vision screening: how do I respond to this parent?

llg, PhD, RN · Feb 28, 2013

Doesn't your employer -- and/or the state have regulations/policies that tell you how to handle such situations?

Sudsy · Feb 28, 2013

Yes, I'm supposed to send a referral and then follow-up if I don't get it back filled out by an eye care professional :)

I'll check my state info and see if there's something more I can do in this situation.

Flare, ASN, BSN · Mar 1, 2013

Is there a concern that her vision is impacting her academics? That angle usually gets some action. Does she come in to your office c/o headaches at all?

Kafergie · Mar 1, 2013

Maybe I am under reacting but my thought is you can't force them to take her in. Although vision is important, it is not life threatening. I agree if it is affecting her academically, then maybe the parent will be more likely to take action. Otherwise, document that you recommended a rescreen and the parent's response re: the MD recommendation. Good luck!

NursChu · Mar 2, 2013

In my state the referral remains open until a response from a physician is received. I would get a note from the doctor and document it. In Texas it would be reported under the referral - no treatment required section.

dfs1961 · Mar 3, 2013

In my state the referral remains open until a response from a physician is received. I would get a note from the doctor and document it. In Texas it would be reported under the referral - no treatment required section.

How do you get a note from the doctor if the parent's won't get you one? She (the nurse) has done due diligence by 1. discovering the eye problem, and 2. making the referral. The parents have responded. I think the issue is out of her hands and the case is closed.

Sudsy · Mar 5, 2013

I called the state school nursing supervisor, and she suggested I call the doctor and ask his reasoning for not referring her. I really couldn't think of a way to do that without seeming to be either confrontational or overstepping my bounds. To her credit, she agreed when I told her that.

She suggested I ask the girls' teachers if they thought this was impacting her. Afternoon teacher said no. I will hopefully ask the morning teacher tomorrow. If, as was mentioned, I can make a case that it is hurting her schoolwork, then the parents might reconsider.

And, lastly, ask the girl her thoughts about it. I ask every kid when they sit down for vision screening if they have "any trouble seeing either up close or far away", and she said she did have trouble seeing distances. So I'll try to get some more persuasive details from her and contact her mom one more time.

Many thanks for the input. I appreciate having this board to bounce things off of. May this be the biggest health issue I have to deal with!!!

essmgee · Mar 5, 2013

A lot of what you said is right, Sudsy. First of all, the difficulty is likely myopia, with or without small amounts of astigmatism, and monocular visual acuities are close enough that imbalance is likely not an issue. Keep in mind that near acuity is usually not affected and is most often NOT a useful test. In your screening, think about adding a binocular vision test if you have not done so.

You can't push the doctor and you can't push the parents. The student, teachers and administration are your allies, especially if academics are affected. The student can be encouraged to "complain" to parents, the teacher can be encouraged to make classroom accommodations like seating and bring up vision as part of parent-teacher conferences and administration can reinforce teacher efforts on a per case basis.

ctillett · Mar 5, 2013

I agree that you have done your part, even though you think money isn't an issue sometimes it is. I would gently bring that subject up. Sometimes they will confide in you they are strapped for money. At that time then you could see if you could help. I am not sure that a Dr. would truly tell a 4th grader that they should wait.