Nursing Management of the Child with Asthma - Research Paper Example

Nursing management of the child with asthma. Introduction: Asthma, is one the most chronic diseases of this age. It causes an inflammatory condition of the airways in reaction to some triggering stimuli such as tobacco smoke, mold and dust mites etc (Primomo et al, 2006). It is a disease that is seen to be on rise in terms of incidence but when it comes to the diagnosis and treatment of this illness, we still see that it is posed to ambiguity. Purpose Statement: The purpose of this paper is to present an overview of the childhood asthma in terms of its management and to address the current issue of inconsistent asthma management. Background: Effective management of childhood asthma is an issue that is not only essential, but is vital for the health of the ones suffering from this chronic disease. However, it is seen that the attention to the effective management is still fragmented and needs to be considered seriously for the effectual treatment of the patient. The reason for it can be lack of access to medical care or even the low adherence in primary care paediatric practices. On the practitioner’s side, it could said to be the failure of the practitioner in offering and implementing effective treatment procedures, or the reluctance of the practitioner in partnering with the families while going through the treatment plan. Another reason could even be the lack of understanding or dissatisfaction in terms of the treatment procedures on the parents’ part (Newcomb, 2006). Asthma prevalence has been seen on a rise since 1980 (Primomo et al, 2006). In UK, according to the reports, every one in eight children suffers from this disease (Lyte et al, 2007). While in America, from 1980 to 1996, rates of reported children with asthma increased by 74% (Newcomb, 2006). It is a disease that causes immense problems for the children as well as adults associated with it. According to the analysis it is seen that asthma is one of the most reported cause of school absenteeism for children (Newcomb, 2006). In addition to that the children suffering from asthma are also faced with the risk of poor health outcomes in terms of activity limitations as well as mortality rate (Primomo et al, 2006). Also, it can pose quite a major issue for the family in terms of the management of the child affected by asthma. Over all, it also costs billions of dollars to the society in general, in terms of its health care and indirect costs (Primomo et al, 2006). Literature Review: The analysis portion of this paper has been done in view of a few research articles in relation to the issue of Asthma in children, an overview of which is given as follows: Review Management for children with asthma in primary care: a qualitative case study (Lyte et al, 2007). This study presents an overview of the childhood asthma in terms of its review management in primary care along with the views of then children, parents and health professionals on the role of PNs in asthma care. This study follows a qualitative case study design and makes the use of 18 children, 16 parents, 14 practice nurses and 14 general practitioners in one primary care trust. The study made the analysis based on the observation of the review appointments and the examination of asthma related documentation. For the purpose of highlighting both external and embedded factors of the case, it was made to compose of process subunits (general practices), embedded subunits (children with asthma, parents and health professionals) and the external context (national and local guidelines). One PCT having 32 practices was taken into consideration. In terms of data analysis each practice was completed first, followed by a cross case analysis. Later on the study also makes a use of framework analysis for a better understanding of the complicated behaviour factors. Results of an asthma disease management program in an urban pediatric community clinic (Newcomb, 2006). The primary purpose of this study was to address the problem of fragmented and inconsistent asthma management. It is basically an outcome based evaluation of asthma management program. For this study the practitioners were made to create a structured mechanism for the implementation of national evidence based asthma treatment guidelines. Data regarding asthma related outcomes was collected from each patient enrolled in the program at the time of admission and at the end of the program. The outcomes determined at the start and later at the end of the program were compared and analyzed to determine the change. The study took a sample of 120 children for the program out of which 79 resulted in intact data appropriate for the analysis. Ages of the children enrolled in the program ranged from 1.6 to 16 years with a mean of 7.4 years and comprised of Latino, African-American, Caucasian and bicultural families. Treatment plans were negotiated to the parents in the first visit with subsequent changes being made later on. Medications were written for 3 months. No single set of educational material was used for the program based on the diversity in literacy levels and learning skills of the client families. The role of the nurse practitioners was to develop the treatment plans and monitor the outcomes along with educating the families and prescribing appropriate medications and facilitate referrals. Evaluation of a community based outreach worker program for children with asthma (Primomo et al, 2006). This study implemented asthma outreach worker program with the purpose of providing home based education about asthma management along with education about minimizing the home related asthma triggers. The sample consisted of 60 care givers whose children received asthma outreach worker services. A pre intervention and post intervention design was used for the analysis of program effectiveness. The measures for analysis included quality of life, use of asthma management plans, home environmental behaviour for the reduction of triggers, medication usage along with the satisfaction level with the asthma outreach worker services. The baseline survey was made by the general questions related to age, gender, and home environment along with asthma related issues while the follow-up instrument consisted of the same elements along with the determination of the asthma outreach worker program. The survey questions were developed by experts in asthma care development. Data analysis for the study was made using the statistical package for the social sciences, descriptive statistics, percentages, statistical test and baseline and follow-up response analysis. Major findings: The first study came up with the results that there is a huge diversity when it comes to the services being provided for asthma management, and that it is the view of most the stakeholders that the primary responsibility for the review management falls on practice nurses. The study was able to convey the fact that in terms of management, families do tend to feel a little neglected, while on the other hand, professionals do also show uncertainties when it comes to providing family centred care. The second study showed significant positive results having shown a tremendous decrease in hospitalizations, emergency room visits as well as clinic visits for asthma related cases after the intervention. In addition to that, the service utilization outcomes could not be seen to have declined in any of the participant’s case. At the conclusion of data collection over a three month period, parent satisfaction with the program was seen to be uniformly positive. The parents expressed being more capable of managing the child’s asthma related symptoms at home and also perceived the health of the patient to have increased over the program. In the third study a considerable higher quality of life was reported at follow-up as compared to at the time of base line. The number of hospitalizations was also observed to have reduced after the intervention along with high satisfaction of those having received asthma outreach worker services. The parents were recorded to have been able to minimize asthma triggering factors in the home environment, as a result having improved the health of the child. Discussion: The analysis of the studies taken into consideration verifies the fact that it is the review management is actually the responsibility of the practice nurses. It also authenticates the importance of involving the families the development of the treatment plans and having family centred care programs. Another thing that seems to have been validated in both of the later studies is the positive effects of the intervention programs for the management of asthma on the livelihood as well as health of the child with asthma. It signifies the level of impact of organizing management programs for children within primary care systems which validates the fact that more of such programs need to be organized. Also, it is seen that outreach programs such the asthma outreach program are highly effective in terms of increasing awareness of enhancing self management capabilities. Along with that it also contributes in increasing the quality of life of the child as well as the family with the increase in the use of asthma management plans. From the review of the studies we see that the inculcation of specific programs, aimed at facilitating the child as well as families in terms of better asthma management, can greatly contribute not only health wise, but also in terms of acquisition of the treatment plan and prevention of triggering factors. For this purpose such research findings should be inculcated in clinical practices, by organizing such treatment plans and programs that can help the health care community plan ongoing care for children with asthma at both individual and population level. References Lyte, G., Milnes, L., Keating, P. & Finke, A. 2007, Review management for children with asthma in primary care, a qualitative case study. Journal of nursing and health care of chronic illness in association with Journal of clinical nursing, 16, 7b. 123- 132. Newcomb, P. 2006. Results of an asthma disease management program in an urban paediatric community clinic. JSPN. 11. 3. Primomo, J., Johnston, S., DiBiase, F., Nodolf, J. & Noren, L. 2006. Evaluation of a community based outreach worker program for children with asthma. Public health nursing, 23. 3. 234- 241. Read More