Feasibility Assessment of a School Nurse-Led Approach Using Chronic Absenteeism to Establish the School-Based Active Surveillance Process 2022 Maughan

Abstract

This article shares what was learned from the feasibility assessment of a nurse-led school-based active surveillance (SBAS) pilot to track chronic absenteeism using myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an exemplar. This pilot encompassed a 3-year period with training and feedback from school nurses (SNs) on data collection and ME/CFS. SNs found that the SBAS process helped them effectively identifying undiagnosed conditions. The assessment revealed the importance of focusing outreach efforts and establishing relationships with the school leadership in developing health policies and programs in the school setting. The pilot data were used to develop a manual to guide SNs for the SBAS process. This can be viewed as a model for SNs in establishing a surveillance to identify and track conditions like ME/CFS. With overlapping symptoms of Long COVID to ME/CFS, this assessment may provide insights for additional efforts to understand the impact of Long COVID on students’ education.

Paywall, https://journals.sagepub.com/doi/10.1177/10598405221144259

 

This need not be problematic, but given the legal implications of school absences for the families there is a risk of children/guardians being pressured into particular treatment or management options. Patient choice in this situation may be undermined or even indirectly forced.

I certainly felt that Prof Crawley’s School Absences study, which resulted in referral for identified children to her clinic and at that time most likely curative GET/CBT, placed children at risk of harmful intervention in a situation where they families may feel that refusing the specialist service intervention was not an option.

 

This actually represents serious lapses in healthcare systems. It's not normal that school nurses should identify medical issues that have been "missed" by standard medical care, especially as we know that they are not actually missed in the actual meaning of the word.

Impossible to check what is known about the clinical history of the patients with the article being paid access, but there is usually a history of seeking healthcare and being denied and discriminated the usual way, refusing to record reality specifically to justify having done nothing about it, being massively negligent.

Those patients will have consulted with a GP. Maybe even seen specialists. A school nurse surveillance program should not be expected to find things that have been missed by this process unless that process is extremely dysfunctional. And it sure is. The only way such a program makes sense is in accepting that standard medical care is too inept to fix this flaw, when really all of this is deliberate.

Continuing in the tradition of presenting systemic failure as a success. Somehow.

 

I find the use of the word "surveillance" very troubling in connection with children and health/sickness. It makes me think that the only point of it is to coerce sick children into doing what certain adults think they should be forced to do, even when the children are extremely unwell.

 

Have school nurses not gone the way of the dodo? Never heard any of my grandchildren mention one.

 

Apart from many other flaws, they definitely do not have the resources or spare time for this, making the premise of this laughable. 1:1 consultations are the worst form economically, they have to be massively effective in order to be considered superior to any other mode of treatment, with drugs being the far better option in almost all cases. Everything about healthcare is determined by economics, it's absurdly foolish to ignore this.

It's not much better when it comes to identifying complex health issues, especially as a way to bypass the healthcare system's refusal to do it in the first place. Not failure: refusal. This is paying twice over for worse results. Wait, no, it's 3 times over, since you have to account for the losses incurred by someone being unable to work when they're left untreated indefinitely.

But that was always the case, chronic illness is endless, you never get to the end of it. It's created non-stop from even mild infections and medicine has turbocharged this recently by making every possible mistake about COVID. Even if the BPS paradigm worked, the only way to deliver this would be something like IAPT, just the cheapest, most industrialized McDonald's approach of quickly served, quickly out the door. But of course even the most highly-formalized way of doing this, the PACE model was extremely expensive, doesn't even work.

It's fantasy-based medicine. The fantasy that it could even work. The fantasy that it works despite evidence otherwise. The fantasy that it's cheap and effective. The fantasy that it can be delivered safely to everyone when not even 10% of patients could realistically be seen in that model, which at its very best boasts of a 1/7 with some marginal benefits.

In project management, you always have to choose between cost, speed and quality. Somehow, the combination of EBM and the BPS model managed to produce the absolutely worst case of completely ineffective, extremely expensive and stuck in the 19th century. Eventually this will be studied as a textbook example of how to fail perfectly, it's right there with the war on drugs, not accomplishing a single one of its objectives and not only making all existing problems worse, but creating entirely new ones that take a life of their own, problems that will far outlast even the end of this error.

You have to go to politics to find anything equivalently dumb. There is nothing else like it.

 

I'm American and was last in school in 2014. We always had a school nurse.