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School Nurse Perspectives

Gerri Harvey, RN, MEd

12 School Nurse Actions to Support Inclusion

1. Coordinate

Offer to be the case manager for students with health problems. Don't get hung up on what this entails in special education language. It means that you serve as the coordinator of information in and information out and that you can touch bases with anyone who needs information or should provide information about this child. You don't need to know everything, you don't need to become a special ed expert, you just need to know who does what, and then know how the child's health issues could affect what they do.

2. Compensate

Many people think that inclusion means that the child should do what everyone else is doing. It doesn't mean that. Modification is a very acceptable and realistic educational and health-related tool. If a child cannot see, we don't expect him to read out of a book, we compensate for no sight by offering Braille or tapes. Likewise, if a child cannot run, we compensate by offering other types of activity. If he cannot feed himself, we compensate by offering assistance in the form of finger foods, special utensils, someone to feed him. Remember that the goal is always to enable the child to do as much for himself as possible. The ultimate goal is Functional Independence, i.e. getting on in life able to do as much as possible for oneself.

3. Communicate

Be willing to reach out, to offer information, to ask for information, even if someone else should be making the first move. Do not wait. Never say, "No one asked." Ask kids, parents, teachers, physicians, "What do you need? How can I help?"

4. Collaborate

Many of the things that kids need to function optimally in a school are available from an expert out there somewhere who doesn't yet know that you need what they have to offer. School nurses are so accustomed to being independent, that we sometimes stop asking. Diabetic teaching, nutritional counseling, physical aids, etc are available through state and privately funded agencies and groups. Don't work in isolation, obtain support and permission to utilize the experts in your community or state.

5. Facilitate

Remember that the educational system can be intimidating to parents and health care providers. The HealthCare system can be intimidating to educators, parents and kids. Both have walls, territory, and their own form of tunnel vision. You are a bridge between them...you know the culture, language, strengths, weaknesses, resources and roles of the players in both camps. Be a conduit of information.

6. Translate

Both education and Health Care have their own abbreviations, language, lingo. Don't ever pass along a report from a physician to a school team without translating it, and providing the implications to educators. "Serous otitis media responding to prophylactic antibiotic therapy with a prognosis of short-term intermittent conductive hearing loss." might not mean much to a classroom teacher or the team, but you can let them know that it means that the child has an ear infection, is on antibiotics for a bit, and is expected to hear again when it is cleared up.

Likewise, translate for physicians too. When the team asks for a diagnosis for a three year update, let the physician know that we do understand that a child with CP will always have CP, it's just that educational quality assurance equals restating the problem every three years so that old labels and goals are reviewed and updated.

7. Advocate

Sometimes, someone, somewhere just does not want to budge for one small child, one quiet teenager. Usually, it is not refusal so much as not understanding why, or perhaps not wanting to take the responsibility of making a decision that must be justified to the system. An example might be the excuse-weary gym teacher who doesn't want to have to deal with the tolerance level of an asthmatic student. Advocating might be putting in writing, on your own computer generated letter head, an official request to let the child drop out of an activity according to his own tolerance level. Sign your full name, including RN, and cc a copy to the student's file. It's officially your call when you do this, and those who are not comfortable bending the rules will often feel better if they know they can invoke proof that you made them do it. There is a lot of power in putting a request in writing. Not a scrap paper note, but an official communication.

8. Educate

No matter how much you know about a student's condition or needs, no matter how beautiful the written care plan, if it does not have relevance and meaning to the people who need the information, it serves no real purpose. Speak in language they understand, save the professional lingo, i.e.: don't say alteration in independent elimination when they need to know that the student needs help toileting. Don't just pass out written instructions to people, have mini lessons with staff, kids and parents as needed.

9. Innovate

Some of the best solutions are the simplest, and sometimes it takes a very creative school nurse to come up with them. You don't have to be super creative, you just need to know who the creative people are in your circle and tap them. Sometimes it's the kids. Sometimes it's the parent. Sometimes it is the custodian. Sometimes it's your husband. Mine happens to be very fond of saying, "Form follows function." He's an engineer who is frugal with resources, consequently, he can create something from practically nothing.There are hinged wall-hung changing tables in several schools in our district that cost about $20 apiece and take up zero space. My school spent ages trying to figure out how we would come up with changing tables for bigger kids that were study, safe, affordable, cleanable, and do-able by the school custodian. It took my husband five minutes and he was free too. Tap your free resources.

10. Demonstrate

There is a lot of power in show and tell. Model helping skills to others, and show staff how to assist children appropriately. Much "health-related " care can be safely and legally delegated to others who have been trained to do it under your supervision.Document the training, and observe periodically to be sure it is done with the safety of student and staff in mind.

11. Appreciate

Positive expressions of appreciation to those who work to meet the needs of the child in school can often come from the school nurse. Compliments to support staff, notes to teachers affirming their inclusive efforts, even comments in team meetings recognizing that yours is a school that includes all children can go a long way toward providing positive reinforcement for even the smallest efforts. While it is true that it is the law, and while it's true that sometimes the efforts are made grudgingly, you can be a catalyst for staff reframing their self-concept from "we have to do this" to "we want to do this."

12. Celebrate

Be the one to let people know when a child, a school or a team accomplishes something for inclusion of all kids. Send notes to the kids, to parents, to teachers. Include the special kids accomplishments in your newsletters, newspapers, talks to civic groups. Let taxpayers and legislators know that education is about learning, and that every child learns something from others, from being together, from being their best self.

________________________________________________

Copyrighted 2002 Gerri Harvey, RN, MEd.

