Posted: April 18th, 2023

The PICOT is In asthmatic children 14-19 years old

The PICOT is In asthmatic children 14-19 years old, how does the implementation of a comprehensive asthma management program compared to no asthma management program affect asthma knowledge

SNHS PROFESSIONAL DOCTORATE
Doctoral Project Prospectus – DPP Form

Learners who are completing a Professional Doctoral Project will use this DPP Form to go through the process of mentor, committee, and school review. The goals of this process are:
(1) To facilitate the planning of the details of your Doctoral project,
(2) To ensure that the proposed project has rigor and allows for review, and
(3) To facilitate your progress through the project.

This is not an addition to your Doctoral project but rather a step to assist you in obtaining mentor, committee, school, and IRB approval more efficiently. You will be assigned a mentor and committee member, and submit your project for school approval before submitting your IRB application.

The following criteria will be used to establish whether the proposed Doctoral Project meets the criteria and expectation for the degree. The purpose of the review is to determine if the proposed project:

1. Contributes to society by improving or changing practice, policy, or research utilization.
2. Documents the need for change by utilizing evidence-based needs assessment.
3. Meets the Essentials of Doctoral Education for Advanced Nursing Practice for DNP learners.
4. Meets the industry expectations for Health Administration or Public Health.

According to the American Association of Colleges of Nursing (AACN), Practice-focused graduates are prepared to generate new knowledge through innovation of practice change, the translation of evidence, and the implementation of quality improvement processes in specific practice settings, systems, or with specific populations to improve health or health outcomes. New knowledge generated through practice innovation, for example, could be of value to other practice settings. This new knowledge is considered transferrable but is not considered generalizable (2015, pp. 2-3).

American Association of Colleges of Nursing (2015). The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations. Washington, DC: Author.

Characteristics of SNHS Projects:

a. Focus on a change or changes that positively impact(s) healthcare/public health outcomes.
b. Have a systems (micro-, meso-, or macro- level) or population/aggregate focus.
c. Demonstrate implementation in the appropriate arena or area of practice.
d. Include a plan for sustainability (e.g., financial, systems or political realities, not only theoretical abstractions).
e. Include an evaluation of processes and/or outcomes (formative or summative).
• All SNHS Doctoral Projects should be designed so that processes and/or outcomes will be evaluated to guide practice, process and/or policy.
• Real world application is as important in guiding practice as statistical significance is in evaluating research.
f. Provide a foundation for future practice scholarship

NOTE: DNP Projects based on nursing education topics are not permitted.

In the DHA and DrPH programs, the focus should be a quality improvement or process change project that may lead to recommendations for the sponsoring organization.

SNHS Doctoral Plan Approval
Your completed DPP Form will be approved, not approved, or deferred for major or minor revisions. Your mentor and committee will use the information you provide on the form to determine if your project meets the criteria for a doctoral project. Your mentor and the committee will provide specific feedback designed to identify any issues that need to be resolved related to the project.

Obtaining committee and school approval does not guarantee you will obtain IRB approval. The IRB review will focus on ethical issues. A detailed ethical review will be conducted during the process of IRB approval.

Recommendations for Using This Form

The DPP Form is intended to help you and your mentor plan the design and details of your professional doctoral project.

After your mentor approves your DPP Form, your entire committee will review the form for appropriateness for a Professional Doctoral Project. When the entire committee approves your inquiry project form, then it will be submitted for school approval. It is recommended that you use this form in a step-by-step way to help plan your design. Expect that you will go through a few revisions before your mentor and committee approve this form.
Tips for filling out the DPP form:
• Prepare your answers in a separate Word document to make editing and revising easier.
• Copy and paste items into the fields when they are ready.
• Don’t delete the descriptions!
• Don’t lock the form, because that will stop you from editing and revising within the form.
• Leave no blank spaces in the form. If an item does not apply to your project, type “NA” in its field.
• Read the item descriptions carefully. Items request very specific information. Be sure you understand what is requested (good practice for your IRB application!).
• Use primary sources to the greatest extent possible as references. Textbooks are not acceptable as the only references supporting methodological and design choices. Use them to track down the primary sources.

DPP Form Part I

Learner’s Name Laura Chapman
Learner’s Capella Email Address LCHAPMAN9@CAPELLAUNIVERSITY.EDU

Learner’s Phone 312-865-3318
Mentor’s Name /
Email Sheila Allen Stokes – sallenstokes@rich227.org

Committee Member’s Name /Email Dr Susan Hale
Preceptor for DNP Name
Sponsor for DHA/DrPH Name

Email Sheila Allen Stokes
sallenstokes@rich227.org

Project Working Title The Implementation of a Comprehensive School-Based Asthma Management Program in a High School Clinic Setting
Site Selected Rich Township High School District 227
Contact Information for Site Approver (if different from preceptor or sponsor) & Expected Approval Date Dr. Iyuna Harris
Iharris@rich227.org
708-545-0875- Cell
708-679-5640-Office
* My site was approved in April
PICOT Question

State your PICOT question here. Use the elements of the PICOT sections below to describe each component.

In asthmatic children 14-19 years old, how does the implementation of a comprehensive asthma management program, compared to no asthma management program, affect asthma knowledge, avoidance of triggers, spacer techniques, and school absenteeism, over an eight-week period?

Determining the Need and Gap in Practice, Policy or Program

What is the gap in practice, policy, or program at your organization that this question seeks to address?

How did you determine this was a need at your organization/site of project implementation?
What data is available from your site or organization to substantiate the identified need?
Provide 2-4 studies or EBP guidelines from the literature that supports this need change
.

