Asthma Knowledge, Roles, Functions, and Educational Needs of School Nurses

Article excerpt

Asthma, the most common chronic childhood condition, affects 5% of children in grades 1-12,[1] and in some communities as many as 10% of children.[2] Asthma, responsible for 5,000 deaths annually, has increased twofold since 1980,[3] and costs Americans an estimated $6.2 billion annually.[4] Children with asthma experience 12.5 days of restricted activities annually and are absent from school an average of 7.6 days per school year,[1] totaling more than 20 million lost school days a year.[5] Because children spend approximately 7 to 10 hours per day in school, and because of the prevalence of asthma, the school becomes a significant area to focus attention on asthma issues.[6] To effectively address the needs of children with asthma, school staff need to be knowledgeable about asthma management.

Asthma morbidity can be reduced when education focuses on factors associated with asthma and its medical management.[7] In the school setting, nurses strive to enhance the educational process by modifying or removing health-related barriers to learning.[8] Health education is an integral part of the standards of school nursing and is essential to health promotion, health counseling, and prevention.

School nurses make decisions about nursing practice, and establish and maintain a comprehensive school health program. School nurses also use the nursing process to develop and evaluate Individualized Health Plans (IHP) for students with special medical and nursing needs. For children with asthma, school nurses must set specific goals and outline interventions to meet their unique needs. As with all children, the overall goal is to promote and maintain health, prevent illness, and improve student outcomes. To identify school nursing services for children with asthma in Maryland and Washington, DC, researchers developed a survey to measure attitudes, knowledge, and beliefs about asthma among school nurses. The objectives of the survey were to assess school nurses' roles, responsibilities, and functions; to examine health room policies and procedures related to asthma medication administration; and to review school nurses' asthma educational needs.

SURVEY PLANNING

All public school districts in Maryland and Washington, DC, were contacted. Two Maryland school districts declined to participate, citing workload and commitment to other research as their reasons. All nurses (N=790) in the remaining 24 school districts (23 MD, 1 DC) were sent surveys.

The survey was conducted as part of "A+ Asthma Partnership for Minority Children," a program funded by the National Heart, Lung, and Blood Institute. A study protocol was approved by the Johns Hopkins University Institutional Review Board (IRB), and piloted in May 1997 in one Maryland school district. During summer 1997, the one school district in Washington, DC, and 23 Maryland school districts were contacted by telephone to determine their interest in participating in the survey and to request permission to distribute the survey. Assistance with distribution and support was obtained from school program coordinators. All school nurses were encouraged to complete and return the survey. Two districts required additional IRB approval. Surveys were distributed in October 1997 to allow school nurses time to complete most of their new school year functions. All surveys were distributed either by direct mail using labels/addresses provided by the school nurse coordinator or through distribution by the coordinator in the school district. Follow-up phone calls were made to the coordinator requesting that they remind nurses to complete and return the survey.

The survey instrument was developed by adapting the "School Nurses' Asthma Awareness, Needs and Concerns Survey" from a previous NIH-NHLBI study completed in 1996. Survey content included five sections: Demographics, Attitudes/Beliefs, Function/Role, Medication Administration, and Educational Needs Related to Asthma. …