Students "faking" symptoms

[RNCourt]

Hello all,

This is my second year as a school nurse and I'm still not able to figure out what to do in this particular situation.

I have grades 6-12 and I work in a Charter School. My problem is, once a student hits their head I always go through and do a concussion checklist. Most of the times the student will state that only their head hurts, no other s+s and I'll give them an ice pack send them on their way and ask that the check in with me next period. However, sometimes I'll have students start agreeing to every symptom on the list (nausea, dizziness, etc.) Knowing I can't measure for these things and having some serious doubt in my mind as they are almost smiling while answering these questions and all vital signs are stable, how should I handle these cases? If my gut is telling me there isn't anything wrong and they are fibbing, should I still send a student out?

The same goes for allergic reactions. After explaining to the student s+s of severe allergic reaction the student comes back stating she is feeling nausea, dizzy, etc. All vital signs stable, no hx allergic reaction. Call parents to inform. Parents agree student has been stung before without allergic reaction.

So my question is, do you educate students on these things because you want them to be aware?

[Flare, ASN, BSN]

I will educate them, but if they are grinning like a Cheshire cat and telling me that they are nauseated and dizzy, I will also educate them about the importance of having good credibility in the nurse's office. It would be a shame for a kid to fall victim to the "Boy who cried wolf syndrome" because they wanted to waste an extra five minutes out of history class. On one hand we're tempted to cover our butts and provide a full assessment, but in reality, we need to weed through, doing focused assessments and identifying the malingerers along the way. We can still cover our butts this way. Document, document, document.

Don't be afraid to call a student out on their patterns. If it's the third time in a month that the student is claiming they may have hit their head, nausea and dizziness present - then a call needs to be made home. The student is either full of it of is simply being careless. Same thing with frequent allergen exposures.

My other thought is balancing the subjective s/s with the objective. A student states dizziness after supposedly hitting their head, but practically skips into the office?? NOPE. Student tells me they feel nauseated, but then sits there with a big grin or proceeds to get into a big debate about the likelyhood of the Mets to win the pennant this year with another student... check in later or come back when you puke and bring proof.

[Wave Watcher]

I agree 100% with Flare! If I can hear them laughing or chatting coming down the hallway or they get into my clinic and are smiles and talkative....my radar goes off and I'm very unlikely going to take them seriously unless I can see outward symptoms. I understand kids are hard to read because they can be running around with a 102 temp but if you can laugh and run down the hallway you can sit in a chair in class and survive until the end of the day.

[SaoirseRN]

You could try asking them to describe how they feel, instead of suggesting symptoms. For the nausea test, simply tell each student you'd like them to have some water and judge their nausea or lack there of that way.

[JenTheSchoolRN, BSN, RN]

I, too, agree about the asking "tell me now you are feeling?" I often get students that come in saying, "I'm sick" and I always say, "well, tell me more about how you fell" to get a list of symptoms. I like to educate students, of course, but I will also tell a student that hits his/her head to not only report any different symptoms from how they are feeling now, but reach out to the parent, and then to the staff to be on the lookout for changes. I often stress how important it is to be HONEST in my office, as if they are not, they could be a consequence.

For example, I do have a student that flat out lies about serious symptoms (I can never find anything physically wrong with this student and no doctor has either). For that case, I reached out to not only to the mom, but our student support team and dean, and together we are working on a plan that lets this student know that this cannot happen all the time. I document, document, document every time, though.

As for the kids that tell me they are nauseous or have vomited (unwitnessed), I usually sit them down with some water and observe them for 10 minutes. Word has gotten around that I do that, I think, because the number of kids using that complaint has dwindled...

[NutmeggeRN, BSN]

I love when they come in with 5 or 6 symptoms, all rattled off in one sentence....to which I will ask "what is the main reason that you are not well enough to be in class right now?" Then it is usually one or two...they are typically my frequent flyers who just need some reassurance...I try to reassure them and send them, on their way.....