NURSING INTERVENTIONS

Sickle Cell Nursing Interventions



Abstract

Sickle cell disease (SCD) affects over 30,000 students in the United States. Central nervous system complications are widespread among students with SCD and include stroke, silent cerebral infarction, and cognitive impairment. The effects of these complications may lead to academic failure, limited career options, and for some, total disability. Despite studies describing the significant academic and cognitive impact of sickle cell disease, reports describing interventions are limited. There is a lack of awareness among educators of the academic risks associated with sickle cell disease and a lack of appropriate resource allocation. The school nurse, as community health advocate, will be called upon to bridge the gap among healthcare providers, parents, students, and educators. This article provides a review of both recent and landmark studies describing the cognitive and academic impact of sickle cell disease and discusses the role of the school nurse as an advocate, liaison, and educator. Objectives: The aim of this study was to describe strategies needed to maximize the base of nursing intervention science.

Sickle Cell Nursing Interventions

Literature Review

School nurses face a multitude of tasks with the rising rate of students diagnosed with chronic illnesses. Students with sickle cell disease (SCD) have a genetically acquired blood disorder that makes their chronic illness relatively invisible. These students are usually mainstreamed into the regular classroom within the school system, but as many as 50% of students with SCD will fail at least one grade (Javid, 1999). It has been reported that there is a lack of knowledge among educators concerning the academic implications of the direct and indirect complications from SCD (Schatz, 2004; Freeman, 2003).

The role of the school nurse is critical to improving the academic status of students with SCD. The nurse must have an accurate and comprehensive understanding of the academic and cognitive impact of SCD and be ready to imple- Sara Day, RN, MSN, is the nursing director of the International Outreach Program at St. Jude Children's Research Hospital, Memphis, TN. Elisabeth Chismark, RN, MSN, is a clinical nurse specialist for the Adolescent Sickle Cell Clinic at St. Jude Children's Research Hospital, Memphis, TN. ment specific interventions. These interventions include promoting classroom educator awareness, developing individualized health care and educational plans, and referring the child and family for services as indicated by the individual need of the child.

SCD is one of the most prevalent genetic disorders, affecting over 70,000 people in the United States; approximately 30,000 of these are students. Although SCD primarily affects those of African heritage, it is also found in persons of Mediterranean, Caribbean, South and Central American, Arabian, or East Indian ancestry (National Institutes of Health, Lung and Blood Institute, 2004). SCD includes a group of genetic diseases characterized by the predominance of sickle hemoglobin in erythrocytes. The most common genotypes of SCD include hemoglobin SS (Hb SS), hemoglobin SC (Hb SC) disease, and sickle beta thalassemia.

The clinical manifestations of SCD are the result of a single substitution in the gene encoding the human ...