Wound Management

This resource provides current and comprehensive health care information for school health nurses. Related procedures, instructional videos and downloadable skills checklists can be searched by selecting the [More Information] button at the bottom of this web page.

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Overview

Students may require wound management for varying reasons including, but not limited to, pressure sores from immobility, burns, trauma, or post-surgery. There are different types of wounds that can be classified by status of skin integrity, cause of the wound, or the extent of tissue damage.

Table 1. Wound Classification

Description	Cause	Implications for Healing
Onset and Duration
Acute
Wound that proceed through an orderly and timely reparative process that results in sustained restoration of anatomical and functional integrity	Trauma Surgical incision	Wound edges are clean and intact
Chronic
Wound that fails to proceed through an orderly and timely process to produce anatomical and functional integrity	Vascular compromise, chronic inflammation, or repetitive insults to the tissue	Continued exposure to insult impedes wound healing
Healing Process
Primary Intention
Wound that is closed	Hematoma, surgical incision that is sutured or stapled	Healing occurs by epithelialization; heals quickly with minimal scar formation
Secondary Intention
Wound edges not closed or approximated	Surgical wounds that have tissue loss or contamination	Wounds heals by granulation tissue formation, wound contraction, and epithelialization
Tertiary Intention
Wound that is left open for several days; then wound edges are approximated	Wounds that are contaminated and require observation for signs of inflammation	Closure of wound is delayed until risk of infection is resolved

Source: Potter et al., 2023, p. 1325.

Wounds can also be classified based on the extent of tissue loss. Partial-thickness wounds involve only a partial loss of skin layers. They are “shallow in depth, moist, and painful, and the wound base generally appears red” (Potter et al., 2023, p. 1323). A partial thickness wound heals by regeneration. Full-thickness wounds extend into the subcutaneous layer and can be painful. The depth and tissue type vary based on location on the body. Full-thickness wounds heal by forming new tissue (Potter et al., 2023).

Assessment of Wound

The school nurse should assess the wound when performing a dressing change. It is important to note, assessments can only be performed by a registered nurse or licensed practical nurse and thus dressing changes that require an assessment should not be delegated to an unlicensed assistive personnel (UAP). The following should be assessed during the dressing change:

• Location of the wound
• Size of the wound
• Depth of the wound
• Color of the wound
• Color of drainage
• Consistency of drainage
• Amount of drainage
• Odor present
• Condition of the skin surrounding the wound
• Level of pain

(Cox, 2019; Potter et al., 2023)

Table 2. Types of Wound Drainage

Type	Appearance
Serous	Clear, watery plasma
Purulent	Thick, yellow, green, tan, or brown
Serosanguineous	Pale, pink, watery, mixture of clear and red fluid
Sanguineous	Bright red, indicates active bleeding

Source: Potter et al., 2023, p. 1327

Phases of Wound Healing

There are four stages of wound healing. They are distinct phases but also overlap. They include:

1. Inflammation: Generally completed within 3 days unless there is impaired wound healing due to infection or other factors. The wound is the weakest at this time.
2. Epithelialization: Refers to basal cell proliferation and epithelial cell migration. This phase continues for 5 days to 4 weeks. The wound is fragile at this time and granulation tissue bleeds extensively if disturbed.
3. Proliferative Phase (Fibroplasia): In this stage, proliferation of fibroblast, accumulation of ground substance, and collagen production occur.
4. Maturation: This stage includes collagen cross-linking, collagen remodeling, wound contraction, and repigmentation.

(Armstrong & Meyr, 2022a; Baker, Mondozzi, & Hockenberry, 2024).

Managing Wounds

The goal of wound treatment is to eliminate the factors that interfere with normal healing. Treatment is aimed at preventing further damage, eliminating the cause, preventing complications, and providing relief from discomfort while the tissue heals (Baker, Mondozzi, & Hockenberry, 2024). Most wound dressings will promote moist wound healing to help increase the “rate of collagen synthesis and reepithelialization, and decrease pain and inflammation” (Baker, Mondozzi, & Hockenberry, 2024, p. 1214).