Background and Significance
Asthma is the most common chronic condition affecting an estimated 6.1 million children under 18 years of age (Center for Disease Control, 2018). Asthma is the third leading cause of hospitalizations among children under the age of 15 years. In the United States, nearly 1 out of 12 children have asthma, which is the leading cause of school absenteeism (Centers for Disease Control, 2018). In 2012 asthma accounted for an estimated 13.8 million lost school days in school-aged children. Asthma has caused lower academic performance and assessments, especially among urban minority children (Hsu, Qin, Beavers, & Mirabelli, 2016). Death rates from asthma are particularly high for African-American and Hispanics (four to six) times higher than for Caucasians in urban areas, including Chicago (Martin, Kapheim, Erwin, Ignoffo, McMahon, O’Rouke, Gerald, Barrett, Press, Darabi, Krishnan, 2018).
Needs Assessment
The Rich Township High School District utilizes an electronic charting system called Power School to document health visits, immunizations, school absences, and health conditions. Power School listed a total student population of 821 students. Currently, 166 students have a diagnosis of asthma. The data shows that 20.22 % of the student population is asthmatic. This number is subject to change when school starts in the Fall of 2020. The computerized program Power school will be the tool used to calculate absenteeism rates for asthmatics. During the past school year 2019-2020. A total of 166 asthmatic students missed 516 days of school.
Current Practice Problem
The proposed practicum site is a high school clinic setting. The school setting is an urban high school located 45 minutes outside of the city of Chicago. In the clinic setting, there is no standardized process or program for asthma management or education. Asthma is the highest reported health condition in the school. Currently, Parents of asthmatic students receive three forms at registration. They are the asthma care plan, the medication administration form, and the consent form to self-administer medication. A complete management program does not exist. Two essential steps for successful asthma management in the school setting include beginning the school year with a completed school asthma care plan, a quick-relief inhaler in school, and educating students about their condition. Although the paperwork is distributed during registration, the completion is unsatisfactory. Several students suffer from asthma episodes during the school day. They do not have a rescue inhaler or an asthma action plan . Students should be educated on inhaler technique, asthma triggers, and when to stay home. An Asthma Management program is needed due to high absenteeism rates and emergency room visits due to asthma exacerbations during school hours.
Organizational Support
Implementing a comprehensive asthma management program into the school setting would benefit the organization and the students. Stakeholders such as the Director of Special Education/ Pupil Services and the school principals have expressed concern for the need of an Asthma Management Program due to high absentee rates of asthmatic students. Physical Education teachers and general education teachers have also inquired about what could be done to assist asthmatic students after witnessing asthma attacks in the classroom following physical education or during a physical education class. School nurses have shared their frustration due to the lack of a comprehensive program that will encompass education and medication management. The nurses feel that implementing such a program could improve the asthma outcomes for students in our school district. They have stated that several students do not carry their inhalers, and others do not use proper technique when they use them. Due to the high absenteeism rates and emergency room visits related to asthma exacerbations during school hours, all stakeholders are eager to see a program. The director of special education and the school principal and school nurses are willing to provide whatever assistance and resources are needed to assist with the implementation of the asthma management program.
Evidence- Based Guidelines
School-based asthma education programs for children can positively impact student’s asthma outcomes such as decreasing absenteeism, physical activity intolerance, emergency hospital visits, and asthma exacerbations (Walter, Sadeque-Iqbal, Ulysse, Castillo, Fitzpatrick, & Singleton, 2016). The school setting can offer many advantages over the traditional clinic or doctor’s office setting for delivering asthma education to students. Students spend most of their day in school and can grant them easy access to resources. Asthma education programs such as Fight Asthma Now have shown that it significantly increases asthma knowledge and spacer technique competency with high-risk populations following the program (Mosnaim, Li, Damitz, Sharp, Li, Talati, Mirza, Richardson, Rachelefsy, Africk, & Powell, 2011). A program title Step -Up Asthma Program has as proven to be useful for asthmatic children. According to Liptzin, Gleason, Cicutto, Cleveland, Shocks, White, Faino, and Szefler (2016), significant improvements were noted in the number of asthma action plans, rescue mediations at school, and asthma controllers. Students also had improvements in asthma knowledge scores (P<.001) and inhaler techniques (P<.0001). There were significant reductions in asthma exacerbations, urgent care visits, and missed school days (P <.05 (Liptzin et al., 2016). This school-based program indicated that it could significantly reduce asthma morbidity.
P (Target population or problem)

Who is your target population or what problem will be addressed?
The proposed DNP project population will be asthmatic high school students 14 – 19 years of age. The identified problem is how to decrease the number of school absences related to asthma exacerbations. Asthma is the most common chronic disease affecting 6.1 million (8.3%) children (< 18 years old )in the United States of America ( Salazar, Tarwala, & Reznik, 2018). According to the Centers for Disease Control and Prevention (CDC), asthma is the leading cause of school absenteeism resulting in 49% of American children with asthma reporting one or more asthma-related absences, which equals 13.8 million days per year. Implementation of an asthma management program has resulted in significant improvements in the number of asthma action plans, rescue inhaler medications at school, and improvements in asthma knowledge scores. Asthma management programs have also resulted in reductions in asthma exacerbations, urgent care visits, and missed school days (Liptzin, Gleason, Cicutto Cleveland, Shocks, White Faino & Szefler, 2016).

I (Intervention)
• What are you planning to investigate or implement as a policy/process or program?
• What are you doing that is different than what is currently happening?
• If this is a part of a larger project, what is your unique contribution?
• List 2-3 potential interventions that can be applied in this practice change.

Note: Be very specific in your description.
Intervention
Currently, there is not an Asthma Management Program in place. The intervention will be implementing the Fight Asthma Now (FAN) program, which is sponsored by the Respiratory Health Association of Greater Chicago (Respiratory Health Association, 2018). This program is a school-based asthma education program designed for children and teens. Through the FAN program, certified asthma educators use engaging and active lessons to provide children with the necessary tools to identify and avoid asthma triggers, manage asthma episodes, and control asthma. The program’s objective is to teach students how to manage their condition to decrease school absenteeism and asthma exacerbations.
Multidisciplinary Team
Certified Asthma Educators or Respiratory Therapists will teach this program. School Social Workers will distribute consent forms and follow up on completion. The school nurses in the school will collect asthma action plans.

Practice Change Potential Interventions
Intervention One: A pre- and post-Asthma Knowledge Questionnaire will be administered to each student. This questionnaire will assess their basic level of asthma knowledge. It will test their knowledge first before they are taught any asthma education lessons then again at the end of the program to see how much the students learned. The students will also be given the FAN Spacer Competency Checklist before and after their educational sessions. Each form will be passed out at the beginning of their session. Instructions will be provided, and the students will be asked to complete the form. Once the form is completed, it will be collected.
Intervention Two: Once written parent/ guardian consent is obtained, students will be asked to attend educational sessions during their study hall period or a time that has the least impact on instruction. The sessions will take place in the conference room near the nurse’s office. Certified Asthma Educators and Respiratory Therapists will conduct the lessons. The students will be educated over the course of four 45- minute sessions held on four consecutive school days. The students will be taught about asthma basics, how to avoid asthma triggers, how to use medication, managing asthma episodes effectively, and controlling asthma on a long-term basis (Respiratory Health Association, 2018). They will also learn tobacco avoidance and asthma-related peer pressure at home and school. The students will be taught using various tools such as PowerPoint presentations, videos, and handouts. The FAN curriculum provides conventional core asthma education and has proven to significantly increase asthma knowledge and spacer technique competency within high-risk populations (Mosnaim et al., 2011).
Intervention Three: Spacer techniques – the ability to perform proper spacer technique is particularly crucial because if the medication is delivered incorrectly, little or no medication reaches the lungs (Mosnaim et al., 2011). Unfortunately, many people with asthma do not use the best inhaler technique. The students will learn how to use a metered-dose inhaler (MDI) with a spacer.
– How to clean an MDI
– Different types of spacer devices
– Preparing a new spacer
– Cleaning a spacer
Intervention Four: Asthma Action Plans- An asthma action plan establishes clear guidelines on what to do in response to changes and symptoms. With an appropriate asthma action plan, a child with asthma should expect fewer symptoms, no activity limitations, occasional exacerbations, and normal lung function (Kelso, 2016). The National Heart, Lung, and Blood Institute (NHLBI) National Asthma Education and Prevention Program (NAEPP) published the Diagnosis and Management of Asthma in 2007. The guidelines recommend that all children with asthma have a written asthma action plan and that a plan is provided to the child’s school (Kelso, 2016). Students will be given an asthma action plan to have completed by their health care provided if they do not have one on file with the school nurse. Asthma action plans can improve the student’s quality of life and reduce asthma exacerbations. School nurses will follow up with phone calls to parents after two weeks to inquire about their completion.
DNP Learner Role as Project Manager- The DNP project manager is responsible for coordinating, implementing, and monitoring the program. Responsibilities include contacting the Respiratory Health Association of Illinois to request that they provide the program and confirm dates. The advertisement of the program is another responsibility. The project manager will display flyers provided by the Respiratory Health Association at the school’s annual Open House, send emails to parents, and post signs throughout the school. Meeting space such as the conference room or auditorium must be reserved. Parental consent will be obtained from parents or legal guardians during open house because this is the most opportune time to explain the program if they have questions. Guidance counselors, deans, and school principals will be consulted regarding suitable meeting times to alleviate students from being removed from core subjects. The project manager will also observe educational sessions and record data. The project manager will work with the social worker to make sure consent forms are received. She will work with the school nurses to ensure the completion of asthma action plans.

