N682 Module 5 assignment: disability and special education paper, a full sample

The Nurse at the IEP Table: Health Assessment and Health Goals for a Fifth Grader With Down Syndrome

Student Name

Master of Science in Nursing Program, Aspen University

N682: School Nursing

Instructor Name

Month Day, Year

The Nurse at the IEP Table: Health Assessment and Health Goals for a Fifth Grader With Down Syndrome

Students with intellectual disabilities often have health conditions that affect their learning, from hearing loss that is mistaken for inattention to sleep problems that are mistaken for low motivation. Special education law entitles eligible students to an individualized education program, and the team that writes it is expected to consider every area of need. Yet school nurses are not always invited to the table, and when they are, their contribution may be limited to a list of medications. This paper follows a composite student through a reevaluation and program meeting to show what the school nurse contributes: a health assessment that informs eligibility and services, advice on whether health needs belong in the education program or a separate disability plan, and health goals written so that progress can be measured.

The Student

Jordan is a composite 11-year-old fifth grader with Down syndrome, receiving special education services under the category of intellectual disability. Jordan spends most of the day in a general education classroom with support from a special education teacher and an aide, reads at about a second-grade level, and is well liked by classmates. Jordan's three-year reevaluation is due. Teachers report that Jordan has become more tired in the afternoons, often does not respond when called from across the room, and has gained weight over the past year.

The Nurse's Health Assessment

A reevaluation must assess the student in all areas related to the suspected disability, and health is one of them. School nurses contribute by reviewing records, screening, observing and consulting with families and clinicians, and by interpreting health findings for the rest of the team (Yonkaitis & Shannon, 2017). For Jordan, the nurse's assessment includes several steps. A hearing screen shows reduced hearing in the right ear, and the nurse refers Jordan to audiology, since children with Down syndrome are prone to fluid in the middle ear and hearing loss. A vision screen is passed, but the nurse notes that Jordan's last eye examination was three years ago and recommends one. The nurse asks the family about snoring, and Jordan's parent reports loud snoring and pauses in breathing at night; the nurse recommends discussing a sleep study with Jordan's pediatrician, because obstructive sleep apnea is common in Down syndrome and can cause daytime fatigue and attention problems.

The nurse also reviews growth: Jordan's body mass index is now above the 95th percentile. Adolescents with autism and Down syndrome have been found to be two to three times more likely to be obese than adolescents in the general population, and obese adolescents with developmental disabilities had more secondary conditions such as high blood pressure, depression and fatigue (Rimmer et al., 2010). Finally, the nurse confirms with the family that Jordan's thyroid function was checked in the past year, since hypothyroidism can also cause fatigue and weight gain. The nurse's written report summarizes these findings in plain language and explains how each might affect Jordan's learning.

Where Health Needs Belong

Once health needs are identified, the team must decide how to address them. Under special education law, an eligible student's program must address needs that result from the disability and affect access to education, and it can include related services such as school health services. A separate Section 504 plan is used for students who have a disability that substantially limits a major life activity but who do not need specially designed instruction, or to document accommodations. For Jordan, who already has an education program, the health needs that affect learning, hearing, fatigue and physical activity, belong in that program rather than in a separate plan, so that they are reviewed together with academic goals (Shannon & Yonkaitis, 2017).

The nurse recommends that the program include preferential seating near the teacher and away from noise until audiology results are available, checking that Jordan has heard instructions, a short rest break after lunch if needed, and adapted physical education with specific activity goals. An individualized health plan, maintained by the nurse, covers routine health care such as medication and monitoring and is referenced in the education program.

Writing Health Goals

Goals in an education program must be measurable. A goal such as improve health cannot be evaluated. The nurse helps the team write goals that describe what Jordan will do, under what conditions and to what standard. One goal addresses physical activity: during adapted physical education and recess, Jordan will take part in moderate activity for at least 20 continuous minutes on four of five school days, as recorded by the physical education teacher, by the end of the year. A second addresses self-advocacy: when Jordan does not hear an instruction, Jordan will ask an adult to repeat it in four of five observed opportunities. A third addresses nutrition education: Jordan will choose a fruit or vegetable at lunch on four of five days, with a picture menu. Each goal is realistic for Jordan, observable by staff and linked to the health findings.

Collaboration With Family and Clinicians

The nurse's recommendations depend on follow-through outside school. With the parent's written consent, the nurse sends the pediatrician a summary of the school findings and the concern about sleep apnea, and asks the audiologist to send results so that classroom accommodations can be updated. The nurse also talks with Jordan's parent about school meals and activity, recognizing the family's knowledge of what motivates Jordan. At the annual review, the nurse will report progress on the health-related goals and any new findings.

Conclusion

For students with intellectual disabilities, health and learning are tightly linked, and the school nurse is the team member best able to see the connection. In Jordan's case, the nurse's assessment turned vague observations of tiredness, inattention and weight gain into specific concerns about hearing, sleep and activity, with referrals and accommodations to match. By recommending where those needs belong and writing measurable health goals, the nurse makes sure the education program serves the whole student.

References

Rimmer, J. H., Yamaki, K., Lowry, B. M. D., Wang, E., & Vogel, L. C. (2010). Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities. Journal of Intellectual Disability Research, 54(9), 787-794. https://doi.org/10.1111/j.1365-2788.2010.01305.x

Shannon, R. A., & Yonkaitis, C. F. (2017). The role of the school nurse in the special education process: Part 2: Eligibility determination and the individualized education program. NASN School Nurse, 32(4), 249-254. https://doi.org/10.1177/1942602X17709505

Yonkaitis, C. F., & Shannon, R. A. (2017). The role of the school nurse in the special education process: Part I: Student identification and evaluation. NASN School Nurse, 32(3), 178-184. https://doi.org/10.1177/1942602X17700677