There is a gap in the nursing literature regarding children who frequently visit school nurses' offices with recurrent unexplained physical symptoms. A review of the scientific health literature was undertaken to examine the clinical presentation, associated variables, and implications for school nurses regarding children who are frequent school health office visitors with somatic symptoms. This subset of students with medically unexplained symptoms accounts for disproportionate use of primary care and school health resources. Common somatic complaints in school-age children, such as headache and stomachache, are associated with the psychosocial variables of anxiety and depression, childhood adversity, and school stress. Effective and practical treatment approaches to this complicated child health issue require accurate identification, appropriate referral, screening for associated conditions, and individualized treatment plans. Research to identify effective interventions for frequent health office visitors is needed.

School nurses need evidence-based clinical practice guidelines (CPGs) to provide quality care for students with special health-care needs. However, a gap analysis revealed a paucity of rigorous school nursing CPGs. To fill this gap, a Model for Developing Evidence-based Clinical Practice Guidelines for School Nursing (School Nursing CPG Model) was designed under the auspices of the National Association of School Nurses to offer school nurse scholars, school health leaders, and pediatric clinical experts a standardized structure and systematic process to create rigorous evidence-based CPGs. The aim is to employ the School Nursing CPG Model to build a repository of CPGs that are projected to improve the quality of school nursing practice, thereby improving health and educational outcomes for students with special health-care needs. The School Nursing CPG Model is anticipated to apply to CPG development for other nursing specialties.

Every U.S. student is entitled to a free and appropriate education. School districts must identify and evaluate any child who they find is unable to engage fully in learning as a participant in the general education curriculum. The Individuals with Disabilities Education Act of 2004 requires that these students be assessed by qualified individuals in any areas that may be impacting learning, including health, vision, hearing, social and emotional status, communicative status, and motor abilities. The school nurse, as the health expert, has an important role to play as a member of the special education team in evaluating whether a student has health concerns that are impacting learning and how health barriers to learning might be reduced. As part of the full and individual evaluation, the school nurse composes a written report and makes recommendations to the team regarding necessary health services and other modifications the student may need. This article (Part 1 of 2) will outline the school nurse's role in identification and evaluation of students who may benefit from special education services.

School nurses are challenged by federal civil rights laws and the standards of school nursing practice to care for a burgeoning population of students with special health care needs. Due to the realities of current school nurse-to-student ratios, school nurses are frequently responsible for directing unlicensed assistive personnel (UAPs) to support the health and safety needs of students, where State Nurse Practice Acts, state legislation, and local policy mandates allow. The delegation of health care tasks to UAPs poses many professional, ethical, and legal dilemmas for school nurses. One strategy to reduce the risks of delegation is through the use of procedure skills checklists, as highlighted by the experience of one large urban school district. Part 1 of this two-part article will explore the scope of the problem and the principles of delegation, including legal and ethical considerations.

This is the second of two articles outlining the professional school nurse's role in the special education process for students with disabilities. The Individuals with Disabilities in Education Improvement Act of 2004 mandates the special education process: identification, full and individual evaluation, eligibility determination, and development of the individual education program (IEP), including special education placement. Part 1 focused on the importance of the school nurse's role in student identification, response to intervention, and the full and individual evaluation. Part 2 highlights the school nurse's vital and unique contribution to the subsequent special education steps of eligibility determination, IEP development, and special education services placement and minutes.