Childhood Asthma

Asthma is a common chronic illness in children, causing them to miss school days and limiting their participation in activities. When not properly managed, it can be a life-threatening disease. Because of the prevalence of asthma in children, the chronic nature of the disease, and the importance of education in the management of asthma, the nurse plays a significant role in asthma management in children. In carrying out this role, the nurse’s strategies include forming a quality relationship with the parents and providing thorough education to patients and their parents on asthma and its treatments. To provide effective management, another strategy that can be utilized is providing nurse-led outpatient management of children with asthma.


Asthma is a chronic disease that causes inflammation and resultant narrowing of the airways, leading to difficulty breathing. For children under the age of 15, asthma is the third leading cause of hospitalization. It is the leading cause of school absenteeism attributed to chronic conditions (American Lung Association, n.d.). Not only does it affect a child’s quality of life, it can also lead to death. Asthma attacks can be caused by a variety of physical and environmental triggers, and although effective medical treatments are available, asthma continues to be ineffectively managed in many children. According to McMullen et al. (2007), there are “significant gaps in education, particularly in content areas of communication and development of a relationship between health care provider and patient/family” (p. 43). Improving education is vital in improving the quality of life of children with asthma and reducing mortality.


The first strategy the nurse would use as a basis for all interactions with patients and their parents is to develop a partnership with the parents. A caring attitude and effective communication are key aspects of this relationship. Buford (2005) states that parents felt supported by attentive health care providers, whose approach included “listening to them and their children, validating their perspectives and feeling, and providing comfort in response to their fears and concerns” (p. 158). In communicating with patients and families, the nurse should be aware of and take into consideration the cultural values of the family. Goals should be developed mutually. When a quality relationship is formed, the parents are more likely to trust the nurse and adhere to the guidelines of their asthma action plan. This will aid also in compliance with followup. Communication will be more effective, and the nurse can be more assured that the parents understand what is being taught.


The content of asthma education should be thorough and communicated clearly. According to McMullen et al. (2007), key components of educational content identified by the National Asthma Education and Prevention Program (NAEPP) include “basic facts about asthma, specific skills in symptom monitoring, the role of medications and medication administration, appropriate responses to changes in asthma severity, and environmental controls” (p.37). To aid in this education, nurses can provide appropriate literature, Internet resources, and resources in the community. When providing literature and resources, the nurse should take into consideration the educational level of the families. When teaching about medications, the nurse should ensure that the patient and family understand what the effects of the medications are, including side effects, and the proper administration of medications, including inhalers. It is also essential for nurses to stress the importance of preventing asthma exacerbations by controlling environmental factors and avoiding triggers. Additionally, nurses need to keep current with new treatments and guidelines for asthma management.


The third strategy in asthma management of children is providing nurse-led outpatient management of these children. Followup and monitoring of patients with asthma are vital in ensuring adherence to the asthma action plan, checking for correct medication usage, and reinforcing education. In a study undertaken by Kamps, et al., their results “clearly show that asthma nurses can take over large parts of long term management of mild to moderate childhood asthma from physicians without compromising quality of care or control of disease” (p. 972). In the Community Asthma Program, a nurse-led community program which has adopted a holistic psychosocial approach to asthma management, Wyatt (2002) reports a decrease in numbers of parents reporting their children’s asthma as moderate to severe and a reduction in school absences in children participating in the project. Providing nurse-led outpatient management would facilitate the ability of the nurse to develop a closer relationship with patients and their parents, resulting in more effective asthma management in children.


Childhood asthma continues to negatively affect society as a whole and the individual lives of children and their families. It is a chronic disease without a definite cure. Effective management of the disease is vital in preventing its adverse effects. As education is a major component in asthma treatment, nurses are in the perfect position to affect the outcome of management of children with asthma. By forming a partnership with parents, providing thorough education, and taking an active and leading role in outpatient management of children with asthma, nurses can play a significant part in improving asthma management and control, thus leading to improved quality of life for the child with asthma.

Intervention #1

Nurses need to develop a partnership with the parents.

