Special Health Care Needs

Special Health Care Needs

Purpose of Training To improve the effectiveness of school-based personnel in providing services to students with special health care needs. To develop awareness and knowledge of specific conditions that students may experience and the tasks that school personnel may be required to perform.

This Training Is Intended For. Unlicensed Assistive Personnel (UAP) which is defined as a staff member that does not hold a nursing degree.

This Training Applies To. The provision of special health care needs services to students that require individualized health care intervention to enable participation in the educational process.

Section I

Objectives Guidelines for Training Laws and Practice Guidelines Overview

Registered Nurse is responsible for the following: General training Student specific training for all UAP and Training for students involved in self care

General Training Key components of general training for the UAP include: Awareness Training Individual Health Care Plan (IHP) Emergency Plan

Student-Specific Training Key components of student-specific training for the UAP include: Overview of the Training Health Care and Medical Procedures Emergency Plan

Student Training Designed to assist students in providing self-care. Key components of student training include: Independence of Self-Care Responsibility of the Care Provider

Nursing Laws That Impact Students A.C.A. § 6-18-1005 (a)(6)(A) “Students with special health care needs, including the chronically ill, medically fragile, and technology-dependent and students with other health impairments shall have individualized healthcare plans.” A.C.A. §6-18-1005 (a)(6)(B)(i) “Invasive medical procedures required by students and provided at the school shall be performed by trained, licensed personnel who are licensed to perform the task subject to A.C.A. §17-87-102 (6)(D) or other professional licensure statutes.”

Federal and State Laws Family Educational Rights and Privacy Act (FERPA) Health Insurance Portability and Accountability Act (HIPAA) American with Disabilities Act (ADA) Section 504 Individuals with Disabilities Education Act (IDEA)

What is the Family Educational Rights and Privacy Act (FERPA)? FERPA is a Federal law that protects the privacy of students’ “education records.” (See 20 U.S.C. § 1232g; 34 CFR Part 99). FERPA applies to educational agencies and institutions that receive funds under any program administered by the U.S. Department of Education. U.S. Department of Health and Human Services and U.S. Department of Education, 2008, p.1. Joint Guidance on the Application of the FERPA and HIPAA To Student Health Records. Retrieved from https://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa-guidance.pdf Generally, schools must have written permission from the parent or eligible student in order to disclose any information from a student’s education record which includes health records. All student records are covered under FERPA but in some instances Health Insurance Portability and Accountability Act (HIPAA) may also apply. Written permission must be obtained from the parent or eligible student in order to disclose any information from a student’s health record.

Section 504 (1973) IDEA ADA (1990) A Comparison Type and Purpose Section 504: a federal law designed to eliminate discrimination on the basis of disability. IDEA: a federal law that requires schools to serve the educational needs of eligible students with disabilities. ADA: a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and public and private places that are open to the general public.

Section 504 IDEA ADA A Comparison Who is protected? Section 504: Protects all people with a disability that impairs a major life activity (learning is one). Prohibits discriminating in any program that receives federal dollars. IDEA: Provides educational services to children ages 3-21 who are determined by a multidisciplinary team to be eligible within one or more of 13 specific disability categories and need special education and related services. ADA: Gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion.

Section 504 IDEA ADA A Comparison Provides for FAPE Section 504: Provides accommodations to remove discriminatory barriers. In education, a “504 Plan” is a blueprint for how the school will provide supports to remove barriers for a student with a disability, to that the student has equal access to the general education curriculum. IDEA: States that districts must provide a Free Appropriate Public Education (FAPE). Provides a special education plan known as an Individualized Education Program (IEP) that describes services provided. ADA: Guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, state and local services, and telecommunications. It does not directly provide for FAPE.

Section II

Objectives Standard Precautions Within Scope of Practice Within Scope of Practice with Supervision

Standard Precautions

Standard Precautions A set of infection control practices used to prevent transmission of diseases that can be acquired by contact with: Blood Body fluids Non-intact skin Mucous membranes

Standard Precautions Prevention of exposure may require: Handwashing Personal Protective Equipment At risk situations Cleaning up spills Handling used equipment and/or linens Sharp objects

Handwashing The most effective procedure to protect staff and other students from the transmission of infectious diseases is Handwashing!

Personal Protective Equipment Appropriate personal protective equipment MUST be used in a CONSISTENT manner to reduce the risk of exposure. Disposable Gloves Masks Protective Eyewear Cover Gowns or Lab Coats

Cleaning Spills Clean up spills immediately. Wear gloves during cleaning of spills. If splashing may occur, wear protective eyewear in combination with mask and cover gown. If broken glass or sharp objects are involved, use a brush and dustpan to remove the objects. DO NOT USE YOUR HANDS!