C (Comparison)

Not every PICOT question will have a comparison or control group (in which case there is no “C” in the question). If this is the case for your project, then describe the current state vs. the desired state in relationship to the problem and/or gap in practice.

Note: A Doctoral project many times centers on a process improvement. Be cautious when determining what you will be comparing as this is not a research project.
Current Practice
The current state of the problem at this site is the lack of an asthma management program. Out of 821 students 166 of them have asthma and missed 516 school days in one year. Several asthmatic students are not equipped to self – manage their chronic condition. They do not have asthma action plans, do not carry their inhalers, and do not know what to do when they suffer from an asthma flare up. The FAN program will provide education on medications administration, avoidance of asthma triggers, spacer techniques, and asthma actions plans.
A comparison will be made at the conclusion of the program to determine if asthma exacerbation and school absences decreased because of the implementation of the program.
Desired Practice
The FAN program will be implemented in high school students with asthma. A multidisciplinary team of specialists such as certified asthma educators, school social workers and school nurses will provide pre and post asthma knowledge assessments, education on asthma, asthma action plans, and spacer techniques. Through the FAN program there will be increased asthma knowledge, improved spacer technique, and reduced number of school absences. This program will provide them with the necessary skills to be successful at managing asthma to decrease asthma exacerbation and school absences.

O (Outcomes to be measured)

Every project is required to have an evaluation plan.
• What outcomes are expected for your project?
• What outcomes will be measured?
o How do you plan to do this?
o Will you be using a tool?
o For doctoral projects that will use an established tool, be certain to include the published reliability and validity.

Be sure your outcomes link to the identified problem.
• How will you know if your intervention resulted in change?
• How do you plan to look at your data?

Note: If quantitative analysis is an appropriate outcome measurement, you may want to consult with your mentor or a statistician early in this process.
Desirable Outcomes
The outcomes to be measured will be measured using descriptive data processes.
1. Asthma Knowledge -The desired outcome is an increased asthma knowledge. The DNP student will measure the outcome of asthma knowledge by using the pre and posttest given titled the Asthma Knowledge Questionnaire (Appendix 1). This tool is a 28-question questionnaire with yes and no questions. The purpose of the tool is to assess the necessary level of asthma knowledge. The study design is a preintervention/post-intervention study with the implementation of the FAN program as the intervention. A paired t-test will compare the pre and posttest. Baseline data will be their knowledge of asthma before the classes, and their end of survey data will be the posttest.
2. FAN Spacer Competency Checklist-The administration of the FAN Spacer Competency Checklist will take place before and after each educational session. It will measure their ability to administer their medication correctly with and without a spacer. The spacer competency checklist has seven assessment steps listed for the students. They will demonstrate the skill then the observer will document whether they were able to perform it correctly.
3. Asthma Action Plan- The DNP student will document the number of asthma action plans collected before the program, compared to the number of action plans received following the program. A bar graph will display this ratio of data. The goal is to see an increase in the number of asthma action plans obtained after the program implementation.
4. School Absenteeism- The DNP student will review baseline data of school absences in a computer program called Power School. Data from the previous school year will be collected from Power School when the FAN program begins to determine the number of absences for each student. Following the completion of the FAN program, an absentee report will be conducted for the participants. The DNP student will compare the data for both years.
Measurement of Outcomes
1. Asthma Knowledge- the mean score pretest compared to the mean score posttest using simple descriptive statistics will be done to obtain data.
2. FAN Spacer Competency Checklist- the mean score pre compared to the mean score post using simple descriptive statistics will be done to obtain data.
3. Asthma Action Plan- The DNP student will record the data for the number of asthma action plans collected in an excel document. This number will be compared to the number of asthma action plans received before the program.
4. School Absenteeism- The baseline data recorded in Power School will be assessed from the previous school year. At the end of the program, the end of the survey data, which is the current number of absences during the present school year, will be recorded. A comparison between the absentee rates will be conducted. The goal is to see a decrease in the number of school absences
Total Validity and Reliability- A study was conducted on the asthma knowledge questionnaire to test validity. They evaluated the instrument’s face, content, and concurrent validity and analyzed its factorial structure. The test-retest reliability of the questionnaire and its sensitivity to change were also assessed (Rodriguez Martinez, 2005). The asthma knowledge questionnaire developed was determined to be useful and reliable for quantifying the baseline level of asthma knowledge of parents who had asthmatic children and to assess the efficacy of an educational intervention aiming to increase knowledge and understanding of the disease.
Data Collection- Data collected using the tools above will be documented in an excel spreadsheet. Data will be secured on a flash drive. The DNP student will collect data during all four education sessions.
Asthma knowledge will be measured using a pre and post asthma knowledge questionnaire, and a FAN spacer checklist after the students are taught proper spacer techniques (Mosnaim et al. 2011). Students will also be given asthma action plans they must have completed by their healthcare provider. The DNP student will record the number of completed action plans and the number of school absences in an excel spreadsheet. Power School will tabulate and analyze the absentee data at the end of the program.

T (Timeframe – Proposed)

As a leader, you need a project management plan. What is your timeframe? How long will your project take? Does your timeframe make sense when you consider the length of the program? Can you complete it in 8-12 weeks? Please be aware that data collection or implementation cannot occur until after IRB approval. Consider that your last few quarters should be devoted to data analysis and writing your final Doctoral Project paper.

Timeframe
(July 2020 – September 2020)

• Milestone 1: DPP I – Submit and correct identified concerns on DPP I from Keystone course.
• Milestone 1: DPP II – Begin working on Part 2

(October 2020 – December 2020)
• Completion of Milestone 1 : Work will continue towards completion of DPPII
• Completion of Milestone 2: Mentor and School approval / Research Plan

(January 2021 – March 2021)

• Completion of Milestone 3: IRB approval
• Completion of Milestone 4: Mentor and Committee Approval of Capstone

(April 2021 – June 2021)

• Completion of Milestone 5: School Approval/ Publications Review/ Dean’s Final Approval

To be completed by mentor only:

DPP Plan Part I Approved by Mentor Name of mentor: Dr. Anita Harris Date:

End of DPP Form Part I
SNHS DPP Form Part II

Each section below must be filled out completely. Please address each section using the headers and explanation to guide your work. Learners should expect this to be an iterative process, requiring several revisions after consultation with your DNP/DHA, DRPH Mentor and Committee Member. This is considered your project proposal.

