maybe there isn't.

Just my observations. Lets just hope something better can come out of this tragedy.

[LadyFree28, BSN, LPN, RN]

We don't know if she was diagnosed in an ER and simply given a rescue inhaler and nebulizer. Maybe she never did have access to primary care we don't know that. I had that happen with a student just recently. Went to ER doc said you have asthma here's a rescue inhaler and sent them on the way. I work with inner city kids. The girl has had continued issues at school with her asthma. Asthma has to be controlled with daily meds, not just rescue meds. Unfortunately when you are in and out of ER's parents and students just don't get the education they need regarding asthma. This is where having a school nurse in the building could have played a large role in the scenario.[/quote']

Thank YOU!!!

There are many that do slip the cracks all too often; they aren't given the education they sorely needed; there is still the myth that children are "little people" that goes around; they DON'T KNOW.

There has been a coordinated effort in the city's two Children's hospitals to involve school nurses to target these children with chronic diseases; the cuts by the state have not made it helpful to allow school nurses to coordinate these efforts efficiently, when they have double the school nurse:child ratio.

[LadyFree28, BSN, LPN, RN]

I really hope that something can be worked out in Philly this is just sad all around and as LadyFree said, IT'S THE KIDS that are LOSING!! In my neighboring district, they employ school nurses in all of their buildings. The nurses hold inservices a few times a year where parents are invited to come and discuss health issues and talk about management of things like asthma, autism spectrum disorders, diabetes, STD and safe sex in the high schools, etc. EDUCATE!! What a difference it makes. My school district employs health aides. I work in the local hospital that serves these communities; we see wayyyy more kiddos from my district rather than the neighboring district in the ER for these illnesses. Maybe there's a correlation, maybe there isn't. Just my observations. Lets just hope something better can come out of this tragedy.[/quote']

Ci, I agree; that was my point; in a lot of the inner city school districts, the nurse is sometimes the first line clincian to assess the child. Like I stated before in the link, there is a study cited that there are nurses I know that are working in Harrisburg to increase school nurses to ensure the access of healthcare to children; this is a huge issue in part of Healthy People 2020. The NIH program that has been a part of a the local Children's hospital that I was fortunate to have rotated in nursing school with during my public health rotation had a coordinated effort with local school nurses with positive results; this was before the cuts were ensued. That's why it's a huge deal that these cuts even happened.

[Madras]

Ci, I agree; that was my point; in a lot of the inner city school districts, the nurse is sometimes the first line clincian to assess the child. Like I stated before in the link, there is a study cited that there are nurses I know that are working in Harrisburg to increase school nurses to ensure the access of healthcare to children; this is a huge issue in part of Healthy People 2020. The NIH program that has been a part of a the local Children's hospital that I was fortunate to have rotated in nursing school with during my public health rotation had a coordinated effort with local school nurses with positive results; this was before the cuts were ensued. That's why it's a huge deal that these cuts even happened.

I wish I could like this a thousand times. What a great report! The stats are astounding. 70%!!!!! Of meds being administered by teachers/staff!!! 46% of parents being asked to come and give treatments and administer meds during the school day!!!

Looks like this initiative will be promising! Hopefully it sticks and makes precedent for everyone to follow in boosting community healthcare. If I lived in Philly I'd be all over the volunteer bandwagon.

[Jolie, BSN]

LadyFree,

You seem to think that I m disagreeing with you. I'm not. I'm arguing a parallel point. If you say that Philadelphia Public Schools don't have enough nurses on staff, then so be it. I'm not questioning your judgement about that. I'm saying that the number of nurses on duty is irrelevant in this case, because it was not a lack of nursing presence that caused this child's death.

Nurse staffing is a red herring here. Laportia's Dad understands that, and he's using it to assign blame to someone else for his failings.

I understand your need to collect data and objective examples to support your assertion that nurse staffing needs to be improved. But I don't believe that this case supports your argument, rather detracts from it. Unless a nurse was to follow that Laportia home and care for her there, there is no reason to believe that nursing involvement would have changed the outcome of this case. A father who ignores 2 phone calls and the presence of a school staff member on his doorstep is not going to suddenly perk up and take notice because the nurse is on the phone.

I don't disagree with a previous poster's suggestion that the school "demand" Laportia's father come to school and pick her up. I only wonder how one accomplishes that. In our district, there have been rare instances of a principal calling the police to escort a parent to school. That was not practical at the end of the day when a ride from a staff member could get Laportia home sooner. And had it been tried, it certainly wouldn't have fostered a good working relationship between the school staff and the father.

The staff of this school was between a rock and a hard place, responsible for a sick child, but lacking crucial information, and lacking cooperation from her family to take her home where appropriate care could be provided. (Laportia was capable of walking, talking and running up stairs, not candidate for 911 @ that time.) School staff acted responsibly by keeping the child under adult supervision until her father received her at home. Without diagnostic information, medication or parental cooperation, there was nothing more the school staff could have done, nurse or not.

The argument for more nursing staff in Philadelphia Public Schools in not enhanced by citing the case of a student failed by her own family, unless you believe that school staff should trump parental rights and responsibilities. I don't think anyone wants to go there.

