Return to Newsletter | Revised 2-20-02
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Bureau for Students with
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A project funded by the Georgia State Improvement Grant
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On-Line - Fall 2000
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Students with physical and health impairments sometimes require specialized health care procedures during school hours. Procedures such as tube feeding, clean intermittent catheterization, colostomy/ileostomy care, suctioning, oxygen delivery, and ventilator care are commonly found in the school. The Division for Physical and Health Impairments of the Council for Exceptional Children recently formed a position statement that stressed the importance of viewing these health care procedures as self-help skills or independent living skills that may be taught to the student to perform (DPHD, 1999). If the educational team decides it is appropriate for the student to be taught his or her health care procedure, it should be included in the IEP as an educational objective.
Students with a variety of disabilities have been taught to perform health care procedures, including those with physical, intellectual, or multiple disabilities. Students may be taught to independently perform the procedure or partially participate in performing some steps of the procedure. In a tube feeding procedure, for example, a student may be taught to perform the entire procedure of giving himself a specific formula (or liquid food) via a tube that goes directly into the stomach or small intestine. Some students may learn only parts of the procedure such as preparing the formula, cleaning the equipment when finished, or helping to hold the syringe barrel in which the formula is poured. In some instances, the student may be too physically impaired to physically assist with the procedure, so he may have the objective to direct another person in the procedure. This promotes active participation and helps protect the student against errors. Some students may also have the objective of learning about the health care procedure. Some students may be taught about the gastrointestinal system, while others may be taught what to do if they have abdominal cramping.
To teach a health care procedure, each procedure should be broken down into small steps (also known as a task analysis). Students should be assessed with performing the steps and appropriate modifications made. Caution steps and time-limited steps must also be identified. Caution steps are any steps that could result in injury should the student make a quick, jerking, or incorrect movement. Time-limited steps are those that need to be completed in a specific period of time (Heller, et. al, 2000). In tube feeding, for example, connecting the syringe barrel to a G-tube or connecting a connecting tube to a gastrostomy button are considered caution steps since the student could accidentally dislodge the tube or button. A time-limited step is pouring more formula into the syringe barrel before it has completely emptied in order to avoid air entering the tube. When these steps are identified, the educational team will need to determine if the student should be taught these steps. If so, the teacher needs to provide shadowing, which means that the teacher's hands should be within 1 inch of the student's hands in order to prevent any problems. After identifying these steps, the teacher would select the most appropriate instructional strategy and systematically teach the procedure.
The educational team decides if it is appropriate for the student to learn the health care procedure. If it is determined that it should taught and it is included as an instructional objective on the IEP, the team needs to work together to assure the success of the student learning the procedure. The nurse provides information regarding the procedure, the teacher provides information on instructional strategies and modifications, the physical and occupational therapists provide information on proper positioning of the student and the equipment, the speech language pathologist provides information on communication strategies regarding the procedure, and the parent (and student) provide information about their experience with the procedure and the student. For many students, learning to participate in the performance of their health care procedure will decrease learned helplessness, increase self-esteem, and enable them to be more independent.
- by Kathy Heller, Professor, Georgia State University
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