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History:  Increased number of medically fragile, chronically ill and terminally ill students are attending school.

Description:  In some instances, parents of 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 Do Not Resuscitate (DNR) order.

Rationale:  DNR orders are a sensitive issue.  Professional school nurses will often need assistance in developing a plan of care for 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 DNR orders for 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 (IHCP) developed by the professional school nurse with involvement from the parents, administrator, physician, teacher and, when appropriate, the student.  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 reviewed at least annually.  The IHCP should state the steps to be taken in case of respiratory or cardiac arrest.

 Adopted:  April 1996
Revised:  January 2006

History:  The passage of PL 94-142 in 1975 provided for appropriate public education for all students in the least restrictive environment regardless of physical 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 provide services to students with special 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 responsibility 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 opportunities along the full continuum of services that best meet the student's needs in the least restrictive environment. 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.

History:  The school code of Michigan of 1976, revised in 1995, Section 1178. states that "A school administrator, teacher, or other school employee designated by the school administrator, who in good faith administers medication to a pupil in the presence of another adult or in an emergency that threatens the life or health of the pupil, pursuant to written permission of the pupil's parents or guardian, and in compliance with the instructions of a physician is not liable in a criminal action or for civil damages as a result of the administration except for an act or omission amounting to gross negligence or willful and wanton misconduct." Federal legislation including I.D.E.A. (1990) PL101-476, previously known as PL94-142 of 1973, and Section 504 of the Rehabilitation Act of 1973, PL93-112, obligates local districts to provide related services, including health services to students. This includes administering medications needed during the school day.

Description:  The current code does not adequately address the wide variety and modes of administration of medication in the school setting. With improving technology, students are coming to school with more complex health problems, many involving administration of medications not previously required in the school setting. e.g.. Medications given via gastrostomy tube; rectally; intravenously; bladder instillation; injections such as adrenalin, glucagon, insulin, and Epi-pen; eye, ear, and nose drops; inhaler and/or nebulizer breathing treatments; and topical ointments. It is essential that inservice training and supervision of staff who administer medications be comprehensive and ongoing.  

Rationale:  When possible medications should be scheduled outside of the school day. However, we recognize the need for medication to be dispensed to students while they attend school. We further recognize that medication needs to be administered in a safe, effective manner. Medications need to be administered in compliance with existing state and federal statues. Due to the wide variety/complexity of medications being administered in the school setting, the inservice training, delegation and supervision must be provided by qualified licensed health professionals (e.g. R.N./physician) who by the Public Health Code have the right to delegate.  

Conclusion:  It is the position of the Michigan Association of School Nurses that medications be administered in a safe, effective manner in order to provide for the safety of the student and to protect the liability of the staff administering the medication.  Therefore, the following guidelines are recommended:

• The school district shall have a clear and concise written policy for administration of medication by school personnel. The school nurse or a physician shall be involved in the development of policy.  Procedures and protocols must be approved by the school nurse or physician in accordance with the Public Health Code of Michigan, Article 15, 333. 16109 (2) (c) of Act 368 of 1978*.
• All prescription, nonprescription, and homeopathic medications shall be given only with a written order from the physician which shall include the name of the medication, dosage, time to be given, length of time the medication will be prescribed, side effects of the medication, and the reason for the medication to be given.
• Written permission of parent or guardian must be obtained. 
• Self-administration of medications must follow the above criteria be approved by the physician, parent and monitored by the school nurse.
• Any change in prescription requires newly signed authorization.
• New authorization is needed at the beginning of each school year.
• Old authorization is retained according to state confidentiality laws.
• All prescription medications shall be administered only from containers properly labeled by a pharmacist or other licensed prescriber of medicine.
• The school district should have a standard method of documentation for all medications given in school. Completed logs must be stored according to state confidentiality laws. One member of the school staff shall be designated to administer medication, with a second person selected to act as backup.
• Non-nursing staff personnel shall administer medication in the presence of another adult.
• All medications shall be stored in a locked cabinet, with limited access.
• Medications shall be brought to school by the parent/guardian unless other safe arrangements are made and approved.
• Controlled substances shall be counted by the parent, confirmed by staff, and recorded in the log when received.
• Unused medication shall be picked up by the parent. Empty container shall be promptly returned to the parent.
• No medications shall remain in the building over the summer.
• If not picked up by the parent or guardian, medication shall be disposed of. This shall be witnessed and documented on the authorization form.
• Medication errors shall be documented and immediately reported to the child's physician and/or school nurse with appropriate follow-up as indicated. Parent(s) must be notified.

