Children with Diabetes: The Nurses Role in Educating Proper Management of Their Care

Type 1 diabetes is a chronic illness that usually begins in childhood. It is the result of pancreatic beta cell destruction which can be caused by an autoimmune process or from other unknown causes (Hernandez & Williamson, 2004). If diabetes is not managed properly it can result in terrible consequences, such as the loss of eyesight, limbs, or even life. All of these complications can affect the person’s personal, social, and work life. Since diabetes that is not managed properly can put a child at risk for long-term health and social problems, the role the nurse plays in educating children and their families on the management of their care is very important. Nurses can provide this information in a variety of settings, such as hospitals, schools, and at diabetic camps.

When diabetes is managed properly, complications like retinopathy, nephropathy, and neuropathy can be prevented (Hernandez & Williamson, 2004). Good management of diabetes can be difficult for anyone, but there are special challenges when the person with the disease is a child. Youth with diabetes have a much higher rate of depression than the general population (Kanner, Hamrin, & Grey, 2003). Young children may not understand why they need to get shots and have their fingers poked all the time, while many teenagers think they are invincible and do not believe poor management of their disease will lead to any consequences for them. The teens are usually more interested in fitting in, and doing whatever their friends are doing at the time (Nabors, Troillett, Nash & Masiulis, 2005). All of these challenges increase the need for good education to prevent diabetes related health problems

Many children are diagnosed with diabetes in a hospital and nurses will provide much of their primary diabetes education during this stay. The average hospital stay for a child newly diagnosed with diabetes is less than three days (Habich, 2006). This is barely enough time for the child, and his or her family, to learn the minimum skills needed to manage this disease at home. Skills include how to check blood sugar, what is the normal range, what to do if it is not within the normal range, and how to administer insulin. To help patients get the most out of their short stay, a task force was put together at a hospital in the Midwest with the sole purpose of implementing a program to improve the education process for pediatric diabetics and their families (Habich, 2006). The hospital admits about sixty children with new cases of diabetes each year. The program the task force developed puts the staff nurse in charge of the education during their stay. This nurse works with a team of individuals on staff to provide the best possible education process. The nurse then works with a certified diabetes educator to transition the patient from an inpatient to an outpatient program. After three years of studies, the readmission rate of children diagnosed with diabetes at this hospital is zero (Habich, 2006).

After being discharged from the hospital, most children spend a good portion of their day at school where the school nurse will play a role in the management of their care. Most school nurses claim to have developed a written health care plan for at least one student during their career (Nabors et al., 2005). The nurses may also be the only ones at school with enough knowledge about diabetes to educate the students’ teachers and coaches about their disease. Educating the staff is important because they need to watch the children for signs and symptoms of hypoglycemia, such as nervousness, shaking, irritability, or blurred vision. They should also know how to check the child’s blood sugar if they suspect it is low, and what to give them if it is. When away from the school, the teachers or coaches should always have juice, soda or something that can raise the child’s glucose level quickly when necessary.

Children can continue to be educated about diabetes during school breaks. Camps designed for children with diabetes provide them with a great opportunity to learn about managing their disease, while meeting other kids in similar situations. Nurses are both educators and managers of care at these camps. The more children are educated about their own disease, the better the chance of it being managed properly. Diabetes camps provide a great place for this to happen. The goal of these camps is to let diabetic children have a traditional camping experience in an environment safe for their medical condition (“Diabetes”, 2007). It is also a good place for kids to feel like they fit in, and be able to talk to others who have had similar experiences. This environment is a perfect place for nurses to educate children about self-management of their disease. They can teach about a variety of topics from blood glucose monitoring, to pump issues, to stress management, or even about possible complications. Most of these camps have a high return rate; this gives nurses an opportunity to reinforce important issues, while adding different types of education as the children get older (“Diabetes”, 2007).

