Alyssa Perez
I 310 Spring 2022
Dr. Kayla Booth
March 30, 2022
Research Map Draft
Type 1 Diabetics Blood Glucose Monitoring - School Nurse/Student
Connection
Research Problem
Identified Problem
The problem that I identified was a lack of communication regarding blood sugar level and
insulin intake between a trained school nurse and the students who have been diagnosed with
type 1 diabetes. Although the students with diabetes have an improved quality of life due to the
technological advancements made, like an “artificial pancreas,” there continues to be an issue
surrounding the students-nurse communication regarding the students blood sugar level. The
student with diabetes must report back to the nurse's office continually throughout the day, at
almost one hour intervals, to ensure that the student's blood sugar levels are in a safe range. To
add, the student must also report to the nurses office ten minutes before and after lunch and
any physical education classes to monitor the fluctuation of the students blood sugar level due
to an external stimulant. Adding all of the visits to the nurses office, the accumulated amount of
time spent away from the classroom can affect a students academic performance, and may
cause them to fall behind in the courses. Although this is beneficial to the student and their
overall health, this aspect of their diagnosis can stunt the normality of their everyday life, and
leave them at an academic disadvantage compared to other students. Digital medical tools like
the artificial pancreas and the Dexcom digital glucose monitoring system have created a more
convenient lifestyle for students with diabetes and their caregivers, there is only so much these
technological advancements can do for the user and the corresponding parties that are
involved.
What You Need to Know
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Type 1 diabetes is an autoimmune disease that currently can not be cured, IT occurs
when the pancreas can no longer create insulin to support the body. An external insulin
flow source (artificial pancreas, insulin injections) must be provided in order to maintain a
healthy blood sugar level.
An artificial pancreas is a digitized tool that automatically pumps insulin according to the
measurement of carbohydrates that will be absorbed by the blood stream. The insulin
pump also uses blood sugar levels to determine when more insulin is needed to
maintain a healthy blood sugar level.
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Continuous Glucose Monitoring system is a non temporary medical implant that replaces
the manual system and reports the blood sugar levels periodically and reports it back to
a mobile application. This tool is semi-permanently injected into the the skin for a short
period of time and uses technology to determine the blood sugar level.
A school nurse is a licensed nurse that can administer insulin, and analyze blood sugar
levels accordingly. They also have the access to administer emergency protocols
regarding diabetic shock.
A medical accommodation release is protected under the Disability Act and is labeled
under the 504 medical disability accommodation protection clause. It allows students
with a disability (type 1 diabetes) to leave early from class to report to the school nurse
regarding their blood sugar levels, and also allows them to have special accommodation
for standardized tests, along with physical education classes, field trips, and their
designated lunch periods.
A blood sugar level fluctuation is when an individual's blood sugar level rises too high or
too low compared to the normal rate ( 80-120 ) at an alarmingly fast rate, and may cause
the individual to go into diabetic shock.
Who is Affected
There are multiple people affected by this issue, including the students with diabetes, their
caregivers, the school trained nurses, the companies responsible for creating both the artificial
pancreas and the Dexcom blood glucose monitoring system, the school districts involved, along
with the students specific health care provider.
What we Know
The part of this problem that I am most interested in is lacking in information and research in
this specific area of students navigating the educational process with type 1 diabetes. What we
know most about this focus is the nurse’s personal reactions to the efficiency and usability of the
artificial pancreas and continuous blood glucose monitoring system. This can be useful in a
certain context, and could help create a connection between the lacking information and the
experiences of the students who live through this. The most relevant information regards the
operational instructions of these tools which is in the same realm of the research problem, but
does not specifically address it.
Why This Problem Matters
This problem is significant because there is a certain quality of life that any person should have
access to, this includes people who have to live with a disability and want to ensure a-close-tonormal lifestyle. However, this aspect of living with diabetes has created issues for students and
their quality of life regarding their educational aspirations and goals. It is hard for a student to
feel included in the daily academic and social aspects of a school environment when their
routines are constantly being interrupted by repeated visits to the school nurse.
How This Problem Relates to Informatics
This problem directly relates to the three elements of informatics because there are a number of
technological problems involved, along with the involvement of the parties that are affected by
this issue. The concept of sharing information between the mobile application and the parties
involved connects this issue on a larger level to informatics as a whole. There is a constant flow
of information between the user and the network it is connected to, and after the information is
processed throughout the network there is the server that withholds the information and
professionals or designers work to analyze this on a larger scale that can help improve the
value of life for the users.
Which Informatics Concentrations Does This Problem Fall Under
This issue relates to two main concentrations within informatics, those being user
design/experience and health informatics. There is an involvement of both design and
healthcare improvement, and both of these concepts are dependent on the other to coincide.