Dressings help wound management by:

• Providing a moist environment for healing
• Protecting the wound from infection and trauma
• Providing compression in the event of bleeding or swelling
• Applying medication
• Absorbing drainage
• Debriding necrotic tissue
• Reducing pain
• Controlling odor

(Baker, Mondozzi, & Hockenberry, 2024).

There is little evidence that aids in the selection of wound dressings. “Consensus opinion supports the following general principles for chronic wound management but similar principles may be used for acute wound management:

• Hydrogels for the debridement stage
• Low-adherent dressings that maintain moisture balance for the granulation stage
• Low-adherent dressings for the epithelialization stage” (Armstrong & Meyr, 2022b).

Table 3. Types of Dressings

Category		Description		Example
Gauze or sponge for external use		Nonresorbable		Pads
		Sterile or nonsterile		Island dressings
		Strip, piece, or pad
		Woven or nonwoven mesh cotton cellulose
		Simple chemical derivatives of cellulose
		Intended for medical purposes
Hydrophilic wound dressing		Sterile or nonsterile		Alginate dressing
		Nonresorbable		Foam dressing
		Material with hydrophilic properties		Hydropolymer dressings
		No added drugs or biologics		Sheet gel dressings
		Intended to cover wound and absorb exudate		Hydrocolloid dressings
				Composite dressings
Occlusive wound dressing		Sterile or nonsterile		Transparent adhesive
		Nonresorbable		Thin film dressing
		Synthetic polymeric material with or without adhesive backing		Foam dressing
		Intended to cover wound, provide or support moist wound environment, and allow exchange of gases		Hydrocolloid dressings
				Composite dressings
				Hydropolymer dressings
Category		Description		Example
Hydrogel wound dressing		Sterile or nonsterile		Alginate dressings
		Nonresorbable		Hydropolymer dressings
		Matrix of hydrophilic polymers or other material combined with at least 50% water		Hydrogel dressing
		Intended to cover wound, absorb wound exudates, control bleeding or fluid loss, and protect against abrasion, friction, desiccation, and contamination		Gauze dressing impregnated with hydrogel (without active ingredients)
Porcine wound dressing		Made from pigskin
		Temporary burn dressing

Source: Baker, Mondozzi, & Hockenberry, 2024, p. 1214

Table 4. Dressing Types and Uses

Dressing Type	Wound Type	Use	Considerations
Dry gauze	Draining wound	Absorb drainage, nonocclusive, inexpensive	May stick to dry wounds, moisten before removal
Silicone	Wounds or incisions with abnormal healing which could lead to raised scars	Relax and soften scar tissue. Conforms to body contours.	Reduces pain on dressing removal.
Hydrogels	Pressure ulcer, partial or full-thickness wounds, vascular ulcers, burns, abrasions, or skin tear	Water- or glycerin-based dressing provides moisture to dry wounds.	Not for heavily draining wounds. May require a secondary dressing. Can cause maceration.
Transparent films	Closed surgical incision, small tear with minimal drainage	Thin, transparent sheets with adhesive backing. Protect from water and bacteria. Provide a moist healing environment.	Usually has its own adhesive, so it needs less tape. Doesn’t cause pain or trauma when removed.
Impregnated gauze	Skin grafts, burns, and skin tears	Gauze is treated with substances such as petroleum, iodine, bismuth, and zinc. Adds moisture.	Will need a secondary dressing to cover.
Foam	Moderate-to-heavy draining wounds, partial and full-thickness wounds, and minor burns	Polyurethane pads, sheets, or cavity packing that may have air- and watertight backing. Maintains moisture and protects the wound. Conform to wound bed.	Not recommended for dry wounds. Can be left in place for 4 to 7 days.
Collagen	Minimal to heavy draining wounds.	Woven material that absorbs blood and forms a gelatin mass which is absorbed within 2 to 7 days.	Maintains wound moisture and enables healing at a rapid pace.
Alginates	Highly draining wounds (i.e., surgical incisions and infected wounds)	Nonwoven fibers made from brown seaweed. Forms a gel when placed on a wound. Provides a moist environment. Conforms to the wound bed.	Available in sheet, ribbon, or rope. May be kept in place for 7 days. Not used for dry wounds.
Hydrofibers	For moderate drainage	Sterile fibrous sheets convert to a solid gel and conform to the wound when moistened.	Highly absorbent and allows debridement.

