Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Susan L. Instone, DNSc, CPNP, Chairperson; Patricia A. Roth, EdD, MSN, RN; Susan Bonnell, PhD, RN, PNP


asthma, decisions, inhaler, school nurse, self-carry, students


Every state in the United States has passed legislation allowing students to self-carry rescue inhalers in the school setting. Many organizations are stakeholders in respiratory issues, school health issues, and pediatric issues, recommending the support of this practice. Students’ ability to self-carrying rescue inhalers in the school setting has been impacted by school nurse perceptions and decision-making. This study addressed the questions: (a) What are school nurse perceptions and attitudes in regard to children self-carrying inhalers in the school setting? (b) How do school nurses decide whether children can self-carry inhalers in the school setting? and, (c) Are school districts and school nurses aware of the laws and guidelines regarding children self-carrying inhalers in the school setting? In this grounded theory study, 20 elementary and high school nurse participants were interviewed. The taped interviews were transcribed and analyzed utilizing grounded theory methods. The data were categorized into a conditional matrix that addressed context, conditions, actions, and consequences. From this analysis, a substantive theory was developed, “Balancing decisions about the self-carry practice: Powerful influences.” Various factors weighed on the nurses’ decision-making, such as laws, policies, school characteristics, student characteristics, trust, knowledge deficits, teachers, safety nets, control, nursing philosophy, internal policies, praxis, and assessments of students. The consequences included elementary school nurses manipulating the situation and micromanaging; and high school nurses manipulating the situation, letting it go, and fostering independence and empowerment. Elementary school nurses neither encouraged nor facilitated the self-carrying of rescue inhalers unless the parent was adamant about the need to self-carry. Conversely, high school nurses encouraged and facilitated the self-carry practice. These findings have implications for nursing practice, nursing science, and policy development that could enhance self-carry practices. Based on these implications, future study could address many areas of limited research, such as manipulation of the self-carry situation, appropriate practices to support or prepare students for the self-carry practice, legislative evaluation, and outcomes with students who self-carry.

Document Type

Dissertation: Open Access



Included in

Nursing Commons