Students with Psych Issues

[Keepstanding, ASN, RN]

Just wondering how deeply do you get involved with students with Psych issues ?

Even though I have been in school nursing a long time, I still feel deeply inadequate (sp?) when dealing with these children.

I most often default to the Guidance Counselors. This is really not my forte, but was wondering what you all do with these cases.

Thanks Group !!

[AdobeRN]

I am in elementary so the few I have are just violent, out of control behavior issues - I do not deal with them unless medication or injury are involved - usually the special ed teacher, AP, Principal & counselor handle them. When these students get out of control we have a "Core Team" - same individuals involved along with the PE coaches if needed - they are trained to restrain & handle the kids a certain way. I too feel inadequate - I just don't understand the issues at times and sometimes I feel that what we try to do at school to help these kids is not followed thru with the parents at home.

[Farawyn]

Praiser, I already started a thread on this. Would you mind if I ask the mods to merge the 2?

[SnugglePuggle, MSN, RN]

At the Middle School level a lot of what I see in the clinic is related to mental health. I spend a lot of time trying to differentiate between true physical illness and emotional discomfort. If I know that a kid is struggling I try to open a door of communication. I want them to feel comfortable coming to me and that they can trust me. Sometimes they just need a break and a listening ear. Middle School is tough these days! Many students have not yet developed good coping skills so sometimes I discuss mechanisms of coping. I work closely with the guidance counselor and will refer students to her that may need additional support.

[MrNurse(x2), ADN]

We have no counselor and that statistic of 10% school aged children with anxiety is spot on. I have about a dozen who routinely come to be talked down. Research the topic, you will find lots out there and can be applied across the board for mental illness. The best thing is to get them mentally outside the school building, talk to them about the weekend or their sports, or anything outside of school. This is by far the hardest thing for me to do.

[Keepstanding, ASN, RN]

Absolutely ! I'd be happy to do that. Thanks !!

[Flare, ASN, BSN]

As far as crisis mode type things, my school has me in the trenches. I have been trained to the gills in restraint techniques and have had to use it more times than one would l have like to.

As far as counseling type things and day to day support type things, I am always glad to be there, be supportive and be a part of whatever team approach is being made in that respect - at the same time - i am no replacement for guidance and school psychologist.

[JerseyTomatoMDCrab, BSN]

My school has a behavioral/emotional disturbance class so we have lots of resources for the kids with these issues. I never have to handle restraints or seclusion issues, usually I just check them out after they have calmed down. I don't really feel inadequate. I just tell myself I am doing my part by assessing for any injuries sustained during a "meltdown."

The SpEd teachers, AP, principal and teachers in the behavioral area are the ones who typically restrain and transport the kids. I am very hands off in that respect which I am a-ok with! I did my share of holding down combative patients working in the hospital!

[KelRN215, BSN, RN]

Do your schools not have adjustment counselors/school psychologists?

[Farawyn]

Do your schools not have adjustment counselors/school psychologists?

We do. Many times it presents as physical, though, (stomach ache, or being high, etc) so they come through the nurse.

[JenTheSchoolRN, BSN, RN]

We do. Many times it presents as physical, though, (stomach ache, or being high, etc) so they come through the nurse.

Yep. Or the school counselor/psychologist is busy dealing with another crisis, so the student ends up in my office. I have had that happen a lot.

I have been trained in restraint techniques, but thankfully that job is usually done by another staff and the students ends in my office as it is private.

[Rubor]

While I am not a therapist or hold a psych degree, I can provide effective communication and am comfortable to do so. I feel like being the nurse I can look at the whole picture (holistic care approach) of a student. I like what someone once said about psych/mental health and getting comfortable with it especially with asking folks about it. I really feel like nurses belong in the group that needs to get comfortable with it and should be included in it. So yes I have done suicide assessments and have talked to students about their emotional health. I refer also to the counselor but sometimes she is not available so I step up. I will say, that I have an assistant who generally will see kids so I am able to free myself up to address all aspects of health.