SCHOOL HEALTH SERVICES AND SCHOOL NURSING SERVICES
The IDEA 1997 definition of school nurse services has been expanded and re-named school health services and school nurse services. According to federal regulations, the expanded definition clarifies that “ school nurse services” are provided by a qualified school nurse, and “school health services” may be provided by a qualified school nurse or other qualified person. School health services and school nurse services are designed to enable a student with a disability to receive a free and appropriate public education (FAPE) as described in the student’s IEP. Nursing is governed by nursing and medical facilities follow standards and practices set forth by agencies such as the National Association of School Nurses and the American Nurses Association.
Referral for Evaluation
The school nurse or the school health assistant (as directed by the school nurse) must coordinate all health and nursing supports.
The school nurse can assist in coordinating communication between the school and the home and help ensure that evaluations conducted are comprehensive and address all areas of the student’s suspected disability.
When student health is of primary concern, the Intervention Assistance Team (IAT) chairperson and school nurse:
participate in the IAT process and referral meeting
address the student’s school health information and needs, and
complete a referral for evaluation when necessary.
Evaluation Criteria/Process
The evaluation of a student’s health care needs involves a multidisciplinary process. For a student with a verified disability or who is in the process of a special education evaluation, the request for a health care evaluation may be part of the evaluation planning process.
After completion of the IAT process, the school nurse may:
Schedule a meeting with the parent for completion of pertinent background information.
Obtain written release of information consent from the parent.
Contact the student’s primary physician to discuss the student’s special health care needs.
Obtain a copy of the physician’s order and parent authorization for potential special health care services to be performed at school
Complete a written summary of the student’s specialized health care needs. For a potential student with a disability, this summary should become part of the multidisciplinary evaluation team report.
A key component of this multidisciplinary evaluation for a student with a health related condition is a health assessment that may be conducted by the school nurse.
Based on this assessment, the school nurse identifies those health issues that are relevant to the student’s educational progress.
If the assessment reveals that the student’s medical needs exceed the capacity of the campus nurse to perform safely, the nurse should contact the Cincinnati Health Department for further assistance.
If a student with health related disabilities is determined eligible for special education and related services, an individualized health plan (IHP) should be initiated by the school nurse. Need to look at this!!!! - 504?
Health assessment refers to the collection and analysis of information or data about the student's state of health, patterns of functioning, and need and management for health services in the school setting.
The health assessment is conducted by the nurse and consists of data collection, data analysis, and nursing diagnosis.
The extent of information gathered by the nurse will be determined by the student’s health care needs.
The assessment of resources and needs should be based on information gained from the medical records, school records, and concerns of the parents, student, and school personnel.
The assessment process must consider needs for training, equipment, and accessibility with each setting the student will be in during the school day as well as during transitions between these settings.
A statement of the special education and related services, the supplementary aids and services, and a statement of the program modifications or supports for school personnel that will be provided for the student are to be included in the IEP. If a student with special health care needs has been referred to special education or has already been identified according to state regulations as a student in need of special education, the recommendation is that the school nurse be part of the multidisciplinary evaluation team and provide a written report for the multidisciplinary evaluation team report
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Nursing is governed by nursing and medical facilities that follow standards of care and practice set forth by agencies such as the National Association of School Nurses and the American Nurses Association.
Definition of an Individualized Health Plan (IHP)
A written document that outlines the plan to manage school healthcare services
based on the nursing process and must include assessment, nursing diagnosis, outcome identification, planning, implementation, and evaluation. The IHP is similar to a nursing care plan. IHPs are intended to promote learning by improving the communication/coordination/continuity of healthcare within the school setting, along with other healthcare providers. This includes the regular evaluation of, and any necessary revision of, healthcare being provided.
Who is eligible for an IHP?
Students whose healthcare needs affect their daily functioning or safety, students with multiple healthcare needs, students needing lengthy procedures or treatments, students who require routine or emergency contact with a school nurse or unlicensed assistive personnel and/or those students that have healthcare services indicated as part of the IEP or 504 Plan. The need for an IHP is based on required nursing care, not educational entitlement such as special education services or Section 504 of the Rehabilitation Act of 1973.
When is an IHP Indicated?
Students with significant or chronic health problems, which can interfere with school participation and/or require specialized services, indicate a need for an IHP. Students eligible for special education services must receive any necessary service to access or benefit from their educational plan. Healthcare services should be outlined in an IEP, and an IHP may be included as an attachment to the IEP.
Where is an IHP applicable?
An IHP is applicable anywhere a student is in the custody/supervision of school staff. This includes on the bus and during field trips; however, no special considerations may be needed on the bus or during field trips. For example, a student with a seizure disorder will have an IHP that should be followed while on the bus as well as at school. A student with an intermittent catheterization at school will have an IHP but will not have any special provisions while on the bus, and transportation services would not be given the health information on that student.
Who writes an IHP, how often is an IHP written and when is an IHP updated?
It is the responsibility of the RN to write/develop the IHP. It is the responsibility of the RN to implement (or delegate the implementation of) and evaluate/update the IHP at least yearly. In addition, the RN is responsible for updating the IHP when there is any significant change in healthcare to be provided and/or change in doctor’s order.
What procedure do schools/teachers/principals follow to obtain an IHP?
Currently, there is no specific procedure in place. The RN responsible for a school identifies students that are determined to have a need for an IHP and one is initiated. Other times a teacher, intervention specialist, principal, or secretary may alert the RN to a student (or newly enrolled student) that may need healthcare services and the RN begins the process of assessing, which may lead to the development of an IHP.
Who is responsible for ensuring it is followed in the building?
The RN is accountable for creating the IHP, managing the IHP interventions/activities and evaluating the IHP outcomes, even when the implementation is delegated to unlicensed assistive personnel.
Definition of a School Health Assistant (SHA)
A type of unlicensed assistive personnel hired and trained specifically to provide support in addressing the healthcare needs of students while in the school setting. The SHA follows state guidelines for emergency intervention, helping ill or injured students and administering medications. The SHA provides treatments and assists in implementing IHPs.
Definition of a School Nurse
School nursing is a specialized practice of professional nursing that advances the well-being, academic success and life-long achievement and health of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning (NASN, 2010).