A high level of detail as well as an exhaustive review of the literature is required. Use headings (Level 1 and 2) to present the different components of each section. Answer all of the questions in each section below.

Introduction to the Project
• Identify the focus of the project.
• Establish the significance.
o Be certain to include at least one or two background studies related to the topic.
• State the project aims and their relationship to your PICOT question.
• Explain how the project is relevant to nursing, health administration or public health practice.
Note: Be sure to include in-text citations in this section and a full reference page (in Help write my thesis – APA format) following Part II.

Introduction
Asthma is the most common chronic disease of childhood that affects 1 in 11 children in the United States (Halterman, Tajon, Tremblay, Fagnano, Butz, Perry, & McConnochie, 2017). Morbidity from Asthma affects children’s quality of life and school performance. Asthma accounts for $56 billion in direct costs, lost school or work, and premature deaths. Every day in the United States, 36,000 students miss school because of Asthma. Not only is Asthma the leading cause of missed school days, but it also contributes to limitations inactivity, low academic achievement, missed workdays for parents and caregivers, as well as caregiver stress, and depression. A school centered asthma program that focuses on education, medication administration techniques, and adherence have led to reduced school absenteeism and health services use and improved quality of life (Cicutto et al., 2018). Schools are ideal for reaching children with health care needs because they spend most of their wakeful hours in school.
This evidence-based practice project aims to implement a school-based asthma management program called Fight Asthma Now into a High School Clinic setting. The program’s goals are to improve asthma knowledge of the students, teach avoidance of triggers, improve spacer techniques, and decrease school absences.
PICOT statement
The PICOT statement used for the foundation of this literature search is: In asthmatic children 14-19 years old, how does the implementation of a comprehensive asthma management program, compared to no asthma management program, affect asthma knowledge, avoidance of triggers, spacer techniques, and school absenteeism over an eight week period? An exhaustive review of the literature was conducted to allocate high-quality articles using keywords from the PICOT question. The literature review was done using the Capella Library on the following research databases Allied Health Literature (CINHAL), MedLine, PubMed, Cochrane Library, Google Scholar, and Ovid Nursing. Standard search methods were used with the following search terms, asthma management, teens, school-based asthma action plan, adolescents. Initially, 2,942 articles were found. Research articles were limited to scholarly journals with full-text articles, peer-reviewed with the last four years. After narrowing down the search further by subject asthma and it yielded 128 articles. The DNP student excluded research articles after reading and analyzing them and determining they did not meet the keywords’ PICOT question. Finally, the DNP student retained 25 research articles for the literature review.
Review of the Literature
• Conduct an exhaustive review of the literature.
• Synthesize the literature on the topic (provide evidence table as an appendix).
• Summarize how the study will contribute to knowledge by filling in gaps, validating, or testing knowledge.
• Provide details of your exhaustive search process. Be certain to list:
o All of the keywords or search phrases.
o Each database used
o How many articles were found?
o What the inclusion/exclusion criteria were.
o How many articles were retained and why.
The synthesis should not be an annotated bibliography, but a description of the themes found in the literatures, which are supported by clusters of evidence. In most cases, a minimum of 20 studies will be needed to support your project.
Note: Be sure to include in-text citations in this section and a full reference page (in Help write my thesis – APA format) following Part II
Review of the Literature
A literature review has shown that school-based asthma education programs can enhance knowledge of Asthma, self-management behaviors, and health outcomes. Asthma Management programs implemented in the school setting are most likely to be beneficial. A systematic review conducted by Geryk, Roberts, & Carpenter (2017) assessed the school-based interventions that include inhaler techniques. The systematic review’s objective was to identify school-based asthma interventions that include inhaler technique instruction because proper use of inhaled medication is essential for successful treatment of childhood asthma. However, improper inhaler technique among school-aged children is common. The authors of the systematic review analyzed 71 full-text articles. Nine articles met the inclusion criteria. They found that a minimal number of school-based interventions evaluated improvements in student’s inhaler techniques. Inhaler technique instruction varied in length from 15 minutes to 1 hour. Students sustained technique improvements up to 12 months follow up period. This review indicated that students benefit from school-based inhaler technique education.
In an article titled Evaluation of the Fight Asthma Now (FAN) program to improve asthma knowledge in urban youth and teenagers ( Mosnaim et al., 2011), a school-based asthma education program targeting disadvantaged youth and teens Asthma was implemented by school nurses. Students in the Chicago area elementary schools were invited to participate in a stratified 2 -arm study. A total of 26 low income predominately minority-serving schools were recruited. Once the students were selected and the permission slips were submitted, the interventions began. Four FAN educators were recruited from the Respiratory Health Association of Metropolitan Chicago to deliver FAN interventions. They provided four 45-minute sessions conducted in the school on four consecutive school days. The education consisted of one to one training for spacer technique, peak flow meter use, and approach to tobacco avoidance and asthma-related peer pressure at home and at school. The program for teens also educated the students self -management skills for college and job settings. The student’s asthma knowledge and the ability to perform the spacer technique was assessed using the absolute number of items correct on the FAN Asthma Knowledge Questionnaire and the FAN spacer technique competency checklist. Following the study, the researchers found that the FAN program significantly improved asthma knowledge and spacer techniques in high-risk youth and teen groups.
A school -centered program titled Building Bridges for Asthma Care was implement in Colorado and Connecticut (Cuicutto, Gleason, Haas-Howard, White, Hollenbach, Williams, McGinn, Villerreal, Mitchell, Cloutier, Vinick, Langton, Shocks, Stemper, & Szefler, 2020). This program was a quality improvement design project to improve asthma care, increase asthma care plans, possess quick-relief inhalers at school, and accurate inhaler techniques. This program consisted of five steps. The steps were as follows identify students with Asthma, assess asthma risk/control, engage the family and student at risk, provide case management and care coordination, including engagement of health care providers, and prepare for the next school year. The program was implemented in 28 schools. Significant improvements were noted in the number of students with asthma care plans and quick-relief inhalers at school (p> .01 for all variables) because of educational coaching sessions with school nurses.
Research has shown that school-based asthma management programs can improve
medication adherence. In a study titled Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr. Haggerty, adherence rates to medication was approximately 50% (Halterman et al. 2017). However, school-based programs offer the potential to reach large numbers of children. School is where they spend most of their wakeful hours. Four hundred inner-city children with persistent Asthma participated in the study. After their program was implemented, which aimed to provide preventative care for children with Asthma. The authors of this study found that children who received preventive mediation in school had improved outcomes. The school nurse administered Asthma controller medications > 95% of the time the child was in school.
Current research supports school-based asthma management programs with asthma education components. The school-based asthma management program (SAMPRO) consists of four parts. The parts are a circle of support that facilitates communication among the child, family, clinicians, and school nurse, an Asthma management plan, a comprehensive education plan, and a method for assessment of the school environment (Lemanske, Kakumanu, Shanovich, Antos, Cloutier, Mazyck, Phipatanakul, Schantz, Szefler, Vandik, & Williams, 2017). Implementation of this program into schools was designed to disseminate necessary tools that develop a circle of support for students to improve their asthma outcomes.
Education is only one factor in improving health outcomes for Asthmatic children; they must also adhere to daily medication recommendations. Research indicates the adherence to daily inhaled corticosteroids is central to controlling Asthma and reducing morbidity for youth with persistent asthma (Cushing et al., 2019). Improving adherence to inhaled corticosteroids is an essential step toward better self-management.
Several articles in the research literature support the fact that school-based asthma management programs are effective. Simoneau et al. (2020) found that students had a 25% decrease in absentee rate after participating in the Easy Breathing for Schools Program. They also found that students demonstrated improvement in the inhaler technique score (P< .001) ( Simoneau et al.,2020). Trivedi et al. (2017) also conducted a study on a school nurse program in a school in central Massachusetts. They found that after educating students on proper inhaler technique and the school nurse supervising inhaled corticosteroid therapy, hospital utilization also decreased from a pre-intervention mean of 0.3 admissions to a post-intervention mean of 0 admissions (p=< 0.001) (Trivedi et al. 2017).
A program implemented in a Midwest urban school had the opportunity to reach several at-risk children with poor Asthma control ( Mikel, Shanovich, & Jackson, 2017). This program focused on providing asthma education to children and families. A total of 173 students participated in the program, and thirty-one parents provided feedback. They found that asthma knowledge increased significantly (p<.001) between the pre and post-test ( Mikel, Shanovich, & Jackson, 2017).
Marsland et al. (2018) completed a parallel randomized pilot trail student on a program called ” I Can Cope.” Students were educated with the program Open Airways for Schools (OAS) and given psychoeducation games. They found that students exhibited few asthma symptoms and gained greater confidence that they could perform behaviors and manage their Asthma after completing the program (Marsland et al., 2018).
The purpose of the literature review was to analyze school-based asthma management programs and interventions to reduce school absenteeism and improve asthma outcomes for students. There is strong evidence present that supports the notion that the implementation of a school-based asthma management program will lead to increased children’s knowledge, reduced adverse health outcomes, and a decrease in school absences (Cuitto et al., 2018; Ebell et al., 2019; Halterman et al., 2018; Kneal et al.,2019; Marsland et al.,2018; Mosnaim et al.,2011). Reducing school absences is critical for the success of students. Uncontrolled Asthma leads to tremendous costs for society, families, and students. The average annual medical cost of Asthma is $983 per child (Zahran et al., 2018). Not only is there a financial burden, but the student is also academic achievement suffers. The health of children can be improved by providing the necessary skills such as asthma trigger reduction, appropriate guideline-based asthma management skills, asthma education, and spacer techniques. With programs in place, students can be successful in asthma management.
.