Cleaning Spills Use chlorine bleach solution (1 part bleach and 9 parts water) or Cidex Must be clearly labeled Must be made daily Must be kept out of reach of children Remove majority of spill with disposable paper towels. Place disposable paper towels in a plastic bag.

Handling Used Equipment and/or Linen Handle, transport, and process used equipment and/or linen soiled with blood, body fluids, secretions, and excretions in a way that prevents skin and mucous membrane contact, contamination of clothing and transfer of microorganisms.

Sharps ALWAYS place used disposable needles, syringes, and other sharp items in appropriate puncture-resistant containers.

Within Scope of Practice

Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/L S-19-006--School Nurse Guidelines 201 8 Revision Updated 7.11.18.pdf

Nursing Tasks A Within Scope of Practice S Within Scope of Practice with supervision D Delegated task with supervision EM In emergencies X Cannot perform Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2018 Revision Updated 7.11.18.pdf

Within Scope of Practice What is Within Scope of Practice? Everyone has a Scope of Practice Determined by your license and education/training What is allowed Within your Scope of Practice? Toileting and diapering Dressing Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Toileting/Diapering Notify RN immediately if these occur: Foul smelling urine or stool that is abnormal to the student Difficulty expelling urine or stool Complaint of pain or discomfort with elimination Change in color of the urine color/consistency of stool Any changes in skin: Extreme redness Bleeding Breakage of skin

Within Scope of Practice With Supervision

Within Scope of Practice With Supervision What is Within Scope of Practice with Supervision? “the active process of directing, guiding, and influencing the outcome of an individual’s performance of an activity” How does Within Scope of Practice with Supervision apply to the UAP? Supervision is accessible; not necessarily physically present. Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Within Scope of Practice with Supervision Who supervises nursing tasks? Only the RN can supervise health services. What is allowed within your Scope of Practice with Supervision? Dental hygiene Oral hygiene Lifting/positioning/transfers Oral feeding External catheter application Indwelling Catheter Vital signs Ostomy care Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2018 Revision Updated 7.11.18.pdf

Within Scope of Practice with Supervision Activities of Daily Living (ADL) include: Bathing Dental and Oral Hygiene Grooming Application of deodorant Remember your standard precautions when working with any of these that involve bodily fluids. Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Within Scope of Practice with Supervision Activities of Daily Living also include: Lifting includes 1-man/2-man Assistive Equipment Transfers include Transferring from one location to another. Positioning can include Head Feet Back Side Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Lifting/Positioning/Transfers Body Mechanics The coordinated effort of the musculoskeletal and nervous system to maintain balance, posture, and body alignment during lifting, bending, moving, and performance of ADLs. Student specific Must receive training from the nurse or physical therapist

Within Scope of Practice with Supervision Activities of Daily Living: Feeding Includes: Oral Feeding - providing nutrients and fluids to a student that requires assistance putting food in mouth and swallowing Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Within Scope of Practice with Supervision External Catheter Application: noninvasive method to drain the bladder Indwelling Catheter Care: cleansing and emptying of collection bag(urine) Ostomy Care: cleansing and emptying of collection bag(fecal matter) Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2018 Revision Updated 7.11.18.pdf

Within Scope of Practice with Supervision Vital Signs: Clinical measurements of a person's physical condition: Pulse Rate Temperature Respiration Rate Blood Pressure Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Confidentiality If a parent has a question/complaint, ALWAYS direct them to the nurse and/or special education teacher. You can ONLY have a discussion about a student IF all people involved in the discussion (or are able to hear) are also directly involved with the care of the student.

Section III

Objectives Delegated Tasks with Supervision In Emergencies What Cannot be Performed by the UAP

Delegated Tasks with Supervision

Principles of Delegation After assessment and consideration of the principles of delegation, the decision to delegate nursing care must be based on the following: Student’s nursing care needs are stable Performance of the task does not pose a potential harm to the student Task involves little or no modification Task has a predictable outcome Task does not inherently involve ongoing assessments, interpretations, or decision making The unlicensed assistive personnel skills and competency levels The availability of supervision Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks What is Delegated Task? Only the Registered Nurse responsible for a student’s nursing care may determine which nursing tasks may be delegated to Unlicensed Assistive Personnel. American Nursing Association (ANA) defines supervision as “the active process of directing, guiding, and influencing the outcome of an individual’s performance of an activity.” How does Delegated Task apply to the UAP? Supervision does not require the supervisor to be physically present 100% of the time; however, the supervisor must be able to critically watch and direct the activities or course of action. The amount of supervision required is directly related to the individual’s experience, skills, and abilities and the healthcare needs of the students being served.

