Asthma Management in Educational Settings - Implementing System Change for School Nurses

1. Robin Evans-Agnew, RN, MN Robin@alaw.org Asthma Management in Educational Settings - Implementing System Change for School Nurses

2. 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

3. 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 Kaiser work group report December, 2001

4. Addressing asthma within a coordinated school health program* Family/community involvement Health services • Support systems • Health services • Asthma Education • Environment • P.E. • Community efforts Physical education Counseling/psych/ social services Nutrition services Health education Healthy school environment Health promotion staff * CDC, 2002. www.cdc.gov/healthyyouth/healthtopics/asthma

5. The AMES Manual: Contents • Asthma Basics • Working With Parents and Students to Manage the Students asthma in the School Setting • Creating a Safe and Supportive School Environment for the Student with Asthma • Resources • Appendices

6. Spokane Implementation Study • Can an intensive implementation of the Ames manual increase the number of children on effective case management? • Real – time, practice-based study • Convenience sampling • Study period: February – May 2002 • Implementation team

7. 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

8. 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

9. Methods: Data collection Study Nurses Control Nurses February Training COCA, HAFYS Training May COCA, HAFYS, Process, manual evaluation

10. Results: Demographics • Elementary school • Urban, suburban, and rural differences • Nurse: student ratio • Nurse coverage area

11. Results: Asthma Action Plans

12. Results: Absences

13. Results: Asthma Friendly Schools

14. 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

15. 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”

16. Qualitative Results: other • Care plans • Communication • Case finding • Other • Barriers • Materials • Time • Confidentiality/nursing practice

17. 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

18. 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.”

19. Conclusion • Limitations • Entrée • 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

20. Areas of concern • IAQ/irritant issues • All student education and awareness • Nurse coverage for chronically ill students

21. Credits • Wenjin Li, MD, University of Washington • Paul Williams, MD, NW Asthma and Allergy • Lyndia Vold, MPH, Spokane County HD • Implementation Team: • Carol Johns, MSN, RN • Cheryl Funke, RH • Kathy Reed-MvKay, RN • Linda Bordwell, RN • Julie Schultz, RN • Cindy Thompson • Trry Reid