Вы находитесь на странице: 1из 12

Running head: ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 1

Development of Asthma Guidelines for School Age Children and its Effect on Absenteeism

Kristine Krumdiack

Western Washington University

NURS 402 Translational Research for Evidence-Based Practice

Christine Espina, DNP, MN, RN

February 27, 2017


ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 2

Abstract

Background: Asthma is one of the leading causes for school absenteeism and is one of the most

common childhood illnesses. An asthma-management program that encompasses thing such as

monitoring, action plans, education and school nurse case management have been successful in

many parts of the country in reducing these attendance rates and maintain heather youth.

Purpose: The purpose of this project was to demonstrate to the Bellingham school district, in

Whatcom County Washington. The importance of established asthma care guidelines, education,

monitoring and the impact that these have on reducing absenteeism. This project will also assist

the district with ideas for the implementation of such programs that are supported with evidence

based research.

Methods: Research literature for this project was obtained through searches on CINAHL,

PUBMED and Google Scholar. Data pertaining to children outside the age range and small

studies were excluded. A second exclusion criterial was placed for any articles that were

published before 2012. The search was expanded back to include certain studies from 2004. A

concept map was completed during the group portion of this project and helped focus the

direction of the search.

Findings: The prevalence of asthma in young children is astounding. With it being the most

common cause for a child to miss school. School based asthma management programs,

implementation of asthma action plans combined with the presence of a nurse care manager has

a strong relation to the reduction of asthma related absences. The children have also been found

to have a stronger knowledge base and control over their illness.


ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 3

Implications: Some of the implications to this new practice includes the need for increased

staffing both temporary and long-term. The need for increased collaboration with healthcare

professionals and the funding needs for the programs implementation.

Keywords: Asthma guidelines, Elementary schools, School nurse


ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 4

Development of Asthma Guidelines for School Age Children and its Effect on Absenteeism

Background

Fifteen elementary schools make up a majority of the Bellingham school district. All

fifteen are without a set plan for the care and management of one of the most prevalent

childhood illnesses, Asthma. Asthma is also the leading cause for absenteeism. With this

correlation and concern for the wellbeing of the children with in the district, who have asthma. A

need for a plan was the request of a few school nurses within this Bellingham school district.

For these nurses who have to divide their time between multiple schools and only being

present for a few days at each. Need to rely on the administrative staff and teachers to be able to

response to an emergency in the event that he or she is not present. For this reason, the push for

at least a step by step action plan for each child is in desperate need and should be handles in the

way that any other potentially fatal illness such as peanut allergies is handled.

The PICO question was established as Will school aged asthmatic children, grades K -

5, with a standardized asthma care guideline in place, have improved attendance records in

comparison to school aged asthmatic children without a standardized asthma care guideline

enacted?

Purpose

The main purpose of this project was to demonstrate to the Bellingham public school

district that there is a desperate need and evidence, that supports the use and implementation of

an asthma- management program. The population was students kindergarten thru fifth grade

within the Bellingham school district or similar districts in size. The suggested intervention was

to have asthma histories taken, contacting parents and providers, obtaining medications,

constructing asthma step plan, and school based education programs. The comparison would be
ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 5

for school or students that did not have the interventions. The outcome would be the attendance

improvement and knowledge and management of asthma symptoms. With this program, there

would not only be young children and families that are able to understand and manage their

asthma better but absentee rates that are increased with worsening asthma symptoms will go

down. Lastly, would give the elementary school staff a reliable action plan in the event of an

asthma related medical emergency.

Methods

The search for my literature began with PUBMED, Google Scholar and CINAHL. Using

key terms such as asthma care and school nurse. The second search used key terms such as

elementary schools and asthma action plans. To filter the research some criteria was placed

on the search such as peer reviewed, full text and published after 2012. Articles were excluded if

there was a small study size or if the study had not yet completed. Other exclusions were for

studies with school districts that are of a unproportionate size to the school district in question.

Some articles where retained that were outside of the publication date indicated but the findings

were crucial to the research that followed.

Overall the research we found was strong. It was narrowed down to ten studies. The

strongest of our evidence included four randomized controlled trials, two systematic reviews and

two quasi- experimental studies as well as practice guidelines that where provided to use by our

mentors.

In an attempt to organize all of the literature and direct the project a concept map was

created with the main points and focus of the PICO question in the center of the map. In making

this map it was easier to find connections and common themes among the studies with color

coding. This also made it easier to develop recommendations based off of the findings. For the
ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 6

questions that arose during this process I was able to look into further or write down and ask our

mentors at our meeting.

Synthesis Review

Some common themes among the research was the implementation of asthma education

programs such as Open Airways sponsored by the American Lung Association. This program

is a school-based curriculum that is a fun and interactive way to educate and empowers children

to feel more confident in asthma self-management. When following programs such as this one

researchers noticed a significant increase in self-management, knowledge, grades and

attendance. (Taras et al, 2004).

In a study conducted by (Levy, Heffner, Stewert, & Breeman,2006) the interventions

during the study where based off of the National Heart and Lung Association asthma guidelines

in which the four components are periodic physiology assessment and monitoring of asthma

symptoms, appropriate use of medication, patient education and control of factors contributing to

asthma. The students in this study again exhibited an increase in school performance.

Another theme that developed in the research was the use of an asthma tracking survey.

This survey would help nurses identify students with asthma by the completion of this parent

completed form that was given at the beginning of each school year (Moricca et al ,2012). An

assessment was then completed with information such as medication available at school,

severity, and peek flow. The nurses would follow up throughout the year with education, calls to

physician and parents. Again, showing a promising increase in asthma management and

control.