Delegated Tasks Only the RN may delegate tasks and only if the five rights of delegation have been met by the UAP: Right Task Right Circumstance Right Person Right Supervision Right Communication

Delegated Tasks with Supervision Bowel and Bladder Training Gastrostomy (G-tube) Feeding and Monitoring Gastro-jejunal G/J Tube Feeding Monitoring Clean Intermittent Catheterization Monitor Ventricular Peritoneal Shunt Monitor Ventilator Intermittent Oxygen/continuous Oxygen monitoring Medications: Oral Prescription & Over the Counter Routine Asthma Inhaler/Emergency Rescue Inhaler Eye/Ear Drops Topical Ointments Prescription/OTC Medications per G-Tube Postural Drainage/Percussion Pharyngeal and Tracheal Suctioning/Tracheostomy care Assist with BMI/Hearing/Scoliosis screenings Blood Glucose/Urine Glucose, Ketones Seizure Safety Procedures Vagal Nerve Stimulator Pressure Ulcer Care/ Sterile and Nonsterile Dressings

Delegated Tasks Elimination Impairment Bowel/Bladder Training Clean Intermittent Catheterization Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Feedings Gastrostomy Feeding (G-tube) Bolus (specific amount at one time - usually 20-30 minutes) Continuous (runs continuously, over a number of hours, usually on a pump) Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Ventricular Peritoneal Shunt Key Elements to watch for: Headache, vomiting, confusion, increased sleepiness Vision difficulties, fever greater than 101.5 orally Increased redness or discomfort or new or excessive drainage from an incision or wound from a recent shunt placement/revision Report these to the nurse IMMEDIATELY. Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2018 Revision Updated 7.11.18.pdf

Delegated Tasks Mechanical Ventilator & Oxygen Monitoring Mechanical Ventilator It is important to understand the ventilator has many settings which are set to alarm if a value goes out of the acceptable range. Intermittent Oxygen and Continuous-Monitoring Oxygen Some students may require oxygen during the school day. Oxygen therapy is used to keep the students from becoming hypoxic. If an alarm goes off call the nurse. Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks !! Administration of Medication !! Each individual school district should have a policy regarding administration of medication. Parental consent must be obtained for each medication administered. The licensed school nurse is responsible for the administration of medications. The licensed nurse is responsible for identifying qualified persons to be trained to administer medications in the nurse’s absence. Documentation by the UAP is required when administering medication. Administration of any medication (topical, drops, G-tube, oral) is student specific. Disposal of unused medication is the responsibility of the school nurse.

Delegated Tasks Medications: Oral Prescription Oral Prescription Must have medical provider order Must be in current prescription container with Student’s Name Drug Name Amount Frequency MUST have parental consent! Medications: Over The Counter (OTC) May be included in the IHP or Emergency Plan Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Routine Asthma Inhaler/Emergency Rescue Inhaler An IHP or Emergency Plan is needed Must be in current prescription container with student’s name and directions Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Eye/Ear Drops and Topical May be Prescription or OTC ALWAYS consult with nurse Medications: Over The Counter (OTC) May be included in the IHP or Emergency Plan Must Have Parental Consent! Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Medications per G-Tube Administration via G Tube Addressed in the IHP May be with or without feeding according to medical orders Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Postural Drainage and Percussion Facilitate drainage of secretions Positioning Vibration and shaking to loosen secretions Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS19-006--School Nurse Guidelines 2018 Revision Updated 7.11.18.pdf

Delegated Tasks Suctioning: Pharyngeal and Tracheostomy Sometimes it may be necessary to suction secretions from the mouth or tracheostomy. Suctioning may be performed with a suction machine or a bulb syringe. Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Tracheostomy Tube Replacement and Care Proper Tracheostomy care Trach Tube replacement done only in emergency Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Assist with School Screenings Body Mass Index (BMI) Hearing Scoliosis Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Blood Glucose/Urine Glucose, Ketones Blood Glucose Student specific The concentration of glucose (sugar) in the blood Urine Glucose/Ketones Student specific The concentration of glucose/ketones in the urine Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Key points during seizure Remain calm Help child to the floor Move objects away from the child Do not put anything into child’s mouth Once the jerking movements stop turn the child on side Follow IHP for length of seizure activity before medication administration Stay with student until fully alert Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Document Seizure Episode Time of onset Length of episode Loss of consciousness Loss of bowel/bladder Did student return to pre-episode state of alertness?

