In the home, young people with chronic conditions will manage their medication with assistance from their parents. A number of researchers have identified varying levels of assistance and differing patterns of partnership in these activities.1,2,3
However, whilst at school, in the absence of their parents, young people with a chronic condition may have to assess their need for, manage and administer medication without assistance or support.
British government policy relating to support for young people in managing medication for chronic conditions in schools has been limited. The National Service Framework for Children, Young People and Maternity Services4
emphasised the need for schools to carefully consider arrangements for the management of pupil's medication, but there was little elaboration on this point. The most extensive guidance relating to the management of medication in schools has been the publication of Supporting pupils with medical needs: a good practice guide
This document stated that it was the responsibility of the parent to provide the school with information regarding their son's/daughter's health and medical needs and that within the school head teachers were responsible for the medical needs of children. However, the extent and nature of this responsibility was not discussed. The implementation of school policies regarding medication was strongly recommended in the document and guidelines to assist schools in the formulation of policy were laid out.
Researchers have investigated the extent of school policies relating to medication. In a survey of London primary school head teachers,6
95% reported having a policy relating to the medical needs of young people and 50% had individual care plans in place for specific conditions, as advocated by the Department of Education and Employment.5
In County Durham, a survey involving 296 head teachers7
revealed that all secondary schools and two fifths of primary schools had a policy relating to asthma. A survey of head teachers in Wales8
216) noted that 40% of schools allowed young people to take responsibility for their own inhalers.
Research among young people (n
33) with a variety of conditions reported that young people generally found ways to manage the effects of their conditions whilst at school. However, they reported difficulties in participating in school activities and in responding to teachers' and peers' attitudes.9
For young people in the US with diabetes, attitudes of teachers and their lack of understanding of actions and procedures required for good diabetic control has also been reported to lead to problems in maintaining effective management.10
These young people also valued the assistance of the school nurse, a person not available in most schools in the UK. The pressures of having a condition such as diabetes have been shown to affect young people's academic performance at school.11
The transition from elementary to middle school has also been reported to lead to increased obstacles to young people's management of asthma. Young people, again in the US, reported the more diffused support, greater peer pressure and increased demands in physical education as greater challenges to the management of their condition in a secondary school setting.12
Parents of young people with chronic conditions have also expressed concerns regarding the management of conditions at school. In particular, they attributed many of these concerns to teachers' lack of knowledge about the condition.13
In Australia and Canada, schools have been the location for peer led asthma education programmes, which have reported improvements in quality of life for young people with asthma.14,15
In the USA, a pilot study in which diabetes care visits were conducted at school, has been shown to improve diabetes management at school and at home.16
The American Diabetes Association has advocated the use of “individualized diabetes medical management plans”, devised and agreed between health professionals and parents to set out guidance for the medical care needs of the young person when at school.17
Recent UK debate about the management of chronic conditions in schools suggests that despite guidance documents from the government and the creation of school policies, difficulties surrounding medication and condition management in schools are still prevalent.18,19
The need to train school staff regarding the management of chronic conditions and the use of medication has been identified by head teachers and researchers.8
The aim of this paper (which was part of a wider study into partnerships between young people and their parents in the management of medication for asthma and diabetes) is to examine the experiences and concerns of young people and their parents in the daily management of medication for asthma or diabetes whilst at school. Specific objectives were to document the views and experiences of young people regarding the management of their medication whilst at school, to identify the concerns of parents regarding the role of the school in supporting their son/daughter in effective management of their condition, and to examine the implications of these experiences for successful management of the condition in the context of school life.