School Nurse Perceptions of Barriers and Supports for Children with Diabetes

Article excerpt

Adolescents with diabetes often need support because it is stressful for them to manage their illness. (1,2) Moreover, approximately 30% of adolescents with diabetes may have significant difficulties following their medical regimen. (3) Support from school staff is essential for many of these youth. (4-6) This paper presents school nurses' perceptions about supports for and barriers to diabetes management for adolescents at school.

Diabetes is a common illness in children. Type 1 diabetes occurs in about 1 in every 700 youth and is most commonly diagnosed during adolescence. (7) As such, a school is likely to have a child with type 1 diabetes at some point in time. (5) Most of these children require medical planning at school. A position statement by the American Diabetes Association titled "Care of Children With Diabetes in the School and Daycare Setting" provides guidelines for writing health care plans to support children and adolescents with diabetes at school. (8)

Adolescents in poor control are at risk for long-term health problems. (9) Information about barriers to implementing health care plans for youth with chronic illnesses is needed. (10) Reducing barriers to and improving support for adolescents with type 1 diabetes may improve regimen adherence and health outcomes. (2,11)

School nurses are resident experts at medical care in schools. However, a literature search revealed only 1 study where researchers examined nurses' views of how to support children with special health care needs at school. (12) For this study, researchers surveyed 43 school nurses about the challenges and requirements of having children with different types of special needs in school. After reviewing study results, 3 themes summarized nurses' views of supports for these children. The 3 themes focused on education, communication, and administrative and policy support. First, the school team needs information and education to best serve these youth. Second, communication among school staff, the child's health care team, parents, and the child enhances self-management. Third, administrative and policy support for youth with special needs provides a critical framework to ensure that their needs are met at school. Nurses reported that educating school staff about chronic conditions, such as diabetes, was one of their job responsibilities. However, studies examining nurses' perceptions of how to assist youth with diabetes are lacking.

SURVEY PLANNING

This survey examined nurses' perceptions of how to support adolescents with type 1 diabetes at school. In addition, nurses recorded their thoughts about the barriers faced by adolescents trying to manage their diabetes at school. Nurses also provided ideas about the roles that school nurses can play in assisting these youth, including information about whether they had been involved in developing written care plans for students with diabetes.

Participants

Researchers surveyed 110 school nurses from 3 states (Maine, Kansas, and Maryland). Nurses were female (n = 109; only 1 participant failed to record this information). Participants provided data about age, most were in their 40s (86%), and ages ranged from 20s to 60s. Fifty percent held a bachelor's degree, while 34% were registered nurses and 11% also had a master's degree. Participants had been in nursing from 2 to 44 years (mean = 22 years 1 month; SD = 9 years 2 months) and had worked in schools from 6 months to 32 years (mean = 8 years 6 months; SD = 6 years 3 months). Eighty-seven percent reported a child with type 1 diabetes at their school. Thirty-one percent of the nurses worked in middle schools, 38% worked in high schools, and 31% worked in both middle and high schools. Most (75%) returned the survey by mail, and 25% returned it via e-mail. A university-based institutional review board approved this project.

Instrument

Nurses recorded demographic information and their perceptions of supports and barriers for teenagers with diabetes in school settings (open-ended/free-response questions) on a 2-page survey. …