Assessment

October 20, 2006 --Today Jim Flink, of Kansas City ABC television affiliate KMBC, reported that a local school nurse had been "credited with saving a student's life" by diagnosing a brain aneurysm. The piece highlights school nurses' autonomy and skill. And it shows why they deserve adequate resources, at a time when many face extreme short-staffing despite the increasing number of students who attend with serious health concerns.

The KMBC site headline for the piece is "School Nurse Helps Save Student With Aneurysm." Liberty High School nurse Michele Kist (right) says that, in the prior week, a student had come to her office with a severe headache. The piece says that Kist had a "hunch" there was more to it; the piece also suggests that she "followed her instincts." Apparently the student got a conclusive diagnosis and treatment for the aneurysm, though the piece oddly does not pursue that. It does quote "Health Services coordinator Kathy Ellermeier" as noting that "[t]he aneurysm was the size of the student's pinky finger, which is very unusual. Normally, they're stringy and small. I just can't imagine how this student had something that size and it didn't burst." Ellermeier also says that (in the piece's words) "school nurses diagnose all kinds of problems, and they don't have doctors or high-tech equipment as backup." So, she notes, the nurses' "assessment skills have to be top-notch." The piece closes with a quote from Kist: "We take care of the most precious commodity every parent has, and that's their children."

This short piece does several good things. Although the instinct-oriented language does not necessarily portray nurses as serious science professionals, the rest of the piece does. The piece suggests broadly that Kist saved the student's life with her diagnosis. The quotes from Ellermeier paint an excellent quick portrait of nursing skill and autonomy in a front-line community setting. And unlike some pieces about nursing, this one actually quotes two nurses.

Note that while the direct quote from Ellermeier employs the standard nursing term "assessment" for what nurses do, the report's indirect quote of another comment from her uses the term "diagnose." There is a conceptual distinction between diagnosis and nursing assessment, and nurses have historically been warned away from the term "diagnosis" (except in relation to "nursing diagnosis") because it has been seen as the province of physicians. But some feel that it is important that the public understand that nurses often diagnose or play a key role in diagnosing serious conditions, and that nurses should use the word to describe what they do, when appropriate.

The piece might have made clear that Ellermeier, who displays clinical knowledge, is a nurse (with a masters degree in nursing), and that she manages the school district's health services. Because Ellermeier is not identified as a nurse, readers may assume that she is not one, particularly since the media often suggests that nurses do not manage their own profession, and nurse experts are not usually consulted. It would be helpful for the public to understand that this expert health manager is a nurse.

The article might also have provided more detail on what actually happened to the student. But it notes that the student's family "did not want to comment," so perhaps that reluctance was a factor.

We thank Jim Flink and KMBC for this generally helpful report.

See the story "School Nurse Helps Save Student With Aneurysm" by Jim Flink on KMBC.