asthma management in educational settings - implementing system change for school nurses robin...
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Asthma Management in Educational Settings - Implementing System Change
for School Nurses
Robin Evans-Agnew, RN, MNRobin@alaw.org
History
Washington Asthma Initiative: “To mobilize individuals and communities throughout
the state to improve the prevention, diagnosis, and management of asthma in order to decrease its individual and societal burdens."
Access to inhalers and “zero tolerance” NAEPP asthma care in schools publication Successful partners: Boeing, CSHCN, OSPI,
SNOW, Mary Bridge, Childrens Hospitals, DOH K-20 presentation on world asthma day 2001 GlaxoSmithKline grant for Spokane project
Kaiser work group report December, 2001
School health services: National Recommendations*
Full time SN all day every day for each school ID and track all students with asthma Use asthma action plan Assure immediate access to medications Use standard emergency protocols Assure access to care for consulting physicians Provide intensive Case Management for
students with 10+ absences
* CDC, 2002. www.cdc.gov/healthyyouth/healthtopics/asthma
Addressing asthma within a coordinated school health program*
1. Support systems
2. Health services
3. Asthma Education
4. Environment5. P.E.6. Community
efforts
Family/community involvement
Physical education
Nutrition services
Healthy school environment
Health services
Counseling/psych/ social services
Health education
Health promotion staff
The AMES Manual: Contents
1. Asthma Basics
2. Working With Parents and Students to Manage the Students asthma in the School Setting
3. Creating a Safe and Supportive School Environment for the Student with Asthma
4. Resources
5. Appendices
Spokane Implementation Study
Can an intensive implementation of the Ames manual increase the number of children on effective case management?
Real – time, practice-based studyConvenience samplingStudy period: February – May 2002Implementation team
Methods
Data Children of concern with asthma (COCA)
selection Absences Asthma Care planning
How asthma friendly is your school survey (HAFYS)
Number of children with asthma in school setting School staff and other personnel trainings Process evaluations AMES evaluations
Methods
Study group: 23 nurses, 55 schools, 80 cases Control group: 22 nurses, 48 schools, 73 cases Attrition rates (study: 1 incomplete, 2 opted out,
control: 1 incomplete, 6 opted out) Confidentiality/Consent Study Group:
Two trainings on AMES and implementation strategies Incentives for staff training: extra training, spacers/Peak
flow meters, camp scholarships Control group:
AMES manual only
Methods: Data collectionControl NursesStudy Nurses
Training
Training
February
May
COCA, HAFYS, Process, manual evaluation
COCA, HAFYS
Results: Demographics
Elementary school Urban, suburban, and
rural differences Nurse: student ratio Nurse coverage area
Intervention Con Total
CV 81 101
Number of students 32 48 73 153
Age (average) 9.4 9.0 10.4 9.6
Grade (average) 3.6 3.3 4.7 3.9
Intervention Cont
CV ESD 81 101
Number of schools* 10 45 48
Number of students 5185 25669 11874
Number of students with asthma
465 2359 390
Rate of students with asthma (%)
9.0 9.2 3.3
Number of nurses available 9 10 15
Nurse: students w/asthma 51.7 235.9 26
Results: Asthma Action PlansFigure 1. Children of Concern With Asthma: Change in Care planning before and after
intervention
54%
42% 40% 38%35%
31%
15%
71%
59% 57%54%
48%
36%
14%
75%
86% 84%
71%
77%
56%
48%
00%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Care Plan Secretary Teacher PE Teacher Principal Play Aide Bus Driver
Staff members plan is shared with
Study in WinterStudy in SpringControl in spring
Results: Absences
Mean Monthly Absences, Children with Asthma, Spokane Area Schools, 2001 -
2002
0
0.5
1
1.5
2
Sept - Dec Jan - May
Control
Study
Results: Asthma Friendly Schools
Figure 2 : How Asthma Friendly Is Your School Survey Scores
0%
20%
40%
60%
80%
100%
120%
Med
icatio
n us
e
Tobac
co fr
ee
PE opt
ions
Self c
arry
Mod
ified
activ
ities
IAQ
Reduc
e irr
itants
Teach
scho
ol st
aff
Emer
genc
y pla
n
Nurse
Ava
iabl
e
Teach
stud
ents
Study-Feb
Study-May
Control
Qualitative Results:
Training (study:control – 297:80)
• Using training PowerPoint
• Using the manual sheets• Identify early symptoms• Teachers, students,
childcare staff, aides, kitchen staff, bus drivers
• Passive education systems (staffroom notebook)
• Using incentives
Qualitative Results:
Self knowledge• More educated-Have more tools• Increased my awareness of importance of good asthma
management• “I take it much more seriously”• “Better understanding of asthma and how it effects my
students”• “I knew I needed to learn more and this helped me learn
the easy way”• “Better use and understanding of peak flow”
Qualitative Results: other
Care plans Communication Case finding Other Barriers
Materials Time Confidentiality/nursing
practice
Qualitative Results: Behavior change
100% of study group nurses agreed the project had “changed or increased” their behaviors regarding asthma
Nurse goals: Student quality of life
“keep students safe” “to decrease absences”
“better management of asthma “to complete emergency plans” making sure “all appropriate people get plans”
“to increase asthma awareness” “more interaction with students, staff, bus drivers, parents, &
physicians” “improve staff awareness” : preparation of staff for a severe
attack “more involvement with parents” improving school systems
Qualitative Results: the manual
“I think the manual is very easy to use and is very well organized. I plan to use it extensively.
Thank you for this wonderful guide.”
Conclusion
LimitationsEntrée
Strategies for collaboration with school nurses Consent of leadership Participatory activities Training and education Access to relevant resources Openness to innovation
Ability to collect absence data
Areas of concern
IAQ/irritant issues All student education and awarenessNurse coverage for chronically ill students
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