This relates to user design because the creation of a new
Literature Review
Sources
DeBoer, M. D., Breton, M. D., Wakeman, C., Schertz, E. M., Emory, E. G., Robic, J. L.,
Kollar, L. L., Kovatchev, B. P., & Cherñavvsky, D. R. (2017). Performance of an artificial
pancreas system for young children with type 1 diabetes. Diabetes Technology &
Therapeutics, 19(5), 293–298. https://doi.org/10.1089/dia.2016.0424
Latham, J. (2018). The artificial pancreas: What school nurses need to know. NASN
School Nurse, 34(2), 86–89. https://doi.org/10.1177/1942602x18804491
March, C. A., Oyetoro, R., Adams, J., Rodriguez, H., & Albanese-O'Neill, A. (2021).
School nurse perspectives on do-it-yourself automated pancreas systems in the school
setting. Diabetes Technology & Therapeutics, 23(10), 705–709.
https://doi.org/10.1089/dia.2021.0042
Wu, Z., Luo, S., Zheng, X., Bi, Y., Xu, W., Yan, J., Yang, D., & Weng, J. (2020). Use of a
do-it-yourself artificial pancreas system is associated with better glucose management
and higher quality of life among adults with type 1 diabetes. Therapeutic Advances in
Endocrinology and Metabolism, 11, 204201882095014.
https://doi.org/10.1177/2042018820950146
Where These Papers Were Found
Using the UT libraries databases, I found these papers after a quick search that involved the
keywords type 1 diabetes, school nurses, and artificial pancreas. I tried to refine my search by
adding other keywords like missing class and academic disadvantage, but didn’t really find any
different information than what I had previously seen. Most of the papers
Questions
Although the papers concluded that school nurses have shown to have little to no prior
knowledge, I was surprised to see that there was not much research done on the elements of
missed opportunities due to the lack of knowledge on how to handle this in a better fashion.
Most of the papers emphasized on educating school nurses on the importance of learning how
to use these artificial pancreas’ and how to operate them efficiently in order to aid the students
in their education endeavors, but this issue does not seem to be a prominent issue within the
education system and the parties that are involved. The questions that I have formulated
surround the idea of missing perceptions and the idea that most of the research done is very
quantitative and diligent in funding quantifiable research. I would prompt the questions: how well
do artificial pancreas’ aid in creating a more convenient lifestyle? Do the constant trips to the
school nurse during class hours affect a students academic performance? In that same sense,
does this situation affect the social aspects of a students academic life? How does the constant
interruptions of type 1 diabetics’ daily life affect the perception of their diagnosis, in other words,
does this aspect of their treatment make their diagnosis feel more disabling then it has to be.
Systematic Review
There was no known systematic review that came to the surface, even after refined searches
were conducted. There does not seem to be much research done on this aspect of a type 1
diabetic diagnosis, and much of the research is very data-driven and focused on the efficiency
and usability of the digital artificial pancreas. As more research is done one this issue, there will
be more information available that could result in a full systematic literature review.
What We Know
The information that was available on students and a type 1 diabetic notice surrounded the
aspect of building school nurses’ knowledge on the operation of the artificial pancreas in order
to better manage a student's blood sugar levels and avoid fluctuation. There is also an
abundance of research regarding students and how the artificial pancreas and digital blood
glucose monitor has improved the quality of life and the social anxiety of being diagnosed with
type 1 diabetes. Another prominent factor in the research that was available was noting the
reaction from school nurses to the new technology and recording how this has improved their
course of treatment for students who actively monitor their blood sugar levels, or for students
who are new to the diagnosis.
The Gap
As mentioned before, there is little to no research done on the constant interruptions of
students' academic and social lives in an educational setting. This is not mentioned enough in
the research and is proven to be of little importance to those who work to understand students
who have to navigate the school setting with diabetes. There is no information on what affects
managing type 1 diabetes has on students and their academic performance, and there is little to
know research done on how this impacts school nurses and their ability to properly treat
students with type 1 diabetes.
Epistemology
Epistemological Approach
The epistemological approach I believe I should take given the information already known and
the information that is not known, the best approach would be an interpretive approach. The
reasoning behind this comes from the idea that there is not one single truth to this issue, and it
does not affect every student the same way. One student's experiences may be different
compared to another, and one may even be more disabling in certain circumstances. Given the
extent of the problem found, there is no preconceived idea that can be accompanied with the
lack of information know, and it is important to look into this issue knowing that every student
with type 1 diabetes may share a different perspective on how they manage their diagnosis and
how they react to the constant trips to the school nurse's office. The research I am focused on
targets the specific feelings of these students, and what change can be made to this issue after
the research has been conducted. It should be assumed that there will be a different response
from every student, and there will be a different response from every school nurse, but there
could be one coherent solution that may accommodate these different perspectives.
