Exploration of the role of nurses in caring for children in foster care

This is a descriptive qualitative study of nurses working with school-age children in foster care in two organizational settings, school and child welfare. This study describes what nurses want to do for this population, what they are actually doing, the nurses' view of their organization, and how the organization affects their role. The study investigates whether the nurses adopt of the Social Ecological Model of Health. The nurses' practice is viewed in terms of the Minnesota Public Health Intervention Model (PHI), which operationalizes the Ecological Health Model for community nurses. The Bolman/Deal Organizational Framework provided the lens to view the organizations by dividing them into four frames: structural, political, human resource and symbolic.; The primary data source was interviews with nurses working in child welfare and schools. Data about the actual practice of the nurses included a survey of the PHI interventions and observations of nurses performing their jobs. Data was analyzed using guidelines for phenomenological research. Four themes were derived from the data. The first theme was all nurses lacked physical access to the population of foster children. The second theme was differing views on the cause of poor health of foster children. Child welfare nurses adopted the broad determinants of health in the Social Ecological Model and wanted to do upstream and downstream interventions. School nurses felt that the foster child's health issues resulted from being in the “system” and wanted to give standard care. Nurses had different approaches to practice; child welfare nurses wanted a team while school nurses wanted independent practice. Finally, both groups had little political influence in their organizations and were unable to improve care for foster children.; In conclusion, nurses who work with children in foster care need more organizational support to provide comprehensive care. It was clear that the organizations had significant influence on what nurses wanted or were able to do. Since nurses increasingly are working in non-health settings and in host environments, nursing faculty need to educate students about how to understand organizations and create effective work environments.