School Health Care

The number of students with special health care needs in the education setting is increasing due to advances in medicine and increased access to public education as authorized by federal and state laws. Furthermore, some chronic conditions have a potential for developing into a medical emergency and require the development of an Emergency Care Plan (ECP). The ECP is a component of an IHP, not a substitute.

Standardized IHPs, both printed and computerized, are available for the most frequent chronic health problems that occur in school-age children. These standardized care plans help promote consistency of care.

In addition, the use of standardized language is being encouraged in the development of IHPs to ease communication with other team members, to assist with data collection demonstrating the school nurse contribution to student health and education outcomes, and to examine linkages between interventions and outcomes. Nevertheless, individualization is essential in order to meet the unique needs of each student.

Who needs an individualized health care plan?

A significant task for the school nurse, especially when assigned high student ratios and/or multiple buildings, is the determination of which students require an IHP. Prioritization of students and their needs is essential and begins by identifying students whose health needs affect their daily functioning, that is, students who:

• Are medically fragile with multiple needs.
• Require lengthy health care or multiple health care contacts with the nurse or unlicensed assistive personnel during the school day.
• Have health needs that are addressed on a daily basis.
• Have health needs addressed as part of their IEP or 504 plan.

Next, prioritization is accomplished by focusing on health issues that affect safety and the student’s ability to learn or that the student, family, and/or teachers perceive as priorities. Ideally, the IHP is developed collaboratively with the student, family, school staff, community, and other health providers, as appropriate.

Ongoing evaluation assures a commitment to achieving measurable student outcomes. IHPs are updated as appropriate and revised when significant changes occur in the student’s health status.

How can the IHP be helpful?

As a leader of the school health team, the school nurse is responsible for first assessing the student’s health status; identifying health problems that may create a barrier to educational progress, safety or well being; and developing a health care plan for management of the problems in the school setting. The use of current care standards in the development of the IHP will help assure administrators, parents, and staff that the student is properly cared for. The IHP can assist in many areas:

• Professional school nurses utilize IHPs to communicate nursing care needs to administrators, staff, students, and parents.
• The IHP will create a safer process for delegation of nursing care, supporting continuity of care.
• The IHP can serve as the health plan component of a 504 plan, and for students qualifying for special education; it can be incorporated into the Individual Education Plan when the health care issues are related to the educational needs of the student.

Resources

http://www.nasn.org/Default.aspx?tabid=226

Utah State Office of Education—Special Education http://www.schools.utah.gov/sars/