School Nurse Case School Nurse Case Management:Management:

The Importance of The Importance of

Process and Process and OutcomesOutcomes

Maria M. Bonaiuto, Maria M. Bonaiuto, RN,MSN,NCSNRN,MSN,NCSN

Mecklenburg County Health DepartmentMecklenburg County Health Department249 Billingsley Road249 Billingsley RoadCharlotte, NC 28211Charlotte, NC 28211

mbonaiuto@carolinas.orgmbonaiuto@carolinas.org704-336-4707704-336-4707

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School Nurse PanelSchool Nurse Panel

Mary Cappleman, RN, MPH, NCSNMary Cappleman, RN, MPH, NCSN

Glenna Cook, RN, MPHGlenna Cook, RN, MPH

Dixie Furr RN, BSN, NCSNDixie Furr RN, BSN, NCSN

Denise McIlwain, RN, BSNDenise McIlwain, RN, BSN

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Lillian Wald 1867-1940

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Mecklenburg County School Mecklenburg County School Nurses:Nurses:

Our Place in HistoryOur Place in History

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Who Should be Case Managed?Who Should be Case Managed?Students who haveStudents who have:: Multiple complex interactions with the nurseMultiple complex interactions with the nurse Chronic health conditions (poorly controlled)Chronic health conditions (poorly controlled) Academic concerns, with a health componentAcademic concerns, with a health component Health or behavior issues that impede learningHealth or behavior issues that impede learning Multiple absencesMultiple absences A goal for improving health or other relatedA goal for improving health or other related

criteria that effect learningcriteria that effect learning

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Improved Quality of Life….what Improved Quality of Life….what is it ?is it ? Increased participation in activities, sportsIncreased participation in activities, sports Improved nutrition, healthy weightImproved nutrition, healthy weight Improved relationships, acceptance by Improved relationships, acceptance by

othersothers Decreased anxiety, depressionDecreased anxiety, depression Decreased tobacco use, substance useDecreased tobacco use, substance use Decreased risk taking behaviorsDecreased risk taking behaviors Self report of increased well beingSelf report of increased well being Improved score on a formal Q of L ToolImproved score on a formal Q of L Tool

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Steps to Case ManagementSteps to Case Management

Select students, using established Select students, using established criteriacriteria

Set goals with student, family, school, Set goals with student, family, school, provider (SMART goals)provider (SMART goals)

Document baselineDocument baseline Identify strengths, needs, Identify strengths, needs,

stakeholders, and resourcesstakeholders, and resources Implement strategiesImplement strategies Monitor, evaluate, repeatMonitor, evaluate, repeat Document outcomesDocument outcomes Celebrate!!!Celebrate!!!

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SMART GoalsSMART GoalsSSpecificpecificMMeasurableeasurableAAttainablettainableRRealisticealisticTTime relatedime related

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Documentation of OutcomesDocumentation of OutcomesPart of the Individual Student Health Part of the Individual Student Health

RecordRecordOutcomesOutcomes Before Before

CMCMAfter After CMCM

ImproveImproved Yes / d Yes / NoNo

AttendanceAttendance

BehaviorBehavior

GradesGrades

Health Health ComplianceCompliance

Quality of LifeQuality of Life

Goal in one or more areas:

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Outcomes of Nursing Case Outcomes of Nursing Case ManagementManagement

School YearSchool Year ‘‘02-0302-03 ‘‘03-0403-04 ’’04-0504-05 ‘‘05-’0605-’06 ‘‘06-’006-’077

# of Students Case # of Students Case ManagedManaged

240240 320320 685685 1,6251,625 1,5541,554

Improved AttendanceImproved Attendance 34%34% 29%29% 31%31% 26%26% 33%33%

Improved BehaviorImproved Behavior 27%27% 21%21% 21%21% 26%26% 31%31%

Improved Academic Improved Academic PerformancePerformance

29%29% 19%19% 29%29% 27%27% 28%28%

Improved Quality of LifeImproved Quality of Life 59%59% 54%54% 60%60% 64%64% 81%81%

Improved in health/health Improved in health/health ComplianceCompliance

63%63% No dataNo data 69%69% 66%66% 79%79%

ImprovedImprovedIn one or more areasIn one or more areas

92%92% 74%74% 84%84% 84%84% 94%94%

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School Nurse Case School Nurse Case ManagementManagement

and YOUand YOU