Source: American College of Surgeons, n.d., pp. 25, 27; Armstrong & Meyr, 2022b

The school nurse should have an order from a health care provider that outlines the type of dressing(s) to be used, how often the dressing should be changed, and if any topical medications should be applied. For more information on health care provider’s orders see the Medication and Documentation sections.

Delegation

There are many factors for the school nurse to consider when deciding whether to delegate this procedure to unlicensed assistive personnel (UAP). This section provides 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: The delegation questions are based on the American Nurses Association’s Decision Tree for Delegation by Registered Nurses (ANA, 2012).

1. Has the school nurse performed an initial student assessment determine their needs?
   The school nurse should not delegate the procedure to a UAP until they have completed the initial assessment.
2. Does school district policy, the school nurse’s job description, and the UAP’s job description allow procedures related to wound care to be delegated?
   Although the Missouri Nurse Practice Act allows for registered nurses to delegate wound management, the district may have policies that prohibit or limit the school nurse’s ability to delegate. The school nurse and UAP job descriptions may restrict delegation as well.
3. 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.
4. Is the student’s condition stable? Is this an established wound?  How predictable are the outcomes of the procedure?
   A school nurse should not delegate wound management to a UAP if the student has an acute wound. The outcomes are not predictable and thus the school nurse should perform the procedures until the student’s condition has stabilized.
5. Does the procedure require initial or ongoing assessment be done during the procedure?
   If an initial or ongoing assessment is required for the procedure to be performed, the procedure should not be delegated. Note, wound management frequently requires an assessment each time the dressing is changed and thus wound management may not be an appropriate procedure to delegate to a UAP.
6. 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. In that case, identify and train another UAP. The registered nurse must retain responsibility for the procedure until training is complete.
7. 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. The steps should be outlined in a written procedure or protocol. If the written procedure/protocol has not been developed, the school nurse should retain responsibility for the procedure until the procedure/protocol is in place.  The procedure or protocol for wound care should include instructions on when the UAP should contact the school nurse and/or parents/guardians (i.e.,bleeding from the wound, purulent drainage from the wound, student complains of pain, has a fever, etc.).
8. 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).
9. 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 nurse needs to teach the student more 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

Based on the severity, location, and type of wound the student has they may have restrictions related to physical activity. The school nurse should review the health care provider’s orders to determine if any modifications to the student’s curriculum (i.e., physical education class) or activities should be made. If there are no orders from the health care provider regarding physical activity restrictions but the teacher, school nurse, student, or parents/guardians have concerns, the school nurse should discuss with the student’s health care provider.

Students

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

• Current health conditions
• Medications
• Allergies
• Previous hospitalizations and surgeries
• Most recent hospitalization (if applicable)
• Wound location
• Wound size
• Type of wound
• Insurance coverage
• Health care provider(s) name and contact information
• Home health agency, if applicable
• Preferred hospital, if applicable

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

1. What do you believe caused the wound?
2. When did the wound occur?
3. What has changed with the wound since it occurred?
4. Do you have any pain, itching, or other symptoms with the wound?
5. How are you managing the itching, if present?
6. Are there any activities that are difficult to participate in because of the wound?
7. How independent is the student in their wound management?
8. Does the classroom environment support the student’s needs (i.e., desk/seating options)
9. Does the student and/or their parents/guardian have any concerns related to the student’s wound?
10. Do you feel the student has been sufficiently supported by the school staff in managing their wound?
11. Has the student had to change any of their social activities because of their wound?
12. Does the student attend before or after school care?
13. Does the student participate in school-sponsored clubs or athletics?
14. For students with an underlying health condition or wound management that is estimated to be longer than 6 months:
    1. 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?
    2. 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)?
    3. Does the student have an Individualized Health Care Plan (IHCP)?
    4. Is there a need for a specific plan for this student’s individual needs if there is a crisis in the building?
    5. 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?
    6. How is the student transported to and from school?

