Disclaimer: this toolkit is intended to provide resources for school nursing practice as it relates to the care of students with chronic health conditions. This is not medical or nurse practice advice, and is not prescriptive as it relates to individual students or individual nursing practice. These resources do not override laws, scope of practice, individual assessment, and clinical judgement.
Type 1 Diabetes (T1D) is an autoimmune metabolic disorder that is characterized by absolute insulin deficiency. This condition requires exogenous insulin in order to sustain life ( Lucier & Weinstock, 2021). There are a wide variety of insulin regimens prescribed in the management of T1D, which includes the administration of insulin at mealtimes. Children spend 6 to 8 hours a day in the school setting during the academic year. For children T1D this means a plan for continuity of care and insulin administration at school and planning for response to potential complications is central to their access to education. Due to the complex nature of diabetes and both the physiological and the pharmacological implications of T1D and associated regimens, understanding of the nurses role, case management and best practices for school nursing is critical (Lawrence et al, 2015, ISPAD, 2018)
Evidence Based Practice
Basic Disease Information
For disease information, epidemiology and pathophysiology
Legal Practice Standards
At the forefront of nurse case management for school nurses, is the understanding of scope of practice as it relates to case management and delegation of nursing tasks in a community setting:
Nurse Practice
Oregon Revised Statutes Pertaining to Glucagon
Public Access Practice Resources
The professional nurse in the school setting should understand and access existing resources and framework for care of students with T1D.
Note: the following are national or regional resources that serve as a reference, they may or may not be consistent with Oregon law and do not supersede Oregon Nurse Practice or clinical judgment.
National Association of School Nurses (NASN)
American Diabetes Association
American Association of Diabetes Educators (AADE)
Centers for Disease Control and Prevention(CDC)
National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
Colorado Kids with Diabetes
Academy of Nutrition and Dietetics
Intermountain Primary Children’s Hospital
Professional Development
Nurses must ensure that they have proficiency in areas of practice in which the delegate. The following include Free Continining Education resources for Nursing related to T1D:
Khan Academy
These videos provide content on diabetes pathophysiology and complications.
Association of Diabetes Care & Education Specialists
CDC
Novo Nordisk
University of California San Francisco (UCSF)
UAP Training Resources
In the state of Oregon there are specific training required for care of students with diabetes that are prerequisite to individualized training. These include medication administration and glucagon administration.
Oregon Department of Education (ODE)
Medication administration training is an annual requirement and is a prerequisite to additional medication training.
Oregon Health Authority (OHA)
The below training is a requirement in the state of Oregon for injectable glucagon administration. This training must be updated every 3 years, with annual refreshers advised. Staff who are not up to date on Glucagon Provider Training, should instead be limited to administering intranasal glucagon (OHA Interim Guidance for Training Protocol for Emergency Glucagon Providers).
Leveled Training Resources for School Staff and UAPs
In addition to legislatively required training, it is suggested that districts follow a leveled approach to training a variety of staff when there are students with T1D in the school setting.
Templates
The following templates are modifiable for use by school nurses as it relates to their practice and should be used consistently with Oregon State Board of Nursing, Delegation Laws and local school policy.
Individualized Health Plans/Protocols
An individualized health plan is the totality of a student specific plan that includes a plan for emergencies for potential complications and all associated procedures for students with chronic diagnoses. Because these are intended to be individualized, the attached is an example of a compiled IHP:
Procedures
Procedures also greatly vary by student health status, needs, level of care and type of regimen. The following are modifiable sample templates for specific diabetes procedures. A complete student assessment should be made to determine appropriate procedures:
Authorizations
Signed parent authorization is required for medication administration and specialized procedures in the school setting. Included here are authorization forms for medication administration, T1D care, and emergency glucagon administration.
Student Intake Form T1D
In order to ensure collection of information related to T1D diagnosis, the following intake form may be used for new or transfer students with T!D.
Self-Management
For individuals diagnosed with type 1 diabetes (T1D), Self-Management is an important goal in disease management. Self-Management can be described as the ongoing process of developing knowledge, skill and ability physically, developmentally and cognitively to provide diabetes selfcare (Funnel et al., 2008).
Effective self-management of T1D at school begins with a supportive physical and social environment in the school setting where students can effectively manage care with the level of support, privacy, and accessibility necessary for the individual student. Best outcomes are achieved when the school team works collaboratively with family members, caregivers and Health Care Providers to encourage the student to develop autonomy of care in all settings: school, play, work, and beyond (Gurkan, 2019).
Self Management Assessments and Inventories can be accessed in NASN’s T1D Toolkit for School Nurses.
Section 504
The American Diabetes Association recommends that all students with T1D be covered under accommodations in a 504 plan; it is advised that nurses provide assessment and recommendation for students with T1D. Below are sample assessments and sample accommodations.
About
Author: Jan Olson
Peer Reviewers:
Lead: Denise Cardinali
Emily Parkhurst
Tiffany Bass
Alanna Russell
Amanda Larsen
Sally Wu
Editorial Reviewer: Wendy Niskanen
References
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Aronson, R., Brown, R., Jiandani, D., Walker, A. Orzech, N., Mbuagbaw, L (2018). Assessment of self-management in patients with diabetes using the novel LMC Skills, Confidence and Preparedness Index (SCPI). Diabetes Research and Clinical Practice 137 (128-136)
Buschur, E. O., Glick, B., & Kamboj, M. K. (2017). Transition of care for patients with type 1 diabetes mellitus from pediatric to adult health care systems. Translational Pediatrics, 6(4), 373–382. https://doi.org/10.21037/tp.2017.09.06
Centers for Disease Control and Prevention ( 2021) Diabetes self-management education and support toolkit. https://www.cdc.gov/diabetes/dsmes-toolkit/background/background.html
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Juvenile Diabetes Research Foundation (2019) Type 1 diabetes resilience: Recognizing and Developing it. https://www.jdrf.org/desertwest/wp-content/uploads/sites/90/2019/05/Resilience-in-Diabetes.pdf
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