Urinary Catheterization

Elimination

This resource provides current and comprehensive health care information for school health nurses. Search for related resources, including procedures, videos and skills checklists by selecting the [MORE INFORMATION] button at the bottom of this page.

Overview

Students who have difficulty or the inability to fully empty their bladder may require intermittent urinary catheterization at school. There are several health conditions that could result in the need for intermittent urinary catheterizations including neurogenic bladder, spina bifida, posterior urethral valves, urinary retention, & bladder exstrophy. The use of intermittent urinary catheterization assists the bladder in fully emptying which reduces pressure on the kidneys, promotes mucosal healing, and assists to prevent urinary tract infections (Tobias, 2017).

Neurogenic Bladder:

Neurogenic bladder, also known as neurogenic lower urinary tract dysfunction (NLUTD), is the abnormal function of either the bladder, bladder neck, and/or its sphincters related to a neurologic disorder. In children, the most common causes of neurogenic bladder are congenital neural tube defects (NTD), such as myelomeningocele, spinal dysraphism, or tethered

cord lesions but can also be caused by spinal cord injury or a spinal tumor. Urinary continence is achieved when the bladder stores urine, produced by the kidneys, & expels the urine when appropriate. Both storing and expelling urine require neurological input and disruption anywhere along the neural pathways can lead to various degrees of bladder dysfunction (Lucas, 2019).

Spina Bifida:

Spina bifida occurs when the spinal column of the fetus doesn’t close completely during the first month of pregnancy. This can damage the nerves and spinal cord. The symptoms of spina bifida vary from person to person. Students with spina bifida may need assistive devices such as braces, crutches, or wheelchairs. They may have learning difficulties, urinary or bladder problems and/or hydrocephalus (Medline Plus, 2016).

Posterior Urethral Valves:

“Posterior urethral valves are obstructing membranous folds within the lumen of the posterior urethra” (Holmes, 2023). The obstructing tissue flaps cause a blockage that doesn’t allow urine to flow out of the bladder. After surgical treatment most children will have normal urinary function although some children may have lasting problems (Nationwide Children’s, 2023).

Urinary Retention:

Urinary retention is a condition in which the student is unable to fully empty urine from the bladder. Urinary retention can be caused from a blockage that partially or fully prevents the flow of urine, or the bladder does not have the capacity to completely expel all the urine.

Bladder Exstrophy:

“Bladder exstrophy is a complex congenital anomaly involving the musculoskeletal system and the urinary, reproductive, and intestinal tracts. It is characterized by an open, inside-out bladder on the surface of the lower abdominal wall and an open dorsal urethra” (Borer, 2023).

Mitrofanoff (Appendicovesicostomy) and Monti Procedure :

Mitrofanoff Procedure: The Mitrofanoff Procedure is a surgery that uses the appendix to create an alternative route for the intermittent catheterization. With this procedure, the appendix is removed from the colon and is then used to create a continent conduit between the abdomen and the bladder (Norman, Leach, & Taha, 2024).

The Monti Procedure:is similar to the Mitrofanoff Procedure however, a portion of the ileum (small intestine) is used to create the tube that connects the bladder to the abdominal wall (Kennedy Krieger Institute & Maryland State Department of Education, 2017).

Both of these procedures create a stoma in the student’s belly button or lower abdomen in which a catheter can be inserted to drain the urine from the bladder (Nationwide Children’s, n.d.). If the student will be having intermittent urinary catheterization performed in the school setting after the procedure is completed, the school nurse must discuss with the parents/guardians and health care provider how soon after surgery the site can be used for catheterization and when it would be appropriate for the school nurse to delegate the procedure to unlicensed assistive personnel (UAP).

Delegation

There are a number of factors for the school nurse to consider when deciding whether to delegate this procedure to a UAP. This section will provide a list of questions that the school nurse should answer to assist them in determining whether it is appropriate and safe to delegate the procedure. It is also important to remember that the questions related to delegation need to be answered for every individual student. The decision to delegate is based on circumstances related to the student, the nurse, the UAP, and the situation.

Questions to Inform Safe Delegation: These delegation questions are based on the American Nurses Association’s Decision Tree for Delegation by Registered Nurses (ANA, 2012).

