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Factors Impacting School Nurse Care Coordination for Children with Special Healthcare Needs a DISSERTATION SUBMITTED to the FACU

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Factors Impacting School Nurse Care Coordination for Children with Special Healthcare Needs a DISSERTATION SUBMITTED to the FACU Factors Impacting School Nurse Care Coordination for Children with Special Healthcare Needs A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY Lynn Marie Choromanski IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Connie W. Delaney, PhD, RN Bonnie L. Westra, PhD, RN November 2011 © Lynn Marie Choromanski 2011 i Acknowledgements A researcher cannot complete a study without the willing participation of subjects. For this I am most grateful to 27 enthusiastic women willing to share their stories and their insights into school nursing. My advisers, Connie Delaney and Bonnie Westra, have encouraged me through this long process always reminding me to envision myself walking across that stage to receive my degree. My supportive colleagues have been there to listen and advise on the progress of my dissertation and for this I thank John Belew, Paula Forte, Cathy Johnson, Karen Brill and Christine Milbrath. Not only did they offer words of encouragement but supported my time to complete this academic work. Thanks to Connor, Amelia and Cavan who allowed their mother at critical points to put a dissertation ahead of their personal needs and for their continuing support. Their pride in the work I did was a huge motivator in completing this work. To my parents and sisters who were always willing to listen, to offer advice and to support, without you this would not have been possible. And to Shelly for her hours of tireless and accurate transcription, a difficult job performed with joy and willingness to go above and beyond to help a friend. Many thanks go to Leslie Morrison Sandburg who confirmed the logic of the coding scheme. The School Nurse Organization of Minnesota provided a grant to support the expenses of this research. Gillette Children’s Specialty Healthcare provided the software for coding the transcripts. ii Dedication This dissertation is dedicated to my children, my sisters and my parents. Thank you for your support. iii Abstract Background: Children with special healthcare needs (CSHCN) compose a significant potion of pediatric clients. Approximately 14.2 million U.S. children have special healthcare needs. CSHCN are integrated into the school system to the level their disability allows. School nurses are responsible for the healthcare needs of these children while in school. Purpose: The purpose of the study was to explore the factors which impact school nursing care coordination of CSHCN. Six specific study aims were identified to support the research purpose. Methods: The design of this research was a qualitative descriptive study. Data were gathered during semi-structured interview with 27 school nurses from one Midwestern state. Participants described their experience with care coordination for CSHCN in their schools. Results: A total of 19 separate themes across the six study aims were identified. From the 19 themes identified there were four overarching factors which could encapsulate all 19 themes. Factors which impact school nurses’ provision of care coordination for CSHCN are: school nurses need to establish relationships with a team; information needs to be collected and shared; each child has individualized plans to meet overarching educational goals; and sufficient time is needed. Conclusions: The school nurse participants in this study provided insights into the care coordination efforts they make on behalf of the CSHCN in their schools. Little research has been conducted about factors contributing to care coordination for CSHCN by school nurses. This study fills a gap in knowledge about school nursing and raises questions for future research about the understanding, contributing factors and barriers to effective care coordination by school nurses for CSHCN. iv Table of Contents Acknowledgements ........................................................................................................... i Dedication......................................................................................................................... ii Abstract............................................................................................................................iii Table of Contents ............................................................................................................ iv List of Tables.................................................................................................................viii List of Figures.................................................................................................................. ix CHAPTER 1 INTRODUCTION...................................................................................... 1 Research Problem......................................................................................................... 1 Children with special healthcare needs in schools. .................................................. 2 Care coordination across multiple settings............................................................... 5 Study Purpose............................................................................................................... 6 Research Question........................................................................................................ 6 Study Aims ................................................................................................................... 6 Research Design Overview .......................................................................................... 7 Investigator’s Background and Assumptions............................................................... 8 Significance ................................................................................................................ 10 Chapter Summary....................................................................................................... 12 CHAPTER 2 LITERATURE REVIEW......................................................................... 14 Search Strategies ........................................................................................................ 14 Topics Addressed in Literature Review ..................................................................... 15 Care coordination. .................................................................................................. 15 Care coordination in ambulatory pediatrics. .......................................................... 16 Impact of care coordination.................................................................................... 18 Providers of care coordination................................................................................ 20 Care Coordination in the Educational System............................................................ 23 School Nursing Outcomes Research ...................................................................... 27 Conceptual Framework .............................................................................................. 40 Search strategies. .................................................................................................... 45 School nursing framework for practice in school nursing literature. ..................... 46 Chapter Summary....................................................................................................... 51 CHAPTER 3 METHODS............................................................................................... 52 Study Aims ................................................................................................................. 52 Participants ................................................................................................................. 53 Recruitment summary. ........................................................................................... 55 Setting......................................................................................................................... 56 Key Definitions and Terminology.............................................................................. 57 School nurse. .......................................................................................................... 57 Children with special healthcare needs (CSHCN). ................................................ 57 Care coordination. .................................................................................................. 58 Terminology. .......................................................................................................... 59 Research Design ......................................................................................................... 59 Design features of qualitative description. ............................................................. 61 Data Collection Methods............................................................................................ 63 v Qualitative semi-structured individual interviews.................................................. 64 Demographic survey............................................................................................... 66 Field notes. ............................................................................................................. 66 Data Analysis.............................................................................................................. 67 Qualitative data analysis plan................................................................................. 67 Coding scheme. .....................................................................................................
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