Media attention surrounding the increased rates and serious consequences of concussions among American youths has instigated the passage of laws in all fifty states requiring improved management of concussions and the development of programs, such as the Center for Disease Control and Prevention, Heads Up to Concussion. Progress has been reported in the efficacy of concussion diagnosis and return-to-play decisions. However, there has been less progress in managing the protocols for cognitive rest and return-to-classroom. The purpose of this study was to identify significant stakeholders and factors that could improve management of cognitive rest and return-to-classroom protocols in high school students. A multidisciplinary concept analysis identified cognitive rest as a key component of concussion management. A descriptive pilot study, based upon the Theory of Planned Behavior, was conducted to explore the norms in concussion management and perceptions of school nurses in Texas. A new instrument, The Schneider Concussion Care Survey was developed and tested. The results of the pilot study were also employed to develop a study that tested the effect of a video modeling a conversation between a school nurse and a school principal, suggesting the development of a concussion care management team. Although the results for the intervention were statistically non-significant, the study identified study variables that affected the intention of school nurses in return-to-learn management and supported the Decomposed Theory of Planned Behavior. The overall results supported the need for further research among stakeholders in concussion management in order to impact the health of concussed students.

Date of publication

Spring 4-25-2017

Document Type




Persistent identifier


Committee members

Dr. Jenifer Chilton, Dr. Barbara Haas, Dr. Luzita Vela, Dr. Benjamin Tseng


Doctor of Philosophy in Nursing