SPINAL SCREENINGS...

I'm getting ready to do my 8th grade spinal screenings tomorrow, I don't know if I can offer much help, but....I'm going to PM you.....

We are lucky - our state "unmadated" scoliosis screening as it is not educationally relevant. Of course if a parent asks or we see a obvious signs we can screen, but not mass screenings anymore.

Anyway, first - send out permission slips. We used the "reverse permission" - if they wanted to opt the child out, they had to return it. I would always take a couple minutes to talk to the kids so they knew what I was going to do. We had a video, or you can just go in and let them know. I have elementary school, so always told them when I was going to do the screening (usually within the next couple days) and reminded the girls to wear a bra or swimsuit. During the screening, I would have small groups (3 or 4) come to the room I was screening in. I did one at a time while the others waited on the other side of the door. Had them stand with shirt off facing away from me, then slowly touch their feet. Then have them stand sideways and slowly bend forward.

If they forgot to wear a bra or swimsuit, they got a pass. If they started crying (had several do that), they got a pass. If it just freaked them out, they got a pass. I had one boy say "I forgot to wear something under my shirt".

As you can probably tell, I hated every minute of it, and am very glad we don't have to do it any more :)

Oh, forgot to mention - I would screen all the girls, then all the boys (or vice versa). I would never have them send a mix of boys and girls like they do with vision and hearing. Just the idea of a boy standing outside the door as a 5th grade girl takes her shirt off would freak them out.

I'm embarking on my first screenings in this school next month. I have an experienced sub nurse coming in and 2 scoliometers. Our plan is to close the nurses office for the PE periods we need to go and screen then go down for the beginnig of class. Girls locker room we'll just find a pritave area or set up a screen. Boys will need to form a line and be screenend in equipment room one at a time. Students in health classes will be called on the next day and screened one gender at a time in the office. I have two private areas in my office so we both can screen.

The United States Preventative Task Force not only does not recommended doing scoliosis screenings, the evidence shows that scoliosis screenings are more likely to harm a child by unnecessarily referring them for unnecessary testing and may lead to unnecessary treatment. This recommendation has been in effect since 2004.

http://www.uspreventiveservicestaskforce.org/3rduspstf/scoliosis/scoliors.htm

I read the USPTF recommendation, and after a little more digging around (wasn't able to find much) I did find a British Journal of School Nursing article from 2008 that concluded scoliosis screenings in schools should be done. I think this is a topic that deserves more investigation, but in the meantime, the state of Texas mandates it be done, so we do it. I also think that because, especially in the poorer districts, the school nurse may be the only health care provider a child sees outside of the ER, scoliosis screenings in schools are just as important as hearing, vision, and acanthosis screenings.

The role of the United States Preventative Services Task Force is to analyze all of the evidence published and make a recommendation. Until new research comes out, that is the United States guideline. You can always find a source that is going to argue against any evidence based recommendation. Evidence based school nursing practice warrants that we weigh the evidence available, and adapt our practice to the strongest evidence. If you look at this evidence based practice pyramid, clinical guidelines are among the strongest evidence, just below Meta-analyses and Systematic reviews. http://healthlinks.washington.edu/ebp/ebptools.html The article in the British Journal of School Nursing was written by a nurse who had to admit to a Conflict of Interest, she is an orthopedic nurse who works for a Spinal Surgery Center. Orthopedic surgery centers benefit greatly from the free case finding performed by school systems. The journal does not claim to be peer reviewed and many of its articles are written by the editorial staff.

School nurses across the country have worked with state legislatures to end mandated school wide scoliosis screenings. In this climate where school nurses are being asked to do more and more with less and less it is important to make sure what we are doing helps and not harms, in addition to decreasing instruction time and costing schools dearly. A 1999 article by Yu & Yu found that the incidence was so low that the cost of finding students who actually need treatment cost schools almost $11,000 each.

I read the USPTF recommendation, and after a little more digging around (wasn't able to find much) I did find a British Journal of School Nursing article from 2008 that concluded scoliosis screenings in schools should be done. I think this is a topic that deserves more investigation, but in the meantime, the state of Texas mandates it be done, so we do it. I also think that because, especially in the poorer districts, the school nurse may be the only health care provider a child sees outside of the ER, scoliosis screenings in schools are just as important as hearing, vision, and acanthosis screenings.

I agree that many kids see no health care provider other than the school nurse, but thing is there is no educational impact with scholiosis. That was the arguement used when our state repealed screenings. Obviously if you can't see or hear there will be problems learning. We don't screen specifically for acanthois negricans, just keep it in mind if we see it.

We don't do them either... we just send out information on scoliosis and recommend to have their physician evaluate.

No argument that school nursing practice should be based on sound scientific rationale.

But in reality, of necessity, it is based on state mandates. Woe to the district and/or nurse who ignores state law regarding school nurse practice.

Our state legislature recently passed a bill updating state mandates regarding school nursing practice (for the first time in decades). Previous attempts to move such legislation thru the state house had failed due to lack of interest (on the part of the lawmakers, not the school districts or nurses.) Experts from education, nursing, pediatrics, family medicine, public health, opthamology, social services, etc. testified and provided written evidence to support re-vamping state requirements to put them in line with current professional recommendations and also utilize precious resources more effectively. A group of respected experts wrote sample legislation. There was great anticipation among school nurses of new guidelines that would be consistent with current medical and nursing literature and professional organization guidelines.

What we got was a hot mess. Screenings that should have been eliminated were increased in frequency, and new screenings added without regard to the cost or ability of some districts to perform them. In adition, new requirements for lab tests were added to the Kindergarten physical. They are not discretionary, so physicians have no leeway to waive them in low-risk students. This is NOT what we need in a time of economic distress with ever-increasing numbers of uninsured families. I have no doubt this will result in more families refusing Kindergarten physicals altogether, which will benefit no one.

This is what happens when legislators interfere in health care.

What state was this? Who were the lobbiest representing?

I always do my scoli screenings at the same time I do Hearing / Vision. I set up stations and then the last thing i do is have them take off their shirt and screen very quickly. This way, I only pull once from class not twice. It only takes a few more minutes.