Date of Award

Spring 5-18-2015

Degree Type


Degree Name

PhD Nursing




Marie C. Foley

Committee Member

Pamela Galehouse

Committee Member

Donna Mesler


diabetes, adolescents, school nurse, diabetes management, self-efficacy, youth


Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases of childhood. Adolescents with T1DM experience decreased treatment adherence, poor glycemic control, and acute complications more frequently than adults. Self-efficacy is the belief that one can carry out specific behaviors in specific situations and is the major determinant of intention, and has been shown to influence diabetes self-management in the adolescent.

School nurses are in a unique position to influence self-efficacy for type 1 diabetes management in adolescents. Although previous research has shown that school nurses positively influence student health outcomes in a variety of ways, there is little empirical evidence regarding the impact of the school nurse on students’ perceptions of their self-efficacy, or ability, to manage their diabetes.

The purpose of this descriptive correlational study was to determine if there is a relationship among the school nurse to student ratio, self-efficacy for type 1 diabetes management, and glycemic control in adolescents; age and diabetes duration were also explored. The sample consisted of 89 parent-adolescent dyads. Adolescents aged 10-16 years old with T1DM completed the Self-Efficacy for Diabetes Self-Management (SEDM) scale and a brief questionnaire about diabetes in the school setting. Parents completed a 42-item questionnaire about adolescents’ diabetes in general and in the school setting.

A negative correlation (r = -.244, p = .021) was noted between school nurse to student ratio and glycemic control, measured by HbA1c levels. No statistically significant relationships were found between self-efficacy for type 1 diabetes management and either school nurse to student ratio or HbA1c levels. The SEDM was associated with age (r = .224, p = .036) and showed gender differences; a t-test was significant, t(87) = -2.00, p = .048, with females scoring higher. A large correlation between school nurse to student ratio and age was also noted (r = .539, p < .01).

Several other findings derived from the questionnaires contribute new knowledge to the paucity of existing literature on school nursing and adolescents with type 1 diabetes, with numerous implications for nursing practice, education, research, and policy.

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