Chronic complications from diabetes can affect almost every organ in a person’s body. These complications can lead to loss of independence, social isolation, and depression (Hernandez & Williamson, 2004). Nurses play an important role in the prevention of these complications by educating diabetic children and their families about the proper management of their care. The initial education nurses provide in a hospital setting will plant the roots for lifelong management. The ongoing education school nurses provide will help the children keep control over their disease while away from home, and the additional education nurses provide at diabetes camps will help the children understand why proper management of their disease is so important, while at the same time provide them with an environment where there are many other children in similar situations.

Intervention #1

In hospitals, nurses play an important role in educating children with diabetes and their families on the proper management of their care.

Disadvantage #1

Many families receive the news that their child has diabetes while in the hospital. It can be difficult for them to absorb all of the information they need to know about taking care of a diabetic child, while they are still getting over the shock of the diagnosis. Many parents need support just to cope with their own emotions, and insecurities about the future (“Parents Traumatized”, 2005). A diagnosis of diabetes can be a life changing event for the entire family.

Disadvantage #2

Another disadvantage to nurses providing children and their families with their initial diabetes education in the hospital is the short amount of time they have to do it in. “It becomes very difficult to balance the impact of diagnosis and the need to provide critical education in anticipation of a length of stay less than three days.” (Habich, 2006, p.113). This short stay barely gives the nurse enough time to teach the basic skills related to managing diabetes.

Intervention #2

School nurses play an important role in educating children with diabetes about the proper management of their disease.

Disadvantage #1

The lack of education the teachers have about diabetes can restrict how well the children are able to manage their disease. If students’ teachers are not knowledgeable about diabetes they may not allow the students to test their glucose levels or have a snack when they need it (Nabors, Troillett, Nash, & Masiulis, 2005). In order for school nurses to have good results when educating students on how to manage their disease, the students have to be able to follow the nurse’s recommendations.

Disadvantage #2

Large ratios of students to nurses can make it difficult for the nurses to have enough time to spend with each student. This ratio also limits the amount of time the nurses have to educate other staff members about the needs of the diabetic children. According to Guttu, Engelke, & Swanson (2004) “The National Association of School Nurses endorses a nurse-to-student ratio of 1:750, but few school systems consistently achieve this ratio.” (p. 7). A study done in 21 counties in North Carolina, showed that two counties didn’t have school nurses and of the other nineteen, the ratio ranged from 1:451 up to 1:7440 (Guttu et al., 2004). Those kinds of ratios make it difficult for nurses to find the time to educate the children or the teachers.


References


Diabetes care at diabetes camps. (2007). Diabetes Care, 30, S74-S76. Retrieved April 17, 2007 from Proquest Database.

Guttu, M., Engelke, M. K., & Swanson M. (2004). Does the school nurse-to student ratio make a difference? The Journal of School Health 74(1), 6-9. Retrieved May 6, 2008 from Proquest Database.

Habich, M. (2006). Establishing a standard for pediatric inpatient diabetes education. Pediatric Nursing, 32(2), 113-116. Retrieved April 10, 2007 from Proquest Database.

Hernandez, C. A., & Williamson, K. M. (2004). Evaluation of a self-awareness education session for youth with type 1 diabetes. Pediatric Nursing, 30(6), 459-465. Retrieved January 16, 2008 from Proquest Database.

Kanner, S., Hamrin, V., & Grey, M. (2003). Depression in adolescents with diabetes. Journal of Child and Adolescent Psychiatric Nursing, 16(1), 15-24. Retrieved January 16, 2008 from Proquest Database.

Nabors, L., Troillett, A., Nash, T., & Masiulis, B. (2005). School nurse perceptions of barriers and supports for children with diabetes. The Journal of School Health. 75(4), 119-124. Retrieved April 17, 2007 from Proquest Database.

Parents traumatized by children’s diabetes. (2005). Australian Nursing Journal, 12(11), 33. Retrieved May 7, 2008 from Proquest Database.