Even though diabetes is a medical condition, its negative effects are observed only in an individual’s physical health. Diabetes also has far-reaching effects on the individual’s social condition, as well as on his or her financial and economic capacities (National Center for Disease Prevention and Health Promotion, 2010).
According to the National Center for Disease Prevention and Health Promotion (2010), diabetes has been known to cause blindness among older individuals. Diabetes has been the leading cause of blindness among adults 20-74 years of age (National Center for Disease Prevention and Health Promotion, 2010). Worldwide, diabetes is the second most prevalent cause of blindness (Riaz, 2009). Diabetes has also been known to cause kidney failures, as well as the amputation of lower limbs (National Center for Disease Prevention and Health Promotion, 2010). In fact, diabetes is the second most common cause for kidney failure worldwide (Riaz, 2009). However, perhaps the most severe effect of diabetes is death (National Center for Disease Prevention and Health Promotion, 2010). The disease makes individuals twice as likely to die, compared to individuals who do not suffer from diabetes (National Center for Disease Prevention and Health Promotion, 2010). Even if an individual does not die due to the complications that arise from suffering diabetes, his or her life expectancy is severely shortened (National Center for Disease Prevention and Health Promotion, 2010).
Individuals who die due to diabetes usually do not die from the disease itself, but from the resulting complications it brings about (Riaz, 2009). Specifically, diabetes causes vascular disease which is the leading cause of death among individuals with diabetes (Riaz, 2009). The vascular diseases caused by diabetes can include atherosclerosis, heart conditions, and strokes (Riaz, 2009). Diabetes also causes nerve damage in three ways. First, diabetes may cause peripheral neuropathy, which causes feelings of pain in an individual’s limbs (Riaz, 2009). Second, diabetes can cause autonomic neuropathy. This disrupts a person’s ability to digest food, and may even contribute to sexual incontinence (Riaz, 2009). Third, diabetes can cause damage to nerves which are associated with the senses. Apart from blindness, damages to an individual’s hearing may also be caused by diabetes (Riaz, 2009).
In relation to nerve damage, individuals with diabetes may also experience brain damage. Should diabetes cause acute cases of hypoglycemia or hyperglycemia – both disorders regarding severe blood sugar imbalances – an individual may experience seizures strong enough to damage the brain, and put the individual in a coma (Riaz, 2009).
Other severe medical effects of diabetes include the heightened risk for developing cancer, infections, and pregnancy complications (Riaz, 2009). An individual with diabetes is more prone to developing malignant and cancerous tumors in his or her colon, pancreas, and liver (Riaz, 2009). Diabetes also causes infections in the feet of individuals, resulting in non-fatal amputations. Infections caused by diabetes, however, are not limited to the feet, and may cause ulcers, yeast infections and urinary tract infections (Riaz, 2009). Among pregnant women, diabetes exacerbates the risks of developing “preeclampsia, miscarriage, stillbirth and birth defects” (Riaz, 2009, p. 368).
Diabetes also has severe effects on an individual’s capacity to think and feel. Diabetes may also increase in the likelihood of developing psychological illnesses such as memory loss, dementia, and Alzheimer’s disease (Riaz, 2009).
Treating the Effects of Diabetes
One of the more severe and more potentially fatal effects of diabetes is the development of cardiovascular disease (Kaku, 2010). To prevent this, certain forms of medication may be taken by an individual suffering from diabetes. The drug pioglitazone, for example, is prescribed to individuals with type II diabetes (Kaku, 2010). This drug suppresses cardiovascular disorder which the individual may have developed because of diabetes (Kaku, 2010). This drug prevents the recurrence of cardiovascular disease (Kaku, 2010). However, for this treatment to be more successful, it must be used earlier, and in conjunction with other treatment and preventive measures like glucose control, and blood pressure control (Kaku, 2010). Furthermore, to treat the effects of diabetes, diabetes management is needed. The goal of diabetes management is to encourage insulin levels in an individual with diabetes to approach normal levels (Thomas & Elliott, 2009). This then stops the development of further complications due to diabetes to occur in the individual.
