Individual Health Plans

[cowgirlBSN]

Do you all do individual health plans? And if so, what diseases/illness do you make health plans for? Do you only make one if they have an IEP?

[Purple_Scrubs, BSN, RN]

I do IHPs for all my kids with meds (school or home if I know about them), any congenital problems like heart defects, all chronic illnesses like asthma, etc. Mine do not correlate with the IEP, heck, half the time I am not made aware that a student has an IEP Hope that helps!

[cowgirlBSN]

Yes that helps a lot! I just had a conversation with our asst principal about a student who is on add medication to see if that student had an IEP. I was reading in our guidlines for Illinois and it said that any student who takes prescription medication while at school should have a 504 plan or IEP? I've been here 3 years and evey year I've learned something else that I've been doing wrong.... Hope one of these years I'll have everything lined out! Do you send health plans home to be filled out by parents or do you compose them yourself from health records?

[Purple_Scrubs, BSN, RN]

I do them myself, and I consult the health records, any previous IHP (although the nurse who was here before me had none so i was basically on my own), and I usually call the parents just to get an idea about the kid and the condition. For instance, if the kid has asthma I'll talk to the parent about what s/s that kid has when he needs his inhaler. I had one that mom told me she can always tell he is about to have an attack because he gets really really quiet. I passed this on to the teacher and that tidbit of info has helped prevent serious attacks. So, after that I always give the parent a shout for their input. For a serious medical condition I like to talk to the treating MD as well, but usually only for kids having issues like asthma not being controlled well, g-button leaking, etc.

I did not know that any kid with meds should have a 504/IEP, I'm going to have to check in my state to see if we are the same! I have been here

[luvschoolnursing, LPN]

Oh my! I know I am not writing that many plans. We only write plans for student's disability impacts their learning. A diagnosis of asthma does not impact learning if it is just a student carrying an inhaler that they use every other month or when they are sick. We do write plans for kids with asthma, but those are kids with a significant condition that require more than the usual abscenses or need large blocks of time out of class for nebs or such. I even have a couple kids I give meds to at school that don't have plans, because they stop in between classes, get their meds and move along, it doesn't significantly impact learning. If I wrote for all those things, including meds at home I would have hundreds!!! Am I doing this wrong?

[cowgirlBSN]

I was thinking that also. I think I have a list of 50+ students who "have asthma" and other such issues. That seems like a lot of plans to me but I wasn't sure exactly what warrants an IHP! Thanks for the feedback

[bergren]

I did a worKshop on this last summer and tried to attach the power point, but the file was too big. So the outline:

Purpose of Care Plans:

• Administrative
  
• Focus
  
• Validate
  
• Accountability
  
• Quality criteria
  
• Reimbursement
  
• Legal
  
• Delegation
  

NASN Standards of Practice

Professional expectations of nurses who serve students, defines &

clarifies role of nursing in schools & the school community

Standard 1**** Assessment****** ************The school nurse collects client data.

Standard 2**** Diagnosis ******************* School nurse analyzes data determine nursing diagnoses.

Standard 3**** Outcome Identification***The school nurse identifies expected individual outcomes.

Standard 4**** Planning******************** The school nurse develops care plan interventions to attain expected outcomes.

Standard 5**** Implementation ********** The school nurse implements interventions in care plan.

Standard 6**** Evaluation******************** The school nurse evaluates progress toward outcomes.

Standards of Professional School Nursing Practice

• Collects data
  
• Analyze data
  
• Identifies outcomes
  
• Plans action
  
• Implements action
  
• Evaluates
  

Who needs a care plan?

• Nursing judgment
  
• Requires preventative measures
  
• Requires education
  
• Requires recognition of symptoms
  
• Requires a response
  
• Treatment
  
• Medication
  
• Procedures
  

Who needs a care plan?

• Acute & chronic physical & health impairments, e.g. cerebral palsy & diabetes
  
• Developmental problems
  
• Diseases, such as Lyme disease & tuberculosis
  
• Medical interventions, e.g. gastrostomies & organ transplants
  
• Allergies, e.g. latex allergies
  
• Social / emotional problems
  

Generic care plans

• General staff and teacher training
  
• Anaphylaxis
  
• Breathing
  
• Bleeding / Injury
  
• Loss of Consciousness
  

Why me?

• Registered nurse
  
• Professional standards
  
• Education and background
  
• Knowledge / evidence dynamic
  

References

Selekman, J. (2006). School nursing: A comprehensive text. Philadelphia: F.A. Davis

http://www.nasn.org/store/

C. Silkworth, M. Arnold, J. Harrigan, & D. Zaiger (Eds).(2005). Individualized healthcare plans and the school nurse. North Branch, MN: Sunrise River Press.

[cowgirlBSN]

Thanks so much for the info. It's an issue I've been struggling with since I started school nursing.