(Clarke, Embury, & Yssel, 2014; Llorens, McKee, & Dempsey, 2020; Potter et al., 2023)

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).

FERPA HIPAA Consent Sample (NASN)

Communication with the student’s health care provider regarding the status of the wound is also important. The school nurse should discuss with the health care provider how often they would like updates and when they would like to be notified regarding the wound healing. The school nurse may find this Wound Care SBAR resource helpful in identifying what information to communicate to the student’s health care provider.

Medications

Antibiotic therapy is not indicated for all wounds and is typically reserved for wounds that appear clinically infected (Armstrong & Meyr, 2022). If antibiotics, antiseptic, antimicrobials or other medications are prescribed for wound management the school nurse will need an order from a health care provider. The order should include:

• Student’s name
• Date of birth
• Name of the medication
• Dose
• Route
• Time of administration
• Reason for administration

Field Trips

Field trips and other out-of-school activities will require some planning by the school nurse. There are several variables that the school nurse will want to consider and plan for, including:

1. Does the student require someone to accompany them on the trip to provide wound care or are they independent in the care of their wound?
2. If the student does require someone to assist with the procedure(s) and/or care of the wound, who will accompany the student on the field trip to perform necessary procedures?
   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). Additionally, the school nurse must determine if an assessment is required during the dressing change. If an assessment is needed, an RN or LPN must accompany the student.
3. Where will the dressing change supplies be stored?
   It is important to have all needed supplies readily available. Supplies should not be left on the bus but should always be with the student.
4. How will the student’s privacy be protected?
   The school nurse should discuss with the student and their family where the procedure(s) will be performed during the field trip and the student and family’s privacy expectations (i.e., the student may not have access to a private bathroom). 
5. 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.
6. How will the procedure be documented?
   Timely documentation is a key component of nursing. The school nurse should consider how procedures and medication administration, if applicable, that occur on a field trip will be documented (Erwin, Clark, & Mercer).
7. 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, 2019; 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.

St. Louis Children’s Hospital, Food Allergy Management and Education Program has developed a NASN Resource: Field Trip Preparation Checklist.

Documentation

Health Care Provider Order:

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

• Student’s name
• Date of birth
• Type of wound
• Wound management materials used to include brand, type of dressing, size of dressing, and any other materials used (i.e. tape)
• Products used for skin care/skin breakdown
• Level of independence the student has with performing the procedure(s) (i.e., fully independent, needs assistance, or fully dependent)
• When the health care provider would like to be contacted

Emergency Action Plan: The school nurse should discuss with the student’s health care provider if an Emergency Action Plan (EAP) is warranted as there are probably minimal circumstances related to wound management that would constitute an emergency. If a wound begins to bleed profusely, the school staff should be knowledgeable regarding the actions to take. If the health care provider and school nurse feel this is a possible scenario or other emergencies may occur, then the development of an EAP is suggested.

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 wound management at school. The authorization form can be a separate document that just the parents sign or a document can be developed that combines the health care provider’s order and parent authorization in one form.

Procedures and Medication Administration: All medication administration and wound management procedures will need to be documented, whether they are performed by the school nurse or the UAP.  Many times the medication administration and procedures are documented in the student’s health record. The school nurse will also want to ensure that medications being administered, or procedures being performed during field trips, before or after school, and/or during any school-sponsored activities are being documented. In addition to documenting that the wound care has been provided, the school nurse will also want to document their assessment of the wound. For more information on wound assessment see the Overview section.