Framework
• Describe the theoretical framework or conceptual model to be used in the study.
• Connect the study aims and PICOT question to the framework or model.
• Operationally define study variables.
• Provide any study assumptions.
Note: Be sure to include in-text citations in this section and a full reference page (in Help write my thesis – APA format) following Part II.
Theoretical Framework: Orem’s Self-Care Deficit Theory
Adolescence is an incredibly important time in a child’s life in which they learn self-care techniques and responsibilities. If Asthma occurs during this time, it makes it more difficult to achieve independence in self- care because adolescence is a period of offensive psychological operations (Hemati, Shakerian, Shirani, Mosaviasl, & Kiani, 2017). A child must learn how to administer medication, cope with psychological stress, deal with family status changes, communicate their symptoms, and manage their condition. Ormes’s Self- Care Deficit Theory is an ideal theory to support this evidence-based practice project.
The basis of Orem’s theory of self- care is the performance or practice of activities that individuals initiate and perform on their behalf to maintain life, health, and well-being (Taylor, 2001). When nursing care is needed, and one cannot perform these duties independently, there is a deficit present. The central concept of the theory states that individuals must perform maintenance for themselves or have care done for them by someone else to maintain proper functioning (Taylor, 2001). Orem’s theory applies to implementing a school-based asthma management program because it provides students with self-management skills that will enable them to care for themselves.
A study conducted by Hemati et al. ( 2017), titled The Effect of the Orem Self-Care Model on Quality of Life in Adolescents with Asthma, found that training based on Orem’s self -care model contributed to improving all of the dimensions of quality of life in adolescents with Asthma. The teaching, patient adaptation, and adherence to treatment plans from the program played a significant role. Adolescence is a time of maturation and growth. The Fight Asthma Now program is appropriate for this population because it will teach students the necessary skills to manage their condition independently.
Variables
The variables for this project are as follows:
The Independent variable is the Fight Asthma Now – school-based asthma management program.
– The Dependent variables are:
– Improved asthma knowledge
– Increased number of asthma action plans
– Improved spacer competency
– Decreased school absences
Assumptions
– The stakeholders are willing to buy into the concept of implementing the program into the school.
– The school nurses and social workers will work together to obtain parents’ consent to allow students to participate in the program.
– Parents will be willing to allow their students to participate in an asthma management program during a pandemic.
– The administration will support the program and provide the resources and assistance needed to make it successful.
– Students will participate in a live classroom setting instead of a remote setting due to the pandemic.
Method
Describe:
• The project design, including detailed intervention information.
• The setting.
• What data needs to collected?
• How the data will be collected (include the validity and reliability of any instruments to be used).
• The statistical or other evaluation methods to be used (as appropriate to your project).
• How data will be measured.
• Anticipated findings.
• The limitations of the study.

*Please provide your data collection tool as an appendix. Remember that use of established tools will require evidence of permission by the author prior to IRB submission. Note: For those doing a quantitative analysis, consultation with a statistician is recommended prior to completing this section.
Method
The implementation of the Fight Asthma Now Program is the chosen intervention because this program has a curriculum that focuses on the age range of 11 – 19 years old. The FAN program has been known to significantly increase asthma knowledge and spacer technique competency within high -risk populations(Mosnaim et al., 2011). This youth and teen program contain age-appropriate language and components that address tobacco and the social pressures of adolescence. The plan will also cover asthma triggers, how to manage asthma episodes, and how to control Asthma. The setting for this program is the Rich Township High School District 227. This school district is located outside of the city of Chicago and is comprised of 2,858 students. The student population is 88.6% African American, 6.7 percent Hispanic, 2.3 % White, 2.6 Multiracial, Native American, or Asian.
The Asthma educator will present the program to the students in four 45-minute sessions held on four consecutive days. Before the session, students will be assessed using the Asthma Knowledge Questionnaire to gauge their basic knowledge level. Following the program, students will be given the same Asthma Knowledge Questionnaire to determine what they have learned during the program. Students will also be tested on the spacer technique. The DNP student will collect the data, which will be the absolute number of items correct on the FAN Asthma Knowledge Questionnaire and the FAN Spacer Competency Checklist. According to Beaurivage et al., 2017 the Asthma Knowledge Questionnaire is a valid asthma knowledge questionnaire which can be helpful for healthcare professionals in individualizing education intervention for people with Asthma,
Once the data is collected, it will be analyzed using SPSS software. The baseline demographics and assessment variables will be compared between treatment groups within strata to assess balance. The cluster adjusted t-test or the Wilcoxon rank-sum test will be utilized to compare the continuous variables age and test scores. The primary outcomes for each student will be the pretest and posttest scores. They will be analyzed using the cluster-adjusted t-test or Wilcoxon rank sum-test. The anticipated findings are that asthma knowledge and spacer technique will improve at the end of the program.
Limitations
Potential limitations while implementing the program could be:
1) Resistance from parents to register their students to participate in the program.
2) A small sample size of students to choose from due to the pandemic. Several students have decided to continue with remote education instead of risking the hybrid option and entering the school building.
3) Difficulty obtaining consent forms from parents.
4) Scheduling conflicts due to some asthmatic students not having a study hall.
Sample

