If you have a student with diabetes please contact me and I will assist you
with with developing an Individual Health Plan for your student. Please
contact Kerri at 365-9235.
National Association of School Nurses
1416 Park Street, Suite A
Castle Rock, CO 80109
303-663-2329
303-663-0403 Fax
Toll Free: 866-627-6767
CONSENSUS STATEMENT
Safe Delivery of Care for Children with Diabetes in Schools
This Consensus Statement was developed to address the needs of a child living
with diabetes for management and safe delivery of care during the school day.
The care of children with diabetes is a mutual concern of many children,
parents, educators, health care providers and health organizations. We are
interested in working with these individuals and groups to find the best
solution for providing these services.
Diabetes is a health concern requiring daily, long-term, comprehensive, safe
management. Students with diabetes must have appropriate management in school:
To promote the safety of students in the school setting;
To reduce the number of emergency situations;
To quickly manage emergency situations that may develop;
To minimize the long-term negative effects of diabetes; and
To support the students'academic success.
Schools are responsible for providing the health needs of students.
Two federal laws provide the right to services to students who need
health services during the school day to remain in school: IDEA and Section
504 of the Rehabilitation Act.
Case law has consistently supported the need for schools to provide
these services.
State nurse practice acts define the scope of nursing practice. They are put
in place to protect the public and provide a standard of care that can be
expected by all.
Nurse practice acts vary from state to state and delineate what, if
any, nursing functions may be delegated, and the conditions under which they
may be delegated.
In some states, it is a clear violation of the nurse practice act to
delegate to anyone other than another nurse.
Tasks that involve assessment or judgment are nursing functions that
cannot be delegated.
Delegation is the transfer of responsibility for the performance of an
activity to another, while retaining accountability for the outcome.
The nurse is responsible for determining the appropriate level of care
needed for the individual student, including whether the task can be
delegated. Each child responds differently to the changes that occur in
growth and health status. The delegation function requires that the nurse
individualize each child's care and does not allow generalizing care.
By definition, a delegated nursing service requires that the nurse
train and supervise the person providing the service. The performance of the
task must be periodically evaluated and documentation of the training and
evaluation are required.
Furthermore, the delegation of care provides a system for a trained
person to contact the nurse for interpretation or questions.
General monitoring and standardized tasks that do not require
assessment or judgment may be delegated to non-medical persons.
Healthy People 2010 Objectives for Improving Health states, "Increase the
proportion of the Nation's elementary, middle, junior high, and senior high
schools that have a nurse-to-student ratio of at least 1:750". The supporting
rationale for the objective includes this statement, "Nurses manage care and
provide services to support and sustain school attendance and academic
achievement."
The Individual Health Care Plan is a description of the nursing interventions
that the student needs for care during the school day. The plan reflects the
individual needs and competencies of the student at a particular period of
time. The school nurse in developing the IHP:
Assesses the developmental, cognitive, and physical status of the
student to determine the ability of the student to independently manage the
care of their health. The younger, less experienced, or newly diagnosed
student may require more assistance with diabetes management;
Identifies the medical interventions the student's physician has
ordered;
Determines the nursing interventions needed based on the health and
developmental status of the student;
Establishes the interventions provided at school, which may include
blood glucose monitoring, insulin administration, dietary intake, instruction
in identifying signs of and response to hypoglycemia or hyperglycemia,
instruction in how to perform a blood glucose test, and instruction in how to
administer insulin;
Prepares an Emergency Health Plan; and
Assists the student to determine realistic and achievable personal
goals to attain self-care and independence in the management of their health.
Unlicensed staff and volunteers who receive training regarding general
diabetes management without regular professional supervision are not a safe
and appropriate management system for children with diabetes.
Non-medically trained school staff may be well intentioned, but may not
have the competence, skills, or availability to handle the responsibility and
complexity of responding to the needs of students with diabetes.
Model legislation promoting volunteers to provide care for students
with diabetes has a provision that protects school districts and school
employees from liability for civil damages if they act "as a prudent person
would." It does not exempt the school district or employees from charges of
negligence, a standard that is often easy to reach.
Minimally trained, non-medical personnel and non-supervised volunteers
lower the standard of care and may jeopardize the health and safety of
students with diabetes.
Adopted: January 12, 2005