[LadyFree28, BSN, LPN, RN]

Joile, I have no issues with your viewpoint; if anything; it seems as though you seem more clear on what my position is; like I stated in my post, this is bringing the issue of what is happening in Philly public schools to light, unfortunately, this child's death IS making the public "go there"; there has been a very rough history of school reform in Philly that had lasted almost 15 years; if anything cutting school nurses was the straw that broke the camels back...like I said, to remain in tact with the thread, I rather NOT introduce the acrimonious history of the state and the Philadelphia School District and the law that has made it impossible for the schools to be managed by the community again, and how no lawmaker wants to improve it; and the issues an culture of the state in terms of the city and the state; again, explaining this history would seriously derail the thread.

The fact remains, again, the history of the school nurse in Philadelphia schools have much more positive outcomes; again, I was very fortunate to have went to a local university that has gave me the knowledge and the experience of being taught and gaining experience with people who work with the NIH study and a mentor of the nurses who have produced the proposal sited in the link; I have had the experience of at overly working with people who are making changes in nursing and showing with EBP the importance of nurses in attempting to achieve the Healthy 2020 goals; the cuts are making it difficult for those who need it most.

I will continue to discuss this position, because it's important; it's unfortunate that ALL sides-I will say all sides; like my link has stated; most principles have called 911 in the past when there was not a school nurse around, so even if they were greatly concerned, they could've done this; but then again; since we were not there; I will refrain from further playing Monday Morning quarterback; either way a child is dead, the school nurses are frustrated and upset, the kids are still at risk, and the school and the local communities as a whole, are upset.

[Laurie52]

Joile I have no issues with your viewpoint; if anything; it seems as though you seem more clear on what my position is; like I stated in my post, this is bringing the issue of what is happening in Philly public schools to light, unfortunately, this child's death IS making the public "go there"; there has been a very rough history of school reform in Philly that had lasted almost 15 years; if anything cutting school nurses was the straw that broke the camels back...like I said, to remain in tact with the thread, I rather NOT introduce the acrimonious history of the state and the Philadelphia School District and the law that has made it impossible for the schools to be managed by the community again, and how no lawmaker wants to improve it; and the issues an culture of the state in terms of the city and the state; again, explaining this history would seriously derail the thread. The fact remains, again, the history of the school nurse in Philadelphia schools have much more positive outcomes; again, I was very fortunate to have went to a local university that has gave me the knowledge and the experience of being taught and gaining experience with people who work with the NIH study and a mentor of the nurses who have produced the proposal sited in the link; I have had the experience of at overly working with people who are making changes in nursing and showing with EBP the importance of nurses in attempting to achieve the Healthy 2020 goals; the cuts are making it difficult for those who need it most. I will continue to discuss this position, because it's important; it's unfortunate that ALL sides-I will say all sides; like my link has stated; most principles have called 911 in the past when there was not a school nurse around, so even if they were greatly concerned, they could've done this; but then again; since we were not there; I will refrain from further playing Monday Morning quarterback; either way a child is dead, the school nurses are frustrated and upset, the kids are still at risk, and the school and the local communities as a whole, are upset.[/quote']

I understand your feelings about school nurses. What I don't understand is why no one is frustrated and upset about the poor parenting that is going on throughout the United States. There was no on site school nurse when I went to school and I know that there is not a full time nurse at my nephews schools. Parents are the ones ultimatemy responsible for their children but what I see in too many cases is that responsibility being give to others.

[LadyFree28, BSN, LPN, RN]

I understand your feelings about school nurses. What I don't understand is why no one is frustrated and upset about the poor parenting that is going on throughout the United States. There was no on site school nurse when I went to school and I know that there is not a full time nurse at my nephews schools. Parents are the ones ultimatemy responsible for their children but what I see in too many cases is that responsibility being give to others.

"Poor parenting" is a very relative quote; especially with income disparity; many years and generations in the most poorest areas, the nurse was the only clinican; there are many generations that rely on their communities to help raise their children; "It takes a village to raise a child" is a VERY cultural forefront; as well as the respect for the nurse in the community.

Again, not everyone is equipped with the best reaction to situations; I have seen many eye brow raising issues that I have to withhold judgment UNLESS I am walking in their shoes and practitioners their behaviors.

I am more frustrated that there are many intelligent people that disregard science; and logic; have traumatic backgrounds and now live with maladaptive coping mechanisms and a multitude of erroneous pre conceived notions yet come to us, as nurses, to utilize and seek care and treatment; I only meet people where there are it better yet, where they prefer to be; more times it's to their detriment; however, being in this business; one thing is for sure about this issue which I had the privileged to experience; is teaching about asthma is not "cake"; it's an arduous process of following up, catching parents in other appointments to make sure that they are reinforced teaching; getting creative if they are not literate; add a language barrier or developmental level, etc to the mix... Like I said earlier, you DON'T KNOW what you know; sometimes it's easy to label and go from there; but sometimes we have NO idea.

That's why I don't get frustrated; I get empowered to do my best.