Running Head: Childhood Diabetes 1

http://www.diabetes.org/assets/pdfs/schools/chren-

wdiabetes-brochure-caregivers.pdf

Childhood Diabetes

Jose Omar Martinez

University of Texas at El Paso

Running Head: Childhood Diabetes 2

Population

The clinical site is Parkland Middle School. The population for this school is among the

ages of twelve and sixteen. At these ages, the Erickson’s developmental stages are industry

versus inferiority and identity versus role confusion. Many students are at the stage of identity

versus role confusion, which is very noticeable by the way they dress and act differently around

the week. According to the computer files at the nurse’s office the population consists of: five

hundred and eighty Hispanics, sixty two Caucasians, forty seven African American, five Native

Americans, two Asian, and five classified as other. The total number of students is seven

hundred and two. Two students are diagnosed with type one diabetes, twenty seven students are

diagnosed with asthma, four are diagnosed with mental retardation, only one student is

diagnosed with multiple sclerosis, and fifteen students are diagnosed with attention deficit

hyperactivity disorder. The diabetic students are really compliant with their insulin, they come in

every day to the nurse’s office and do everything by themselves. They have to check their own

blood sugars, write them down for record, and administer the insulin as needed. Lastly, they have

to do their own documentation in the Medication Administration Record (MAR). The students

diagnosed with asthma carry their inhalers along with a signed permit document by the doctor

and parent’s or legal guardian’s approval required by the Ysleta district. The students diagnosed

with attention deficit hyperactivity disorder take their medications before coming to school,

except for two students that come in daily. In average, almost every student appears physically

healthy. Now, in the economic part of school, seventy-five percent of the student body receives

free or reduced lunch. In summary, the majority of the families are from middle to low

socioeconomic status. Some students have trouble gathering the appropriate medical attention

due to their socioeconomic status, and some parents do not follow the appropriate referral from
Running Head: Childhood Diabetes 3

the RN which causes future complications for the student. The socioeconomic level is very

important to know, so that all needs regarding appropriate referral and resources are met for

further medical attention.

Role and Impact of Faculty

Parkland Middle School has only one RN. The role is the same as for every nurse, but her

duties are really different from other nurses. The basic role of a RN is health promotion in order

to prevent sickness and spread of epidemic, maintain health, assess and identify any sickness

which can be treated within her scope of practice which is really general. There are not a lot of

interventions that can be done by a school nurse. Another health care provider is the community

health nurse which is the boss of every nurse in the Ysleta school district. She is responsible for

audits regarding updating documents like immunization, medications, follow-up with present

diagnosis, and making sure that every nurse is up to date with current student status. Also, she

has the major responsibility to identify any upcoming issues related to health according to the

school. For example, at parkland middle school, there must be education in proper diet, teen

pregnancy, infectious and sexually transmitted disease, and social violence. These three topics

are the most appropriate and fundamental to discuss at this age and site. Another faculty member

is the school’s education counselor responsible for the educational portion of each student. Also

at the site there is another counselor who deals with personal issues and the developmental needs

that each student may encounter at this critical age. Basically this counselor aids students to

develop social skills or at a more personal approach as coping with family issues, anger, or

stress. For example, for this paper about childhood diabetes, students who may feel different or

stressed out about their disease, this counselor could be an amazing referral to help students gain

coping skills. Now, teachers are the main faculty that spends most of the time with the students.
Running Head: Childhood Diabetes 4

The teacher is not only responsible to provide them with the best education a student can get, but

also to help detect any developmental issues that may be keeping the student from learning and

keeping focus at class. Teachers will refer the student to the nurse, believing that the student may

be ADHD, due to the behavior in class and the reflection of grades. Another example is that the

teacher may notice a student having problems with audio and/or vision. The first intervention for

these students is sent them to the nurse’s office, and the RN is responsible for conducting a

hearing and vision screening to verify the student’s adequacy for listening and seeing. Other type

of teacher is the physical education teachers or coaches. Their role at the school is to teach these

kids the body’s capability for physical excercises, the importance of good nutrition, exercise and

its benefits after following a good regime. Lastly, we have the school janitors. Their duty is to

maintain the site as clean as possible. For example in several cases, the RN needs immediate

assistance from the janitor whenever the student is vomiting or female students have trouble with

feminine products. Another role is to keep the classrooms clean in order to prevent the spread of

infection.