*Supervision, according to the Public Health Code of Michigan, Article 15, 333.16109 (2) (c) of Act 368 of 1978 calls for "the provision by the licensed supervising health professional of predetermined procedures and drug protocol." This means school districts need policy and procedures approved by the supervising licensed health professional (e.g. school nurse or physician, and that supervision of the school employee administering medications is needed either by the school nurse or child's physician.)

Revised and adopted 4-97

History: Federal laws, P.A. 101-478, IDEA and Section 504, of the Rehabilitation Act of 1973 mandate transportation and health services needed for disabled children to attend school. The disability must interfere with a major life function limiting the child's ability to get to/from the school/ bus stop. 

Description of the Issue: The special health needs of students which must be addressed during the IEP/IHP process include the following: 1) mode of transportation and modifications necessary to provide safe care; 2) individualized transportation health care plan developed by the school nurse or health care provider; 3) proper delegation, training and supervision of the transportation staff by the school nurse or health care provider.

Rationale: Each school district has the responsibility to provide safe and appropriate transportation for all students as provided in the IEP/IHP developed with the input of the school nurse or responsible health care provider.

Conclusion: It is the position of MASN that transportation is an integral component of the student's school day. Student health needs can best be provided for in the following way:

• Eligibility for transportation and the mode of transportation should be determined by the IEP/IHP process;
• Appropriate transportation staff should be invited to the MET or IEPC.
• Transportation plans should be individualized for students with special health care needs;
• Written procedures for the transportation of students with specialized health care needs should be developed by the school nurse (and physical therapist when appropriate) in conjunction with the physician;
• A completed emergency card for each student with picture identification should always be kept on the bus;
• Transportation personnel should be provided adequate training by the local or attending district school nurse or other appropriate licensed health care professional in transporting students with specialized health care needs. Training should include placing the student on/off the transportation vehicle, appropriate health care procedures, individualized to the student's needs and emergency care.

Adopted by the MASN Board 9-14-96

History:  The traditional role of school nurses has changed dramatically in the past twenty years. The new role of the school nurse includes the "provision of acute, chronic, episodic, and emergency health care, assessment of students' health status, identification of health problems that may affect educational achievement, development of health care plans, and administration of medications. In addition, school nurses provide health education and health counseling for students and families, advocate for students with disabilities, provide wellness programs for school employees, and are involved in program planning, development, management, and evaluation." (1)

Description:  A registered professional nurse (R.N.) certified by the Michigan Department of Education, employed by a board of education or provided by a local health department, enhances the educational process and potential of the student. Certification is required by the School Code, Rules 380.1252, 340.1165-340.1170. The addendum attached explains certification which requires a baccalaureate degree in nursing or other health related field within a specified time period.

Rationale:  The functions of the specialized school nurse includes but are not limited to the following:

1. Promotes and protects the optimal health status of children.
2. Provides health assessments.
• Obtains a health and developmental history
• Screens and evaluates findings of deficit in vision, hearing, scoliosis, growth, etc.
• Observes the child for development and health patterns in making nursing assessment and nursing diagnosis
• Identifies deviant health findings
3. Develops and implements a health plan.
   • Interprets the health status of pupils to parents and school personnel.
   • Initiates referrals to parents, school personnel and community health resources for intervention, remediation and follow-through
   • Provides on-going health counseling with pupils, parents, school personnel and health agencies
   • Recommends and helps to implement modification of school programs to meet student's health needs
   • Utilizes existing health resources to provide appropriate care of students.
4. Maintains, evaluates, and interprets cumulative health data to accommodate individual needs of students 
5. Participates on the child education evaluation team to develop the Individual Education Plan (IEP) by interpreting the health information and assists in planning the development of the IEP. 
6. Plans and implements school health management protocols for the child with special health needs, including the administration of medication and health treatments. 
7. Participates in home visits to assess the family's needs as related to the child's health in school. 
8. Develops procedures and provides for crisis intervention for acute illness, injury and emotional disturbances. 
9. Promotes and assists in the control of communicable diseases through preventive immunization programs, early detection, surveillance and reporting of contagious diseases.
10. Recommends provision for a school environment conductive to learning.
11. Provides health education:
• Teaches parenting skills as they relate to child development and health needs of children.
• Provides direct health education and health counseling to assist students and families in making decisions on health and life styles that affect health.
• Participates in health education directly and indirectly for the improvement of health by teaching persons to become more assertive health consumers and to assume greater responsibility for their own health.
• Counsels with students concerning problems such as pregnancy, sexually transmitted diseases, mental health issues, and substance abuse in order to facilitate responsible decision-making practices.
• Serves as a resource person to the classroom teacher and administrator in health instruction and as a member of the health curriculum development committees. 
12. Coordinates school and community health activities and serves as a liaison person between the home, school and community. 
13. Acts as a resource person in promoting health careers. 
14. Provides health counseling for staff. 
15. Provides leadership and/or support for staff wellness programs. 
16. Engages in research and evaluation of school health services to act as a change agent for school health programs and school nursing practices. 
17. Assists in the formation of health policies, goals and objectives for the school district.