Has the school nurse performed an initial assessment of the student to determine their needs?
The school nurse should not delegate the procedure to a UAP until they have completed the initial assessment.
Does school district policy, the school nurse’s job description, and the UAP’s job description allow procedures related to intermittent urinary catheterization to be delegated?
Although the Missouri Nurse Practice Act allows for registered nurses to delegate intermittent urinary catheterization, the district may have policies that prohibit or limit the school nurse’s ability to delegate. Additionally, the school nurse’s and UAP’s job descriptions may restrict delegation as well.
Is the school nurse competent to perform this procedure or does the school nurse need to acquire some knowledge or skills to be competent in this procedure?
If the school nurse is not competent or does not feel comfortable performing this procedure they should not delegate this procedure to a UAP. The school nurse must first acquire the necessary knowledge and skill to perform this procedure competently before they can delegate it to someone else.
Is the student’s condition stable? Is this a new procedure for the student? How predictable are the outcomes of the procedure?
A school nurse should not delegate intermittent urinary catheterization to a UAP if this is a new procedure for the student. The outcomes are not predictable and thus the school nurse should perform the procedures until the student’s condition has stabilized.
Does the procedure require an initial or ongoing assessment to be performed during the procedure?
If an initial or ongoing assessment is required for the procedure to be performed, the procedure should not be delegated.
Does the UAP have the appropriate knowledge, skills, abilities, and willingness to perform the procedure?
All these factors need to be considered. Although a UAP may be competent to perform the procedure they may not be willing to do so and in that situation another UAP should be identified and trained. The registered nurse must retain responsibility for the procedure until training is complete.
Is there a procedure and/or protocol in place for this procedure?
A delegated nursing procedure must have an established sequence of steps that the UAP can follow. These steps should have a predictable outcome and should be outlined in a written procedure or protocol. If the written procedure/protocol hasn’t been developed, the nurse should retain responsibility for the procedure until the procedure/protocol is in place.
Is the school nurse able to provide supervision to the UAP (direct or indirect depending on the situation)?
If the school nurse is not able to provide supervision, then the procedure should not be delegated. The school nurse will need to assess the situation to determine if direct or indirect supervision is required. The school nurse may also need to reassess the situation if the environment changes, for example, if the procedure is going to be performed during a time that the school nurse is not contracted to provide nursing services (i.e., over the weekend, during the summer, or if the school nurse is part-time).
Is the student ready to assume some responsibility for the procedure?
The school nurse should resume responsibility for the procedure since the school nurse is the only one who can initiate teaching. The school nurse would also want to observe the student performing the procedure to ensure that the student is competent. Once the school nurse has determined that the student is competent and can safely perform the procedure independently, they can delegate the supervision of the student to a UAP. If at a future date the school nurse is needed to teach the student additional skills, the school nurse would again need to resume responsibility for the procedure until the time in which the school nurse determined the student to be competent.

The Decision to Delegate:

There may be times when the school nurse and school administrator have conflicting opinions on the delegation of a procedure to a UAP. The school nurse may feel that delegation is not appropriate or the administrator may want the school nurse to delegate a procedure to an UAP that the school nurse feels is not competent. In these situations the school nurse may need to educate the administrator that the school nurse has a professional and legal responsibility to determine if delegation of a nursing procedure is appropriate and safe (ANA, 2012). See Fact Sheet for School Administrators, Families, and School Personnel: Nursing Delegation Requires the School Nurse and Navigating Delegation in the School Setting (pdf) to assist school nurses’ communication with the school administration.

School Environment

Physical Education and Recess:

The school nurse should review the health care provider’s order to see if there are any activity restrictions associated with the student’s underlying health condition that may require activity restrictions or precautions during physical education class or at recess.

Latex Allergy:

Students who require intermittent urinary catheterization may have a latex allergy. See the Anaphylaxis Whole Package resource for more information on anaphylaxis management.

Students

An important first step when caring for a student who has a health condition that requires an intermittent urinary catheterization would be to complete a health history and physical assessment, preferably with the student and their parents present.

Health History Questions: The school nurse may want to ask the student and their parents/guardians the following questions:

Current health conditions
Medications
- Note any medications that could affect urine color, volume, or odor
Allergies
Previous hospitalizations and surgeries
Most recent hospitalization
Catheter type
Catheter size
Schedule for catheterization
If the catheter is reused
- How long catheter should be reused
- Cleaning technique for used catheter
Whether urine output should be measured
Perineal cleaning solution
Baseline urine characteristics
History of urinary tract infections
Student position during catheterization
Fluid intake goals
Insurance coverage
Health care provider(s) name and contact information
Home health agency, if applicable
Preferred hospital, if applicable

(Kennedy Krieger Institute & Maryland State Department of Education, 2017)

