I don't have any wisdom to offer. Used to case manage tech dependent children and was told by one school nurse that they would _never_ honor a DNR and would always code a child. The rationale was that it would be too traumatic for other children to see another child die. My thoughts on this statement were:
Seeing someone coded can be pretty traumatic, too.
Crowd control would be essential, just like it would be for a lot of school based events like fights or a student's having a seizure or a significant injury.
Not honoring a no code could put the school nurse and the school at risk.
The kids I had that were at greatest risk for suddent death in the classroom were my trache vent kids and my children with degenerative neuro disorders. Some of these kids are in limited settings, like SMH classrooms, where the students might be upset by such events while not being highly able to know just what happened. Other kids are really mainstreamed and their suddent death could be viewed by or impact alot of kids. How you deal with the kids/survivors might be described under crisis plans, which are typically designed to deal with traumatic sudden death like a shooting, but I believe they could be molded to deal with the trache vent kid who experiences sudden unanticipated airway problems and dies, too.
The words of caution I have that flow out of this are:
Make sure your parents of your at risk kids know your policy.
Make sure the school based care givers have what they need (a "go bag" for the trache vent kids) to handle an emergency and have some comfort with what they might have to do (replace the trache tube, give mouth to stoma respirations, etc).
I had a child that had a neuro-degenerative disorder and his mom wanted him to go to school, where he slept alot. The staff had at least some awareness that this kid could snooze off and not wake up (remote, but not impossible) and I think school nurses need to discuss with staff what might happen (and she had) and what to do. This mom was not ready to do the no-code.
Do I think school attendance can be part of "palliative care" for some kids. Well the answer is "yes", but requires great communucation between mom, school nurse and admin and classroom. Most moms are not going to send their kid to school on the day they think the look poorly enough to die, but sudden unexpected death can happen. Good luck. This is truly the new frontier in school health, isn't it?
[This message has been edited by MollyJ (edited November 11, 2000).]