What I Am Most Interested In
The finding of this problem results from personal experience through a family member, and due
to the first-hand knowledge I have gained from living through this, I have become increasingly
interested in the impacts of this overarching issue. I am most interested in exploring the
disadvantages that this problem creates, and understand the specifics regarding the loss of
valuable academic and class time. I want to be able to pinpoint exactly where the disadvantages
begin and how much of an impact they have on the students and their academic and social
lives. Although I feel I have a general understanding of what the major setbacks are, I am
interested in analyzing the specific feelings that are generated when students are faced with this
obstacle, but I am also interested in figuring out what the best approach is to find a solution, and
what all the parties believe will work for them.
Research Questions
Questions Explored
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Does the interruption of class to visit the school nurses’ office affect the academic
performance of a student with type 1 diabetes?
Does the interruption of class to visit the school nurses’ office affect the social aspect of
a school environment for a student with type 1 diabetes?
Does the interruption of class to visit the school nurses’ office change the value of the
treatment regarding the artificial pancreas and the continuous blood glucose monitoring
system?
These are exploratory research questions that aim to help understand more about the missing
information within the type 1 diabetic community, specifically focusing on students and
monitoring their blood glucose levels coherently with the school nurse. The goal of this research
is to understand the perspective of the students and the school nurses in order to later formulate
a solution to the proposed problem.
Addressing the Gap
These research questions address the gap by adding to the unknown portion of the information
we currently have on students in the type 1 diabetic community, and focuses on aspects of their
lifestyle that may be negatively impacted by the gap of information. If more is known about the
effects of blood glucose monitoring and insulin administration through a school nurse. If this gap
becomes closed, the quality of life for students with type 1 diabetes may be significantly
improved. Many of the users' concerns will be diminished, as their daily lives do not have to be
interrupted by their inevitable diagnosis.
How do the Question Embody the Epistemological Approach
The research questions closely follow the ideology of the epistemological approach because of
the exploratory nature of both concepts. An interpretive epistemological approach is closely
similar to the format of the research questions in the sense that they are both open to a wide
perception of understanding and knowledge, and do not focus on a few measurable aspects
that can be distinctly compared among one another. The two concepts are almost
interchangeable as we cannot measure the experiences of a person, but rather we can learn
and begin to understand how the problem affects the different parties involved. The research
questions are also focused on the understanding of the gap that exists between the information
provided and the experiences that have not yet been recorded and analyzed.
Methodology
Method of Data Collection
The method of data collection I will be using is a qualitative approach, knowing that human
experiences and emotions are involved. I will look for the answer to my research question by
formulating patterns that lead to generalizations of what the participants would like to change
about the current method/situation.
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To do this, I would conduct a series of consented interviews with participants of varying
ages in order to have a broad scope of how this problem affects students in different
grade levels differently. These will be semi-structured interviews that allow for open,
more engaging responses and create a relationship between the user and the
participant. This relationship allows for a number of different opportunities regarding the
honest answers we hope they provide, and building trust between participant and
interviewer creates a welcoming environment where the participant will most likely feel
comfortable to share their struggles.
The questions will be open ended to allow for a flow of the general conversation. Instead
of it feeling like an interrogation, it should feel like a conversation between two friends. I
will remind the participant that they can opt out of the interview at any time, and they can
decide whether or not they want to be recorded (video or audio) and they can also
choose to not answer any questions that may make them uncomfortable.
I will ensure that the identity of the participants remains anonymous and that they never
feel like they have to conceal their true answers in order to protect their identity. I will
assign each participant an identifying number, each unique, and i will use this to analyze
their responses.
Method of Data Analyzation
In order to analyze this data, I will use the open coding process, and search through interview
transcripts that I will individually create for each interview. I will analyze these transcripts wordby-word in order to catch keywords that are mentioned often throughout the interviews. I will
follow the open coding process, and come up with the most important, and repetitive aspects of
the situations that each participant has had to deal with, and formulate a response to my
research questions. Using the interviews and accompanying literature, I will create general
conclusions, but will make sure to not epak over any person and their experiences. There is no
need to analyze quantifiable data, as there are no measurements to analyze by. I am dealing
with experiences that we can digest and really pick apart in order to find the clear issues each
participant is having.
The Hopeful Impact
In completing this research, the expected outcome is to allow this aspect of handling a disability
to no longer create inconvenience in a user's life. Type 1 diabetes is an already disabling
disease, that many must change their entire lifestyle just to incorporate the treatment. Although
the new medical digital devices have made the transition from manual to automatic treatment
smooth and welcoming, there are aspects of the technology provided that does not alway make
user’s life easier. This research is meant to solve one of the issues that this technology fails to
address, and will hopefully raise awareness at the need to ensure users of digital medical
devices of their efficiency and dependability that comes with their treatment plans. This research
may also end the disadvantaged academic environment that type 1 diabetics must navigate,
which those without this disease do not have to think about. With new innovation, should come
the vanishment of excessive redirection of a life with a disability. There should be less steps
involved when managing a disability, specifically type 1 diabetes. This research intends to close
a gap in information that we are currently lacking regarding the current treatment plan of
students-aged individuals that rely on medical tools to go about their daily lives.