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HISTORY:
Increased numbers of medically fragile, chronically ill, and terminally ill students are attending school.
DESCRIPTION OF ISSUE:
In some instances, parents of medically fragile, chronically ill, and terminally ill students do not wish Cardio Pulmonary Resuscitation (CPR) to be initiated in the case of respiratory or cardiac arrest. The school district may be petitioned to honor a DNR order.
RATIONALE:
Do Not Resuscitate orders are a sensitive issue. Professional school nurses will often need assistance in developing a plan of care for the student when it is possible to honor a Do Not Resuscitate (DNR) order.
CONCLUSION:
It is the position of the National Association of School Nurses that DNR orders for a student 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 (IHCP) and an Emergency Plan developed by the professional school nurse with involvement from the parents, administrators, physicians, teachers, and, when appropriate, the student. The IHCP needs to include a written Do Not Resuscitate request from the parent(s) as well as the physician's written Do Not Resuscitate order. In some states, the IHCP may need to include a court order to honor the DNR order. The plan should be reviewed at least annually. The IHCP also should state the procedure to be taken in case of respiratory or cardiac arrest.
References/Resources:
National Association of State Boards of Education, 277 South Washington Street, Suite 100, Alexandria, VA 22314. www.nasbe.org
National School Boards Association, 1680 Duke Street, Alexandria, VA 22314. www.nsba.org,
Adopted: September 1994
Revised: June 2000
November 2004 |