Conclusion:  It is the position of the Michigan Association of School Nurses that school nurses employed by boards of education need to have the appropriate educational background, experiences and competencies to carry out the responsibilities and functions outlined above. School nurses strengthen and facilitate the educational process by improving and protecting the health status of children and by identification and assistance in the removal or modification of health related barriers to the learning process for individual children. The major focus of school nursing services is the prevention of illness and disability, and the early detection and correction of health problems. The school nurse is especially prepared and uniquely qualified in preventive health, health assessment and referral procedures.

References:
(1) National Nursing Coalition for School Health. School health nursing services: exploring national issues and priorities. Journal of School Health. 1995;65(9)L370-389.

History: Students with special health care needs are now attending school in a variety of settings. Many of these students have specific health care services that will need to be addressed during the school day. Until the early 1980's, most of these children were receiving their educational, developmental and health care in a hospital or institutional setting. The passage of PL94-142 in 1975 provided for an education for all students in the least restrictive environment regardless of physical or mental disabilities. The law was updated with IDEA (1990) PL101-476. Section 504 of the Rehabilitation Act of 1973, PL93-112, which protects the rights of handicapped persons, obligates local districts to provide related services, including health services, to those not eligible for special education. Local school districts must now recognize the need to provide appropriate staff and services to attain and insure a level of school health services previously not required. 

Description: The special health care needs of students will be provided in accordance with appropriate federal and state laws/ regulations. The responsibility for the provision of these special health care services is the role of the school nurse. The school nurse is the only licensed health professional in the school setting who can assess the health needs of a student and develop an individualized student health care plan in collaboration with the student, family, health care provider and school educational team. The school nurse may delegate the provision of these special health care services to other school personnel in accordance with the general rules/ provisions established in Michigan Public Health Code 1978 PA 368. 

Rationale: It is the legal responsibility of local/ intermediate school boards and school administrators to provide for the health and safety of all students in the school setting. This includes the provision of needed health care services by qualified staff. School administrators may need to be included in the decision making process as to which nursing acts might be delegated and to whom the delegation may be made. However, ultimately, it is the nurse who decides whether the delegation occurs and to which staff person the act can be delegated. Michigan Public Health Code Part 172 Nursing 333.17201, Delegation 333.16104, 333.16215 and Michigan Board of Nursing Rules regarding delegation 8338.0104, specifies that only the RN may delegate and supervise. At home, the parent, as the primary care giver, is able to make all decisions regarding necessary health care for his/her child. It is vitally important for parents to be able to differentiate between their role as a care taker in the home and that of the school personnel employed by the school district to provide care for students. In the school setting, parents do not have the authority to make decisions regarding delegation, training or supervision. However, it is essential that the family, school nurse, school educational team and other health care providers work in collaboration to provide the highest quality of care for the student in an environment that is safe for all students and staff. 

Conclusion: The Michigan Association of School Nurses' position on delegation of health service in schools includes the following beliefs: 

In order to benefit from educational programs and to maximize energy for learning, students with chronic health conditions must maintain their health at an optimal level in school. This requires access to safe environments and to health care services provided by professional registered nurses (RNs) and, when appropriate, by a qualified unlicensed assistive personnel (UAP) to whom a RN may safely delegate aspects of student health care.

