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

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. 目的 为K12系统中患有慢性疾病的学龄儿童开发一个描述与校园护士病例管理相关的过程和行动的理论。 设计 病例管理是校园护士的一项基本实践。现实中并不了解实际病例管理实践。遵循基于文献的校园护士病例管理概念模型的基础理论方法。 方法 数据收集和分析采用了目的性的最大变异抽样。2017年一月至三月,通过会议软件对华盛顿州的校园护士实践进行了半结构化访谈,直到数据达到饱和。并将慢性疾病定义为持续至少6个月以上的疾病。 结果 一共采访了14名平均有12年经验的校园护士。分析表明,参与病例管理的护士使用的核心策略包括避免歧义、平衡多个角色、寻求指导和训练、承认功能有所欠缺并避免系统支持不佳。 结论 调查结果表明,真正的校园护士病例管理实践不同于最优的实践建议。受试者没有讨论促进健康或环境管理,也没有按照文献建议制定目标或确定护理的优先顺序。 影响 本文揭示了护士进行校园病例管理时所面临的现实生活中的挑战。这些调查结果表明,改进系统支持、培训及护士提供此类护理时对挑战的容忍度可能改善校园病例管理。