Graduation Year


Document Type




Degree Name

Doctor of Education (Ed.D.)

Degree Granting Department

Psychological and Social Foundations

Major Professor

Kathy Bradley-Klug, Ph.D.

Committee Member

Jose Castillo, Ph.D.

Committee Member

Jennifer Wolgemuth, Ph.D.

Committee Member

Jennifer Marshall, Ph.D.


chronic illnesses, interprofessional collaboration, qualitative, school nurse


Chronic health conditions impact one in four school-aged youth (Van Cleave, Gortmaker, & Perrin, 2010). Supplemental to the medical challenges that students with chronic health conditions face, they also are at risk for a variety of academic, behavioral, and social-emotional adversities. Using an ecological approach for addressing the diverse needs of students with chronic health conditions has been deemed valuable due to the array of key stakeholders, institutions, policies, and cultural norms that impact the development of the pediatric population. A key stakeholder in supporting the functioning of school-aged children with chronic illnesses is the school nurse. School nurses’ skills in screening, communicating with physicians, consulting with parents, providing school-based health services, developing health plans, promoting healthy school environments, and evaluating health policies has led to them being identified as leaders in the delivery of services to students with diverse health needs (Committee on School Health, 2001). The purpose of this study was to gain a clear understanding of school nurses’ practices and perceptions collaborating in an ecological system to support students with chronic health conditions. Interviews were conducted with ten school nurses who vary in personal and professional characteristics. The epistemological and ontological assumptions of this study aligned with a post-positivist paradigm and in-depth interviews were conducted accordingly. Thematic analysis procedures endorsed by Braun and Clarke (2006) were used to identify, analyze, and report patterns in the data, and deductive and inductive approaches were completed to identify themes. Findings in the current study determined that the extent to which a child's symptoms were managed played an essential role in their academic outcomes. Furthermore, school nurses perceived children with chronic illnesses as having both adaptive and possible maladaptive symptoms. Nurses identified teachers, administrators, school psychologists, social workers, school counselors, and medical providers as being beneficial in facilitating care for children with chronic illnesses. Concerning collaborative practices, nurses stated their primary objectives for collaborating with stakeholders were to improve children access to medical services, develop individualized health plans, and provide interventions and accommodations. School nurses accomplished these objectives in various ways, including being aware of the community's resources, understanding processes for delivering student's services, and being proactive in advocating for their students' needs. These findings emphasize how school nurses work within and across the school, family, healthcare, and community systems to enhance this population's outcomes.