 

Safe delegation of nursing activities in schools requires that:

1. The primary goal is to maximize the independence, learning, and health of students
2. Individualized student health care plans are developed by the RN in collaboration with the student, family, health care provider and appropriate school personnel
3. School nurses receive standardized education related to delegation to and supervision of unlicensed assistive personnel (UAP)
4. Unlicensed assistive personnel (UAP) successfully complete standardized training and child-specific training prior to participating in delegated care; and the RN has sufficient decision-making authority, administrative support, supervisory responsibility and necessary resources to ensure safe care for students.

 

The RN uses professional judgment to decide which (student) care procedures may be delegated, to whom, and under what circumstances. "This professional judgment is framed by the state nurse practice act and national standards of nursing.

Institutional policies cannot contradict state law" (American Nurses' Association (ANA), 1994, p.11).

ADDENDUM
(From Michigan School Code)

R 380.1252 Professional nursing services: rules; reports; section inapplicable to certain nursing services.

1. Sec. 1252. The board of a school district may employ registered nurses necessary to provide professional nursing services. The services shall be operated under rules promulgated by the state board which shall establish the certification requirements for registered nurses in the services.
2. The state board may require reports and information from school districts offering nursing services.
3. This section does not apply to nursing services provided by a county or district health department.

R. 340.1165 Continuing education of school nurse.

Rule 5.
A school nurse shall submit evidence of continuing attainment of theoretical and practical knowledge in the following areas to qualify for a higher level of school nurse certification, as required in R 340.1167 to R 340.1169.

1. Human growth and development.
2. Community health problems and resources.
3. School health problems.
4. Special problems of exceptional children.
5. Analysis of family health and social problems.
6. Communication arts
7. Organization and administration of the school health program, including necessary skills or understanding of curriculum development.
8. Learning theory.
9. Guidance and counseling.

 

R. 340.1166 School Nurse Certification criteria.

Rule 6

1. An application for school nurse certification shall be directed to the department of education on a form supplied or approved by the department.
2. Credits beyond those required for a registered nurse, to be applied toward certification as a school nurse, shall be earned through an approved teacher education or nursing education institution program or accepted by the institution in transfer. The state board of education shall determine the acceptability of credits leading toward programs approved by it.
3. A registered nurse with a currently valid license issued by the state board of nursing employed as a school nurse by an employing school district for a period of not less than one school year prior to June 30,1975, and whose experience is successful as determined by the state board of education upon the recommendation of the employing school district, is eligible for a professional school nurse certificate.

 

R. 340.1167 Interim School Nurse Certificate.

Rule 7

1. An interim school nurse certificate may be issued, after July 1, 1975, upon request of the employing school district to an applicant who holds a currently valid Michigan license as a registered nurse.
2. An interim school nurse certificate is valid for 2 years and may be renewed for one additional 2-year period upon request of the employing school district and submission of evidence of the completion of 8 semester hours of course work in a program planned to fulfill the requirements specified in R 340.1165. 
3. This rule is in effect as long as the applicant holds a currently valid Michigan license as a registered nurse.

 

R. 340.1168 Standard School Nurse Certificate.

Rule 8

1. A standard school nurse certificate may be issued, after July 1, 1975, upon request of the employing school district to an applicant who holds a currently valid Michigan license as a registered nurse and presents evidence of completion of the following requirements:
   1. Two years of work experience in public health or school nursing practice.
   2. Fifteen semester hours of work in areas of theoretical and practical knowledge as outlined in R 340.1165.
2. A standard school nurse certificate is valid for 3 years and may be renewed for 1 additional 3-year period upon recommendation of the employing school district if the holder has completed a total of 24 semester hours of course work outlined in 8340.1165. An additional 3 year renewal may be given upon recommendation of the employing school district if the holder has completed a total of 36 semester hours of course work outlined in 8340.1165.
3. This rule is in effect as long as the applicant holds a currently valid Michigan license as a registered nurse.

 

8340.1169 Professional School Nurse Certificate.

Rule 9

1. A professional school nurse certificate may be issued, after July 1, 1975, to an applicant who holds a currently valid Michigan license as a registered nurse and presents evidence of completion of the following requirements:
   1. Three years of successful experience as a school nurse as determined by the state board of education upon recommendation of the employing school district.
   2. A baccalaureate degree in nursing or a health-related field.
2. A professional school nurse certificate shall be valid if the holder maintains a currently valid Michigan registered nurse license. 