Assessment Questions: The school nurse may want to consider asking the student and their parents/guardians the following additional questions:

How does this health condition impact the student’s daily life?
How often does the student miss school due to their health condition(s)?
Tell me about your friends.
How often do you spend time with them?
Has the student shared information about their health condition(s) with their friends/peers?
How independent is the student in their intermittent urinary catheterization?
Does the student require activity precautions to prevent injury?
Does the classroom environment support the student’s needs and/or equipment (i.e., desk/seating options, maneuverability space, electrical outlets, flash pass for bathroom or nurse)?
Does the student have specific hydration requirements?
What are the student’s and the parent’s goals associated with intermittent urinary catheterization?
Does the student and/or their parents have any concerns related to the student’s health condition?
What challenges does the student face in dealing with their health condition?
Do you feel the student has been sufficiently supported by school staff in managing their health condition?
Who has the student been going to when they need help?
How often does the student have bad feelings about coming to school because they are worried/afraid/embarrassed about something (peers, assignments, teacher)?
Has the student had to change any of their social activities because of their health condition?
Has the student ever been picked on or bullied?
Does the student have a 504 Plan or Individualized Education Program (IEP)?
Would the student benefit from evaluations or assessments in any of the following areas: physical therapy, occupational therapy, speech and language therapy, assistive technology, adapted physical education, functional behavior, psychology, hearing and vision?
Would the student benefit from additional academic support and/or modified education (i.e., copies of notes, extra time, reduced workload, simplified instructions, alternative formats for presentation of material, 504/IEP)?
Does the student have an Individualized Health Care Plan (IHCP)?
Is there a need for a specific plan for this student’s individual needs if there is a crisis in the building?
If shelter-in-place were required or the school day needed to be unexpectedly extended, what additional supplies, equipment, and health care provider orders would be needed?
How is the student transported to and from school?

(Clarke, Embury, Yssel, 2014; Llorens, McKee, & Dempsey, 2020)

Maintaining the Student’s Privacy:

The student’s privacy is an important consideration when planning for and performing the procedure. The school nurse should collaborate with the student, their parents or guardians, and the student’s health care team to establish a plan that ensures the student’s safety, promotes the student’s health and independence, and protects the student’s privacy. The plan should address:

Where will the procedure be performed?
- Does the student want to come to the health room?
- It is preferable that the student would have a private bathroom to use.
Where will the student store their supplies?
- The student may prefer to keep their supplies with them but extra supplies should be stored in the bathroom that the student uses.
- An extra change of clothing may also be recommended.

(Bradley, 2020; Fortuna, Korcal, & Thomas, 2018)

Scheduling of Catheterizations:

Students who require intermittent urinary catheterizations will most likely have a schedule of when the catheterization should occur. The school nurse should collaborate with the student and their educational team to schedule the urinary catheterization at times that are least disruptive to the student’s schedule. For example, elementary age students should be allowed to perform the catheterization at times that would not disrupt their lunch or recess, as these are important social times in a student’s day. Additionally, the school nurse should plan for times when the student will be more physically active, such as during physical education or recess, and schedule the catheterization prior to those activities so there is no urinary incontinence (Fortuna, Korcal, & Thomas, 2018).

Transition Planning:

The nurse should assess the student’s current and desired level of independence to determine what goals should be established for the student. Additionally, the school nurse should discuss with the student and family what steps have been initiated related to transition planning. The school nurse should consider including goals related to self-management and decision-making skills in the student’s Individualized Health Care Plan (IHCP) (NASN, 2019b) and consider how those goals can be expanded upon each year to support independence, if appropriate.

Communication

It is important for the school nurse to discuss with the student and their family the best way(s) to communicate with them. Does the parents/guardian have a preference (i.e., email, text, telephone call)? Do the parents prefer to have the communications sent to both parents or is there a parent who manages the communication with the school nurse?

The school nurse may want to consider having the parents/guardians complete a Health Insurance Portability and Accountability Act (HIPAA) compliant medical release form to facilitate communication with the student’s health care team. Although HIPAA does not require parental consent to allow the school nurse to discuss the student’s treatment plan, such as medications and nursing procedures, with the student’s health care provider, having a signed consent form would undoubtedly make the process go smoother for all involved parties (U.S. Department of Health and Human Services & U.S. Department of Education, 2008). See the FERPA HIPAA Consent Sample (NASN).

The school nurse should determine the baseline characteristics of the student’s urine and should discuss with the parents or guardians and health care provider when the parent or guardian or health care provider should be informed about urinary changes, for example, change in urine color, amount, smell, or if the student develops a fever.

