Help School Nurses !!!

Martha Bergren.....can I draw off of your experience with this ? What would you do ?

I respect your opinion highly !

Elementary is the only school setting I have not worked in - I've been a school nurse in early childhood, where there is usually a classroom aide who did this, and in middle and high school, where I did not see this.

Perhaps it is (do you?) because you have a private bathroom?

how often does this happen?

Is it the same kids all the time?

What is the bathroom schedule for the class?

Do the restrooms provide privacy? One nurse I know was caught up in a cycle like this and found out they had taken off all the doors to the stalls to PREVENT GRAFFITTI!!!!! Half the kids were having accidents, the other half were having urinary tract infections and or constipation - she got the doors put back on.

Are the rest rooms clean? Stocked with toilet paper? safe? Scary? Are the kidnergarteners sent the same time as 4th 5th or 6th graders? In Minneapolis a kindergarten boy was sexually assualted by four 4th graders in the restroom during school hours.

Can you work with the teacher on a way to prevent the accidents? I can tell you right now, decades later, who in my own elementary class ever had an accident in school - it's humiliating, so effort should go into the prevention.

Other nurses I know ask the child to clean themselves up, no matter what age, in the closed nurse's office bathroom. They are given wipeups, towels, soap, etc. If there is no clean clothes, the parents are called.

I heard on the radio that this fall there was an influx of children in kindergartens that were not toilet trained. These are NOT special education kids or children with any special health condition. Has anyone seen this? I wonder if toilet training is taking place so late that it is not complete prior to the start of school? The average age when fully trained has gone up considerably in the last 20 years, with the majority of children being fully trained well over 3 years of age.

Bakker, E. & Wyndaele, J. J. (2002). Changes in toilet training in the last 60 years: The cause of an increase in lower urinary dysfunction? BJU International, 86, 248 - 252.

Brazelton, T. B., Christophersen, E. R., Frauman, A. C., Gorski, P. A., Poole, J. M., Stadtler, A. C., 7 Wright, C. (1999). Instruction, timeliness, and medical influences affecting toilet training. Pediatrics, 103, 1353 - 1358.

1) I'd check with your nursing supervisor as to what the policy for your district - including what level of toilet training does the district expect attendees to have achieved?

2) In some districts the instructional aides and teachers have engineered a contract provision that if they change students soiled clothes they get paid more - but see if the teacher is able to send her aide (if she has one) to the clinic and cheerfully provide gloves and support for them

3) I've found that the school administration and staff are more than willing to help work out a solution if they are truly informed of the issues - perhaps a meeting or a presentation at the next staff meeting and explain the issues you mentioned above :)

4) For students that became "frequent flyers" I sometimes resorted to calling the parent each time - as toilet training is ultimately their responsibility (with understanding, of course, for the student that is developmentally or otherwise delayed)

I work in a special ed school so this is a frequent issue...also some of our kids use inappropriate defecation as a behavior. I supply bleach and water bottles to each classroom for cleanup, and have given a clear message to staff and administration that it is not a nursing function to clean poop, or to have a supplly of clothes in my office. it did seem harsh at first but i explained that i didnt want to have a child who had an accident have to wait while i took care of all of the other issues so that the child would be better off if they changed them themselves:rolleyes: I do help if i am able, but with 4 programs to cover, i am not always available!

I think because of fear of disease the school nurse handles any and all bodily fluids these days. also, the kids need some privacy and there is a bit more in the nurses office. If it occurs alot I would meet with the teacher and parents to try to figure out why. I also have the child clean themselves and call the parents. for some reason the staff at school do think I have an endless supply of clean clothes in just the right size for each child, not just for BMs, but for spilled milk from the lunchroom. this is another of those problems that school nurses deal with until they come up with an acceptable alternative. good luck