A common theme that was un expected was present in all of the research that I found and

that is the need for more nurses in the schools. With budgeting constraints, it is understood why a
ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 7

lot of the schools have such a short contact with the school nurse but it was noted that the need

for the school nurse is there and it is strong (Liberatos et al, 2013). This might be a look into

further research as to what is an adequate student to nurse ratio.

Requirements

In order for the asthma program to be sustainable there were a few common factors that

seemed to be present. There was an asthma care plan in place for each student on hand located in

the childrens classroom. This care plan would give a non-medically trained individual step by

step instructions on how to respond to an asthma emergency based on the symptoms the child is

exhibiting (Maughan & Schantz, 2014). The other factor was the presents nurse case manager.

The duties of the case manager are to offer practice guideline support (Greener, 2014). They

assure the use and creation of the action care plan. Help in the healthcare navigation for the

families. As well as, coordinate referrals and education sessions for the students and staff.

Barriers

A number of barriers were identified within the literature. The first was communication

between school nurses and medical providers. All too often the primary care provided may have

an idea or plan for the medical care of the child and this information or severity of the asthma is

not communicated effectively. Second, was the lack of parental involvement and follow through

in relation to the asthma care provided at school. All too frequently a plan would be set into place

and when it would come time to review the plan the meeting or communication between nurse

and parent would cease to occur. Next, was the lack of time and resources available to all

stakeholders. Another barrier was the limited resources and availability of medication and

medical equipment. The last barrier in the research that was identified was it seemed to be hard
ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 8

to track asthma related absences specifically due to the specific reason for the students absence

was not consistently recorded.

Recommendations

As the research suggests there is a strong need for a nurse case manager to be able to take

the time to follow up with calls to local providers and families as well as conducting the

educational sessions. Use of the screening tool at registration to identify individuals with asthma

is another way to fill that gap in communication and gives the school the ability to reach out to

all of the students as they are coming in to the school year and get a baseline for the student

health. The parents are already in the routine of filling out paperwork so this would be the time to

catch them before the year gets going. Action plan or established asthma management protocol

located in each childs class room with information such as triggers, demographic and emergency

step by step plans. As mentioned above, a school based education program for the children such

as Open airways sponsored by the American Lung Association would give the schools and the

nurses the tools they need to start this path to a more prepared school district.

Implications for Practice

The main purpose of this purposed change is practice for the school district is to improve

the attendance rates for the children in kindergarten through fifth grade who have asthma.

Staffing Increase

Some of the implications that may come from this change is that there will be a need for

an increase in staffing for both temporary and long term positons. One for the influx in students

at the beginning of the school year that will need to be evaluated and a care plan placed and the

long-term portion will be needed for the continued follow up for the case management role.

Healthcare collaboration
ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 9

There will be a need for increased collaboration with the healthcare professionals in the

care for these children. From the first diagnosis and provision of the care plans in place to the

medication that will need to be prescribed in such case that the child should need during school

hours. This involvement form the healthcare professionals I believe will come quickly. If most of

the assessments and paperwork is provided to them at the beginning of the school year when the

children are getting the required checkups for school, then this will be a more convenient

method.

Increased Funding

As with any change there will be an increased need for funding, especially during the

implementation phase of this program. This funding need may be met by things such as

government grants or by applying for reimbursements with the increase in attendance rates.

Conclusion

At the end of this project we come back to the question: Will school aged asthmatic

children, grades K - 5, with a standardized asthma care guideline in place, have improved

attendance records in comparison to school aged asthmatic children without a standardized

asthma care guideline enacted? Evidence strongly suggests that, the implementation of an asthma

care plan in combination with school nurses as a case manager is the most effective way in

managing and decreasing asthma related absences.


ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 10
ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 11

References

Clark, N. M., Brown, R., Joseph, C. L., Anderson, E. W., Liu, M., & Valerio, M. A. (2004).

Effects of a comprehensive school-based asthma program on symptoms, parent

management, grades, and absenteeism. Chest Journal, 125(5), 1674-1679.

Engelke, M. K., Swanson, M., & Guttu, M. (2014). Process and outcomes of school nurse case

management for students with asthma. The Journal of School Nursing, 30(3), 196-205.

Greener, M. (2014). Managing asthma in school age children: An overview. British Journal of

School Nursing, 9(10).

Levy, M., Heffner, B., Stewart, T., & Beeman, G. (2006). The efficacy of asthma case

management in an urban school district in reducing school absences and hospitalizations

for asthma. Journal of School Health, 76(6), 320-324.

Liberatos, P., Leone, J., Craig, A. M., Frei, E. M., Fuentes, N., & Harris, I. M. (2013). Challenges

of asthma management for school nurses in districts with high asthma hospitalization

rates. Journal of School Health, 83(12), 867-875.

Maughan, E. D., & Schantz, S. (2014). NASNs first evidence-based clinical guidelines:

Asthma. NASN School Nurse, 29(5), 221-223.

Moricca, M. L., Grasska, M. A., Marthaler, M. B., Morphew, T., Weismuller, P. C., & Galant, S.

P. (2012). School asthma screening and case management: Attendance and learning

outcomes. The Journal of School Nursing, 29(2), 104-112. doi:

10.1177/1059840512452668

Rodriguez, E., Rivera, D. A., Perlroth, D., Becker, E., Wang, N. E., & Landau, M. (2013). School

nurses' role in asthma management, school absenteeism, and cost savings: a

demonstration project. Journal of School Health, 83(12), 842-850.


ASTHMA GUIDELINES FOR SCHOOL AGE CHILDREN 12

Taras, H., Wright, S., Brennan, J., Campana, J., & Lofgren, R. (2004). Impact of school nurse

case management on students with asthma. Journal of School Health, 74(6), 213-219.

Вам также может понравиться