Medication

There are typically no medications associated with this procedure itself but students who require intermittent urinary catheterization may take antispasmodic medications, anticholinergic medications to reduce detrusor muscle tone bladder pressure, and/or sympathetic agonist medications to enhance sphincter competence (Norman, Leach, & Taha, 2024).

Field Trips

Field trips and other out of school activities can add a layer of complexity to the care of a student who requires intermittent urinary catheterization. There are several variables that the school nurse will want to consider and plan for, including:

Who will accompany the student on the field trip to perform necessary procedures or administer medication?
The individual who will be providing the care or performing the procedure must have the knowledge, ability, skills, and willingness to perform the procedure (Erwin, Clark, & Mercer, 2014).

Where will the supplies be stored?
It is important to have all needed supplies readily available. Supplies should not be left on the bus but should be with the student at all times.
How will the student’s privacy be protected?
The school nurse should discuss with the student and their family where the procedures will be performed during the field trip and the student and family’s expectations related to privacy as a private bathroom may not be available.
How will safety and cleanliness be ensured?
In addition to privacy, the school nurse must think through possible scenarios on where the procedure may be performed and what additional precautions and supplies may be needed to ensure safety and cleanliness.
Will the student’s intermittent urinary catheterization schedule need to be altered due to travel, availability of a restroom and/or privacy concerns?
The travel schedule, restroom availability, and/or privacy concerns may impact the student’s catheterization schedule. The school nurse should discuss the need for modifications with the student and parents/guardians. In addition, the school nurse should review the health care provider’s order to determine if a modification to the order or a new order for the field trip would be necessary.
How will the procedure be documented?
Timely documentation is a key nursing component.The nurse should consider how the procedure that occurs on a field trip will be documented (Erwin, Clark, & Mercer, 2014).
Is the field trip occurring out of state or out of the country?
Field trips that occur out of the student’s home state will require some additional planning. If the school nurse will be accompanying the student on the field trip, they will want to determine if the state(s) that will be traveled through or visited are a part of the Nurse Licensure Compact. If the school nurse will not be accompanying the student but instead will be delegating the procedures, the school nurse will want to review the other state’s nurse practice acts and associated rules and regulations to determine if the procedure can be delegated to a UAP in that state. For out of the country field trips, the school nurse should discuss with school administration any applicable laws to determine what additional steps may be needed. In addition, the U.S. Embassy can provide information on points of contact for destination countries.

(Erwin, Clark, & Mercer, 2014; NASN, 2019a; Wisconsin Department of Public Instruction, 2019)

It is important to note that the Section 504 of the Rehabilitation Act does not allow for a student with a disability to be excluded from a field trip due to their disability.

Documentation

The medical management of a student who requires intermittent urinary catheterization in the school setting will require the school nurse to acquire and complete numerous forms of documentation.

Health Care Provider Order:

For students who require intermittent urinary catheterization at school, the following information should be included in the health care provider’s order:

Name of the student
Date of birth
Catheter type
Catheter size
Schedule for catheterization
If the catheter is reused
- How long catheter should be reused
- Cleaning technique for used catheter
Whether urine output should be measured
Perineal cleaning solution
When the health care provider should be consulted
- For example, for fever or changes in urine appearance or smell
Whether the student can perform self-catheterization
Whether the student can carry their own supplies

(Association for the Bladder Exstrophy Community, 2022).

The Association for the Bladder Exstrophy Community has developed a sample Physician Order for School Intermittent Catheterization form.

Parent/Guardian Authorization: In addition to the health care provider’s order, the school nurse will also need written authorization from the parents/guardians to perform the intermittent urinary catheterization procedure at school. The authorization form can be a separate document that just the parents/guardians sign or a document can be developed that combines the health care provider’s order and parent authorization in one form.

Procedures: The urinary catheterization procedure needs to be documented, whether it is completed by the school nurse, a UAP, or if the student completed the procedure. The procedure and the outcomes of the procedure should be documented in the student’s health record. The school nurse will want to ensure that the documentation is completed when the procedure is completed during field trips, before or after school, and/or during any school-sponsored activities.

