Health services utilization and special education: development of a school nurse activity tool

Increasing competition exists for resources to support health services for children receiving special education. Consequently, management tools to document services when claiming these resources need to be developed. The purposes of this study were to develop a time study instrument based on nursing activities in the school, compare nursing time provided to special education children and their nondisabled peers in general education settings, compare nursing process activities in traditional settings and in special education settings, and elicit feedback from nurses to improve the validity and reliability of the time study process. Eighteen nurses representing rural, urban, and suburban schools completed a time study for two weeks, quantifying services provided in the health room. Nurses recorded student educational status, special education category or not, nursing process activity, and the time utilized per student contact. Results indicated 48.2% of school nursing time was attributed to services for special education students during the study period. Most nursing process activities for both settings were in assessment of problems and in direct services. Findings indicate the instrument can provide objective documentation of special education health services, providing a base for claiming important resources for school health services.