School nurse inservice

Hi, I am a Diabetes Educator in a 56 bed hospital in a small town on the Eastern Shore of Md.  I do inpatient and outpatient teaching but,   I don't counsel a lot of Type 1's because we don't, at this time, have an endocrinologist.  Most of the newly diagnosed patients go to the bigger hospitals with a Diabetes Center.  I am attempting to start a Family Support Group for children with diabetes and their families. The closest family support group is at least an hour away and not practicle for most families.  I also do a lot of community education and have been asked by a local school district to do an inservice with the school nurses.  I plan on having an open discussion to see what problems they run into.  I was wondering if anyone had any suggestions on topics I should focus on such as problems you have run into with the school nurses.  I am open for any and all suggestions for the support group and the inservice.  Thanks for your help.  What better resource than those of you who live with this disease everyday.

Hi! This sounds like such a great thing for you to be doing!

A couple ideas of "issues" to discuss....

-Snacks at school - how to handle birthdays/Valentines Day/Halloween... general sugar fests for grade school kids

-Sports - Yes you can do them! Ideas about educating coaches and being prepared for lows, adjusting for changing meal times on practice vs game vs "normal" days

-Educating the rest of the class or a couple of close friends - maybe a "show and tell day" - friends may see low signs before a teacher will

-Issues with TEACHERS! When the nurse is unavailable... Show and tell for adults....

These are what I thought of real quick, I'm sure you will get plenty more. Good luck!!!

Thanks so much.  That's a big help!

[quote user="ChrissyRN"]

Thanks so much.  That's a big help!


my biggest issue when i was growing up were the parents of kids who volunteered at the school. My teacher was a pain in the butt, but she was an old woman who should've already retired.

in my town, our school nurse covers every single school in the district so she'd be there maybe once a month which meant the teachers and volunteer parents were around more for any emergencies than she was. I think I only met her once or twice in my 6 years at my elementary school.

after i was diagnosed, i had a couple of instances where one of the mom's volunteering as a "recess duty" (they walked around the grounds while we were on recess to make sure we were safe, staying in the school grounds, etc) would actually take my snacks away from me, because I had oeros or juice or something along those lines, which were approved by my D team. "You aren't allowed to have sugar" is what they'd tell me.

that of course made me go sobbing to my bro who was in grade 7 at the time because at 6, I didn't REALLY understand what was going on and why I was being yelled at for someone my mom gave me to eat, and he'd give me food and call my mom who would then have to leave work to come down to the school and deal with it.

Teachers and parents of kids who volunteer need to be taught the same things. Until I was in grade 6, every year in the first week my mom would show up and give a talk about what diabetes was, what that meant for me, etc etc to the students (also for the teacher and any volunteer parent in the class or any parents who wanted to come learn). It really helped after the first year because the other kids stopped telling me I couldn't eat the roll-up fruit snack because it had sugar in it and telling the teacher on me.

I think it's helpful for school nurses and teachers to understand that the student with T1 should miss the least amount of instructional / classroom time as possible. This means, depending on the student's age and maturity level, students should be encouraged to test their blood sugars, treat lows, and take insulin in the classroom. Unnecessary trips to the front office (when older students aren't allowed to keep supplies on them) leads to more missed time as well as the assumption that T1 is something to hide or be ashamed of. Even younger children may be able to do some of these things in the classroom w/ help from a teacher.

I also think that people as a whole (so probably the school nurses too) don't understand that with carbohydrate counting, people with T1 no longer have to be on a fixed meal plan. Instead, with support, children can take insulin to cover "unusual" meals at school (Halloween party, etc.). However, this also means (esp for young children), the classroom team will have to plan ahead with the parents to make sure the extra food will be covered with insulin.

Finally, and this is from personal experience, placing blame on the students and trying to scare them is rarely helpful. Students will be more motivated to comply with a treatment plan giving positive feedback ("I love how you came to the nurses office right away to be tested when you though you were high!" rather than "What did you eat? You're high again! You know you'll go blind and loose a limb...").

I hope your training goes well. Thanks for checking in with us!

I would encourage you to look at the Parents of Children with Type 1 forum. School issues is a frequent topic there - with both horror stories of school nurses and ones about wonderful school care.

I agree with Sarah that testing in the classroom is very beneficial. My son is in a preschool/childcare this year that does not have a school nurse, however his teachers have been awesome in caring for him and following my directions. They decided right away that being in the classroom (just at the teacher's desk) would be a lot less disruptive than having to have one of the teachers take him down to the office to test, since he tests 3-4 times while he is at school. My son has also been able to test himself since starting there and so the teacher is only keeping track of when to test and supervising the process. The teachers also write down the BGs. My son is on a pump, so it did make it easier to train them since I didn't have to show how to do injections, just how to operate his pump meter.

I think nurses need to advocate for the students with all of a students teachers. Every teacher does not need to know everything about T1D, but they should know that it is NOT caused by what the child ate or anything s/he did. The teacher should also know the signs of low blood sugar and be able to call the nurse if they suspect a problem and that if a student is eating outside of lunch, it is for a reason. They should know that if a child has a high BG it can give them a headache or feel nauseus and it is not fair to expect them to perform at their best if that is how they are feeling. And finally, that the T1 child can usually have anything the other kids are having as a treat, it should just be OK'd by the parent first.