Staff Competency Validation: If the urinary catheterization is delegated to a UAP the school nurse should document that the UAPs knowledge, abilities, and skills have been assessed. Many times these factors are documented on a skills competency checklist (see Skill Competency Checklists). There should be a place on the skills competency checklist for the school nurse and UAP to sign to indicate that they feel competent and are willing to perform the procedure. Once the procedure has been delegated the school nurse is responsible for periodic evaluation of the UAP and their competency. The school nurse must determine how often the supervision is needed. After the school nurse has re-evaluated the UAP’s competency, they should document the date of the evaluation (Shannon & Kubelka, 2013; Selekman & Ness, 2019). The school nurse should organize the competency documentation in a way that easily allows them to determine when subsequent evaluation and documentation of competency is needed. For more information, see the Delegation section.

Individualized Health Care Plan (IHCP): IHCPs should outline the plan of care for the student, including but not limited to:

Actions the school nurse will take to support the student’s educational attainment.
The education and training that will be provided to school personnel.
The accompanying expected outcomes for each of the nursing interventions.
If the student has other health condition(s) that would require an emergency action plan or an evacuation plan, the IHP should include the development of these plans (NASN, 2020)
Student goals related to independence and transition planning and actions that the school nurse will take to assist the student in meeting these goals.
Prior to completing the IHCP, the school nurse should complete a health history and physical assessment of the student. For more information on health history see the Students section.

Section 504 Plan: Students who require urinary catheterization may qualify for a Section 504 Plan since they have a physical or mental impairment that impacts one or more major life activities, which includes the functioning of major bodily systems such as the urinary system. If the student has been identified as qualifying for a 504 Plan, the school nurse may be involved in identifying appropriate accommodations and writing the plan. Once developed, the school nurse will want to frequently review, update, and document in the 504 Plan (NASN, 2020).

Procedure

Go to https://showmeschoolhealth.org > Just in Time > Search for ‘Urinary Catheterization”.

Emergency Preparedness

The student who requires intermittent urinary catheterization would rarely have an emergency associated with their catheterization needs but they may have other health conditions that would require emergency planning, especially if the student has limited mobility. The school nurse should assess the student’s health conditions and determine if emergency plans are necessary, including emergency evacuation plans.

If the student has an anaphylactic allergy to latex, then the school nurse should develop the appropriate emergency plans for the student and provide the school community with the necessary education and training. See the Anaphylaxis Whole Package resource for more information on anaphylaxis management.

Shelter-in-Place and Other Emergency Events:

The school nurse should collaborate with the school administrators and school staff to determine what supplies may be needed if there were a lockdown or shelter-in-place situation. The emergency preparedness plan should address the following:

Location of extra supplies in case of lock-down.
Health care provider’s orders for intermittent urinary catheterization that would be necessary if there was an unplanned extended school day or shelter-in-place.
Additional accommodations that may be required during an emergency (i.e., extra staff to help support the student’s needs).
Equipment &/or transportation evacuation needs if the child has limited mobility.

(Center for Inclusive Child Care, 2020; Federal Emergency Management Agency, 2009)

For more emergency planning information see Missouri School Boards’ Association’s Emergency Planning Guide for Students & Staff with Special & Functional Needs in Schools.

Legal Issues

Section 504 Plan:

Students requiring intermittent urinary catheterization may qualify for a Section 504 Plan. Section 504 of the Rehabilitation Act of 1973 as amended through the Americans with Disabilities Amendment Act (ADAA) in 2008 ensures that students who have disabilities have access to a free and appropriate public education (FAPE) (U.S. Department of Education, 2023). FAPE provides a student with a physical or mental impairment that impacts one or more major life activities, which includes the functioning of major bodily systems such as the urinary system, with related services and accommodations in the general education classroom (U.S. Department of Education, 2023; NASN, 2023). If the student does not have a 504 Plan the school nurse should determine if an evaluation is indicated (see Students section for questions to ask student and family to determine if 504 or IEP evaluation is indicated). If it is determined that the student qualifies for a Section 504 Plan, the school nurse may want to consider the appropriateness of the following accommodations:

Allow the student to use the restroom whenever there is a need.
Allow the student to leave class early or arrive late without being penalized.
The option for the student to use a private restroom.
Academic support if they miss class due to health concerns (including health care provider appointments, hospitalization, or illness).
Permission to always use a water bottle.
The provision of necessary accommodations on field trips and other school sponsored activities.

(Association for the Bladder Exstrophy Community, 2022).

Individualized Education Program (IEP):

In addition to their health condition, a child who requires intermittent urinary catheterization may also have another condition, such as an intellectual disability or significant developmental delay, that qualifies them for an IEP (U.S. Department of Education, 2018). An IEP is developed by a multidisciplinary special education team. The IEP outlines the plans for special education services for the student who has a qualifying disability that interferes with learning. The IEP plan identifies what services and accommodations are needed to support the student’s education needs (NASN, 2020d). Many interventions provided as part of the IEP plan are “related services”, which include school nursing services and school health services (U.S. Department of Education, 2017).

