Health care for students with chronic needs can be complex and specialized, resulting in fragmentation, duplication, and inefficiencies. Students who miss school due to chronic conditions lose valuable educational exposure that contributes to academic success. As health-related disabilities increase in prevalence so does the need for the coordination of care within the school and between the school and service providing agencies. This integrative literature review provides a synthesis of published evidence identifying and describing the core concepts associated with the role of school nurses in providing care coordination/case management to students with complex needs. Six core essentials of nurse-provided care coordination were identified: collaboration, communication, care planning and the nursing process, continuous coordination, clinical expertise, and complementary components. Recommendations for improving care coordination were elucidated in the review. Analysis of the literature can help assure application of best practice methods for the coordination of care for students in the school setting.
American Academy of Pediatrics, Committee on Children with Disabilities. (1999). Care coordination: Integrating health and related systems of care for children with special health care needs. Pediatrics, 104, 978–981. doi:10.1542/peds.2005-2070
2.
American Nurses Association. (2011). Scope and standards of practice school nursing (2nd ed.). Silver Spring, MD: American Nurses Association.
AntonelliR. C.AntonelliD. M. (2004). Providing a medical home: The cost of care coordination services in a community-based, general practice. Pediatrics, 113, 1522–1528.
5.
AntonelliR. C.McAllisterJ. W.PoppJ. (2009, May). Making care coordination a critical component of the pediatric health system: A multidisciplinary framework. New York, NY: The Commonwealth Fund.
6.
AntonelliR. C.StilleC. J.AntonelliD. M. (2008). Care coordination for children and youth with special health are needs: A descriptive, multisite study of activities, personnel costs, and outcomes. Pediatrics, 122, e209–e216.
7.
BarrettJ. C. (2000). A school-based care management services for children with special needs. Family and Community Health, 23, 36–42.
8.
BetzC. L.RedcayG. (2005). Dimensions of the transition service coordinator role. Journal for Specialists in Pediatric Nursing, 10, 49–59. doi:10.1111/j.1744-6155.2005.00010.x
9.
BloomB.CohenR.FreemanG. (2012). Summary health statistics for U.S. children: National health interview survey, 2011. National Center for Health Statistics. Retrieved fromhttp://www.cdc.gov/nchs/data/series/sr_10/sr10_254.pdf
10.
BonaiutoM. (2007). School nurse case management: Achieving health and educational outcomes. Journal of School Nursing, 23, 202–209. doi:10.1177/10598405070230040401
11.
BrustromJ.ThibadeauJ.JohnL.LiesmannJ.RoseS. (2012). Care coordination in the spina bifida clinic setting: Current practice and future directions. Journal of Pediatric Health Care, 26, 16–26. doi:10.1016/j.pedhc.2010.06.003
12.
CadyR. G.KellyA. M.FinkelsteinS. M.LoomanW. S.GarwickA. W. (2013). Attributes of advanced practice registered nurse care coordination for children with medical complexity. Journal of Pediatric Health Care, 28, 305–312. doi:10.1016/j.pedhc.2013.06.005.
13.
Center for Child and Adolescent Health. (2012). Data resource center for child & adolescent health. Retrieved fromhttp://www.childhealthdata.org/home
14.
CooperH. (1998). Synthesizing research: A guide for literature reviews (3rd ed.). Thousand Oaks, CA: Sage.
15.
CrickmoreK.JonesA.EngelkeM. K.MottJ. A. (2002). Managing pediatric asthma: A community-based program yields compelling outcomes for children with asthma. Health Forum Journal, 45, 24–30.
16.
DangM. (2010). The history of legislation and regulations related to children with developmental disabilities: Implications for school nursing practice today. Journal of School Nursing, 26, 252–259. doi:10.1177/1059840510368162
17.
EngelkeM. K.GuttuM.WarrenM. B.SwansonM. (2008). School nurse case management for children with chronic illness: Health, academic, and quality of life outcomes. Journal of School Nursing, 24, 205–214. doi:10.1177/1059840508319929
18.
EngelkeM. K.GuttuM.WarrenM. B. (2009). Defining, delivering, and documenting the outcomes of case management by school nurses. Journal of School Nursing, 25, 417–426. doi: 10.1177/1059840509347377
19.
EngelkeM. K.SwansonM.GuttuM. (2014). Process and outcomes of nurse case management for students with asthma. Journal of School Nursing, 30, 196–205. doi:10.1177/1059840513507084
20.
FuchsV. R. (2009). Health reform: Getting the essentials right.Health Affairs, 28(2), w180–w183. doi: 10.1377/hlthaff.28.2.w180
21.
