Standardizing Diabetes Care in Colorado Schools: Nearly Two Decades of Success.

Since 2005, a group of stakeholders in Colorado has collaborated to improve diabetes management in schools and childcare centers by standardizing care and embedding local expertise to support school personnel in this task. This effort has included the development of toolkits for parents, school nurses, and other health care providers; the establishment of a diabetes resource nurses program; and annually updated guidelines titled Standards of Care for Diabetes Management in the School Setting & Licensed Child Care Facilities. This collaboration has fundamentally changed how school nurses and staff in Colorado care for students with diabetes.

The Use of Technology in Managing Diabetes in Youth Part 3-Special Considerations: Integration Into the School Setting.

The advantages of continuous glucose monitoring (CGM) and insulin pump systems have increased the popularity of these devices among students in the school setting. The use of diabetes technology at school and school-sponsored activities strengthens the student's consistent use of the technology and increases the overall beneficial effects. The school nurse has many considerations when supporting the student with diabetes technology. Integrating this technology into diabetes care at school can be complex with collaboration and safety considerations fundamental to success. This is the third article in a three-part series on the use of technology in managing diabetes in youth. The first article described CGM devices and provided tips for the school nurse in incorporating CGM into the student's individualized healthcare plan. The second article summarized insulin pump technologies, from conventional insulin pump therapy to advance automated insulin delivery systems and described keys to success with insulin pump technologies. The purpose of this article is to address some special considerations for facilitating the use of diabetes technology in the school setting. Topics to be discussed are tips on including insulin pump therapy in the student's individualized healthcare plan, safe use of diabetes technology during physical activity, and implications for school nursing practice.

The Use of Technology in Managing Diabetes in Youth Part 2-Insulin Pump Technologies: Information and Tips for the School Nurse.

Insulin pump technologies are commonly used by youth with type 1 diabetes (T1D) for intensive insulin therapy, the gold standard for T1D care. Insulin pump technologies are advancing rapidly, with new insulin pumps becoming available every year offering improvements in glycemic control. School nurses must understand the basics of insulin pump therapy and distinguish between advanced pump technologies to best support their students with T1D. This is the second article in a three-part series on the use of technology in managing diabetes in youth. The first article described continuous glucose monitoring (CGM) devices and provided tips for the school nurses in incorporating CGM into the student's individualized healthcare plan. The purpose of this article is to summarize insulin pump technologies, from conventional insulin pump therapy to advanced automated insulin delivery systems and to describe keys to success with insulin pump technologies. Part 3 will focus on special considerations and problem solving related to technology use in the school setting.

Equipping School Health Personnel for Diabetes Care with a Competency Framework and Pilot Education Program.

BACKGROUND: Schools struggle to support health needs of students with diabetes due to limited funding/resources. A competency framework can help individual schools clarify the knowledge and skills required for school-based diabetes care within their unique context, and inform the development of standardized diabetes education for health staff. METHODS: A consensus-building technique, known as the Delphi method, was used to create a competency framework for diabetes care at school with a panel of 37 stakeholders. A continuing education program based on the resultant framework was developed and pilot-tested with school nurses. Pretest and post-test scores on knowledge, perceived competence, and self-efficacy were compared to evaluate the effectiveness of the program. RESULTS: Consensus was obtained for a total of 70 competencies: 22 competencies for health aids, 36 additional competencies for school nurses, and 12 additional competencies for diabetes resource nurses. Thirty school nurses completed the continuing education program and demonstrated significant improvement in diabetes knowledge, self-efficacy, and competence in pathophysiology and diabetes care tasks (p < .01 for all). CONCLUSIONS: Developing a consensus framework is an excellent starting place for stakeholders to identify the skills and knowledge required for various school personnel and to ensure that all school health staff members receive adequate diabetes education.

Providing Standards for Diabetes Care in the School Setting: A Review of the Colorado Model.

In 2013, a collaboration of organizations in Colorado developed a set of standards to address school nurses' need for current diabetes care practices in the school setting. The Standards of Care for Diabetes Management in the School Setting are successful in meeting the needs of the school nurses in Colorado and are updated annually to continue to provide valid guidelines as diabetes care continues to become more technological and new approaches are adopted. A review of the standards, including background, development, contents, evaluations, and ongoing additions, is provided in this article.

NASN position statement: Concussions--the role of the school nurse.

It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as school nurse) is an essential member of the team addressing concussions. As the school-based clinical professional on the team, the school nurse has the knowledge and skills to provide concussion prevention education to parents, students, and staff; identify suspected concussions; and help guide the student's post-concussion graduated academic and activity re-entry process. The school nurse collaborates with the team of stakeholders including health care providers, school staff, athletic trainers, and parents.

A collaborative approach to diabetes management: the choice made for Colorado schools.

Students with diabetes deserve a school nurse who can effectively manage the disease. Tensions between the school and families sometimes emerge when a child with diabetes goes to school. To resolve these tensions in Colorado, stakeholders collaborated to implement a statewide program to meet the needs of students with diabetes. Colorado school nursing leadership partnered with the National Association of School Nurses to adapt components of the Managing and Preventing Diabetes and Weight Gain Program (MAP), funded by the Centers for Disease Control and Prevention. The Healthy Learner Model for Chronic Condition Management, integral to MAP, provided guidance for the Colorado Collaborative to design the Diabetes Resource Nurse Program. The program supports the practicing school nurse, and facilitates collaboration between the family, school, and health care provider. This article describes how stakeholders in Colorado chose to collaborate when faced with rising tensions over how to best manage students with diabetes.

NASN position statement: caseload assignments.

It is the position of the National Association of School Nurses (NASN) that schools should employ professionally prepared Registered Nurses, to conduct and supervise school health programs which address the variety of health problems experienced by school children. NASN recommends a formula-based approach with minimum ratios of nurses-to-students depending on the needs of the student populations as follows: 1:750 for students in the general population, 1:225 in the student populations requiring daily professional school nursing services or interventions, 1:125 in student populations with complex health care needs, and 1:1 may be necessary for individual students who require daily and continuous professional nursing services. Other factors that should be considered in the formula-based approach are number of students on free or reduced lunch, number of students with a medical home, and average number of emergency services per year.