School Nurse Perspectives Home



	School Nurse Perspectives Gerri Harvey, RN, MEd 12 School Nurse Actions to Support Inclusion 1. Coordinate Offer to be the case manager for students with health problems. Don't get hung up on what this entails in special education language. It means that you serve as the coordinator of information in and information out and that you can touch bases with anyone who needs information or should provide information about this child. You don't need to know everything, you don't need to become a special ed expert, you just need to know who does what, and then know how the child's health issues could affect what they do. 2. Compensate Many people think that inclusion means that the child should do what everyone else is doing. It doesn't mean that. Modification is a very acceptable and realistic educational and health-related tool. If a child cannot see, we don't expect him to read out of a book, we compensate for no sight by offering Braille or tapes. Likewise, if a child cannot run, we compensate by offering other types of activity. If he cannot feed himself, we compensate by offering assistance in the form of finger foods, special utensils, someone to feed him. Remember that the goal is always to enable the child to do as much for himself as possible. The ultimate goal is Functional Independence, i.e. getting on in life able to do as much as possible for oneself. 3. Communicate Be willing to reach out, to offer information, to ask for information, even if someone else should be making the first move. Do not wait. Never say, "No one asked." Ask kids, parents, teachers, physicians, "What do you need? How can I help?" 4. Collaborate Many of the things that kids need to function optimally in a school are available from an expert out there somewhere who doesn't yet know that you need what they have to offer. School nurses are so accustomed to being independent, that we sometimes stop asking. Diabetic teaching, nutritional counseling, physical aids, etc are available through state and privately funded agencies and groups. Don't work in isolation, obtain support and permission to utilize the experts in your community or state. 5. Facilitate Remember that the educational system can be intimidating to parents and health care providers. The HealthCare system can be intimidating to educators, parents and kids. Both have walls, territory, and their own form of tunnel vision. You are a bridge between them...you know the culture, language, strengths, weaknesses, resources and roles of the players in both camps. Be a conduit of information. 6. Translate Both education and Health Care have their own abbreviations, language, lingo. Don't ever pass along a report from a physician to a school team without translating it, and providing the implications to educators. "Serous otitis media responding to prophylactic antibiotic therapy with a prognosis of short-term intermittent conductive hearing loss." might not mean much to a classroom teacher or the team, but you can let them know that it means that the child has an ear infection, is on antibiotics for a bit, and is expected to hear again when it is cleared up. Likewise, translate for physicians too. When the team asks for a diagnosis for a three year update, let the physician know that we do understand that a child with CP will always have CP, it's just that educational quality assurance equals restating the problem every three years so that old labels and goals are reviewed and updated. 7. Advocate Sometimes, someone, somewhere just does not want to budge for one small child, one quiet teenager. Usually, it is not refusal so much as not understanding why, or perhaps not wanting to take the responsibility of making a decision that must be justified to the system. An example might be the excuse-weary gym teacher who doesn't want to have to deal with the tolerance level of an asthmatic student. Advocating might be putting in writing, on your own computer generated letter head, an official request to let the child drop out of an activity according to his own tolerance level. Sign your full name, including RN, and cc a copy to the student's file. It's officially your call when you do this, and those who are not comfortable bending the rules will often feel better if they know they can invoke proof that you made them do it. There is a lot of power in putting a request in writing. Not a scrap paper note, but an official communication. 8. Educate No matter how much you know about a student's condition or needs, no matter how beautiful the written care plan, if it does not have relevance and meaning to the people who need the information, it serves no real purpose. Speak in language they understand, save the professional lingo, i.e.: don't say alteration in independent elimination when they need to know that the student needs help toileting. Don't just pass out written instructions to people, have mini lessons with staff, kids and parents as needed. 9. Innovate Some of the best solutions are the simplest, and sometimes it takes a very creative school nurse to come up with them. You don't have to be super creative, you just need to know who the creative people are in your circle and tap them. Sometimes it's the kids. Sometimes it's the parent. Sometimes it is the custodian. Sometimes it's your husband. Mine happens to be very fond of saying, "Form follows function." He's an engineer who is frugal with resources, consequently, he can create something from practically nothing.There are hinged wall-hung changing tables in several schools in our district that cost about $20 apiece and take up zero space. My school spent ages trying to figure out how we would come up with changing tables for bigger kids that were study, safe, affordable, cleanable, and do-able by the school custodian. It took my husband five minutes and he was free too. Tap your free resources. 10. Demonstrate There is a lot of power in show and tell. Model helping skills to others, and show staff how to assist children appropriately. Much "health-related " care can be safely and legally delegated to others who have been trained to do it under your supervision.Document the training, and observe periodically to be sure it is done with the safety of student and staff in mind. 11. Appreciate Positive expressions of appreciation to those who work to meet the needs of the child in school can often come from the school nurse. Compliments to support staff, notes to teachers affirming their inclusive efforts, even comments in team meetings recognizing that yours is a school that includes all children can go a long way toward providing positive reinforcement for even the smallest efforts. While it is true that it is the law, and while it's true that sometimes the efforts are made grudgingly, you can be a catalyst for staff reframing their self-concept from "we have to do this" to "we want to do this." 12. Celebrate Be the one to let people know when a child, a school or a team accomplishes something for inclusion of all kids. Send notes to the kids, to parents, to teachers. Include the special kids accomplishments in your newsletters, newspapers, talks to civic groups. Let taxpayers and legislators know that education is about learning, and that every child learns something from others, from being together, from being their best self. ________________________________________________ Copyrighted 2002 Gerri Harvey, RN, MEd. School Nurse Perspectives Home