02/20/2020

1

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?

02/20/2020

2

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.”

02/20/2020

3

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…

02/20/2020

4

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

02/20/2020

5

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

02/20/2020

6

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

02/20/2020

7

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

02/20/2020

8

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

02/20/2020

9

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]

02/20/2020

10

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

02/20/2020

11

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