Resources

Association for the Bladder Exstrophy Community:

Kennedy Krieger Institute’s Specialized Health Needs Interagency Collaboration:

Society of Urologic Nurses and Associates:

Spina Bifida Association:

Continence Management at School

References

American Nurses Association. (2012). Principles of delegation.

Association for the Bladder Exstrophy Community. (2022). Bathroom toolkit.

Borer, J.G. (2023, October 17). Clinical manifestations and initial management of infants with bladder exstrophy.

Bradley E. (2020). Achieving independence in toileting: Self-catheterization efficacy and the role of the school nurse. NASN School Nurse (Print), 35(6), 314–318.

Center for Inclusive Child Care. (2020). Tip sheets. Emergency planning for children with disabilities.

Clarke, L.S., Embury, D.C., Yssel, N. (2014). Supporting students with disabilities during school crisis. A teacher’s guide. Teaching Exceptional Children, 46(6), 169-78.

Erwin, K., Clark, S., & Mercer, S.E. (2014). Providing health services for children with special health care needs on out-of-state field trips. NASN School Nurse, 29(2), 84-8.

Federal Emergency Management Agency. (2009). Evacuating the special needs population.

Fortuna, S. M., Korcal, L., & Thomas, G. (2018). Bladder management in children: Intermittent catheterization education. NASN School Nurse (Print), 33(3), 178–185.

Holmes. N. (2023, April 3). Management of posterior urethral valves.

Kennedy Krieger Institute & Maryland State Department of Education. (2017, July). Factsheet: Bladder surgery.

Llorens, A., McKee, S., & Dempsey, A.G.). (2020). In A.G. Dempsey (Ed.). Pediatric health conditions in schools. (pp. 26-27). New York, NY: Oxford Press.

Lucas E. (2019). Medical management of neurogenic bladder for children and adults: A review. Topics in Spinal Cord Injury Rehabilitation, 25(3), 195–204.

Medline Plus. (2016, October 24). Spina bifida.

National Association of School Nurses. (2019a). School-sponsored trips -The role of the school nurse (Position Statement). Silver Spring, MD: Author.

National Association of School Nurses. (2019b). Transition planning for students with healthcare needs (Position Statement). Silver Spring, MD: Author.

National Association of School Nurses. (2020). Understanding student health and education plans.

National Association of School Nurses. (2023). IDEIA and Section 504 Teams – The school nurse as an essential team member (Position Statement). Author.

National Children’s. (2023). Posterior urethral valves.

Nationwide Children’s. (n.d.). What is the mitrofanoff procedure (Appendicovesicostomy)?

Norman, S., Leach, M., & Taha, A.A. (2024). The child with neuromuscular or muscular dysfunction. In Hockenberry, Duffy, & Gibbs (Eds). Wong’s nursing care of infants and children (12th Ed., pp. 1342-43).

Selekman, J. & Ness, M. (2019). Students with chronic conditions. In J. Selekman, R.A. Shannon, C.F. Yonkaitis, (Eds.). School nursing, a comprehensive text (3rd ed., p 493). Philadelphia PA.: F. A. Davis Co.

Shannon, R. A., & Kubelka, S. (2013). Reducing the risks of delegation: use of procedure skills checklists for unlicensed assistive personnel in schools, Part 2. NASN School Nurse (Print), 28(5), 222–226.

Spina Bifida Association. (2018). Guidelines for the care of people with spina bifida.

Tobias, N.E. (2017). Practical considerations and current best practice for pediatric clean intermittent catheterization. Pediatric Nursing, 43(6), 267-273.

Urology Care Foundation. (2021a).

Urology Care Foundation. (2021b, September). What is neurogenic bladder?

U.S. Department of Education. (2017, May 2). Sec. 300.34 related services.

U.S. Department of Education. (2018, May 25). Sec. 300.8 Child with a disability.

U.S. Department of Education. (2023). Frequently asked questions about Section 504 and the education of children with disabilities.

U.S. Department of Health and Human Services & U.S. Department of Education. (2008). Joint guidance on the application of the Family Educational Rights and Privacy Act (FERPA) the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to student health records.

Wisconsin Department of Public Instruction. (2019). Meeting student health needs while on field trips. Tool kit for Wisconsin schools.

Reviewers

Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog

Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing

Last updated 4/18/2025

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