Caring for students with type 1 diabetes: school nurses' experiences

Family and Community Nurses as a Resource for the Inclusion of Youths with Type 1 Diabetes at School

School nurses can facilitate the inclusion of students with type 1 diabetes (T1D) at school; this model has been widespread in some countries but not in Italy, which is due to the insufficient number of school nurses that are able to provide medical attention at all times. The National Recovery and Resilience Plan (PNRR) devised a series of aids and support for the reorganization of the Italian National Health System (NHS) through the creation of community houses in addition to family and community nurses (FCNs), who will operate in these structures to promote the integration of the various professional figures and community services. In this study, starting with the needs and suggestions of teachers (No. 79) and parents (No. 48) collected using a survey, we developed a new model for the inclusion of students at school where FCNs who have experience in pediatric T1D have the role of an educator, coordinator, and facilitator' they cannot be on site and available all the time during school hours, so they must make many efforts to improve the school staff's knowledge, intervene to offer training when requested, and solve new emerging problems.

Responsibility sharing for adolescents with type 1 diabetes: A scoping review

BACKGROUND

The term 'Responsibility Sharing', albeit poorly defined, has emerged from the diabetes literature, to describe a distinct mechanism for comprehensively managing the characteristic shift in responsibility that underpins the transition to self-management for adolescents.

METHODS

A scoping review, following the PRISMA-ScR guidelines, distilled the literature from seven databases to answer the questions: What is responsibility sharing? Who are the key stakeholders? What factors affect responsibility transaction? What are its recognized outcomes? How is responsibility shared?

RESULTS

Responsibility sharing is a transactional arrangement between youth and their caregiver/s that functions to repeatedly and flexibly apply ownership to the management of diabetes care tasks, across the course of adolescence. In the main, responsibility sharing was associated with better metabolic and/or psychosocial outcomes. Effective responsibility sharing was seen as being responsive to adolescent capacity and driven by autonomy supportive, sustained communication patterns that enable mutually agreeable responsibility assumption by all stakeholders.

CONCLUSION

Different perspectives on responsibility sharing for adolescents with Type 1 diabetes, and the lack of a universal definition, have led to discordance within the literature about its operationalization and measurement. This paper proposes a definition of responsibility sharing for future researchers to apply.

A Philosophical Review of School Nursing Framed by the Holistic Nursing Theory of Barbara Dossey

This article is a philosophical review of school nursing and its constructs framed by Barbara Dossey's holistic nursing theory. The author describes the application of holistic nursing theory within the school nurse's area of activity. The review suggests that holistic nursing theory can be applied in several areas of school nursing. School nurses have a multifaceted occupation that includes meetings with students, parents, and school staff. Barbara Dossey's holistic nursing theory offers the school nurse tools to deal with people's varied experiences, feelings, and needs.

Factors Included in T1DM Continuing Education for Korean School Nurses: A Systematic Review

(1) Background: The aim of this systematic review was to identify key factors for inclusion in continuing education for Korean school nurses to improve their competence in managing students with type 1 diabetes mellitus (T1DM). (2) Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. (3) Results: Twelve studies were included in this systematic literature review. The factors identified for inclusion in continuing education on Type 1 diabetes mellitus included 6 competencies. These were strengthening competence in managing students with Type 1 diabetes mellitus, facilitating networking with experts and peers, the perspective of the school nurse as a leader, use of a type 1 diabetes mellitus-specific evidence-based standardized approach of care, supporting self-management to promote healthy learners, and communication and collaboration between key stakeholders. Identified barriers to accessing continuing education on type 1 diabetes mellitus were work demands, difficulty taking time off during the school year, and limited support from administrators. (4) Conclusions: Based on the findings of this study, online or e-learning continuing education on type 1 diabetes mellitus must be developed for school nurses who manage students with this condition.

Content Validation of an Instrument for the Assessment of School Teachers' Levels of Knowledge of Diabetes through Expert Judgment

The objective of this study was to describe the content validation, through expert judgment, of a questionnaire for determining the level of knowledge that school teachers have of diabetes in order to design relevant educational interventions to improve the health of school-aged children. This psychometric study involved 15 experts who assessed each of the items in the instrument. The results revealed that the strength of agreement shown by the questionnaire ranged from substantial to almost perfect in its four dimensions, with the characteristics of “sufficiency” and “relevance” having the highest scores (0.982 and 0.903, respectively) based on the judgments made by the participating experts. Regarding statistical significance, the characteristics “sufficiency”, with p < 0.001, and “relevance”, with p = 0.001, were particularly relevant. The overall degree of understandability for the new version of the instrument was high (91.54%). The psychometric results obtained from validation of the “grado de conocimientos sobre diabetes en docentes del ámbito escolar” (Spanish for “level of knowledge of diabetes in school teachers”)—GCDDaE questionnaire through expert judgment and the pre-test indicate that it is recommended for use as it is both relevant and quick and easy to administer.