Will your project include a sample? As appropriate, address the following:
• Describe the sample for the project, including:
o Inclusion and exclusion criteria.
o Sample recruitment process.
o Human subjects protection methods.
Sample
The target population for this evidenced-based project is teens age 14-19 years old. A randomized convenience sample will be utilized to select who will participate in the program. The inclusion criteria include 1) students with a diagnosis of asthma, 2) parental consent for their child to participate in the program, and 3) English speaking. Students will be recruited by flyers being passed out during events such as an open house, brochures being mailed home to all asthmatics, email advertisements, and phone calls. Recording identifiers will be used to eliminate the possible identification of human subjects. The data collected will be stored in locked file cabinets, and only the school nurses will have access to the keys.

Time Frame for Implementation

Provide a step-by-step listing of activities from implementation through data collection and analysis, including proposed dates and duration.
Time Frame and Implementation
Quarter 1
July 1- September 2020
• Milestone 1: DPP I – Submit and revise identified concerns on DPP I from the Keystone course.
• Submit rough draft to Mentor of DPP I
• Maintain a log of hours and submit to Mentor after preceptor has signed it
• Review Plan of Action and goals to present to Mentor as required
• Completion of Milestone 1- approval from Committee received
• Upload written work into ePortofolio
• Completion of Milestone 1: DPP II – Begin working on DPP II
Quarter 2
October 2 – December 2020
• Milestone 2: Work will continue towards completion of DPPII
• Conduct research
• Post weekly progress for Plan of Action & phone conferences
• Submit DPP II for Committee approval along with the checklist
• Make any revisions needed to DPP II after review.
• Submit IRB to Capella University
• Assignment help – Discuss the IRB process with Mentor
• Plan a timeline with the school administrator and preceptor
• Maintain a log of hours and submit to Mentor after preceptor has signed it
• Review Plan of Action and goals to submit to Mentor as required
• Upload written work into ePortofolio
• Completion of Milestone 2: Mentor and School approval / Research Plan

Quarter 3
January 3 – March 2021
• Completion of Milestone 3: IRB approval
• Begin implementation of the project
• Contact the Respiratory Association to schedule the dates.
• Meet with staff to explain the program and implementation process before the program begins.
• Prepare advertisements for mailing and distribution.
• Search the Electronic Medical Record System (Power School) to obtain a list of students with the health condition Asthma for a target population.
• Send home, mail, or email advertisement and consent forms.
• Reserve the meeting location and room.
• Meet with counselors to discuss student’s schedules and the best time to hold the sessions.
• After the DNP student obtains consent from parents, the students will be given the pre-Asthma knowledge Questionnaire and the FAN spacer competency checklist.
• Present four 45-minute educational sessions to students
• Distribute asthma action plans for completion
• Collect data and analyze results
• Review Plan of Action and goals to submit to Mentor as required
• Upload written work into ePortofolio

Quarter 4

April – June 2021

• Completion of Milestone 4: Mentor and Committee Approval of Capstone
• Complete any pending data analysis
• Homework help – Write and submit the abstract to my Mentor via email and make revisions as needed.
• Review Plan of Action and goals to submit to Mentor as required
• Begin writing the final project and submit to Mentor for revision assessments
• Upload written work into ePortofolio
• Maintain a log of hours and submit to Mentor during week ten after preceptor has signed it
Quarter 5

July – September 2021

• Completion of Milestone 5: School Approval/ Publications Review/ Dean’s Final Approval
• Continue final project revisions while consulting with Mentor.
• Submit the final paper to the Committee for approval
• Complete any formal editing
• Complete practice immersion log hours and submit after preceptor has signed it
• Upload written work into ePortfolio

End of Doctoral Project DPP Form Part II

References in Help write my thesis – APA format should begin on the next page.

References
Beaurivage, D., Boulet, L., Foster, J. M., Gibson, P. G., & McDonald, V. M. (2017). Validation of the patient-completed asthma knowledge questionnaire (PAKQ). Journal of Asthma, 55(2), 169-179. https://doi.org/10.1080/02770903.2017.1318914
Britto, M. T., Rohan, J. M., Dodds, C. M., & Byczkowski, T. L. (2017). A randomized trial of user-controlled text messaging to improve asthma outcomes: A pilot study. Clinical Pediatrics, 56(14), 1336-1344. https://doi.org/10.1177/0009922816684857
Buckner, E. B., Copeland, D. J., Miller, K. S., & Holt, T. O. (2018). School-based interprofessional asthma self-management education program for middle school students: A feasibility trial. Progress in Community Health Partnerships: Research, Education, and Action, 12(1S), 9-9. https://doi.org/10.1353/cpr.2018.0016
Centers for Disease Control and Prevention. (2018, May 15). Controlling Asthma in Schools. CDC. www.cdc.gov/asthma/controlling_factsheet.html
Cicutto, L., Gleason, M., Haas-Howard, C., White, M., Hollenbach, J. P., Williams, S., McGinn, M., Villarreal, M., Mitchell, H., Cloutier, M. M., Vinick, C., Langton, C., Shocks, D. J., Stempel, D. A., & Szefler, S. J. (2018). Building bridges for asthma care program: A school-centered program connecting schools, families, and community health-care providers. The Journal of School Nursing, 36(3), 168-180. https://doi.org/10.1177/1059840518805824
Cushing, C. C., Fedele, D. A., Patton, S. R., McQuaid, E. L., Smyth, J. M., Prabhakaran, S., Gierer, S., Koskela-Staples, N., Ortega, A., Fleming, K. K., & Nezu, A. M. (2019). Responsive asthma care for teens (React): Development protocol for an adaptive mobile health intervention for adolescents with asthma. BMJ Open, 9(8), e030029. https://doi.org/10.1136/bmjopen-2019-030029
Ebell, M. H., Hall, S. P., Rustin, R. C., Powell-Threets, K., Munoz, L., Toodle, K., Meng, (. L., & O’Connor, J. (2019). A Multicomponent, multi-trigger intervention to enhance asthma control in high-risk African American children. Preventing Chronic Disease, 16. https://doi.org/10.5888/pcd16.180387
Geryk, L. L., Roberts, C. A., & Carpenter, D. M. (2017). A systematic review of school-based interventions that include inhaler technique education. Respiratory Medicine, 132, 21-30. https://doi.org/10.1016/j.rmed.2017.09.001
Halterman, J. S., Fagnano, M., Tajon, R. S., Tremblay, P., Wang, H., Butz, A., Perry, T. T., & McConnochie, K. M. (2018). Effect of the school-based telemedicine enhanced asthma management (SB-TEAM) program on asthma morbidity. JAMA Pediatrics, 172(3), e174938. https://doi.org/10.1001/jamapediatrics.2017.4938
Halterman, J. S., Tajon, R., Tremblay, P., Fagnano, M., Butz, A., Perry, T. T., & McConnochie, K. M. (2017). Development of school-based asthma management programs in Rochester, New York: Presented in honor of Dr Robert Haggerty. Academic Pediatrics, 17(6), 595-599. https://doi.org/10.1016/j.acap.2017.04.008