Staff Competency Validation: If the procedures or medication administration 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 are typically developed for students with underlying health care conditions that require daily nursing interventions or if their health condition could result in an emergent situation. IHCP development should be prioritized for students who require significant health services at school, have a medical diagnosis that may result in a health crisis, and/or students with health conditions addressed in a Section 504 Accommodation Plan or an Individualized Educational Program (Yonkaitis & Shannon, 2019). If the student’s wound management is expected to resolve in six months or less, then an IHCP may not be necessary. If the student has underlying health conditions that warrant an IHCP, the IHCP may need to be updated to include would management information and planning.

Section 504 Plan: For most students, wound management in the school setting will be an acute need that should not require ongoing care once the wound is healed. If the wound management is expected to be completed within 6 months, the student would not qualify for a Section 504 Plan. For more information on 504 Plans see the Legal Issues section.

Procedure

See https://showmeschoolhealth.org/our-resources/ and put dressing in search box.

Emergency Preparedness

The school nurse should discuss with the student’s health care provider what may constitute an emergent situation relating to the student’s wound care. Based on the information gathered the school nurse should develop an Emergency Care Plan if warranted. If the location or the severity of the student’s wound impacts their mobility the school nurse will want to develop a plan for emergency evacuations taking into consideration that the student may need some assistance with ambulation. If the student has any underlying health conditions that may be impacted by other emergencies such as a lockdown, extreme weather event, or shelter-in-place situation, the school nurse will want to develop a plan to address these possible emergencies.

Legal Issues

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 with related services and accommodations in the general education classroom (U.S. Department of Education, 2023; NASN, 2023).  For most students, wound management in the school setting will be an acute need that should not require ongoing care once the wound is healed. If the wound management is expected to be completed within 6 months, the student would not qualify for a Section 504 Plan. Congress clarified that an individual is not “regarded as” an individual with a disability if the impairment is transitory and minor.  A transitory impairment is an impairment with an actual or expected duration of 6 months or less (U.S. Department of Education, 2023).

If the student requiring wound management at school has underlying health conditions they may qualify for or already have an existing Section 504 Plan. If the student has underlying health conditions and does not have a 504 Plan the school nurse should determine if an evaluation is indicated (see Studentsection for questions to ask student and family to determine if 504 or IEP evaluation is indicated).

Resources

https://www.facs.org/for-patients/home-skills-for-patients/wound-management

https://www.woundsource.com/woundsource-product-guide

https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/dressing-change-burns

References

American College of Surgeons. (n.d.). Wound home skills kit: Lacerations & abrasions.

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

Armstrong, D.G. & Meyr, A. J. (2022a, May 19). Basic principles of wound healing. UpToDate.

Armstrong, D. G. & Meyr, A. J. (2022b, June 9). Basic principles of wound management. UpToDate.

Baker, R. U., Mondozzi, M., & Hockenberry, M.J. (2024). The child with integumentary dysfunction. In Hockenberry, Duffy, & Gibbs (Eds). Wong’s nursing care of infants and children (12th Ed., pp. 1210-1261).

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. doi/10.1177/0040059914534616

Cox, J. (2019). Wound care 101. Nursing, 49(10), 32–39.

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.

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

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

Potter, P. A., Griffin Perry, A. G., Stockert, P. A., & Hall, A. (2023). Chapter 48 Skin integrity and wound care. In Fundamentals of Nursing. (11th ed.). (pp. 1276-1317). St. Louis, MO: Elsevier.

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.

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.

Yonkaitis, C. F., & Shannon, R. A. (2019). Health and education plans for students with special healthcare needs. In J. Selekman, R. A. Shannon, & C. F. Yonkaitis (Eds.). School nursing a comprehensive text. (3rd ed., p. 179). (Philadelphia, PA: F. A. Davis Company.

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

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