School nurses' perceptions regarding barriers and facilitators in caring for children with chronic diseases in school settings: A mixed studies review

This study aimed to understand school nurses' perceptions regarding barriers to and facilitators for health care services for children with chronic diseases in school settings. Using the PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Web of Science databases, a mixed studies review was conducted for literature published between January 2011 and June 2020. We performed a mixed-methods systematic review using a convergent integrated approach. A quality appraisal of the included studies was conducted using a mixed-methods appraisal tool. Twenty-seven articles (10 qualitative, 10 quantitative, and seven mixed-methods) that met the inclusion criteria were analyzed. Integrated findings that emerged from data synthesis were categorized into four levels (intrapersonal level, interpersonal level, institutional level, and community and public policy level) based on a socio-ecological model framework. This mixed systematic review provides a comprehensive understanding of school nurses' perceived barriers and facilitators when providing school health care for students with chronic diseases and how these barriers and facilitators interact across multiple systems. Further policies and strategies should be developed to provide effective school health services considering this study's findings.

The Role of School Nurse Presence in Parent and Student Perceptions of Helpfulness, Safety, and Satisfaction With Type 1 Diabetes Care

Adolescents with type 1 diabetes (TID) and their parents depend on school nurses to keep students safe in school. Parent satisfaction with T1D care is impacted by school factors including school nurse presence. The purpose of this study was to determine the relationships among parental satisfaction with diabetes care in school, parental report of diabetes-related safety, adolescent report of school nurse helpfulness, and school nurse presence represented by school nurse to student ratios. The sample consisted of 89 parent-adolescent dyads. Adolescents 10-16 years old with T1D completed a questionnaire that included perceptions of school nurse helpfulness. Parents completed a questionnaire that included perceptions of T1D safety and satisfaction. Diabetes-related safety was positively correlated with parental satisfaction and school nurse helpfulness and inversely correlated with age and school nurse to student ratios. Findings validate the importance of school nurse presence to adolescents with T1D and their parents with implications for school nursing policy, practice, and research.

Flying by the seat of their pants: A grounded theory of school nurse case management

AIMS

To develop a theory describing the processes and actions involved with school nurse case management for school-aged children with chronic conditions in the K12 system.

DESIGN

Case management is an essential practice for the school nurse. Little is known about actual case management practice in real-world settings. Grounded theory methodology following a literature-based conceptual model of school nurse case management.

METHODS

A purposive maximum variation sampling was used for data collection and analysis. Semi-structured interviews conducted in-person and via conferencing software from January to March 2017 with school nurses practicing in Washington State until data saturation was achieved. A condition lasting at least 6 months was also used to define a chronic condition.

RESULTS

In all, 14 school nurses with an average of 12 years of experience were interviewed. Analysis revealed that the core strategy used by participating nurses for case management involved navigating through ambiguity; balancing multiple roles; seeking guidance and training; acknowledging imperfect functioning and navigating poor system supports.

CONCLUSION

The findings suggest that actual school nurse case management practice differs from best practice recommendations. Participants did not discuss health promotion or environmental management and did not act to set goals or prioritize care as suggested in the literature.

IMPACT

This article informs nursing leadership of the real-world challenges faced by nurses performing case management in the school setting. These findings indicate that improvements in system supports and training, together with tolerance for the challenges nurses face in providing such care, might improve case management practice in the schools.

The Relationships Among School Nurse to Student Ratios, Self-Efficacy, and Glycemic Control in Adolescents With Type 1 Diabetes

Adolescents with Type 1 diabetes (T1D) experience unique self-management challenges, which can lead to poor glycemic control and sequelae. School nurses may impact student self-efficacy behaviors for T1D management in adolescents. The purpose of this study was to determine the relationships among school nurse staffing patterns, measured by school nurse to student ratios, self-efficacy, and glycemic control in adolescents with T1D. The sample consisted of 89 parent–adolescent dyads. Adolescents aged 10–16 years old with T1D completed the Self-Efficacy for Diabetes Self-Management (SEDM) Scale. Parents completed a demographic questionnaire. Higher school nurse to student ratios correlated with better glycemic control and older age. Higher SEDM scores correlated with older age, and females scored significantly higher. Findings contribute new knowledge to the paucity of literature on school nursing and adolescents with T1D, with implications for nursing practice, education, research, and policy.