Hemati, Z., Shakerian, B., Shirani, F., Mosaviasl, F. S., & Kiani, D. (2017). Effect of the Orem self-care model on quality of life in adolescents with asthma. Journal of Comprehensive Pediatrics, In Press(In Press). https://doi.org/10.5812/compreped.59343
Johnson, S. B., Spin, P., Connolly, F., Stein, M., Cheng, T., & Connor, K. (2019). Asthma and Attendance in Urban Schools. Preventing Chronic Disease, 16, 1-8.
Kneale, D., Harris, K., McDonald, V. M., Thomas, J., & Grigg, J. (2019). Effectiveness of school-based self-management interventions for asthma among children and adolescents: Findings from a Cochrane systematic review and meta-analysis. Thorax, 74(5), 432-438. https://doi.org/10.1136/thoraxjnl-2018-211909
Martin, M. A., Kapheim, M. G., Erwin, K., Ignoffo, S., McMahon, K., OʼRourke, A., Gerald, L. B., Barrett, M., Press, V. G., Darabi, H., & Krishnan, J. A. (2018). Childhood asthma disparities in Chicago. Family & Community Health, 41(3), 135-145. https://doi.org/10.1097/fch.0000000000000187
Mickel, C. F., Shanovich, K. K., Evans, M. D., & Jackson, D. J. (2016). Evaluation of a school-based asthma education protocol. The Journal of School Nursing, 33(3), 189-197. https://doi.org/10.1177/1059840516659912
Mosler, G., Harris, K., Grigg, J., & Steed, L. (2020). Developing a theory-based multimedia intervention for schools to improve young people’s asthma: My asthma in school (MAIS). Pilot and Feasibility Studies, 6(1). https://doi.org/10.1186/s40814-020-00670-6
Mosnaim, G. S., Li, H., Damitz, M., Sharp, L. K., Li, Z., Talati, A., Mirza, F., Richardson, D., Rachelefsky, G., Africk, J., & Powell, L. H. (2011). Evaluation of the fight asthma now (FAN) program to improve asthma knowledge in urban youth and teenagers. Annals of Allergy, Asthma & Immunology, 107(4), 310-316. https://doi.org/10.1016/j.anai.2011.07.008
Muhuri. (2018). Persisting Racial Disparities Among Children with Asthma. Respiratory Health Association, 1-6.
Rehman, N., Morais-Almeida, M., & Wu, A. C. (2020). Asthma across childhood: Improving adherence to asthma management from early childhood to adolescence. The Journal of Allergy and Clinical Immunology: In Practice, 8(6), 1802-1807.e1. https://doi.org/10.1016/j.jaip.2020.02.011
Salazar, G., Tarwala, G., & Reznik, M. (2018). School-based supervised therapy programs to improve asthma outcomes: Current perspectives. Journal of Asthma and Allergy, 11, 205-215. https://doi.org/10.2147/jaa.s147524
Simoneau, T., Langton, C. R., Kuo, C., Marrero, J., Gherlone, N., Cloutier, M. M., & Hollenbach, J. P. (2020). A school nurse-led asthma program reduces absences: Evaluation of easy breathing for schools. Academic Pediatrics, 20(1), 73-80. https://doi.org/10.1016/j.acap.2019.07.007
Trivedi, M., Patel, J., Lessard, D., Kremer, T., Byatt, N., Phipatanakul, W., Pbert, L., & Goldberg, R. (2017). School nurse asthma program reduces healthcare utilization in children with persistent asthma. Journal of Asthma, 55(10), 1131-1137. https://doi.org/10.1080/02770903.2017.1396473
Tseng, T., Chang, A. M., & Wu, C. (. (2017). A randomized control trial of an asthma self-management program for adolescents in Taiwan: A study protocol. Contemporary Clinical Trials Communications, 8, 122-126. https://doi.org/10.1016/j.conctc.2017.09.005
Zahran, H. S., Bailey, C. M., Damon, S. A., Garbe, P. L., & Breysse, P. N. (2018). Vital signs: Asthma in children — United States, 2001–2016. MMWR. Morbidity and Mortality Weekly Report, 67(5), 149-155. https://doi.org/10.15585/mmwr.mm6705e1
Zhong, C. S., & Melendez-Torres, G. (2017). The effect of peer-led self-management education programmes for adolescents with asthma: A systematic review and meta-analysis. Health Education Journal, 76(6), 676-694. https://doi.org/10.1177/0017896917712297

SECTION 4. DPP Form Part II Approvals (To be completed by Mentor only)

Mentor
Name: Committee Member
Name: Preceptor
Name: School level Review Date and Reason for Deferral
(if needed)
DPP Plan Part II Dr. Anita Harris Dr. Susan Hale Sheila Allen – Stokes
Notes:

APPENDIX 1 – EVIDENCE TABLE
Asthma Knowledge Questionnaire

Appendix 2 Evidence Table
Spacer Competency Checklist

Appendix 3 Evidence Table
Asthma Action Plan

Citation Conceptual
Framework Design/
Method Sample/
Setting Major Variables Studied and their Definitions Measurement Data
Analysis Findings Appraisal: Worth to Practice
Ciutto et al.,2018 None

Quality Improvement Design

Sample:
Denver n=228 students
Hartford
n=154 students

Setting: Two Urban School systems: Denver Public School & Hartford Public Schools
Building Bridges for Asthma Care Program (BB) Inhaler technique

Asthma Control

Asthma action plan/home treatment plan

School asthma care plan

Quick relief inhaler at school SPSS software Significant improvements were noted in students with completed asthma care plans, a quick relief inhaler at school, home asthma action/treatment plan and inhaler technique (p<.01 for all variables)

It is feasible to implement school centered asthma care programs that can support students, improve asthma outcomes, and facilitate asthma management.

