Flying by the seat of their pants: A grounded theory of school nurse case management

Abstract

Aims To develop a theory describing the processes and actions involved with school nurse case management for school‐aged children with chronic conditions in the K12 system. Design Case management is an essential practice for the school nurse. Little is known about actual case management practice in real‐world settings. Grounded theory methodology following a literature‐based conceptual model of school nurse case management. Methods A purposive maximum variation sampling was used for data collection and analysis. Semi‐structured interviews conducted in‐person and via conferencing software from January to March 2017 with school nurses practicing in Washington State until data saturation was achieved. A condition lasting at least 6 months was also used to define a chronic condition. Results In all, 14 school nurses with an average of 12 years of experience were interviewed. Analysis revealed that the core strategy used by participating nurses for case management involved navigating through ambiguity; balancing multiple roles; seeking guidance and training; acknowledging imperfect functioning and navigating poor system supports. Conclusion The findings suggest that actual school nurse case management practice differs from best practice recommendations. Participants did not discuss health promotion or environmental management and did not act to set goals or prioritize care as suggested in the literature. Impact This article informs nursing leadership of the real‐world challenges faced by nurses performing case management in the school setting. These findings indicate that improvements in system supports and training, together with tolerance for the challenges nurses face in providing such care, might improve case management practice in the schools.

School nurses' perceptions regarding barriers and facilitators in caring for children with chronic diseases in school settings: A mixed studies review

“…In four articles, nurses recognized that there was insufficient school nurse staffing to support children (Kao et al, 2018; Liberatos et al, 2013; Seki et al, 2017; Svavarsdottir et al, 2013). In five articles, they reported a lack of staff education (Kao et al, 2018; Terry & Trott, 2019) or training (Klein & Evans‐Agnew, 2019; March et al, 2020; Marshall et al, 2013). Recently, school nurses have been required to be skilled with modern devices and receive increased training (March et al, 2020).…”

“…They reported that a lack of evidence‐based guidance and variations in best practices were barriers in providing necessary support to children (Marshall et al, 2013). Typically, school nurses take on multiple roles, which leads to the imperfect care practice (Klein & Evans‐Agnew, 2019). Additionally, they experienced difficulties related to variations in school staff support and inconsistent classroom practices in caring for students requiring the use of modern medical devices (March et al, 2020).…”

“…School nurses appeared generally enthusiastic about school health care for children with chronic diseases, but the lack of resources and practical limitations made it difficult to provide such care (March et al, 2020). Further, a lack of guidance regarding school nurses' roles and poor institutional support were also barriers (Klein & Evans‐Agnew, 2019). School nurses reported that a lack of support from administrators and teachers (Liberatos et al, 2013), including head teachers, also had a negative impact on the level of health care provided in school (Marshall et al, 2013).…”

Care Coordination: A Principle of 21st Century School Nursing Practice With a Focus on Case Management

“…Although there are limited scholarly articles specific to SNCM, Bachman et al (2015) note that school nurses are considered providers of care coordination and case management services including supports within a broad range of providers and systems. In addition, research by Klein and Evans-Agnew (2019) indicate that despite contextual constraints, such as high caseloads and limited hours, school nurses are attempting to do case management.…”

“…The practice component of health promotion is part of the principal of community/public health (community/public health principle). All principles of the Framework were used to address the barriers identified by Washington state school nurses (Klein & Evans-Agnew, 2019; NASN, 2016a).…”