For guardians of children with a long-term illness, starting school may be a worrying time. Children may not be able to manage their medication themselves, but there is no legislation to oblige teachers to take care of medication.
“This is a highly fragmented and difficult issue. Parents are always responsible for the overall wellbeing and medication of their children, but it is of course impossible for parents to medicate their children during the school day,” says University Lecturer Piia Siitonen from the School of Pharmacy.
Siitonen has conducted research on medicine education and the use of medication in schools with a special focus on managing the medication of children with a long-term illness during the school day.
It is the parents’ duty to make inform school staff of any long-term illnesses and the need for medication. What happens after that depends on the guidelines in each municipality or school.
“The problem is that these guidelines are not based on uniform legislation that would stipulate procedures. There are several sections of law that refer to pupils’ safety and wellbeing in basic education, but the responsibility for these matters is not stated clearly,” Siitonen continues.
The Trade union of Education in Finland (OAJ) has also outlined that teachers have no duty to administer medication to pupils. According to the organisation, teaching staff in schools can participate in the medication of children if they wish to do so.
“For example, schools often hire children with diabetes a school assistant who is a trained practical nurse. However, not all schools are able to do this, which puts both children and teachers in an unequal position.”
The obvious solution would be to have the school nurse look after the pupils’ health, but some of them also feel that school nurses lack the authority of a registered nurse, for example when administering insulin to a child with diabetes.
“In addition, small schools often share a school nurse with other schools. This means that the school nurse is only present on certain days of the week. Meanwhile, the medicines are often locked away in the school nurses office, and no-one else has access to them.”
The responsibility for these matters is not stated clearly.
Piia Siitonen
University Lecturer
Teacher attitudes vary
Antti Tonder is in his third year studying to become a class teacher and he has just completed his Bachelor’s Thesis on the views of class teachers on school children with diabetes. Being diabetic himself, Tonder has personal experience of the matter.
“When I was at school, the school provided me with good support in the treatment of my disease. I was lucky to have the same teacher throughout primary school, and we also had a school assistant in my class. The assistant learnt to read me and my symptoms and anticipate the need for medication, and we had no emergencies.”
This is not the case everywhere, as Tonder’s study indicated.
“This is a tricky topic, and teachers’ attitudes vary. Some of the teachers I interviewed felt that looking after the wellbeing of a child with a long-term illness was a natural part of their duties. They even saw it as an opportunity to learn something new, but not all teachers were as eager to participate in the treatment.”
However, all teachers agreed that, during the school day, the teacher has the main responsibility for the wellbeing of the pupils. Some teachers also highlighted the safety aspect. For example, if you have a PE lesson outdoors with 25 children and one child requires treatment indoors, what will happen to the other children.
“After all, the teacher also has the main responsibility for the other children.”
More medicine education for new teachers
Senior University Lecturer Sirpa Kärkkäinen from the School of Applied Educational Science and Teacher Education says that administering medicine to children is not part of the training of new teachers in teacher education.
“Medicine education is not part of the mandatory studies. However, our school has been doing research on medicine education for years in cooperation with Fimea and the School of Pharmacy. We have also produced and tested teaching material for a medicine education website to be used in schools in environmental studies and health education.”
“We have also made plans that involve pharmacy students in the University of Eastern Finland giving lessons on medicines to students in teacher training. This would provide both groups with great experience and knowledge.”
According to Kärkkäinen, medicine education is part of everyday skills and teaches critical thinking.
“It’s just that medicine education has had a bad ring to it. People have thought that it means promoting the use of medicines, when it is, in fact, the opposite. We are teaching new teachers, and their pupils, on how to have a critical and sensible attitude towards medicines. The purpose of medicine education is to provide more information on medicines and how to use them correctly.”
The problem is that teacher training comprises so many things already; it is impossible to fit everything in the mandatory studies.
According to Siitonen, it is important to receive correct information about medicines at a young age.
“Children see many adverts for medicines already at a young age, and it is important to educate them to assess the reliability of the information and to provide children with age-appropriate tools for it.”
Siitonen says that children with a long-term illness, in particular, should learn to read their feelings and symptoms from a young age and also medicate themselves in a age-appropriate manner.
“Our research shows that already in primary school, children know where medicines are kept at home and may take them independently.”
The purpose of medicine education is to provide more information on medicines and how to use them correctly.
Sirpa Kärkkäinen
Senior University Lecturer
Precise instructions provide confidence
The most common long-term illnesses among school-aged children are diabetes, asthma, allergies, epilepsy, migraine and attention deficit and hyperactivity disorders. Lower secondary school pupils also have depression. What action should be taken to make the administration of medication during the school day a reliable process?
“It is vitally important that parents tell the school management and teachers about the health of their child. After that, a medication plan should be prepared with precise instructions for school staff on how to administer medication to the child, and a commitment from the school to follow the instructions,” Siitonen says.
This would give parents and teachers confidence and remove any uncertainties when medication is to be administered and who is responsible.
“Of course, in a real emergency, everyone has the duty to provide first aid. It is not a question of responsibilities.”
Training and peer support
Research shows that some schools use medication plans successfully, while others do not.
“The sad thing is that pupils are in highly unequal situations at the moment. Where you live or go to school should not affect this, nor should your teacher’s attitude,” Siitonen says.
In an ideal situation, there would always be more than one adult in each classroom, so that if required, the teacher or assistant would be able to concentrate on medicating or caring for one child.
“However, this is not reality in most schools. Often, the teacher is the only adult in the classroom,” Kärkkäinen says.
She hopes that teachers could be provided with medicine education and guidance on the use of medicines as part of their continuing education, for example. The medicine education website (Lääkekasvatus.fi) also contains materials for schools.
According to Antti Tonder, the teacher’s threshold for duty to care could be lowered through multi-professional cooperation, for example with the help of the school nurse.
“Of course, some teachers already have experience of caring for children with a long-term illness. They could provide peer support for their less experienced colleagues.”
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