Facilitation of Intensive Insulin Therapy in the Early Primary School Setting: Narratives of Australian Diabetes Educators

The number of early primary school (EPS) children (aged 4-8 years) with type 1 diabetes mellitus (T1DM) rises each year. Intensive insulin therapy (IIT) can be challenging for these children, as adult support may not be available in the school setting. Diabetes educators (DEs) working in the health system facilitate school diabetes care, which can be time-consuming given the large numbers of children with diabetes. These factors are potential barriers for IIT use in the EPS setting. To explore the experiences of Australian DEs who facilitate IIT use in the EPS setting, a qualitative, narrative inquiry method was used to conduct semi-structured telephone interviews with Australian DEs (n = 13) between December 2014 and June 2016. The interview transcript data were analyzed using a narrative analytical approach. Approaches to facilitate IIT use in the EPS setting were normalizing IIT at diagnosis, simple care plans and insulin pump therapy, prioritizing school support, DEs in private practice, and working with school nurses and parents. Despite numerous barriers, Australian DEs implemented varied methods to facilitate IIT use in the EPS setting.

Improving School Experiences for Adolescents With Type 1 Diabetes

BACKGROUND

Diabetes mellitus (diabetes) is one of the most common metabolic diseases in children worldwide and the incidence of type 1 diabetes (T1D) is growing. T1D is complicated to manage and adolescents with diabetes face unique, age-specific challenges. The purpose of this article is to discuss ways in which schools can create a positive environment and improve the experiences and outcomes for adolescents with T1D.

METHODS

The Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed databases were searched and yielded a total of 27 articles that were used in this integrative literature review.

RESULTS

Common concerns identified by students with T1D and their parents included a lack of full-time school nurses, lack of teacher knowledge of diabetes, lack of access to diabetes tools, lack of freedom to perform diabetes self-care, lack of nutritional information in cafeterias, and lack of communication between parents and school personnel. Students who are unable to attend school on a daily basis may not be able to achieve their academic potential.

CONCLUSIONS

Implications for school health including specifics for school nurses, teachers, students, and school environment were identified.

Translation, adaptation and validation the contents of the Diabetes Medical Management Plan for the Brazilian context

OBJECTIVE

to translate, adapt and validate the contents of the Diabetes Medical Management Plan for the Brazilian context. This protocol was developed by the American Diabetes Association and guides the procedure of educators for the care of children and adolescents with diabetes in schools.

METHOD

this methodological study was conducted in four stages: initial translation, synthesis of initial translation, back translation and content validation by an expert committee, composed of 94 specialists (29 applied linguists and 65 health professionals), for evaluation of the translated version through an online questionnaire. The concordance level of the judges was calculated based on the Content Validity Index. Data were exported into the R program for statistical analysis.

RESULTS

the evaluation of the instrument showed good concordance between the judges of the Health and Applied Linguistics areas, with a mean content validity index of 0.9 and 0.89, respectively, and slight variability of the index between groups (difference of less than 0.01). The items in the translated version, evaluated as unsatisfactory by the judges, were reformulated based on the considerations of the professionals of each group.

CONCLUSION

a Brazilian version of Diabetes Medical Management Plan was constructed, called the Plano de Manejo do Diabetes na Escola.

Swedish school nurses’ experiences in supporting students with type 1 diabetes in their school environment

Students with type 1 diabetes (T1D) need to take responsibility for their T1D and need professional support from school nurses. This study describes school nurses’ experiences in supporting students with T1D in school. A qualitative approach was used. After purposive sampling, six school nurses were interviewed and data were analyzed with qualitative content analysis. For professional support, a network around the student was enabled constituting of a continuous dialogue and responsibility and preparedness. For professional support a mutual commitment from the student, parents, and the school nurse was needed which was built from initiating participation and security, the school nurse’s ability to be present and available and on school nurse’s perceived competence. The conclusion of the study, and its practical implication, is that school nurses’ ability for professional support of students with T1D varied in relation to their perceived competence in nursing science as well as their ability to enable, strengthen and sustain teamwork and family–school team meetings.

Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis

Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources. Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA. Method. We have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The team consisted of highly trained nurses. The model effectiveness is measured by comparing the rate of hospital admission for DKA over 4-year period to the baseline year prior to implementing the model. Results. There were 158 admissions for DKA over a 5-year period. Number of patients followed up in the outpatient diabetes clinics increased from 37 to 331 patients at the start and the end of the study years. Admission rate showed a downward trend over the five-year period. Percentage of admission for DKA is reduced from 210% to 1.8% (P 0.001). Conclusion. Diabetes educator care model is an effective and a sustainable measure to reduce hospital admission for DKA in children and adolescents.