 

R. 340.1170 School Nurse Certificate expiration. 

Rule 10

All certificates expire on June 30 of the expiration year indicated on the certificate. Adopted April, 1996

ADDENDUM

Definitions: 

Delegation is "the transfer of responsibility for the performance of an activity from one individual to another, with the former retaining accountability for the outcome" (American Nurses Association (ANA), 1994, p. 11). 

While some state rules, regulations or guidelines may use different terms for delegation of nursing care activities, the critical concept is that when the RN determines that someone who is not licensed to practice nursing can safely provide a selected nursing procedure or task for an individual student and delegates that activity to the individual, the RN remains responsible and accountable for the care provided.

Unlicensed assistive personnel (UAP) "are individuals who are trained to function in an assistive role to the registered nurse in the provision of student care activities as delegated by and under the supervision of the registered nurse" (ANA, 1994, p.2). 

Supervision is "the active process of directing, guiding, and influencing the outcome of and individual's performance of a procedure" (ANA, 1994, p.10). 

State Law: 

Michigan Public Health Code, Part 172 Nursing, 333.17201-Practice of Nursing.

As used in this part:

"Practice of nursing" means the systematic application of substantial specialized knowledge and skill, derived from the biological, physical, and behavioral sciences, to the care, treatment, counsel and health teaching of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury or disability.

"Practice of nursing as licensed practical nurse" (LPN)- means the practice of nursing based on less comprehensive knowledge and skill than that required of a registered professional nurse and performed under the supervision of a registered professional nurse, physician, or dentist.

"Registered professional nurse" (RN)- means an individual licensed under this article to engage in the practice of nursing which scope of practice includes the teaching, direction, and supervision of less skilled personnel in the performance of delegated nursing activities.

 

 

Part 162-General Provisions 333.16104 Delegation Sec. 16104 

“Delegation” means an authorization granted by a licensee to a licensed or unlicensed individual to perform selected acts, tasks, or functions which fall within the scope of practice of the delagator and which are not within the scope of practice of the delegatee and which, in the absence of the authorization, would constitute an illegal practice of a licensed profession.

"Supervision"- means the overseeing of or participation in the work of another individual by a health professional licensed under this article in circumstances where at least all of the following conditions exist:

The continuous availability of direct communication in person or by radio, telephone, or telecommunication between the supervised individual and a licensed heath professional.

The availability of a licensed health professional on a regularly scheduled basis to review the practice of the supervised individual, to provide consultation to the supervised individual, to review records and to further educate the supervised individual in the performance of the individual's functions.

The provision by the licensed supervising health professional of predetermined procedures and drug protocol.

 

333.16215 - Delegation Sec. 16215 

A licensee who holds a license other than a health profession sub field licensee may delegate to a licensed or unlicensed individual who is otherwise qualified by education, training, or experience to perform selected acts, tasks, or functions where the acts, tasks, or functions fall within the scope of practice of the licensee's supervision. An act, task or function shall not be delegated under this section which, under standards of acceptable and prevailing practice, requires the level of education, skill, and judgment required of a licensee under this article.

 

333.10104 - Michigan Board of Nursing Rules Regarding Delegation Rule 104 

Only a registered nurse may delegate nursing acts, function or tasks. A registered nurse who delegates nursing acts, functions or tasks shall do all of the following:

Determine whether the acts, functions or tasks delegated is within the registered nurse's scope of practice.

 

Determine the qualifications of the delegatee before such delegation.

Determine that the delegatee has the necessary knowledge and skills for the acts, functions or tasks to be carried out safely and competently.

Supervise and evaluate the performance of the delegatee.

Provide or recommend remediation of the performance when indicated.

The registered nurse shall bear ultimate responsibility for the performance of nursing acts, function or tasks performed by delegatee within the scope of the delegation.

 

Federal Law:

Section 504 of the Rehabilitation Act of 1973 Public Law 93-112

"...no qualified handicapped person shall, on the basis of the handicap, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program; or activity which receives federal financial assistance." {Sec. 84.4(a)} 

Subpart A--General provisions, Section 84.3 Definitions 

(j) "Handicapped person."- (1) "Handicapped persons" means any person who (i) has a physical or mental impairment which substantially limits one or more major life activities, (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment. 

(2) As used in paragraph (j) (1) of this section, the phrase: 

(i) "Physical or mental impairment"- means (A) any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculosketal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine, or (B) any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.