Ebell et al, 2019 None Quasi-experimental pretest-posttest study Sample:
n=23 children

Setting: Georgia Department of Public Health Multicomponent, Multi-Trigger Intervention (MCMT) Asthma control

School absences

Use of rescue inhalers McNemar test for paired data

A P value of less than .05 was considered significant Strata version 14.0 was used for all analysis The number of children whose asthma went from being well controlled from 4 out of 20 to 17 out of 20 (P<.001) data were missing for 3 children

Significant reductions in days of missed school (1.4 vs 3.3, P=.01)
And ER department visits in the past 6 months (0.27 vs 0.95, P=.004)

Fewer hospitalizations (0.18 vs .59, P=.05) The interventions of this project created modest success that can help children with asthma improve their health outcomes
Geryk, Roberts, & Carpenter
(2017) None A systematic review of literature was conducted

Searches were conducted on PubMed, Medline, CINAHL, Informit, Embase, Psychinfo, ERIC, IPA,

A Randomized Parallel- group design

Two-group exploratory quasi experimental study design Sample: n=9 studies were selected out of 285 citations from 71 full articles School-based intervention Inhaler technique

Covidence Systematic Review Software

Articles included were : school based, about asthma, strictly intervention, program curriculum or education, targeted children and adolescents aged 5-18 Students benefit from school-based inhaler technique education

Two of the nine studies (22%) used a validated measure of inhaler technique. Inhaler technique varied in length from 15 min to 1 hr and nurses implemented inhaler technique instructions in six of nine (67%) interventions Proper inhaler techniques is essential for successful treatment of childhood asthma and school based interventions can provide this skill
Halterman et al., 2018 Chronic Care Model Random Controlled Trail Sample: n=400 students

Setting:
Rochester City School District SB-TEAM “School-Based Telemedicine Enhanced Asthma Management program- this program is intervention guided , prevention based, and delivers medication through school Asthma symptoms
-coughing, wheezing, chest tightness, or shortness of breath and no need for rescue medications

Observes administration of medication Controller medications were administered in school >95% of the time the child was in school Students who received preventive medications in school through directly observed therapy had improved outcomes across multiple outcome measures School based asthma management programs improve asthma outcomes
Kneale et al., (2019) None A systematic review of intervention studies was conducted

Searches were conducted on Cochrane: CENTRAL, MEDLINE, Embrase, CINAHL

A Randomized Parallel- group design Systematic review of 379 studies
Sample:
n=33 studies met the inclusion criteria

School-based self-management interventions Knowledge of asthma
Self-management skills
Improving self -management behaviors and practice Cochran’s Q statistics The meta-analysis showed that school-based self-management interventions are effective in improving healthcare usage including hospitalizations (6 studies) and ED visits (13 studies)

Reduced days of restricted activity Self – management interventions delivered in schools reduce healthcare utilization and improve health outcomes
Marsland et al., 2018 None A Parallel Randomized Pilot trail Sample:
n=35 students in ICC program

n=34 students in OAS

n= 35 student with no treatment

Setting: Urban Public Schools in Pittsburgh I Can Cope (ICC)- 50 min. session included 15 min. psychoeducation, 15 min related to games/activates 15 min. relaxation training and 5 min. homework assignment and review

Open Airways for Schools (OAS)
-50 min. session on asthma education Student knowledge Pre and Posttest was given to students

Perceived Stress scale

The Child depression index

The State-Trait Anxiety Inventory for Children

The Children’s Health Survey for Asthma
Pulmonary Function Chi-Square analysis

To conduct examination of efficacy of ICC – analysis was conducted in SPSS

A Wald test was used to compare the coefficients for ICC and OAS groups No parallel improvements in emotional or activity-related quality of life
ICC program (d=0.15: Wald’s Z=1.81, p=0.07) OAS program (d=0.37; Wald’s Z=1.96, P=0.05)

Fewer symptoms of asthma

OAS program reported
Greater confidence that one could perform behaviors to manage their asthma (d=0.42: Wald’s Z=2.03, P=0.04).

School based interventions improve health outcome
Mickel et al., 2017 None Convenience sample- if attended school, had diagnosis of asthma in health record and took medication in school health office

Age 7-11 years Sample: n=173 students

Setting: Midwest Metropolitan School District Iggy and the Inhalers – Asthma Education Program

Asthma knowledge Pre and Post test

One month follow up test
Asthma knowledge The results were summarized as least square means with 95% confidence intervals. A two-sided p value less than .05 was regarded as statistically significant. Asthma knowledge increased significantly (p<.001) between pretest and posttest and increase was retained at 1 month follow up The program had a significant impact on students’ asthma knowledge.
Mosnaim et al., (2011) None Stratified 2-arm study

Randomized controlled Trail Sample:
26 low income predominately minority-serving schools
n=275 youth n=141 teens

Setting: Chicago-area elementary schools Fight Asthma Now (FAN) Program

Asthma Questionnaire

Spacer Technique Competency Asthma knowledge pre & post knowledge test
Spacer competency test intervention and baseline test Stratified (youth vs teen) 2-arm clustered (by school) 3:1 randomized design,

The cluster-adjusted t-test or Wilcoxen rank sum test was used to compare continuous variables (age and test scores) The FAN intervention increased both knowledge and spacer competency test scores among both youth and teen participants
P= .011 for knowledge score among teens, P< .001 for all other cases. The FAN program significantly increased the asthma knowledge and spacer technique competency within the high-risk population
Salazar, Tarwala, & Rezink (2018) None Literature search using electronic search engines (PubMed and Cochrane)
Search terms:
School-based asthma
School based asthma therapy
School-based supervised asthma therapy
Inclusion criteria were: school based interventions with supervised asthma medication administration in the U.S. Systemic Review of 443 articles 9 studies met the inclusion criteria School- Based supervised Asthma therapy interventions Asthma outcomes

Medication adherence
Out of the 9 studies reviewed 7 utilized a rigorous RCT study design and 5 had sample designs >100. Seven studies were conducted over 1 or more school years and asthma education programs were incorporated in 6 studies. 9 studies included in this literature review showed improved asthma outcomes

School based supervised therapy and interventions improve asthma outcomes Schools are ideal environments for implementation of asthma management programs
Simoneau et al., 2020 None Random Control Trail for Nurses (n=51) were invited to participate 28 nurses volunteered to participate
Study design – pragmatic
The nurses decided what student to include in the study based on clinical judgement as determined by the Student Asthma Survey. Sample:
2015-16 n=114 students,
2016-17 n=137 students
Setting:
Urban Community school
Easy Breathing for Schools (EzBfS)

EzBfs was delivered to students with asthma.

Nurses were trained in an on-site, one-on-one 30-minute session where they were given a tool kit, training manual, and instructions on the 5 program elements.
1.Assessment of risk
2. Assessment of Asthma control
3. Asthma Education
4. Asthma Medication Review
5.Communication with primary care provider School Absences

Inhaler technique Comparison between easy participating and non-easy breathing students were conducted by Chi-Square tests for categorical outcomes and t-tests for continuous outcomes Students in program experienced a 25% decrease in absentee rate after adjusting for age, sex, race/ethnicity, and school year (rate ration = 0.75, 95%, confidence interval. 0.67, 0.85) compared to the students with asthma not enrolled in the program. Participants also showed improvement in inhaler technique (P<.001). Easy breathing for schools was successfully implemented by school nurses and significantly decreased school absences among a sample of students with asthma
Trivedi et al.,2017 None Quasi-experimental time -series design Sample:
n=84 children
(grades 1-12)

Setting: a school in in central Massachusetts

Medication administration

Inhaler technique

Hospital utilization

School absenteeism Nonparametric Wilcoxen signed rank sum tests Asthma related ED visits over 1-year period decreased by 37.5% from a pre-intervention mean of 0.8 visits to a post intervention mean of 0.3 vistis (p<0.001)

Asthma related hospital admissions decreased from a pre-intervention mean of 0.3 admissions to post intervention men of 0 admissions (p<0.001). Asthma rescue medication refills decreased by 46.3 % from pre to post intervention period (p=<.001). School nurse supervised programs can significantly reduce healthcare utilization

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