Nurses at Papatoetoe High School in Auckland are delivering better health care for students with chronic conditions, by providing a service that meets their needs, facilitates referral to other services and promotes self-management.
Young people with chronic conditions need special support from school-based health services to learn how to manage the particular challenges they face.
Recently, registered nurses at Papatoetoe High School began to notice that a lot of young people coming through their clinic with chronic conditions such as diabetes and asthma weren’t managing their health as well as they could be.
Using plan, do, study, act (PDSA) cycles, the nurses developed the Chronic Care Kids project, aiming to identify students with chronic health conditions, build relationships with them, and help them to maintain the best possible health.
The first step for the nurses was to agree on how they would incorporate Chronic Care Kids into their already busy timetable. They decided to share responsibility: every Tuesday, when all three of them were at the clinic, one nurse would do Home, Education/Employment, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) assessments, one would run the clinic and the third would see Chronic Care Kids students.
The next step was to identify students with chronic conditions. The nurses were already aware of 15 students at the school who would benefit from the project. In addition, they identified Year 9 students with chronic conditions through HEEADSSS assessments. They devised a schedule to assess new enrolments at the school in Years 10 to 13 to identify further eligible students. Consequently, the nurses have enrolled 25 students in the project since it began in October 2014.
The nurses meet with each student in Chronic Care Kids at least once a term. They ask the student about their illness, make sure they’re attending appointments and taking medication, and connect them with general practitioners and other health services if necessary. They also advise and support students with managing their condition, and check on how well they are doing in this respect, depending on the individual student’s condition.
An important part of the project is empowering students to acknowledge and take responsibility for their condition. The nurses encourage students to build skills for lifelong management. They provide education about the health care services available, and encourage older students to contact those services for appointments personally. ‘We’re very proactive about developing independent young people,’ says Suzie King, one of the nurses. ‘When they leave the protected environment of school, they know what to do if something goes wrong.’
Building trust with students and their families is the key to making the project work. The nurses acknowledge that students sometimes don’t tell nurses everything at first. Regular meetings help to build more open and honest relationships. To improve communication between school and home, nurses contact the family members of students with chronic conditions to introduce themselves. Thereafter, they keep in touch.
This effort to establish relationships with students’ families has opened communication lines between families and the school. The result is that both sides are better informed, and can work together to improve young people’s health.
Another benefit is improved relationships between students and teachers. Prior to the project, teachers sometimes did not realise they had a student with a chronic condition in their class. Teachers have told the nurses that they appreciate the improved awareness the project has brought about.
The nurses at Papatoetoe High School have shared their experiences with the Chronic Care Kids project with other school nurses, through a regional professional development group.