Nurse Education Webinar Series

1. Nurse Education Webinar Series Susan Hoffmann MSN, RN, NCSN February 6, 2019

2. Care Coordination: Planning and Implementation Part 1 Individual HealthCare Plans

3. Planning Care for Students Who What When Why & HOW TO

4. Objective Participants will be able to develop an Individualized Healthcare Plan (IHP) using a student-centered approach

5. Polling Question #1 How many of your students have a written Individual Healthcare Plan? • None • 1-5 • 6-20 • Over 20

6. Polling question #2 Referring to the students in the previous question: • All the students who need an IHP have one • There are more students who should have an IHP • I’m not really sure who should have an IHP • Most of the students who an IHP don’t really even need one

7. Background • 25 % of all students have chronic health condition • FEDERAL LAWS • IDEA ensures a free, appropriate public education (FAPE) in the least restrictive environment (LRE) • Section 504 (Rehabilitation Act of 1973) Prohibits discrimination on the basis of a handicap (civil rights legislation). Deals with providing reasonable accommodations for students with disabilities. • The school nurse is responsible for developing a plan to meet the in school medical needs of students so that they can be healthy, safe and ready to learn • Planning care is a Standard of School Nursing Practice

8. Deciding which Plan to Develop IEP 504 Emergency Action Plan Individual Healthcare Action Plan Individual Healthcare Plan Sampson, C.H., Will, S. I. (2017)

9. 504 Plan Student Eligibility • Student has a mental or physical impairment that adversely impacts a major life activity. Characteristics • Includes health accommodations, aids, and services to provide access to education • The IHP and EAP, when required, should be referenced as “on file in the health office.” Purpose • Provides access to education for students with disabilities. • Demonstrates compliance with federal civil rights laws (Section 504) and ADA.

10. Emergency Action Plan (EAP/ECP) Student Eligibility • Potential for specific actions by school staff to intervene for a student in the event of healthcare emergency or situation. Characteristics • School nurse uses IHP information and medical orders to determine the treatment protocol for school staff to follow. • Distributed to school staff who are responsible for the student. Purpose • Provides other school staff with criteria to identify emergencies and directions to assist the student. • Demonstrates compliance with standards of school nursing practice. • Used by school staff when responding to a health emergency

11. INDIVIDUAL HEALTHCARE Action Plan (IHAP) Student Eligibility: Students with special health care needs Purpose: Provides for effective and efficient delivery of services Promotes school success Reduces the liability of the school district. Process: All students requiring technical skills and services to meet their healthcare needs are seen by the school RN for assessment, planning and monitoring. Developed by the nurse for use by school personnel dealing with students requiring specialized nursing care

12. Individual Healthcare Plan (IHP)Guides Nursing Care Student Eligibility • School nurse creates an IHP when a student has chronic or significant health needs that require ongoing direct or indirect care from the school nurse. Characteristics • Created from assessment data and identifies nursing diagnoses, nursing interventions, and expected student outcomes. • Stored as an electronic or hard copy file in the student’s health record. • IHP information used to inform the 504 or IEP team regarding student health needs. Purpose • Documents the nursing process and outlines health services provided at school. • Demonstrates compliance with the state nurse practice act and the Standards of School Nursing practice.

13. Who Develops the IHP? “a plan of care written by the registered nurse”

14. Who – Student criteria for an IHP • Students with or at risk for physical or mental health needs • Need health services • Have health conditions that may lead to a medical emergency and require an Emergency Action Plan • Require specialized care • Receive health services under an IEP or Section 504 Accommodation Plan • Receive care delegated by an RN to unlicensed assistive personnel at school (detailed in the Individual Healthcare Action Plan)

15. Why Develop in IHP? Outline nursing care Combines all the healthcare needs of a student with a chronic condition into one document. Sets priorities Provides continuity of care as a student progresses through the school system (Sampson & Will, 2017).

16. Purpose of an IHP? Document nursing process in school nursing care. Provide legal documentation of an appropriate standard of safe care. Consolidate relevant student health information. Prioritize student health needs. Clarify clinical evidence-based practice. Facilitate a systematic approach to management of health conditions (planning). Foster multidisciplinary team approaches to support student access to a free and appropriate public education (planning).

17. More Purposes of an IHP Prepare for prompt response to medical emergencies planning (planning). Facilitate a safe process for the delegation of health services in the school setting, when allowed by state law (planning). Support the health components of education plans for the students (planning). Communicate the student’s plan of care to other nurses who may care for the student (implementation). Guide care coordination (implementation). Provide a method to review and evaluate nursing goals (evaluation). Provide information for administrative purposes (evaluation): accountability, quality improvement, data collection, and third-party reimbursement.

18. IHP Components Assessment Diagnosis Planning Outcomes Interventions Goals Evaluate

19. IHP - Assessment • Health History • Current Health Status • Social and Cultural Contexts • Current Academic and School Function

20. IHP Components – Nursing Diagnosis Problem statement focused on: • Specific health problem • Potential health risk • Health promotion strategy Prioritized by • Safety • Barriers to learning • Factors important to family and student

21. Standardized Nursing Language • NANDA- International • Nursing Interventions Classification • Nursing Outcomes Classification • Omaha System

22. IHP Component – outcomes identification The student will… Long range health goal Specific Measurable Achievable Realistic/Relevant Time-framed

23. Example of Long term Outcome By the end of the school year the student will increase compliance with the use of his/her prescribed inhaler by 20%.

24. Example of Long term Outcome By the end of the school year, the student will improve school attendance by 10%.

25. IHP Components – Planning Evidenced based interventions May include development of additional documents such as emergency care plan and disaster plans Equipment needed Health teaching topics How and where to document the care provided Communication plan for interacting with family and healthcare provider Participation in all school activities (sports, clubs, field trips, etc) Delegation as permitted by state law

26. IHP component – Evaluation • Process – were the planned interventions effective • Outcomes – progress toward the long range goal • Establish benchmarks • Short term objectives

27. Case Scenario #1 Student with SpinA BIFIDA

28. Case Scenario #2 STUDENT WITH LUPUS

29. Case Scenario # 3 STUDENT WITH DIABETES

30. Case Scenario #4 Student with seizures

31. Next Steps: What will you do this week? What can you do this year? What will you do in the 2019-2020 school year?

32. REFERENCES • National Association of School Nurses. (2015). Individualized healthcare plans: The role of the school nurse (Position statement). Silver Spring, MD: Author. • National Association of School Nurses. (2017). The role of individualized healthcare plans (IHPs) in care coordination for students with chronic health conditions: Principles for Practice. Silver Spring, MD: Author. • Sampson, C.H., Will, S. I. (2017). IHP Basics and Using IHPs with Other Educational, Health and Home Care Agency Plans. In S. I. Will, M. W. Arnold, & D. S. Zaiger (Eds.), Individualized healthcare plans for the school nurse (pp. 9–10). Forest Lake, MN: Sunrise River Press. • Younkitis, C.F., Shannon, R.A., (2019) Health and Education Plans for Students with Special Healthcare Needs, In J.Selekman, C.F. Younkaitis, & R.A.(Eds.) School Nursing A Comprehensive Text 3rd Edition, Philadelphia, PA: F.A. Davis Company.