Approximately 8.4% or 6.4 million children are diagnosed with asthma in the United States. Asthma is a chronic and life threatening disease that cannot be cured but only managed. Asthma is also one of the most expensive conditions to manage, requiring direct health care services if not adequately controlled. Asthma symptoms and exacerbations are also the number one reason for school absences among children. The PICOT question that guided the review of the literature to answer the clinical question was: In children with asthma, how does a school-based self-management asthma education program compared to standard management affect school absences and unscheduled asthma health care visits over a 12-month period? The purpose of this evidenced-based practice project was to provide asthma education at school for children with asthma to improve asthma self-management skills and decrease asthma symptoms that lead to emergency room visits, hospital admissions, and school absences. Students enrolled in grades two through five identified with either parent reported or physician diagnosed asthma were asked by the school nurse to participate in the Open Airways for Schools asthma education program held at school once per week for five weeks taught by trained student nurses. Parents signed a consent form for the child to participate in the Open Airway for Schools program and were asked to complete a questionnaire about their child’s asthma. Childhood Asthma Control Tests (cACT) were administered to students and parents at the start of the program and then 4 weeks after the program. Students with rescue inhalers at school completed a Rescue Inhaler Skills Checklist (RISC) before the inhaler lesson in the Open Airways for Schools program and 4 weeks after the program was finished. School nurses and student nurses followed up with and encouraged students, parents, and outside health care providers to provide rescue inhalers and asthma action plans. An ANOVA was conducted on the cACT pre and post summary mean scores revealed no significant difference, F(1, 36)=1.34, p = 0.26; however, an ANOVA performed on the RISC pre and post summary mean scores revealed a significant difference, F(1, 27)=7.88, p = 0.009. Pre and post cACT summary mean scores at the individual school level suggested improvement among three of the seven schools; while, four of the seven schools noted improvement between the pre and post RISC summary mean scores. An ANCOVA further analyzed the covariates of grade, school, sex, ethnicity and number of sessions attended for cACT and RISC scores; significance was found in the difference of the cACT scores, F(1, 31)=4.910, p = 0.034; but the RISC scores found no difference, F(1, 22)=.0007, p = 0.933 with all covariates; at the individual school level significance was found, F(1, 26)=6.82, p=0.016. School absenteeism increased during the intervention, and emergency department visits and hospital admissions were insignificant. Limited time frame for tracking outcome data related to absences, emergency department visits, and hospital admissions, low return rates on Childhood Asthma Control Tests and rescue inhalers were limiting factors of this project. Nevertheless, self-management asthma education programs have the potential to improve asthma symptoms that impact everyday life. Properly controlled asthma is associated with less asthma symptoms, emergency department visits, and hospital admissions which have the potential to decrease overall economic expenditures for health care expenses, missed school for students and missed work for parents.
Bochenek, J. M. (2017). Easy Breathing for Elementary School Children with Asthma at Dayton Public Schools. Wright State University, Dayton, OH.