How involved a patients school work should be expected?

JustBeachyNurse, LPN · Oct 1, 2014

What are you being asked to do? I've been in a case with home schooling due to serious injury or illness. I did the medical care, helped with positioning/support, checked or applied splints & braces, assisted with adaptive equipment. The home school teacher was experienced working with students like my patients.

SLHLPN · Oct 1, 2014

So far, sit with him during on-line classes and ? guess how he is responding to the teachers questions. He is non-verbal but does answer questions SOMETIMES by moving his tongue or feet.

JustBeachyNurse, LPN · Oct 1, 2014

Can he operate an adapted switch? That may work. I've never done "traditional" homeschooling with a child it's always been a 1:1 teacher due to home bound status

SLHLPN · Oct 1, 2014

He is working with ST on a DynaVox that picks up his eyes. His responses are very intermittent. ST is trying to get CG to use a head or foot switch as needed. His responses OVERALL are pretty random, so pretty much it would be a guess at answer to a question at this point. Thank you!

caliotter3 · Oct 1, 2014

If this is addressed in the care plan and no one comes to the house for teaching/reinforcing, or the family does not get involved, then you would need to use your judgement about how involved you need to get. Normally, this type of activity is not part of our regular duties, and not addressed on the nursing care plan, but most will assist in order to facilitate matters. You should touch base with the instructor(s) so that whatever effort you make does not contradict what they are trying to do. It may seem like it does not matter, but you don't want the family to get an erroneous impression and then get upset over it.

SDALPN · Oct 2, 2014

I've never seen instructions on a care plan to tell us to help with school work. Care plans will never cover every situation.

Nursing comes first. The patients health and safety come first. As nurses its our job to educate patients on their health and care, not school. However, in the gray area of private duty, we must do other tasks to help care for the patient. At the time most parents are helping with homework, special needs parents may be using that time to get med refills or make calls about appointments. So they need someone to help with tasks like homework do they can do things that most parents don't have to. But we still have to prioritize and if we can't help because the nursing care came first, the parents will have to deal with that.

When we work with (developmentally appropriate) toddlers, we play while naming colors, numbers, shapes. That sure won't be found in the care plan either. Some things just flow with the care of the child.

Exceptions to me would be things such as being in a classroom and being expected to help or work with other kids. Of course I've tied a shoelace for the 3 year old classmate who didn't understand why I was there. A 3 year old wouldn't understand why I should say no, so I let that go. But I'm not helping other kids in a classroom with things the teacher should be doing. That's why she is paid to be there. I'm not changing another kids diaper in class. And I'm not a nurse to any kid other than my patient. That's where the line should be drawn.

amoLucia · Oct 2, 2014

Maybe I'm seeing something different - could a PDN getting involved in school work somehow erroneously skew testing/scoring of a student's test results/achievement?

Like the PDN knows that 2+2=4, and she tries to help/guide/direct the student in answering 4. But how does she know that the student might have answered 5 because student doesn't really know the answer was 4?

Just thinking ...

caliotter3 · Oct 2, 2014

If the people involved with the student's schooling were concerned about an extended care nurse skewing the student's answers, then they would either appropriately instruct the nurse or they would provide the in-home instruction/facilitation themselves.

amoLucia · Oct 3, 2014

TY for your response. Question - in general, who provides the in-home schooling? Parent or outside provider, like a school district?

I find the forums in other fields of nsg informative & enlightening. When one has been in their own nook for a while, it becomes quite a learning experience about what's out there.

For example, like 'who'd thunk it' that there was a hierarchy of assignment and selection of which prisoner gets the upper bunk or the lower one in prisons. Learned about it reading here.

caliotter3 · Oct 3, 2014

I've always known the school district to provide the schooling. Only difference I've ever seen, thus far, is that the parents either will have the student attend school outside the home, or will have a home instructor come to the house (if this is an option). Some parents prefer to have their children exposed to life outside of their bedroom, while others prefer not to be inconvenienced (or whatever) with sending the child out of the home.

SDALPN · Oct 3, 2014

Parents can still choose to home school their child with special needs. If the child can't go to school, the school has teachers that go to the patients home. Usually for about an hr or so, but I've seen longer. Every child has a right to school (though I wonder if it does more harm than good). Some schools don't allow oxygen because its considered a fire hazard (still wonder why its ok in science labs, but not for medical use). One way or another, they make it work.

We can't change a patients answers. If they are capable of answering independently, we let them. If they need the help that most of our patients need, we are usually just going through the motions. Many of the kids can't answer and the switches are just in case they do understand. I've seen very few that can really understand and use the switches. If a kid repeatedly bangs his head on the right side of the headrest and they put a switch there, the kid is just doing the same repetitive behavior and the switch is just there. When the school does real testing, they administer the tests themselves.