School nurses boost asthma knowledge, skills and teaching after training
Thomas F. Plaut, MD and Frances Belmonte-Mann, MA, RN
Presented at the Annual Meeting of the American College of Allergy, Asthma and Immunology,
San Antonio, Texas, November 2002.

INTRODUCTION

Many health professionals are not up-to-date in their asthma knowledge. Even those who are often present information to patients and parents in ways that seem inconsistent or contradictory. To remedy these problems, I developed a distance learning program that would:

• provide a uniform approach to asthma care and education
• meet the needs of participants with differing levels of knowledge and skill
• create a collegial group of professionals who can support and reinforce each other in communicating asthma knowledge and skills to their clients
• provide the effective tools and materials needed to teach both parents and staff about asthma prevention and treatment
• be economical in terms of time and money.

CHICAGO CASE STUDY

The nurses of the Early Childhood Education Program in the Chicago Public Schools provide services to 15,000 preschoolers in more than 300 schools. They provide health education for parents and staff, in addition to many other duties. When their supervisor contacted me for assistance, I offered to pilot the One Minute Asthma Training with her staff.

INTERVENTION

Before attending a group session in June, 2001, five nurses and their supervisor completed AND scored a detailed questionnaire to assess their knowledge of asthma and its treatment. 

They then read the booklet, One Minute Asthma: What You Need to Know.

After that, they met for three hours to discuss the basic elements of asthma education and to watch a videotape illustrating the use of four asthma treatment devices.

The nurses practiced using these devices during the session and then were videotaped using them.

At the end of the session, the nurses sent the tape to me for scoring and again completed and scored their questionnaires.

• Two weeks after the initial training, four of the nurses attended a follow-up session to practice their technique using asthma devices and were videotaped again.

• The four nurses spent a total of approximately ten hours in preparation and at the two meetings.

RESULTS

Average scores for the group increased from 50% correct on the pre-test questionnaire to 85% at the end of the three-hour training session. The nurses’ skill in using devices increased from an average of 66% correct vat the initial session to 88% on the second videotape.

COMMENT

The year before the training, the nurses offered only a single asthma education activity, a workshop attended by 25 parents.  The next year, the four nurses trained four of their colleagues who joined them in providing asthma education to 774 parents, teachers and aides. Of these contacts, 201 were one-on-one and 573 were in groups. In 2002-2003, there were 1,788 contacts - 556 one-on one and 1,222 in groups.

Asthma Education Contacts

School Year	2000-01	2001-02	2002-03
Individual Parents	0	170	323
Parents (groups)	25 (1)	113 (3)	282 (29)
Individual Teachers & Aides	0	31	241
Teachers & Aids (groups)	0	460 (4)	942 (18)
Total Contacts	25	774 (7)	1788 (47)

The nurses gave a copy of One Minute Asthma to each person attending an individual or group session. They referred to selected pages during their presentations and suggested further study at home. They assisted in the development of the Asthma Emergency Plan (Rule of Nine) and used it to teach school staff how to assess the signs of asthma. It is posted in every classroom, and teachers have used it to arrange appropriate transfer of sick children. Each of the eight nurses has been told by a parent or teacher that attending the asthma workshop caused them to seek and obtain better asthma care for themselves or their family.

SUMMARY

• Eight school nurses increased their asthma knowledge and skills and provided useful information to more than 2,500 staff and parents in the two years following the One Minute Asthma Training.

• As a result of these contacts, asthma care has improved for students and school staff.

IMPLEMENTATION AT OTHER SITES

Four groups (public health nurses, office nurses and nurse practitioner students and respiratory therapists) piloted the One Minute Asthma Training the following year. Since then 14 additional groups of health professionals have completed the training at a cost of $995 for a group of six.

Summary
Training Process
Sample Questions & Answers
Report of the Training in a Boston Area Pediatric Office
Report of the Training by Chicago School Nurses