Delegated Tasks Seizures Partial Seizures Affects one area of the brain in one hemisphere May or may not have loss of consciousness Muscle twitching, repetitive motions, and daydreams, and/or may become generalized Generalized Seizures Affects both hemispheres Loss of consciousness, and/or blank stares, sudden jerking movements Blank stares, falling to floor, sudden jerking movements, and repetitive stiffening and relaxing of muscles Absence Seizures (petit mal) Most common, blank stare

Delegated Tasks Vagal Nerve Stimulation Used when medications do not control seizures and the student is not a candidate for surgery. Approved for children over the age of 12. The VNS is a flat battery which is surgically implanted in the chest wall close to the collarbone. Thin wires are then fed to the Vagus nerve in the neck to send small amounts of electrical pulses to the brain. If a seizure is approaching, a magnet can be passed over the device to activate the stimulation. Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Delegated Tasks Pressure Ulcers Prevention is key Dressings, Sterile Dressings, Non-sterile Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2018 Revision Updated 7.11.18.pdf

Emergency Situations

In Emergencies What is Emergency? A case-by-case situation and deemed life-threatening that will be covered in student-specific training How does Emergency apply to the UAP? Maintain Standard Precautions Assurances of Proper Protocols Knows location and follows Emergency Care Plan Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

In Emergencies Nursing tasks that may be performed in Emergency situations by a UAP Naso-Gastric Tube Removal Ambubag Epinephrine Auto-injector Tracheostomy Tube Replacement Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

In Emergencies This medication is used to reverse the effects of opioid overdose (hydrocodone, oxycodone, heroine, etc.) Naloxone Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006-School Nurse Guidelines 2018 Revision Updated 7.11.18.pdf

Cannot Perform Can Volunteer

In Emergencies What is Can Volunteer? A trained school volunteer personnel may only administer in the absence or unavailability of the school nurse. May administer Glucagon Insulin (unscheduled dose) How does Can Volunteer apply to the UAP? Sign a volunteer form Cannot be coerced or made to feel obligated Parent must approve of volunteer Written into the IHP Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Cannot Perform - Can Volunteer Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

Cannot Perform

Cannot Perform What is Cannot Perform? Nursing tasks that SHALL NOT be delegated How does Cannot Perform apply to the UAP? The UAP can NEVER perform these tasks UAPs who violate the Nurse Practice Act by practicing nursing without a license are subject to civil and/or administrative prosecution Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2 018 Revision Updated 7.11.18.pdf

What I can NEVER do!! Develop protocols Health care procedures Emergency protocols Individualized health care plans Nursing tasks which require nursing judgement/intervention Teaching student-focused self-management care Receiving or transmitting verbal or telephone physician orders

What I can NEVER do!! Nasogastric (NG) feeding and monitoring Jejunostomy tube feeding Total Parenteral (IV) feeding and monitoring G-tube reinsertion Sterile urinary catheterization Ventilator adjustment Central Line Catheter Peritoneal Dialysis Oral controlled substance administration (w/ exception of parental delegation and specific guidelines and policy)

What I can NEVER do!! Injections (w/ exceptions: emergency epinephrine or glucagon) Naloxone (w/ exception: in emergency and specific training) Nasal insulin or controlled substances Rectal medication administration Bladder instillation Medication administration via NG tube or IV Ostomy irrigation Vision Screening Remember, these are only the things you cannot do. There are many, many more that you can do.

Section IV

Objectives Individualized Healthcare Plan (IHP) The Role of the UAP in the IHP Emergency Care Plan

Individual Health Care Plan (IHP) What is an IHP? A document based on nursing processes which is a series of organized steps designed for nurses to provide quality care For students to have safe and optimal attendance and academic performance (best outcomes) Consists of five steps and is completed by a RN (Nurse Practice Act) How does IHP apply to the UAP? UAP needs to be aware that students with IEPs and 504 plans may have IHPs. UAP training will be developed from the students’ IHP needs.

Emergency Care Plan What is an Emergency Care Plan? It provides a plan of treatment based on symptoms specific for a student and when a condition is likely to result in an emergency Recognition and response of problems and emergencies Individual responsibilities: who, how, and what to do List of contacts in case of emergency How does Emergency Care Plan apply to the UAP? Based upon the UAP’s responsibility designated in the Emergency Care Plan, the UAP will react and respond to the situation according to the training that has been provided

Crisis Management Plan What is an Crisis Management Plan? A plan to ensure that ALL students remain safe and able to access medications according to their IHP in the event of a crisis such as: Fire Tornado Active Shooter Earthquake Hazardous Spills Etc. How does Crisis Management Plan apply to the UAP? To provide support depending on the crisis, environment, and student.

Thank You! References U.S. Department of Health and Human Services and U.S. Department of Education, 2008, p.1. Joint Guidance on the Application of the FERPA and HIPPA To Student Health Records. Retrieved from https://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa-guidance.pdf Arkansas State Board of Nursing (Revised 2018). School Nurse Roles and Responsibilities - Practice Guidelines [Nursing Tasks]. Retrieved from http://adecm.arkansas.gov/Attachments/LS-19-006--School Nurse Guidelines 2018 Revision Updated 7.11.18.pdf