Current conventional methods for diabetes management include using the glycemic index to plan out a person’s meals (Thomas & Elliott, 2009). However, according to Thomas and Elliott (2009), this method has been found to be inconsistent. Past studies conducted to survey the effectiveness of this method have not unanimously supported it (Thomas & Elliott, 2009). Thus, to establish an assessment of the effectiveness of diets informed by the glycemic control method, Thomas and Elliott (2009) conducted a meta-analysis of 11 past research endeavors which used controlled trial methods to compare low glycemic index diets with high glycemic index diets among individuals suffering from diabetes mellitus. The results of the meta-analysis showed that a low glycemic index diet has the ability to improve glycemic controls among individuals suffering from diabetes mellitus (Thomas & Elliott, 2009).
Financial Effects
According to the National Center for Disease Prevention and Health Promotion (2010), individuals who suffer from diabetes are severely affected financially by their illness. To be exact, individuals who suffer from diabetes spend 2.3 times more compared to individuals who do not suffer from diabetes (National Center for Disease Prevention and Health Promotion, 2010). In total, Americans spend 174 billion dollars to address the adverse effects of diabetes. Of these, 116 billion dollars are devoted to direct medical costs such as medication and treatment, while 58 billion dollars are devoted to addressing the indirect costs of the disease such as the loss of income due to the inability to work (National Center for Disease Prevention and Health Promotion, 2010).
Role of School Nurse in the Management of Students with Diabetes
Every student with diabetes is entitled to a school nurse with the knowledge and capacity to provide effective care and communicate with teachers, physicians, and families (Bobo & Butler, 2010). The school nurse is positioned to promote healthy lifestyle choices and diabetes self-care. Researchers found that promoting lifestyle behavior change requires that nurses shift from simple advice giving to a more counseling-based approach (Jansink, Braspenning, Va Der Weijden Elwyn, & Grol, 2010).
All students who have diabetes are in unique situations, whether developmentally or intellectually, in their abilities and needs for assistance in managing their disease. The Diabetes Medical Management Plan (DMMP) and Individual Health Plan (IHP) have been developed for normal or almost normal blood glucose levels. Hypoglycemic or hyperglycemic episodes should be rare and normal development and mental health as well as academic achievement should be prioritized (Kaufman, 2009).
As children with diabetes grow older, they transition to independence and self-management (Silverstein et al., 2005). The levels of supervision/assistance that they need for daily care and management will vary. Those who lack experience or who have cognitive or developmental challenges must be assisted throughout the day as dictated in their IHPs.
In contrast, high blood glucose, or hyperglycemia may take hours or days to develop. However, if it is left untreated, it can be life-threatening because students may develop diabetic ketoacidosis (DKA). If they are using insulin pumps, lack of insulin may result in DKA (ADA, 2011). In those cases, school nurses can resort to the three levels of staff training from the National Diabetes Education Program’s (NDEP) so that students with diabetes can get prompt care that is safe and appropriate to the situation (NDEP, 2010).
It is important for students with diabetes, who are also students with disabilities, to have the same opportunities as their peers to participate in all school activities, whether academic or extracurricular. Any institutions that received federal assistance must not discriminate against people if they have disabilities of any kind according to Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (NDEP, 2010). The Office for Civil Rights (OCR) in the U.S. Department of Education makes schools enforce such laws , making them accountable for providing students with disabilities with free and appropriate public education (FAPE) (NDEP, 2010). Because diabetes management is always undergoing change, then school nurses must maintain the latest skills and knowledge so that DMMPs can be fully implemented in schools (ADA, 2011; NDEP, 2010).
When all school staff and others can partner with students with diabetes this condition can be managed accordingly. These staff, coordinated by the school nurse, include families, the students themselves, and those who provide transportation, classroom education, physical education, counseling, and administration. School nurses are responsible for having the expertise and coordination abilities so that all of the foregoing individuals are able to cooperate in assisting students with diabetes to manage their own disabilities.
