History: Increased numbers of medically fragile, chronially ill students are in school.
Decription: In some instances, parents of chronically ill students do not wish CPR to be initiated in the case of respiratory or cardiac arrest. The school district may be petitioned to honor a DO NOT RESUSCITATE order.
Rational: DO NOT RESUSCITATE orders are a sensitive issue. School health nurses will often need asistance in developing a plan of care for medically fragile students and learning when it is possible to honor a DNR order.
Conclusion: It is the position of the Michigan Association of School Nurses that DO NOT RESUSCITATE orders for medically fragile students must be evaluated on an individual basis at the local level, according to state and local laws. The local Board of Education should refer this matter to school district legal counsel for guidance. Each student involved should have an individualized Health Care Plan developed by the professional school health nurse with involvement from the parents, administrator, physician, teacher and student, when appropriate. At a minimum, this request needs to include a written DNR request from the parent(s) as well as the physician's written DNR order. The plan should be reveiwed at least annually. The health plan also should state the steps to be taken in case of respiratory or cardiac arrest.
Adopted April, 1996.
History: The passage of PL 94-142 in 1975 provided for appropriate public education for all students in the least restrictive environment regardless of physiccal or mental disabilities. The law was updated with IDEA (1990) PL 101-476 and Section 504 of the rehabilitation Act of 1973 PL 93-112 which protects the rights of handicapped persons and obligates local districts to provide related services, including health services to those not eligible for special education. Due to improved medical technology, high risk infants and children are now entering school. Many of these students have special health care needs that will need to be addressed during the school day.
Description: Local school districts must porvide services to students with specal health care needs that are consistent with services that are offered to their students. However, the unique health care needs of these students cannot be compromised in the school setting. The local school district has a respnsibility to adequately plan for these students by including health care services that will meet the needs of the technology dependent/medically compromised child now and in the future.
Rationale: The provision of educational services for students with special health care needs must include the use of appropriate health care personnel to reduce and limit the health risk for these students. The school nurse is uniquely qualified to provide the health services needed for students with special health care needs. The registered professional school nurse is recognized as the only school employee who is licensed and certified to assess, plan, and evaluate the health needs of children.
Conclusion: It is the position of the Michigan Association of School Nurses that every child is entitled to a level of health and wellness that will permit the maximum utilization of educational opprtunities along the full continuum of services that best meet the student's needs in the least restrictive environmentt. The school nurse is the best qualified professional to provide this level of health and wellness to the student with special health care needs.
Adopted April, 1996.