Mission, Goals, Funding and Leadership

As a school nurse, the mission at this site is to promote and support student success in the

academic process by addressing the student’s physical, mental, emotional, and social health. The

mission is being achieved with the help of the rest of the faculty. The preceptor is very proactive

in every situation related to the student’s health, emotional and mental needs and is always

willing to do everything at a hundred percent for them. For example, the student’s mental and

emotional needs are somewhat difficult to address. The RN knows several ways to meet these

needs, sometimes is the therapeutic communication between the nurse and student that helps

meet the emotional need. At University of Texas at El Paso, one of the main goals that was
Running Head: Childhood Diabetes 5

taught from the instructor was how to conduct vision and hearing screenings. That is one of the

main assessments done at this site. The RN must identify student health needs with these

screenings and depending on the result of the assessment, an appropriate referral will be made.

The school nurse has a computer with an Ysleta school district software system which has all the

student’s information like assessments, treatments, general information such as birth date, and

family information. Also this program has referral sheets, for example one of the main ones is

the doctor’s referral and parent’s consent for permission to bring the medication to school and

that paper shows the action taken by the doctor and parent. In relation to economics, the school

gets funded by the state of Texas. Next, the funding must be approved by district of Ysleta.

Lastly, the district decides how much money the site is getting. For every site it varies. The

principal receives the money, and afterwards his job will be to decide which departments need it

the most. Obviously at the nurse’s office, it is not getting enough funding. The site lacks of

fundamental supplies such as Ziploc bags for ice packs. The site is small, the filing cabinet is in

the restroom, and the site actually needs more materials and not just covered everything with a

bandaid. This site needs better funding and support from the principal. The preceptor agrees

upon every statement.

Internal and External Politics

External Politics do not appear to be a big impact or factor by the way the health care

delivery system functions at parkland middle school, but there are some internal politics

affecting it. As mentioned above, there are some issues affecting the health care that is being

provided at Parkland M.S. This is in reference to the relationship between the preceptor and the

principal of the site. The preceptor has tried to get more funding from the budget that the

principal gets from the district, her petitions have already been denied. Both of them have a
Running Head: Childhood Diabetes 6

negative perspective or attitude towards each other. This issue may be the lead cause for the

nursing funds to be so low. From the rotation at this site, these issues have been present. For

example, the preceptor requested his help for making daily announcements for getting the

students to the nurse’s office to drop the immunization shot records. He denied his request, and

told her to call each student one by one to the office. This makes the preceptor fall behind in all

other tasks and it is a waste of time calling each student individually instead of calling them

through the speaker during morning announcements. The preceptor seems stressed about this

situation, because there is over seven hundred students that she must call one by one. The

preceptor wants to do everything independently but if the principal does not agree to her plan,

there is nothing she can do to override his decision. In summary this internal issue at the site, is

affecting the population and how the health care delivery system is being done.

Legal and Ethical Issues

Apparently there are no legal or ethical issues at this site that is directly related to the

health care delivery. As mentioned above, everything is kept in the computer under the nurse’s

username and password. The computer has this software from the Ysleta district, that maintains

the student’s confidentiality related to their health status, assessments, medications if any,

interventions and referrals. The only problem at this site, is that the office is too small, and it is

impossible to maintain a private conversation. To have a private conversation here, the nurse

must go to the restroom and have the door closed, which is the only possible way to do it. The

nurse is great and follows every policy and procedure as it was meant to be conducted. As a

nurse and a person, the preceptor is very professional and believes in justice for the whole

population. There are many visits to the nurse’s office and most of them are really superficial,

but the preceptor treats every individual equally with the best possible care that a school nurse
Running Head: Childhood Diabetes 7

does. Every student is treated with dignity and respect. The population has the right for

autonomy at every opportunity. At the site, the RN always offers several options, before actually

doing the first intervention. Justice, autonomy, and confidentiality are the ethical issues

discussed at Parkland. For legal issues, there are immunizations, permits from doctors and

parents to administer medication at the nurse’s office or school, and the medication

administration record. First, the population must have all the immunizations updated in order to

keep attending school. If someone fails to, by law they must be out of the school until proven

administration of immunizations. Secondly, if a student is required to take an inhaler or

medication at the site, a permit signed by the doctor and legal guardian is required by law at the

site in order to carry any medication or inhaler. Last, after administration of medication the nurse

must date the time and sign the MAR for legal purposes.