All school nurses must develop IHPs for all students with diabetes and continue to oversee how the plans are implemented and evaluated in school (American Nurses Association /National Association of School Nurses [ANA/NASN], 2011). Part of the duties of school nurses is to plan individualized healthcare. No one else is allowed to have this responsibility (American Nurses Association / National Council of State Boards of Nursing Association of School Nurses [ANA/NCSBN], 2006). Any delegation of these responsibilities, if the school nurse is unavailable, is up to state laws and nurse practice acts (ANA/ NASN, 2011).
According to Nguyen et al. (2008), for those whose type 1 diabetes is not controlled well, good nurse supervision significantly improves the control of blood glucose for these students. In the absence of this supervision, students may experience poor academic performance as well as complications that include retinopathy, cardiovascular disease, and nephropathy. As long as blood glucose levels are maintained within an acceptable range, long-term complications can be prevented or reduced. Butler (2007) emphasized the role of the school nurse in managing and coordinating care for diabetes in school-aged children, especially if they have hypoglycemic episodes there.
Sustained lifestyle changes which includes nutrition and physical activities must be the cornerstone for obesity management implemented by the school nurse. The school setting is a safe and trusted environment or children since they spend most of the day there. The school nurse must emphasize the importance of physical activities which enhances insulin sensitivity by improving the transportation of glucose into the cells and also increase the production of muscle glycogen, replacing the amount used (Rabbitt & Coyne, 2012). School nurses, under the direction of the health care provider, can provide nutritional and physical activity advice to parents, students and staff along with strategies for change.
Literature on Methods
Majority of the literature reviewed for this paper made use of the qualitative method. In an article published by the American Academy of Pediatrics (2008) where the authors discussed the role of the school nurse in providing care for students, particularly for children with chronic diseases, the qualitative method in the form of a systematic review was used in discussing the role and activities of the school nurse, their professional preparation, as well as their role as part of the school health services team. Similarly, a study conducted by Bowen and Rothman (2010) used a formal review as their research method in order to make the assertion that the use of a multidisciplinary management team in the care of children and adolescents with type II diabetes promoted increased efficiency and effectiveness, as well as improved outcomes for these children. In the same regard, a formal review was used by the National Association of School Nurses in its position statement where it asserted that the school nurse was the only member of the school staff who had the statutory authority, knowledge base, and skills necessary for meeting the needs of students with diabetes in the school setting (Butler, Fekaris, Pontius & Zacharski, 2012). Peimani, Tabatabaei-Malazy and Pajouhi (2010) also used the formal review method in asserting that the role of nurses in providing education for patients with diabetes was important, particularly because of their capabilities in providing effective quality care at lower costs. As well, Jameson (2006) conducted a review of the challenges that students with diabetes encountered at school, particularly with regards to the management of hyperglycemia and hypoglycemia, exercises and sports, nutrition management, insulin administration, blood glucose monitoring, and the training of school personnel
The interview method was used by Wang, Brown and Homer (2010) in order to determine the school-based lived experiences of adolescents with type 1 diabetes. It made use of the Heideggerian hermeneutical phenomenological approach as the philosophical underpinning that guided it. It involved adolescents who were aged between 12 and 16, were diagnosed with type 1 diabetes mellitus for at least ac year, did not have other significant health issues, and were studying in either in private or public junior high schools in Taiwan. Purposive sampling was used for recruiting the adolescents and in the end, the authors had two participants for the study – one girl and one boy who were aged 14 and 15, respectively. Semi-structured interviews were conducted. Some of the interviews were transcribed verbatim and a memo journal, along with field notes, was also used during the entire study. The gathered data was analyzed using the hermeneutic circle, which enabled the authors to gain a global understanding of the participants’ lived experiences. NVivo 8.0 was used for managing and analyzing the data.