GordonJ. B.ColbyH. H.BarteltT.JablonskiD.KrauthoeferM. L.HavensP. (2007). A tertiary-care primary care partnership model for medically complex and fragile children and youth with special health care needs. Archives of Pediatric and Adolescent Medicine, 161, 937–944.
LevyM.HeffnerB.StewartT.BeemanG. (2006). The efficacy of asthma case management in an urban school district in reducing school absences and hospitalizations for asthma. Journal of School Health, 76, 320–324. doi:10.1111/j.1746-1561.2006.00120.x
27.
LewisC. C.Alford-WinstonA.Billy-KornasM.McCaustlandM. D.TachmanC. P. (1992). Care management for children who are medically fragile/technology-dependent. Issues in Comprehensive Pediatric Nursing, 15, 73–91.
28.
LindekeL. L.LeonardB. J.PreslerB.GarwickA. (2002). Family-centered care coordination for children with special needs across multiple settings. Journal of Pediatric Health Care, 16, 290–297.
29.
LoomanW. S.PreslerE.EricksonM. M.GarwickA. W.CadyR. G.KellyA. M.FinkelsteinS. M. (2013). Care coordination for children with complex special health care needs: The value of the advanced practice nurse’s enhanced scope of knowledge and practice. Journal of Pediatric Health Care, 27, 293–303.
30.
MoherD.LiberatiA.TetzlaffJ.AltmanD., & the PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151, 264–270.
31.
MoriccaM. L.GrasskaM. A.BMarthalerM.MorphewT.WeismullerP. C.GalantS. P. (2012). School asthma screening and case management: Attendance and learning outcomes. Journal of School Nursing, 29, 104–112. doi:10.1177/1942602X10374344
NewacheckP. W.InkelasM.KimS. E. (2004). Health services use and health expenditures for children with disabilities. Pediatrics, 114, 79–85.
35.
NolanK.OrlandoM.LiptakG. (2007). Care coordination services for children with special health care needs: Are we family centered yet?Families, Systems, & Health, 25, 293–306. doi:1037/1091-7527.25.3.293
36.
OrszagP. R.EmanuelE. J. (2010). Health care reform and cost control. New England Journal of Medicine, 363, 601–603.
37.
PenningtonN.DelaneyE. (2008). The number of students sent home by school nurses compared to unlicensed personnel. Journal of School Nursing, 24, 290–297. doi:10.1177/1059840508322382
38.
PetitgoutJ. M.PelzerD. E.McConkeyS. A.HanrahanK. (2012). Development of a hospital-based care coordination program for children with special health care needs. Journal of Pediatric Health Care, 27, 419–425. doi:10.1016/j.pedhc.2012.03.005
39.
PolitD.BeckC. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
40.
PreslerB. (1998). Care coordination for children with special health care needs. Orthopaedic Nursing, 17, 45–51.
41.
SelekmanJ. (2013). School nursing: A comprehensive text (2nd ed.). Philadelphia, PA: F. A. Davis.
42.
SmithL. D. (1994). Continuity of care through nursing case management of the chronically ill child. Clinical Nurse Specialist, 8, 65–68. doi:10.1097/01.NUR.0000443072.05277.7a
43.
TarasH.WrightS.BrennanJ.CampanaJ.LofgrenR. (2004). Impact of school nurse case management on students with asthma. Journal of School Health, 74, 213–219. doi:10.1111/j.1746-1561.2004.tb07935.x
44.
TaylorA.LizziM.MarxA.ChilkatowskyM.TrachetenbergS. W.OgleS. (2012). Implementing a care coordination program for children with special healthcare needs: Partnering with families and providers. Journal for Healthcare Quality, 35, 70–77. doi:10.1111/j.1945-1474.2012.00215.x
45.
ToomeyS.ChienA.ElliottM.RatnerJ.SchusterM. (2013). Disparities in unmet need for care coordination: The national survey of children’s health. Pediatrics, 131, 217–224. doi:10.1542/peds.2012-1535
46.
TorracoR. J. (2005). Writing integrative literature reviews: Guidelines and examples. Human Resource Development Review, 4, 356–3367.
Van RoeyenL. S. (2013). Management of pediatric asthma at home and in school. Nursing Clinics of North America, 48, 165–175. doi:10.1016/j.cnur.2012.12.006
52.
WeismullerP.GrasskaM.AlexanderM.WhiteC.KramerP. (2007). Elementary school nurse interventions: Attendance and health outcomes. Journal of School Nursing, 23, 111–118. doi:10.1177/10598405070230020901
WhittemoreR.KnaflK. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52, 546–553. doi:10.1111/j.1365-2648.2005.03621.x
55.
WinzerM. (1993). The history of special education: From isolation to integration. Washington, DC: Gallaudet University Press.
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