Understanding School Nurses' Diabetes Education and Transitional Care for Students With Type 1 Diabetes

Purpose: The purpose of this study was to gain a better understanding of school nurses’ current practice and their perspectives about diabetes education and transitional care for students with type 1 diabetes in K-12 school settings. Transitional care is defined as “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health-care systems (Blum et al., 1993, p. 570)”. This concept has been applied for youth with type 1 diabetes to emphasize successful transitions from childhood to adulthood in terms of care continuity related to changing healthcare systems. Since there are differences between pediatric care and adult care, having independent diabetes self-management responsibilities is an important element of successful transitions in youth with type 1 diabetes. Similarly, the term transition planning, which refers to “a coordinated set of activities to assist students with chronic health conditions” (Baszler et al., 2015, p. 125), has been used to discuss nurses’ roles in providing care for children with special health needs. These roles include being knowledgeable about applicable laws; maintaining care competence; communicating with healthcare providers, school staff, and families; and being involved in policy development for managing children with chronic health diseases. In the context of school nursing, transitions can refer to changes in children’s locations in school systems, such as transferring from one school to another, and entering a new school system. Providing care during any transitional events of students with type 1 diabetes can be time-consuming work for school nurses who coordinate and support diabetes management and education in collaboration with stakeholders, such as parents, teachers, and school staff. However, students with type 1 diabetes may benefit from school nurses’ support in any of the forms of transition they face. There is little information about transitional care provided by school nurses for students with type 1 diabetes.

Methods:  A convenience sample of 115 school nurses who have taken care of students with type 1 diabetes in public school districts in the State of Washington, U.S. were recruited for a study that was designed to explore the roles of school nurses in diabetes education. A subset of 20 individuals was selected to participate in follow-up interviews. Measures included online surveys. Demographic information was collected, and the Diabetes Education and Transitional Care Questions (Cronbach alpha = .72) were two measures employed. Data was collected by using the REDCap system. Descriptive statistics, and Pearson correlations were used for data analysis.

 Results: Participants were highly homogeneous: predominantly female (97 %), non-Hispanic (95 %), White (90 %) RNs (94 %). The majority of participants (79%) were between ages 35 and 64 years. Commonly provided diabetes education in school were carbohydrate counting, hypoglycemia management, nutrition guidance (e.g. healthy eating, snacks, and food choices), and hyperglycemia management. The three educational content topics prioritized by school nurses were hypoglycemia management, carbohydrate counting, and emergency protocols. Sixty-one percent of school nurses did not use any standardized forms to evaluate the effectiveness of their diabetes education for students. Thirty-two percent of participants used the individualized health plan as an evaluation form for diabetes education. Sixty-eight percent of school nurses have provided transitional care. This transitional care focused on transferring students between schools (36 %), communicating with next school nurses (31 %), and supporting independence (23 %). There was no significant relationship between diabetes education and provision of transitional care (p > .05).

Conclusion:  School nurses provided diabetes education to students with type 1 to cope with hypoglycemic or hyperglycemic situations and to manage insulin related to food intake, but diabetes education provided by school nurses was not related to transitional care provided by them. This indicates that school nurses may be taking care of students with type 1 diabetes in episodic situations, rather than supporting long-term education related to transition. Although some school nurses provided care for transitions of students with diabetes, this care was more closely related to exchange of information between school nurses, rather than developing students’ capabilities for diabetes self-management. Communication is essential between school nurses to know the current needs and abilities of students in diabetes management. However, ideally transitional care in schools does not only mean transferring students’ information but also involves preparing students to be independent. School nurses can facilitate the improvement of students’ diabetes self-management behaviors using a long-term educational plan to prepare for transitions as an additional part of an individualized health plan for daily diabetes management. This would be beneficial because the four most commonly provided educational topics in schools are ultimately aimed towards students gaining autonomy in diabetes management. Therefore, providing appropriate transitional care in school settings can help students with type 1 diabetes have successful transitions from one school to another, as well as to become independent in diabetes management.