On the other hand, the case study method was used by Kelo, Erikksson and Eriksson (2013) in a study where they asserted that nurses have an important role in providing patient education for children with type 1 diabetes but that they lack knowledge about the patient education process. In this regard, this study described an educational program that enhanced the empowering patient education process for educating children about monitoring their blood glucose and that also enhanced the perceptions of nurses with regards to the use of empowering techniques. More specifically, this study involved ten nurses who conducted the diabetes education program. Eight of them also participated in the semi-structured interviews, which allowed the authors to gather information about the nurses’ perception regarding their use of empowering techniques. The nurses’ ages ranged from 25 to 55 and their work experience in the ward ranged from six months to thirteen years. The data was analyzed through the use deductive and inductive content analysis. On the other hand, the bases for developing the education program included previous research and literature, as well as studies that focused on the perceptions of nurses, children, and parents regarding patient education.
The case study method was also used by Foley, Dunbar and Clancy (2013) who evaluated the success of two collaborative initiatives that were conducted by the public school system in Springfield, Massachusetts and the Baystate Medical Center, which was affiliated with Tufts University. These initiatives highlighted the care of urban children who either had asthma or type 1 diabetes. The authors conducted their evaluation through their attendance in grand rounds, which featured public school nurses, nurses, and academic medical center physicians. The authors found that increased communication, collaboration, and understanding of roles would benefit students, school nurses, and primary care providers.
Of the ten articles reviewed, only two described the results of quantitative studies. One is a study by Amillategui, Calle, Alvarez, Cardiel and Barrio (2007), which aimed to identify the special needs of children with Type 1 diabetes in schools, based on the parents’ perception. It also aimed to determine how the parents’ perception affected the confidence they had in the school’s capability in caring for their children. It involved the parents of children aged between 3 and 18 years who had type 1 diabetes, and who attended pediatric outpatient clinics in Madrid, Spain. Self-reporting questionnaires were used for gathering data, the results of which were recorded using the Gandia Barwin statistical program. A quality control exercise was also performed in order to detect potential recording mistakes. In addition, a student’s t-test was used.
Another quantitative study was the descriptive research conducted by Engelke, Swanson, Guttu et al. (2011) where they used case management in determining the kind of care that school nurses provided to children with diabetes. It required nurses to complete an expanded health assessment and it also involved the quantitative and qualitative analysis of data for 86 children with diabetes whose ages ranged from 5 to 17. Responses were recorded using a three-point scale for children between the ages of 5 and 7 while a 5-point scale was used for the older children. The scores were then converted to a scale of 0 to 100 in order to facilitate their interpretation. SPSS 17.0 was used for analysis. Moreover, independent-groups t-tests were used for comparing the mean IDs between nurses who handled 1 to 2 schools and nurses who handled 3 to 4 schools. The paired samples t-test was also used for comparing the quality of life scores between the baseline and the end of case management. Assessment of the statistical significance was done at an α level of .05.
Summary and Transition
Diabetes is a widespread group of diseases caused by low levels of insulin (Copeland, Becker, Gottshwalk & Hale, 2005). This causes failures in sugar metabolism, and increased levels of blood sugar. This chapter has outlined the various causes and types of diabetes, as well as their effects on an individual’s physical and psychological health. The chapter also paid particular attention to type II diabetes – a form of diabetes commonly associated with adult populations, which has been increasing in incidence among younger individuals (National Center for Disease Prevention and Health Promotion (2010). According to experts, in order to prevent diabetes, and its ill effects, certain lifestyle changes must be made (National Center for Disease Prevention and Health Promotion (2010). Hence, this chapter also outlined the physical activity and nutritional behaviors observed among youth and adolescents. Identifying these behaviors and planning out strategies to improve them may yet help prevent and curb the negative consequences of diabetes, which is the main goal and significance of the current research endeavor.
Chapter 3: Research Method
Introduction
Research Design and Approach
Setting and Sample
Instrumentation and Matrials
Data Collection and Statistical Analyses
Protection of Human Participants [optional]
Dissemination of Findings [optional]
Summary and Transition
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Appendix A:Title of Appendix
Curriculum Vitae