Improvement

Parkland Middle School needs various tremendous improvements. The plan for next year

is to add the sixth grade to the site. Now it only teaches seventh and eighth graders. With the

sixth grade added, this site is going to be more challenging with the difference of ages, plus more

faculty will be needed. Now the environment will be really different to the sixth graders that are

assisting Dolphin Terrace Elementary. Construction has already begun, and it is bothering the

population. The Ysleta district should get better breakfast servings, which students have already

comment several times. Another improvement that must be addressed is the impact of faculty.

Teachers dress as they want to dress, they have uncovered tattoos showing them to the whole

population at the site. Also, their hair style and grooming it is not adequate for the facility.

Faculty is supposed to be professional and be role models for the population. Specifically to the

nurse’s office, it needs funding. The care being provided at the site is really minimal. The
Running Head: Childhood Diabetes 8

students deserve better care than just a simple wash with soap and water and a bandaid. In

relation to the topic childhood diabetes, and relevant topics related specifically to this age and

developmental stage the site should have brochures for the population’s own education. Every

health site must have educational brochures.

Evidence Based Practice

Physical activity is one of the main factors in the treatment of Type 1 Diabetes Mellitus

for the population at the site. This article focuses on how sedentary lifestyle and physical activity

affect the glycemic control and tries to overcome the disease. The more schoolwork and activity

the population does the less time they have free to spent in front of a screen just sitting down

without exercising or doing any possible movement as meant to exercising. The study has shown

that increased physical activity increase the power of insulin because the sensitivity to insulin

increases and the diabetes becomes more under control. The more sedentary lifestyle that the

child chooses like watching television, sitting in front of the computer should be limited to two

hours per day. The sedentary lifestyle behavior will be reflected in the HbA1c which will

increase. This means that the glucose is not adequately been controlled and needs more further

and specific interventions to achieve a better glucose stability. Physical associations have

demonstrated greater sense of psychological health with a great well-being in children and

adolescents. This is very important because at this age, it is one of the toughest developmental

stages to determine and actually live. As the physical activity reflects this outcome on the

population they feel less worry, greater perception of health, and better general quality of life.

(Wiley, 2009). Finally, these findings should be apply at every site. Especially, at the school

setting, because that is the place where more time spent during the childhood and adolescent

years. The only problem with physical activity according to the study is that many pre-teens and
Running Head: Childhood Diabetes 9

teenagers are spending a lot of time in the computer, watching television, playing playstation 3

or xbox 360. These issues make the interventions somewhat difficult for the population to be

compliant. The study encourages the population to become more active in school activities which

has shown that keeps their minds and bodies working and less time for personal use.

Change Theory

Pender’s Health Promotion Model will be use. This model is for trying to teach health

promotion behaviors that are determined by cognitive-perceptual factors, changing specific

behaviors that will benefit the client for a better health, and internal/external cues to take action.

For example, the population is middle school children ranging from twelve years old to sixteen

years old. Two of them have type 1 diabetes, and both come to the site for blood glucose checks

and self-administration of insulin. The population already knows the importance of health at this

time, both of them are compliant and come by every day during lunch time. Upon selecting this

model and evidence based practice article, the population has demonstrated to be really

knowledgeable upon the topic. The main information of the disease is already understood, and

have demonstrated accurate feedback upon assessment. Both clients appear to have a great sense

of well-being and handle their condition pretty well. As mentioned above in the article, the only

trouble with teenagers is the time they tend to spent watching television or sedentary lifestyle

behaviors they may choose. These are behavioral factors that must be addressed with the clients,

teachers, and family members. The clients must be engaging in more school activities, physical

activity, and less time sitting down in front of a screen. The intervention will be to encourage

more participation from the site, as in offering new recreation sports, varieties of clubs at school

that will keep them active and less time for personal use, and cooperation from parents. Parents

can encourage the population to help out in house chores, which is a great intervention that could
Running Head: Childhood Diabetes 10

be done at the household level. The population attends school a hundred and eighty days, so for

the rest of the days, the community health nurse should be addressed for different activities

during the summer, which is the time when this population do not know what to do with their

personal time. Awareness by the community health nurse is very important, activities planned at

the community setting will depend on the likelihood of the population to engage in these health

promoting behaviors.

