Use of Individualized Healthcare Plans to Support School Health Services
It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) initiates and develops an Individualized Healthcare Plan (IHP) for students whose healthcare needs require more complex school nursing services. An IHP is a plan of care written by the registered nurse for students with or at risk for physical or mental health needs (ANA & NASN, 2017). It is the responsibility of the school nurse to annually evaluate the IHP, as well as to update the plan if deemed appropriate, to reflect changes in the student’s healthcare needs and address nursing interventions and/or student healthcare outcomes.
BACKGROUND AND RATIONALE
A variety of documents is used in the educational setting to support student health, safety and success. Confusion often exists in the educational and healthcare fields regarding the purpose, components and content of the IHP. Many outside the profession of school nursing have attempted to define and describe the use of IHPs (Donoghue & Kraft, 2019; Hopkins & Hughes, 2016). Educators, families, non-school healthcare professionals, and even school nurses have used the term IHP to describe a multitude of health-related plans.
In the school setting, the IHP is the counterpart of the nursing care plan. With chronic health conditions affecting nearly one in four American school children (CDC, 2019), the IHP is a necessary tool for delineating the nursing plan of care to foster academic success and support optimal attendance. The IHP is created by the school nurse for the school nurse. The IHP fosters communication among nursing staff to promote continuity of care (Sampson & Will, 2017), for example, when a substitute nurse is required, or as the student progresses though the school system (Yonkaitis & Shannon, 2019). This document is based on the nursing process, utilizes nursing language, documents standards of school nursing practice, and is driven by outcomes (Galemore & Sheetz, 2015; NASN, 2017). It is the guiding document for delivery of student-specific nursing care, illustrating the school nurse's responsibility and accountability (NASN, 2017).
School nurses create an IHP for select students with healthcare needs that, if not addressed, may negatively affect, or have the potential to affect, attendance and/or academic performance. These students may have chronic health issues or have an acute alteration in their health status that may temporarily require specialized nursing care. Priority for IHP development must be given to those students who require significant health services at school, have a medical diagnosis that may result in a health crisis, and/or students with health conditions addressed in a Section 504 Accommodation Plan or an Individualized Educational Program (Yonkaitis & Shannon, 2019).
Depending on the health condition, IHPs may prompt the development of student Emergency Evacuation Plans (EEP) and/or Emergency Care Plans (ECP), both of which are initiated and developed by the school nurse. These plans stem from the intervention component of the IHP and provide instruction on addressing healthcare needs or appropriate response to a student’s emergent healthcare issue (Sampson & Will, 2017). These plans use language best suited for the non-medical educational staff.
The school nursing profession is responsible for defining its own standards (ANA & NASN, 2017) and has stipulated the purpose and content of an IHP is to:
- Document standards of school nursing practice
- Document the nursing process
- Facilitate evidence-based management of the health condition
- Outline the relevant knowledge and actions needed by school personnel to support the student’s access to a free and appropriate education
- Prepare for prompt responses to medical emergencies
- Support the health components of education plans for the student
- “Support the student's success by providing the school’s multidisciplinary team with a systematic, organized approach to meeting specific health needs” (NASN, 2017 p. 2)
- Guide care coordination for the student
- Serve administrative purposes by defining the focus of nursing, validating the nurse’s role in the school, and differentiating accountability of the nurse from other staff (Hermann, 2005)
- Provide an effective vehicle for documentation of nursing delegation when permitted by state nurse practice act and state law (Sampson & Will, 2017)
The IHP is a vital and practical tool to manage or mitigate student-specific healthcare needs. The school nurse is the sole professional qualified to generate an IHP. Utilizing NASN's Framework for 21st Century School Nursing Practice™ (NASN, 2016) the school nurse, mobilizing the key principles of care coordination and quality improvement, initiates, develops, implements, evaluates and revises the IHP to maximize student health, support academic success, and optimize school attendance.
American Nurses Association & National Association of School Nurses. (2017). School nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Authors.
Centers for Disease Control and Prevention. (2019). Promoting health for children and adolescents. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/children-health.htm
Donoghue, E. A., & Kraft, C. A. (Eds.). (2019). Managing chronic health needs in childcare and schools: A quick reference guide (2nd ed., IrAXW). https://ebooks.aappublications.org/content/managing-chronic-health-needs-in-child-care-and-schools-2nd-ed
Galemore, C. A., & Sheetz, A. H. (2015). IEP, IHP, and Section 504 Primer for new school nurses. NASN School Nurse, 30(2), 85–88.
Hermann, D. (2005). Individualized healthcare plans. In C. Silkworth, M. Arnold, J. Harrigan, & D. Zaiger, (Eds.), Individualized healthcare plans for the school nurse: Concepts, framework, issues and applications for school nursing practice (pp. 1-4). North Branch, MN: Sunrise River Press.
Hopkins, A. F., & Hughes, M. (2016). Individualized healthcare plans: Supporting children with chronic conditions in the classroom. Young Exceptional Children, 19(2), 33–44. https://doi.org/10.1177/1096250614566538
National Association of School Nurses. (2017). The role of individualized healthcare plans in care coordination for students with chronic health conditions: Principles for practice. Silver Spring, MD: Author.
National Association of School Nurses. (2016). Framework for 21st century school nursing practice. NASN School Nurse, 31(1), 46-53. https://doi.org/10.1177/1942602X15618644
Sampson, C. H., & Will, I. S. (2017). IHP Basics and Using IHPs with other educational, health and home care agency plans. In I. S. Will, M. W. Arnold, & D. S. Zaiger (Eds.). Individualized healthcare plans for the school nurse: A comprehensive resource for school nursing management of health conditions (2nd ed., pp.1-10). (Forest Lake, MN: Sunrise River Press.
Yonkaitis, C. F., & Shannon, R. A. (2019). Health and education plans for students with special healthcare needs. In J. Selekman, R. A. Shannon, & C. F. Yonkaitis (Eds.). School nursing a comprehensive text. (3rd ed., p. 179). (Philadelphia, PA: F. A. Davis Company.
Acknowledgement of Authors:
Gina Emge, MSN, RN, CSN-NJ
Louise Wilson, MS, BSN, RN, NCSN
Tina D. Miller, MA, BSN, RN, NCSN
Andrea Ferguson, RN, CSN
Adopted: June 1998
Revised: November 2003, March 2008, June 2008, June 2013, January 2015, January 2020
Suggested citation: National Association of School Nurses. (2020). Use of individualized healthcare plans to support school health services (Position Statement). Silver Spring, MD: Author.
“To optimize student health, safety and learning, it is the position of the National Association of School Nurses that a professional registered school nurse is present in every school all day, every day.”
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.