Municipal Support of Diabetes Management in Daycare, Kindergarten and School: A Qualitative Study of Differences, Challenges and Potentials

"They look into our world" - A qualitative study of intensive support to adolescents with poorly regulated type 1 diabetes and their families

OBJECTIVE

This article is based on a qualitative evaluation of a project offering intensive support to Danish adolescents with poorly regulated type I diabetes and their families. The article explores 1) how the project allowed for another approach to the families than what is possible in usual care at the hospital, and 2) how the nurse involved other professionals in caring for the adolescents.

METHODS

The study involved interviews with four participating adolescents, four parents, a social worker, and the nurse running the project, along with a reading of the nurse's entries in the adolescents' electronic patient records. Data was analyzed within the framework of realistic evaluation.

RESULTS

The findings showed that key mechanisms in the nurse's work was her open and flexible approach to the families, the way she anchored conversations about diabetes in here and now situations, and her efforts at engaging teachers, social and health care professionals in helping the adolescents.

CONCLUSION

The strengths of the project were the nurse's special approach to the families and her ability to engage other professionals.

PRACTICE IMPLICATIONS

A care manager providing individualized and flexible help can have positive results on the treatment of adolescents with poorly regulated type 1 diabetes.

Diabetes Management Support in Preschool and Primary School: A Qualitative Ideation Study Presenting Recommendations for Improved Communicative Practice

Diabetes care in institutional settings is a significant challenge that affects the whole family as well as care workers and teachers. The present study is the ideation part of a rigorous development process in the KIds with Diabetes in School (KIDS) project. We have previously conducted a thorough three-part needs assessment in which we explored the problem area from the viewpoints of (1) municipal administrative staff, (2) preschool and school staff and (3) families. Based on the identified needs and to a great extent on the contents and shortcomings of existing guidelines, the objective of the present study is to explore and develop possible solutions and recommendations for addressing the challenges and problems. To meet this objective, we held comprehensive multistakeholder participatory workshops in each of the five Danish regions. Five main themes with multiple subthemes were identified as areas to be addressed: (1) training and knowledge, (2) communication and collaboration, (3) the designated contact/support person, (4) national guidelines, and (5) the Diabetes Coordinator. Our findings demonstrate that communicative structures and dynamics are at the very heart of the identified problems and challenges and that the possible solutions should revolve around improving existing structures and highlighting the importance of constantly working on understanding and developing communication strategies. We propose a set of recommendations for practice based on these communicative needs.