Goals

The short term goal is to educate and train parents, teachers, and faculty on awareness of

the importance of physical activities and all of its free benefits in the next four weeks. The

population will not engage in health promoting behaviors that do not portray their interest.

Another goal will be to find out what interesting activities will the population would like to try

by implanting a survey or questionnaire. The long term which will be in a time range of six

months is to have an awareness local day of childhood diabetes at the sites, where education will

be on how to educate the population and faculty on the important information regarding these

condition, interventions, signs and symptoms of health status, appropriate referrals, and evaluate

education.

Strategy

The short term goal would be accomplish by coordinating with the school principal on

setting up a day where all the faculty will be available to meet and get their maximum

participation towards the topic. An excellent opportunity could be on those training days that the

district of Ysleta does around the school year. Also planning the event with the community

health nurse and RN, so the training could be done with experts on the topic like knowledgeable
Running Head: Childhood Diabetes 11

pediatricians on diabetes, physical education instructors, and nutriologists. Each school district

has a great conference room where they gather to do their trainings, that place will be great for

the educational activity and completing the short term goal. After the training, learning on the

topic could be done by evaluating the teacher’s response, doubts, and comments.

The long term goal will be accomplished once the short term goals have already been

achieved at a one percent level. As already mentioned, the site must know how to get the

population’s attention. The students will need some fun stuff, so creativity on this awareness day

must be really amazing in order for the population to become involved. The population is visual

learners, at this age colorful and creative things will gain their attention. For starters, that

awareness day must be the only activity during that week, so the population will be eager and

anxious on waiting on it. Next, flyers around the Ysleta district will be a way for everyone to

become aware of the event. Also every site could send letter to each home to invite the parents

and the community to this awareness day like the site does for immunization updates and

records. Also present different case studies and scenarios provided by professionals about the

topic that will teach a variety of strategies about coping mechanisms and help information for the

population. Lastly, as a token of appreciation for the population who attends the childhood

diabetes awareness day, should enter a raffle in order to win a Dell laptop or some kind of prize

that will be use as a hook for gathering people’s attention.

Conclusion

In conclusion, the site needs various changes in order to provide better care to the

population. Many needs must be addressed with the principal of Parkland Middle School.

Childhood diabetes is increasing and should be taken in perspective for education at a

Running Head: Childhood Diabetes 12

community level. Education is the best intervention that a nurse can do about it. Physical activity

helps T1DM in making the body more sensitive to insulin. There are a lot of other interventions

for the population at this site, but the help of parents and faculty is needed due to the young age

of the population. For the teenager with diabetes, having to take insulin, check blood glucose,

and follow a meal plan is tiresome and can cause difficulties for the teens. It is typical behavior

for a teen with diabetes to ease up on diabetes care and try to act like everyone else. Sometimes a

faculty member at the site with whom a teenager has a good relationship, such as a teacher or

coach, can help to provide the teen with the support he or she needs (Lowes, 2008).
Running Head: Childhood Diabetes 13

References
Mount Nittany Medical Center (2010). For Parents: Diabetes Care Issues in Children Ages 11 to
17. Retrieved: November 3, 2010 from http://www.mountnittany.org/wellness/library

Lowes, L (2008). Managing type 1 diabetes in childhood and adolescence. Nursing Standard. 22,

44, 50-56. Date of Acceptance: April 14 2008. Retrieved: November 3, 2010.

Wiley, J & Sons (2009). Associations between physical activity, sedentary behavior, and

glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study

Group on Childhood Diabetes. Retrieved: November 4, 2010 from Ebsco.