(ii) "major life activities"- means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning and working. 

(iii) "has a record of such impairment"- means has a history of, or has been misclassified as having, a mental or physical impairment that substantially limits one or more major life activities. 

(iv) " is regarded as having such an impairment"- means (A) has a physical or mental impairment that does not substantially limit major life activities but that is treated by a recipient as constituting such a limitation; (B) has a physical or mental impairment that substantially limits major life activities only as a result of the attitudes of others toward such impairment; or (C) has none of the impairments defined in paragraph (j)(2)(i) of this section but is treated by a recipient as having such an impairment. {Subpart A, Sec. 84.3 (j)} 

Individuals with Disabilities Education Act (IDEA)
20 U.S.C. Chapter 33, as Amended by Public Law 101-476 

Under IDEA, state and local educational agencies have the responsibility to ensure that eligible children with disabilities receive special education and related services (including health services) without charge, in conformity with an IEP for children ages three to twenty-one or an IFSP for infants and toddlers, birth to age three. The following sections of IDEA are particularly relevant: 

IDEA, Part B (U.S.C. Subchapter 1, General Provisions, Section 1401 

Section 1401, Definitions: 

Children with Disabilities: The term "children with disabilities" means: 

(A) with mental retardation, hearing impairments including deafness, speech or language impairments, visual impairments including blindness, serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities; and 

(B) who, by reason thereof need special education and related services. {Sec. 1401 (a) (1)} 

Special education: means "Specially designed instruction, at no cost to the parent or guardians, to meet the unique needs of a child with a disability, including: 

(A) instruction conducted in the classroom, in the home, in hospitals and institutions, and in other settings; and 

(B) instruction in physical education" {Sec. 1401(a)(16)} 

Related Services: "The term "related services" means transportation, and such developmental, corrective, and other supportive services (including speech pathology and audiology, psychological services, physical and occupational therapy, recreation, including therapeutic recreation and social work services, and medical and counseling services, including rehabilitation counseling, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a disability to benefit from special education, and includes the early identification and assessment of disabling conditions in children." {Sec. 1401(a) (17)} 

Assistive Technology: "The term "assistive technology device" means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain or improve function capabilities of the individuals with disabilities." {Sec. 1401(a)(25)} 

Assistive Technology Services: "The term "assistive technology service" means any service that directly assists an individual with a disability, in the selection, acquisition, or use of an assistive technology device." Such term includes: 

the evaluation of the needs of an individual with a disability, including a functional evaluation of the individual in the individual's customary environment;

purchasing, leasing, or otherwise providing for the acquisition of assistive technology services by the individuals with disabilities;

selection, designing, fitting, customizing, adaptation, applying, maintaining, repairing, or replacing of an assistive technology device;

coordination and using of therapies, interventions, or services with assistive technology devices, such as those associated with existing educational or rehabilitation plans and programs;

training or technical assistance for an individual with disabilities, or where appropriate, the family of an individual with disabilities; and

training or technical assistance for professionals (including individuals providing education and rehabilitation services), employers, or other individuals who provide service to, employ, or are otherwise substantially involved in the major life functions of the individuals with disabilities. {Sec.1402(a)(26)(A-F)}

American Federation of Teachers, AFL-CIO (1992). The medically fragile child in the school setting-a resource guide for the educational team. American Federation of Teachers AFL-CIO. Washington D.C. 

American Nurses' Association (1994). Registered Professional Nurses & Unlicensed Assistive Personnel. Washington, D.C.: American Nurses Publishing. 

Michigan Nurses Association, Michigan Board of Nursing (1992). Legal & Professional Regulations of Nursing Practice in Michigan. Michigan Nurses Association, Okemos, Michigan. 

Michigan Nurses Association (1989). Guiding Principles for Decisions in Utilizing Personnel for Nursing Care. Michigan Nurses Association, Okemos, Michigan. 

National Association of State School Nurse Consultants (1995). Position Paper on Delegation of Health Services in Schools. Journal of School Nursing, April 1995. 

National council of State Boards of Nursing (1991). Nursing Care in the School Setting: Regulatory Implications. National Council of State Boards of Nursing, Inc. 

Wyandotte Schools (1995). School Entrance Procedure for Students Assisted by Medical Technology. Wyandotte Public Schools, Wyandotte, Michigan. 

Adopted April 1996