Disadvantage #1

Nurses may encounter racial barriers to developing a partnership. Not only may there be cultural differences in styles of communication if the nurse and the parents are of a different race, but there may also be a language barrier, leading to misunderstandings and the inability to effectively communicate with the parents. Stereotyping, conscious or subconscious, may also play a part in how nurses treat parents with different ethnic backgrounds. According to Cabana (2007), “The inability to communicate or recognize biases by providers in their treatment of different patient populations may be a factor contributing to racial disparities in asthma care” (p. 812S). In a study by Mansour, Lanphear, and DeWitt (200), parents reported that providers who held judgmental attitudes toward families from impoverished and minority backgrounds were significant barriers to their children’s asthma care (as cited in Buford, 2005, p. 156).

Disadvantage #2

In order for the nurse to develop a partnership with parents, the patients and their families need to have regular visits with the nurse. One barrier to this is that patients may use the emergency department instead of clinics. Reasons for not using clinics include “lack of insurance and/or limitations in the hours of availability or geographic location of available providers. In such circumstances, the ED may be the only alternative to asthma care” (Cabana, p. 811S).

Intervention #2

Nurses can provide nurse-led outpatient management of children with asthma.

Disadvantage #1

One barrier to nurses leading outpatient management of children with asthma relates to the patient’s and family’s perception of a doctor versus a nurse. Parents may be more hesitant to take their children to nurses as primary caregivers, depending on their perception of the nurse. According to a study by Caldow, et al. (2006), “The main perceived differences between doctors and nurses were academic ability and qualifications. Many people thought that if nurse training were longer and more in-depth, then nurses would be as able to deal with medical problems as well as doctors” (p. 41). Overall, however, the study suggests that patients would accept nurses in roles previously the preserve of doctors, particularly if patients receive information on nurses’ capabilities.

Disadvantage #2

Before a child could be seen in a nurse-led practice, the child would first have to be diagnosed with asthma. According to Buford (2005), “Delay in making an asthma diagnosis was the most significant barrier parents reported in their relationship with their health care providers” (p. 159). A delay in making a diagnosis would affect the ability of the family to be seen in an asthma clinic, thus preventing effective management of the child’s symptoms.



References

American Lung Association. (n.d.). Asthma & Children. Retrieved May 1, 2007, from http://www.lungusa.org/site


Buford, T. (2005, July). School-age children with asthma and their parents: Relationships with health care providers. Issues in Comprehensive Pediatric Nursing, 28(3), 153-162. Retrieved January 7, 2008, from Academic Search Premier database.


Cabana, M..D., Lara, M., Shannon, J. (2007, Nov). Racial and ethnic disparities in the quality of asthma care. Chest Journal, 132, 810S-816S. Retrieved April 18, 2008, from http://chestjournal.org/


Caldow, J., Bond, C., Ryan, M., Campbell, N.C., San Miguel, F., Kiger, A., Lee, A. (2006). Treatment of minor illness in primary care: a national survey of patient satisfaction, attitudes and preferences regarding a wider nursing role. Health Expectations, 10, 30-45. Retrieved April 18, 2008, from Academic Search Premier database.


Kamps, A.W.A., Brand, P.L.P, Kimpen, J.L.L., Maille, A.R., Overgoor-van de Groes, A.W., van Helsdingen-Peek, L.C.J.A.M., et al. (2003). Outpatient management of childhood asthma by paediatrician or asthma nurse: Randomised controlled study with one year follow up. Thorax, 58, 968-973. Retrieved January 9, 2008, from http://thorax.bmj.com/


McMullen, A., Yoos, H.L., Anson, E., Kitzmann, H., Halterman, J.S., & Arcoleo, K.S. (2007). Asthma care of children in clinical practice: Do parents report receiving appropriate education? Pediatric Nursing, 33(1), 37-44. Retrieved April 13, 2007, from Expanded Academic ASAP database.


Wyatt, Lessa. (2006, Dec). A nurse-led community approach to asthma management for children. Australian Nursing Journal, 14(6), 18-. Retrieved April 13, 2007, from Expanded Academic ASAP database.