By Debra Anscombe Wood, RN
Concussions frequently occur as children participate in sports, play, or slip and fall on the ice and snow. School nurses assess and monitor their care to help ensure a safe return to academics and physical activities.
“We’re taking it more seriously,” said Jeanne Clark, BSN, RN, the school nurse at Manhasset (N.Y.) High School, explaining that a greater awareness exists about the potential seriousness of a concussion injury.
“Research has borne out that younger brains recover at a different rate than older brains, and they have more sustained damage if they are not treated appropriately and given time to rest,” added Mary Blackborow, MSN, RN, the New Jersey representative to the National Association of School Nurses and co-author of the New Jersey State School Nurses Association position statement on concussion injury.
What is a concussion?
Concussions are a traumatic brain injury, caused by a blow or jolt to the head or one to the body that causes the head to move rapidly back and forth. They can occur with any recreational activity. The injury does not necessarily result in a loss of consciousness but causes a change in behavior, thinking or functioning.
Nurses and athletic trainers should remain alert to students after a blow appearing dazed or confused, forgetting instructions, slowly answering questions, displaying mood changes and not recalling events. The student may complain of headache, vision changes, nausea or vomiting, sensitivity to visual or auditory stimuli, difficulty concentrating, confusion, and feeling sluggish or hazy. “If they are in school and come to see the nurse, we will do an evaluation, and if it warrants it, we send them to their primary care provider,” said Janice McPhee, MSN, RN, NCSN, president of the New York State Association of School Nurses.
Blackborow emphasized the need to notify parents about the injury and provide education to them about concussion injuries.
Athletic trainers aim to work more closely with nurses on this and other sports-related issues, said Kristy Knechtel Hart, MS, ATC, CSCS, PR chair for the New York State Athletic Trainers’ Association, which aims to develop a closer relationship with NYSASN.
Rest allows the brain time to heal. Post-concussion, children should keep a regular sleep schedule and avoid high-risk activities, such as riding a bicycle. A second concussion, before the first has healed, can result in brain swelling and permanent damage or sudden death, particularly among young people.
“It’s not just physical rest, but cognitive rest as well,” said Blackborow, explaining that a relatively minor hit may become more serious with a second impact.
After an injury, the evaluating physician determines a plan of care, for instance excusing attendance in sports or recommending allowing additional time for taking tests or other academic accommodations for mental rest. Students might require time to move between classes at off-times to avoid the noise stimulation, Blackborow said.
Students with a concussion might need frequent breaks, and usually report in with the nurse daily. Some schools use neurocognitive testing to assess progress, and the nurse may administer the test, which measures cognitive functioning.
“They need to be monitored until symptom free and cleared by their primary care provider or, for sports, by the school medical director,” McPhee said.
The physician often gradually increases the amount of activity a child with a concussion can engage in. For instance, they may return to school part time, before full time, Clark explained. Or the student may be allowed to engage in noncontact activities before sports.
“They have to be very cautious,” Clark said.
Clark said some students bounce back within a week, while others might be out of action for two years.
“It’s the impact of where they were hit or how they have fallen and where they have been hit,” Clark said.
Children who have experienced concussions are more likely to suffer another one. Repeat concussions can result in long-term difficulties with memory, headache and balance.
“We try not to overreact,” Clark said. “But concussions are serious. You have to be conscious of it.”
Debra Anscombe Wood, RN, is a freelance writer.