Ostomy care in school

[Jeanine]

I have a new student coming into 7th grade next year. She was an "average" kid prior to discovering a brain tumor a few years ago. Since then, she has had chemo and radiation, which has destroyed quite a bit of brain tissue. They don't really want to place her in a school for multiple-handicapped students because emotionally, she is still an "average" kid. She is now in a wheelchair, needs thickened liquids and a special diet, and is incontinent of B&B. She will be getting a colostomy soon and will be returning to school in Sept. if all goes well. The special ed dept is interviewing for a one-on-one aide for this student. It is my feeling that they should hire an LPN for her because she has some pretty complicated medical issues. I'm not sure that an aide can do ostomy care, deal with the feeding issues, catheter care, and tend to her other needs. I know that families can do these things at home, but in my past experiences, we've never let ER techs do ostomy care in the ER or CNA's do ostomy care in the nursing home. I am responsible for about 800 students, many with diabetes, arthritis, seizures, etc..., so my day really doesn't include the 20-40 minutes a day that it would take to perform these activities, nor does my office have the space for an aide to perform them (supervised) as I attended to the other students. I'm not sure that I amcomfortable being ultimately responsible for the actions performed by an aide, I'd prefer an LPN who has some medical training.

Has anyone dealt with this in the public schools? If so, what have you done?

Am I worrying needlessly and I should give an aide a chance?

What are your thoughts on this delegation issue?

After all, it's my license!!

[valifay]

If the aid is trained properly and the family has approved this person to care for their child then I see nothing wrong with it. A CNA can do ostomy care, catheter care, feeding and other things you mentioned. I'm sure the family and school would not hire someone without plenty of experience relating to her condition. I'm sure you would feel better with an LPN, but I'm not sure an LPN would appriciate doing CNA duties. Either way, if a real emergency was to take place, or her bag needed changing, isn't there a nurse on duty at the school anyway who could step in periodically help out???

[NRSKarenRN, BSN, RN]

Our homecare aides do ostomy care all the time. CNA should be able to care just fine for this patient. Thickened liquids involves adding product like Thick-It to fluids, again our aides do that. Can cafeteria provide dietary needs or is parent providing lunch?

Is school handicapped accessible with elevator for WC use? Handicapped stall for private area to provide incontinent care?

Meeting child now, preparing for issues for fall will go long way in easing your mind and parents. Best wishes.

[Jeanine]

They are not talking about hiring a CNA. They hire a lay-person who would be made aware of their duties. I am the nurse on duty, and as I mentioned before, I can't close my office to change an ostomy bag, replace a wafer, straight cath., or directly supervise her care. There is a handicapped accessable rest room right down the hall from me that will be used for those things. Of course, I am there for emergencies, but not for her ADL's. Perhaps it would be a less expensive alternative to hire a CNA though. I would be more comfortable with a CNA than with someone off the street who "likes to work with kids" as their credentials.

The school has a lift for wheelchairs, so they can get around. She will be eating food from the cafeteria, chosen by the parents in advance and the parents will supply the Thick-It for the drinks.

THANKS FOR YOUR HELP! I feel less like I need an LPN, still not comfortable with a lay-person, but pretty confident about requesting a CNA.

[valifay]

Oh my...do not let them hire a lay person for this job! The things you mentioned she would need care for should be done by someone who is trained, and certified to do so. I'm sure a CNA would be able to handle it, but be sure to stress it is your professional opinion they hire someone with plenty of experience. Not just anyone would be fit for the job, and someone right out of training probably wouldn't be prepared to do one on one care either. WIll you be present when they interview this person? If so, I'm sure you will make the right decision.

[Hilundlass]

We have a child coming to school with continent stomas and a tube feeding. Thankfully, the school has agreed to hire a one on one nurse because these are stomas, not regular ostomies, which require direct cathing into the umbilicus and tube feedings.

I hope your situation turned out the way you wanted it to!

Hilundlass