Diabetes care in the early primary school setting: narratives of Australian mothers

Abstract

Objective: To explore the experiences of Australian parents caring for a child using intensive insulin therapy in the early primary school setting to identify facilitators of this therapy and implications for parents.Background: Young children with type 1 diabetes require adult support when administering insulin in the early primary school setting, yet availability of school support, such as from nurses, is inconsistent across Australia. This increases the burden on parents and in some circumstances, insulin is avoided at school. study design and methods: This study was a qualitative research design using narrative inquiry. Mothers (n=14) from six Australian states/territories with children attending Government, Catholic and Independent schools participated in semi-structured telephone interviews between December 2014 and September 2016. Narrative analysis was used to interpret the interview data. results: Nine narrative threads told the collective story of mothers' experiences supporting their child with intensive insulin therapy at school. Facilitators of intensive insulin therapy were collaborative partnerships between parents and school staff, diabetes education for school staff, reasonable adjustments for integrated care and the use of continuous glucose monitoring systems. Implications for mothers were the stigma of advocating, being worried about their child's safety in other people's care, restricted employment, wanting their child to be like everyone else, and providing 24/7 care behind the scenes. Despite these challenges, all children received intensive insulin therapy at school. Discussion and conclusion:The findings of this study indicate that the Australian education system lacks appropriate health support structures required for children with type 1 diabetes. In order to facilitate diabetes care at school non-nursing staff are trained to administer or supervise insulin and the overall responsibility is transferred onto parents.implications for policy and nursing practice: Nurses working as diabetes educators need to be aware of the burden on parents and advocate for more supportive practices to facilitative intensive insulin therapy in the early primary school setting. Parents, in collaboration with health and education departments, should demand the allocation of appropriately qualified school nurses to legally provide high quality diabetes care that children are entitled to. If current practices, dictated by insufficient resources continue, the Australian Government will make the assumption that existing systems are adequately meeting the needs of students with type 1 diabetes.

Use of diabetes technologies in the primary school environment: a scoping review protocol

“…10 Additionally, the complexity of care in relation to diabetes technologies has increased in both the home and school settings due to the burden of managing the additional equipment, which is always worn on the body. 19 Thus, the integration of the use of diabetes technology into the school setting is essential to ensure effective disease management 20 and to safely meet individualized care needs for long-term wellbeing and optimal academic performance. 4,18,21 Studies have demonstrated the benefits of using diabetes technology in the school setting; a study on the impact of real-time CGM use showed that parents, students, and teachers reported an increase in their ease of managing diabetes in the classroom.…”

Development and Testing of the School Healthcare Partnership Scale for Parents

“…12 Some countries lack clear guidelines to support the implementation of state-led projects and for identifying the role of the school nurses regarding SHC for children with long-term conditions; thus, SHC may vary depending on the degree of partnership between parents and school nurses. 13 In the field of pediatric nursing, partnership includes a collaborative relationship in which the nurse and the child's parents work together to provide the best care for the child. Facilitation of parental participation in the care of hospitalized children has shown to positively impact parental self-efficacy, parents' perceived partnership with nurses, and parental satisfaction and reduce parental anxiety.…”

School Health Teachers as Partners in Diabetes Caring: Maternal Perspectives

“…Some mothers of young children attend the school daily to administer or supervise insulin for their child with T1D. 7 The European framework for school health services requires that school health professionals coordinate an individual care plan that harmonizes the medical needs in school, 8 although the laws and policies of SHC for children with chronic diseases vary from country to country. 9 Collaborative partnerships between parents and school staff foster child-centered supportive care in the United Kingdom, the United States, and Australia.…”

“…Some mothers of young children attend the school daily to administer or supervise insulin for their child with T1D. 7…”

“…9 Collaborative partnerships between parents and school staff foster child-centered supportive care in the United Kingdom, the United States, and Australia. 7,10,11 Specifically, the school nurse, who is the only medical personnel available to manage children’s health, educate children in self-care, and empower children, 12 is of utmost importance for a safe and successful school life. In addition, parental engagement and participation in creating their child’s individualized care plan is crucial.…”