Oregon State (CMdeux)

[ajasfolks2]

http://allergy.hyperboards.com/action/view_topic/topic_id/9277

Opeining Posts (CMdeux)

This one is a gem...There is buried GOLD in here. 

http://www.ode.state.or.us/groups/supportstaff/hklb/schoolnurses/findingsrecommendations.pdf

Highlights:

Defines 'medical fragile;'

Students face daily the possibility
of a life-threatening emergency
requiring the skill and judgment of
a professional nurse.

and the task force recommends a MAXIMUM ratio of 1FTE: 125 students when the population includes such children...

The map on page 33 should be particularly horrifying, however.

  The 'green' districts have nursing ratios which are </= 1 FTE: 750 students.  So, umm.. 'green' just means that those districts are meeting the demands of the 'general school population.'  That is, those without known medical conditions requiring nursing care.

Red means there are NO school nurses for the district.

Oregon ranks 49th in the nation for school nursing ratios.
Wonder who is 50th?   

I'm using it for another.... purpose.  Leverage on the state BOE...   



Wowie-o, though. 


ETA:  This document goes with the one linked above..... printing.... I am printing....      There are some pretty STERN warnings here about not delegating tasks that require nursing skills. I predict that this will be useful...

http://www.ode.state.or.us/groups/supportstaff/hklb/schoolnurses/appendix.pdf

Still digging...

Programs to Treat Allergic Response or Hypoglycemia.
(6) The Registered Nurse may teach and delegate a task of nursing care to one
unlicensed person, specific to one client, under the following conditions:
(a) The client's condition is stable and predictable.
(b) The Registered Nurse considers the nature of the nursing care task to
be provided, its complexity, the risks involved, and the necessary skill
needed to perform the task;
(c) The Registered Nurse assesses the client's condition and determines if
the unlicensed person is capable to perform the task in the absence of
direct Registered Nurse supervision;
(d) The Registered Nurse determines how frequently the client's condition
shall be reassessed to determine the appropriateness of the continued
delegation of the task to an unlicensed person;
(e) The Registered Nurse evaluates the ability of the unlicensed person to
perform the nursing care task; and
(f) The Registered Nurse documents the rationale for deciding that this task
can be delegated to the unlicensed person.

And later on...

(9) Under no circumstances may the Registered Nurse delegate the nursing
process in its entirety to an unlicensed person. Selected interventions or tasks
of nursing care may be delegated.

...

If no school nurse is available, the school administrator/special
education director will formulate a plan to provide for a health assessment of the
student's needs by a person working within the scope of his or her practice.

...

Nursing is both an art and a science and is based on the nursing process, which is a
systematic problem-solving method used by nurses in providing nursing care. The
nursing process is a five-step process that includes:
• Assessing a client's condition based on assessment,
• Making nursing diagnoses based on assessment,
• Planning care,
• Intervening (treatment), and
• Evaluating the effectiveness of the care provided.

At no time can a registered nurse delegate assessment or all aspects of the
nursing process to an unlicensed person.

So... em... correct me if I'm wrong here, but an assessment of possible ANAPHYLAXIS pretty much requires 'assessment' in this context, yes?  (I hear angels singing. )

From:

http://www.ode.state.or.us/groups/supportstaff/hklb/schoolnurses/medicallyfragile.pdf


That really seems to run counter to the information in this document:

http://www.ode.state.or.us/groups/supportstaff/hklb/schoolnurses/injectablemeds.pdf

At least for children who have had atypical presentations of anaphylaxis. KWIM?

[ajasfolks2]

More follow on.

CMdeux

And, just to be perfectly clear....

such an 'assessment' is probably not something that can, say..... wait until a nurse can travel from a neighboring school half an hour hence.   

Hell, given what that MAP shows... half an hour?  In a place like Malheur county?  HA.  Try two hours.

One more question that I have, however.... is regarding what may be considered LRE and FAPE.

Can a school mandate that a medically fragile child be sent elsewhere for services (such as a full-time nurse)?  Even if that is outside of the neighborhood school?

Doesn't that deny LRE for the child and for the family?  (They are no longer afforded inclusion in their neighborhood school as a result... and may be forced to bear an undue burden in terms of transportation to and from extracurricular activities/conferences/etc.)



What if such a placement decision is unanimous?  Or parent-directed?  Is it still a denial of FAPE/LRE?


I think this is perfectly analogous to having a child not ride the school bus or purchase a school-provided lunch.  If we as parents choose that for our children as the BEST option... are we saying that it is by definition 'LRE' as we see it?  Or are we denying them LRE because of our inability to get adequate accommodations from the school?

Just musings on my part.  Probably don't even belong in this thread... but hey.  I'm hiding this here where it is less likely to draw unwanted attention.  For now. 

Some related links...

Technical asst on placement and LRE, 2006

(That one is good.)

http://www.ode.state.or.us/policy/federal/idea/policyproced/05lre.doc

Another excellent find...

http://www.ode.state.or.us/wma/schoolimprovement/accountability/monitoring/2008/indicatorb5lre.ppt#276,6,District Responsibility: Placement Decision & LRE

(check out the fifth page into the presentation... about what should be considered a priority for placements which meet LRE...)

"Is as close as possible to the child's home."

"In selecting the LRE, consideration is given to any potential harmful effect on the child or on the quality of services that he or she needs."

 

Just found something.... wonderful... at Wrightslaw...

In this regard, two points should be stressed. First, there is no quantifiable standard by which to apply the "substantially limits" test. Second, to determine whether a student's learning is substantially limited, schools need to consider more than the student's grades. Both academic and nonacademic activities need to be considered. For example, if a student with diabetes is barred by the school from participating in class trips because of the impairment, the student's learning is "limited."

Interpreting Section 504's coverage too narrowly has resulted in many districts being found out of compliance for failure to identify students protected solely by Section 504.

From Section 504 and IDEA 97]