NU225 Unit 8 School Diabetes Seminar Reflection Example

Who in the Building Can Act: A Seminar Reflection on a Composite Eight-Year-Old With Type 1 Diabetes Whose Glucose Alarm Sounded During a Spelling Test While the School Nurse Was at Another School

[Student Name]

Purdue University Global

NU225: Pediatric Nursing

Unit 8 Seminar Reflection

[Instructor Name]

[Date]

The child, school and classmates are composite; rules on school diabetes care and delegation differ by state and district, and the reflection does not describe any one school's policy.

The View I Brought

I came to the seminar thinking that diabetes at school is mainly about the child's own skills. If an eight-year-old can count carbohydrates, recognize a low and treat it with juice, then the nurse's job is to teach those skills and check on them. I saw the school as a place where the child manages and adults stay out of the way.

The Case

[Eli], composite, 8, uses a continuous glucose monitor and an insulin pump. One nurse covers his building and [two] others. At 1:40 p.m., during a spelling test, his monitor alarmed for a low glucose. His mother received the same alert at work, forty minutes away, and called the school office.

Three Moments in the Discussion

First, a classmate who works as an emergency department technician asked what would happen if Eli were too shaky or confused to treat himself. That question undid my starting point: the times a child most needs help are the times his own skills fail. A severe low can make a child unable to swallow or follow directions, and then someone else must give glucagon.

My view assumed Eli would always be able to help himself, but a low glucose is exactly the moment when he cannot.

Second, a classmate who is a paraprofessional in an elementary school described a Section 504 plan, the written agreement that sets out the accommodations a child with a disability receives at school. For Eli, that could include permission to eat in class, to check his monitor during tests and to retake a test after a low. I had not known that his care at school has legal weight, not just good intentions. The American Diabetes Association's position is that federal law requires schools to provide the care a child needs, including trained staff who can give glucagon when a nurse is not present (Jackson et al., 2015). Third, a classmate who is a school nurse explained that what she may delegate to unlicensed staff, such as giving glucagon or insulin, depends on state law and her board of nursing. In her state, she trains and supervises office staff to give glucagon; in a neighboring state, the rules are narrower. Delegation decisions rest on the state's rules and the nurse's judgment about the task, the person and the circumstances (National Council of State Boards of Nursing, 2016).

The Revised View

I now think diabetes at school is a system, not just a set of child skills. Eli's skills matter, and teaching them is part of the nurse's work. But the school also needs a written plan, trained adults in the building every hour of the day, clear rules about who may do what, and a way for a parent's alert to reach someone who can act. When the nurse is shared among three schools, the most important work she does may be training the people who are there when she is not.

Why I Held the First View

Looking back, I held the skills view because it is how diabetes education is usually described: teach the child, then the child manages. Most of the teaching I had seen was in clinics, where the child and parent sit together and the plan ends at the door. I had not thought about the six hours a day when neither the parent nor the diabetes team is present. I also liked the skills view because it respected the child's independence, which is a real value. The seminar did not take that value away; it showed me that independence needs a backup, because the moment a child cannot act is exactly the moment a low becomes dangerous.

What I Would Do as a Nurse

If I worked with a family like Eli's, I would ask not only what Eli can do, but who will help him when he cannot, where the glucagon is kept, who has been trained to give it and whether his plan covers tests, recess and field trips (Perry et al., 2022). I would make sure the parent knows whom the school calls and that the alert path is tested before the first low happens.

What Stays Unresolved

I am still unsure how a shared school nurse can supervise trained staff in three buildings well enough to be comfortable with delegation. I also wonder how monitor alerts shared with parents should be handled when a parent calls the office during a test, and who decides whether the child keeps testing. And I want to know how schools handle substitute teachers who have not been trained at all.

References

Jackson, C. C., Albanese-O'Neill, A., Butler, K. L., Chiang, J. L., Deeb, L. C., Hathaway, K., Kraus, E., Weissberg-Benchell, J., Yatvin, A. L., & Siminerio, L. M. (2015). Diabetes care in the school setting: A position statement of the American Diabetes Association. Diabetes Care, 38(10), 1958-1963. https://doi.org/10.2337/dc15-1418

National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.