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School Nurses can teach key asthma lessons, one minute at a time
Dottie Bardon, BSN, MEd, RN, NCSN
LaSalle Springs Middle School
Rockwood School District
Asthma in a Minute: Tool Kit for asthma self-management education
Why does it matter? Asthma remains the most prevalent chronic condition affecting students of all
ages. [CDC, 2012]
Expert Panel Report of 2007, defines the Guidelines for Diagnosis and Management of Asthma
The “gold standard” of asthma care, from the National Institutes of Health, and National Asthma Education and Prevention program
Advocated by Missouri Asthma Prevention & Control Program
[NHLBI, 2007]
What is the EPR3?
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Accepted protocol for asthma care & education
Step-wise medication protocols should guide prescribers
Potentially will be linked to third party re-imbursement
EPR3
1. Measurable assessment of asthma severity
2. Medications prescribed according to a step-wise protocol, emphasizing Inhaled Corticosteroids [ICS] for persistent asthma
3. Control of environmental factors
4. Education of patients
EPR3 Four Main Components:
Effective education is a partnership between the clinician and the person who has asthma
Self-management improves outcomes [urgent care visits, perceived control of symptoms, quality of life]
Cost-effective use of professional time Reduces school absenteeism Every encounter, for every reason, should include some element
of asthma education Repetition and reinforcement are essential
[NHBLI, 2011]
Asthma Education: “teach and reinforce key messages at every opportunity.”
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Basic facts about asthma: airways, pathophysiology
Self-monitoring to assess control and recognize signs of worsening asthma
Role of Medications: understanding the difference between
Quick-relief medications
Long-term control medications
Taking medications correctly
Avoiding environmental factors that worsen asthma
Develop a written asthma action plan
EPR3 Key Educational Messages
Use the minute between two puffs!
When do school nurses see students with asthma?
1. Before PE
2. When they are symptomatic
3. When they bring a refill
4. Every other reason for a health office visit!
Time is always the barrier…how can we make use of brief, teachable
moments?
We do this routinely, spontaneously, but seldom track the lessons or document short snippets as “education”
Will it make a difference? Pre and post tests measure knowledge and self-efficacy
Ever wonder if asthma is a convenient “get out of class” excuse? Capturing assessment data and teaching a mini-lesson make every encounter worthwhile!
Minutes add up, but we don’t always count them…
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Checklist: teaching outline for school nurse
Chart: capture airflow data to share with PCP
Cards: student collects as incentive & reminders
Asthma in a Minute
Space for self-care
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Peak Flow/ Forced Expiratory Volume meters
Inhaler technique teaching device
Asthma in a Minute Checklist, Chart and Cards
Poster of lungs & airways
Model of airway
Poster of medications
Use what you have!
Tools
Basic asthma facts
Self-Monitoring
Medications
Triggers
Asthma Action Plan
Teaching Checklist
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Pre & post tests: asthma knowledge questionnaire
Asthma Control Test: five questions, scale 1-5
Getting as much done as you want?
Shortness of breath?
Symptoms at night?
Used quick relief inhaler?
How would you rate control?
Checklist: measurable outcomes
1. Respiration 101, lungs and airways
2. Airways with asthma*
Constriction
Inflammation
Mucous
Basic Asthma Facts
3. Recognize symptoms, day & night
4. Measure airflow: exhale HARD & FAST *
5. PEF/FEV1 skill check: coach a classmate
Self-monitoring
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6. Quick relief inhalers: help in a hurry
7. Control medication: ICS every day to prevent
8. Other medications prescribed for you
9. MDI use: inspiratory device, inhale SOFT & SLOW*
10. Spacer or holding chamber: delivers med better
11. Nebulizer: delivers the med differently
12. DPI [dry powder inhaler]
13. Inhaler skill check: coach a classmate
Medications
14. Allergens and irritants, at home and everywhere*
15. Exercise-induced bronchospasm [EIB], activities and sports
Triggers
16. Calculate your personal best numbers*
17. AAP: use what they were given, or suggest a plan
18. Bonus topic, review or new!
Asthma Action Plan
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Capture the data
electronic record
on paper
Share with
Parents
PCP
Assessing Airflow: Chart it!
Younger students enjoy choosing the ring
Take advantage of small group competitive spirit
18 cards covering the outline, includes one “bonus” wild card
Tweak as you like! words, pictures…your style
Collect the Key Cards
Index cards listing brief reminder of the topic
Gather on a key ring, stored with the student’s MDI at school
Student will eventually take home as a visual reminder
Nurse and student can quickly see where they are on the education plan, as a checklist or posted on wall
If needed, additional time can be allocated with teacher collaboration
Keys to Asthma Control
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What’s the difference between PEF and FEV1?
FEV1 is considered the objective “Vital Sign” of asthma status
Peak Expiratory Flow measures HOW FAST the air is moving
Forced Expiratory Volume in One Second measures HOW MUCH air is exhaled, in liters
Peak flow/FEV monitors
Practice makes Perfect
Teaming Up for Asthma Control [TUAC]
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Start small, with a subset of students who routinely use MDIs at school
Adapt to any age level, but “spiral” the lesson to continually reinforce the key messages over time
Consider using students as peer leaders/teachers to present the concept to the younger class
Get started…and keep going!
Missouri Asthma Prevention and Control Program
Teaming Up for Asthma Control [TUAC]
University of Missouri-Columbia
Asthma Ready Communities [ARC]
Asthma-Friendly Schools
Missouri Department of Health
[Missouri Asthma Prevention & Control Program, 2014]
Resources
Centers for Disease Prevention and Control (2012). National asthma control program: Asthma fast stats. Retrieved from http://www.cdc.gov/asthma/NACP.htm
Missouri Asthma Prevention and Control Program (2014). Issue brief: Teaming up for asthma control, an outlook/analysis by urban and rural school zip codes. Retrieved from http://www.health.mo.gov/living/healthcondiseases/chronic/asthma/pdf/TeamingUpforAsthmaControl.pdf
National Heart Lung and Blood Institute (2007). National asthma education and prevention program: Expert panel report 3, guidelines for the diagnosis and management of asthma, full report. U.S. Department of Health and Human Services. Retrieved from: https://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
National Heart Lung and Blood Institute (2011 update). Summary report,national asthma education and prevention program: Expert panel report 3, guidelines for the diagnosis and management of asthma. U.S. Department of Health and Human Services. Retrieved from: http://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines
References
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Ahmad, E. & Grimes, D. E. (2011). The effects of self-management education for school-age children on asthma morbidity: A systematic review. The Journal of School Nursing, 27(4), 282-292. doi: 10.1177/1059840511403003
Coffman, J.M., Cabana, M.D., Yelin, E.H., Yelin (2009). Do school-based asthma education programs improve self-management and health outcomes? Pediatrics, 124(2), 729-742. doi: 10.1542/peds.2008-2085
Engelke, M. K., Swanson, M., & Guttu, M. (2013). Process and outcomes of school nurse case management for students with asthma. The Journal of School Nursing, 30(3). doi: 1059840513507084
Hester, L. L., Wilce, M. A., Gill, S. A., Disler, S. L., Collins, P., & Crawford, G. (2013). Roles of the state asthma program in implementing multicomponent, school‐based asthma interventions. Journal of School Health, 83(12), 833-841. doi: 10.1111/josh.12101