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The Challenge Before Us:The Challenge Before Us:Development, Development,
Implementation and Implementation and Evaluation of a Paediatric Evaluation of a Paediatric Asthma Resource Nurse Asthma Resource Nurse
WorkshopWorkshop
Tracey Marshall and Jane GauciTracey Marshall and Jane GauciAsthma EducatorsAsthma Educators
The Department of Respiratory MedicineThe Department of Respiratory MedicineThe Children’s Hospital at WestmeadThe Children’s Hospital at Westmead
ChallengeChallenge
• To build capacity of the existing To build capacity of the existing nursing workforce at The Children’s nursing workforce at The Children’s Hospital at Westmead (CHW) and Hospital at Westmead (CHW) and Western Child Health Network Western Child Health Network (WCHN) (WCHN)
• To develop a comprehensive and To develop a comprehensive and interactive Paediatric Asthma interactive Paediatric Asthma Resource Nurse Workshop (PARNW)Resource Nurse Workshop (PARNW)
DevelopmentDevelopment
Why was this workshop needed?Why was this workshop needed?• No asthma workshop that met the No asthma workshop that met the
needs of nurses working in paediatric needs of nurses working in paediatric clinical setting in our Area Health clinical setting in our Area Health ServiceService
Funding:Funding:• From WCHN and Department of From WCHN and Department of
Respiratory Medicine CHW for the Respiratory Medicine CHW for the Asthma Education and Management Asthma Education and Management ProjectProject
DevelopmentDevelopment
• Asthma education and management Asthma education and management is a vital part of our role in caring is a vital part of our role in caring for the child and family with asthmafor the child and family with asthma
• Improving organisational culture: Improving organisational culture: Team approach from nursing, Team approach from nursing, medical, allied health staff and the medical, allied health staff and the communitycommunity
ImplementationImplementation
• Pilot workshop in 2002Pilot workshop in 2002
• 2 -3 workshops per year2 -3 workshops per year
• PARNW is a two day workshop - PARNW is a two day workshop - held on consecutive days held on consecutive days
• Offered free of charge to nursing Offered free of charge to nursing staff at CHWstaff at CHW
Challenge and ChangeChallenge and Change
• Overcome perception that asthma Overcome perception that asthma education is one person or one service education is one person or one service responsibilityresponsibility
• Asthma education and management is a Asthma education and management is a part of our everyday clinical practicepart of our everyday clinical practice
• Underpin clinical and educational Underpin clinical and educational practice with Practice Developments practice with Practice Developments conceptsconcepts
• Advanced accreditation for Registered Advanced accreditation for Registered Nurses on Medical Wards to stretch Nurses on Medical Wards to stretch Inhaled VentolinInhaled Ventolin
Aim and ObjectiveAim and Objective
Aim:Aim:• Increase the knowledge, skills and Increase the knowledge, skills and
confidence of nurses caring for children confidence of nurses caring for children with asthma in an acute settingwith asthma in an acute setting
Objective:Objective:• Identify and address clinical, Identify and address clinical,
community issues related to paediatric community issues related to paediatric asthma management and educationasthma management and education
Program DesignProgram Design
• Developed using feedback from Developed using feedback from nursing staff at CHWnursing staff at CHW
• Frame work is the NAC six step Frame work is the NAC six step asthma management planasthma management plan
• Modules Modules contextualisedcontextualised to paediatric to paediatric setting using case studiessetting using case studies
• Pre and post confidence, knowledge, Pre and post confidence, knowledge, skills assessment and process skills assessment and process evaluationevaluation
Program DesignProgram Design
• Based on adult learning principlesBased on adult learning principles
• Small and large group workSmall and large group work
• Interactive teaching sessions and Interactive teaching sessions and role playrole play
• Comprehensive resource folderComprehensive resource folder
Program Content-Day Program Content-Day OneOne
• Registration and welcomeRegistration and welcome• Overview of National Asthma Overview of National Asthma
Council Council • Pathophysiology reviewPathophysiology review• Assessing asthmaAssessing asthma• Asthma medicationsAsthma medications• Monitoring asthmaMonitoring asthma• Asthma in the communityAsthma in the community• Respiratory assessmentRespiratory assessment• HomeworkHomework
Program Content-Day Program Content-Day TwoTwo
• Stretch inhaled ventolin- asthma care Stretch inhaled ventolin- asthma care pathpath
• Inhalation devicesInhalation devices• Triggers Triggers • AdherenceAdherence• Reducing medication and asthma Reducing medication and asthma
action plansaction plans• Asthma educationAsthma education• Knowledge to practiceKnowledge to practice• EvaluationEvaluation
ResultsResultsAsthma Knowledge ScoreAsthma Knowledge Score
0
10
20
30
40
50
60
70
80
90
100
Knowledge (Newcastle Knowledge questionnaire)Pre PARNW One month post PARNW
Results Results Confident & Very Confident in:Confident & Very Confident in:
0
10
20
30
40
50
60
70
80
Teachingspacer use
Talking tocolleagues
about asthmamx
Talking tochildren abouttheir asthma
Pre PARNW One month post PARNW
Results Results Example of some performed steps Example of some performed steps
correctly when using a puffer with spacercorrectly when using a puffer with spacer
0
10
20
30
40
50
60
70
80
90
SkakeInhaler
Inspiration SlowInspiration
DeepInspiration
Pre PARNW One month post PARNW
Process EvaluationProcess Evaluation
• Interactive sessionsInteractive sessions• Increased skills and confidence Increased skills and confidence
using inhalation devicesusing inhalation devices• Understanding of asthma severityUnderstanding of asthma severity• Understanding of asthma action Understanding of asthma action
plansplans• Great workshop and should be a Great workshop and should be a
part of new graduate education dayspart of new graduate education days
Self Reported Confident Level-Day Self Reported Confident Level-Day OneOne
XXXXX
Not at all Confident
Very Confident
ConfidentXXX
XXX
Self Reported Confident Level- Day Self Reported Confident Level- Day TwoTwo
Not at all Confident
Very Confident
Confident
XXXXXXXXXXX
Future DirectionsFuture Directions
• Continue to challenge existing Continue to challenge existing practicepractice- Stretching of Inhaled VentolinStretching of Inhaled Ventolin- Asthma Care PathAsthma Care Path- Underpin workshop with Practice Underpin workshop with Practice
Development conceptsDevelopment concepts
• Evidence based practiceEvidence based practice
• 5 year outcome evaluation 5 year outcome evaluation
Future DirectionsFuture Directions
• Publication of resultsPublication of results
• Capacity building at CHW and Capacity building at CHW and SWAHSSWAHS
• Clinical assessment tools for:Clinical assessment tools for:- Asthma education sessionsAsthma education sessions
Child and Child and FamilyFamily
Research
Education lies at the interface of research, clinical and community
management
Clinical Management
Health Professionals
Community Management