Impact of a nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled study

Abstract

Abstracthood asthma. 1 2 Asthma re-admissions are also Background -Re-admissions to hospital common. For example, Senthilsevan recently in childhood asthma are common with reported that re-admission rates (asthma restudies reporting that 25% or more of chil-admissions/all asthma admissions) for children dren will be re-admitted within a year. from all 134 hospitals in Saskatchewan ProvThere is a need for strategies to reduce re-ince, Canada were between 20% and 30% admissions.during the decade 1980-9. 3 Mitchell et al reMethods -A prospective randomised con-ported higher rates in children in New Zealand 4 trol study of an asthma home management and there is even some evidence that re-adtraining programme was performed in missions may be increasing.5 The need to dechildren aged two years or over admitted velop strategies to reduce the high re-admission with acute asthma. Two hundred and one rate in childhood asthma has been highlighted. 4 children were randomised at admission to At the Royal Hospital for Sick Children, either an intervention group (n=96) which Glasgow we also noted that asthma re-adreceived the teaching programme or a con-missions were common with approximately trol group (n=105). A nurse-led teaching 21% of children being re-admitted within a programme used the current attack as a year. This occurred despite the fact that over model for the management of future at-90% of the children admitted to hospital retacks and included discussion, written in-ceived nebulised bronchodilators and oral formation, subsequent follow up and corticosteroids. Care around discharge was, telephone advice aimed at developing and however, less satisfactory -for example, only reinforcing individualised asthma man-10% were noted to have been given written agement plans. Parents were also provided instructions about their treatment. with a course of oral steroids and guidance There are now many published studies on the on when to start them.use of asthma self-management programmes to Results -The groups were similar in dedecrease asthma morbidity. Several narrative gree of social deprivation, length of stay, reviews have evaluated the existing paediatric number of previous admissions, acute literature and found positive results for some asthma treatment, and asthma treatment programmes and inconclusive results for at discharge. Subsequent re-admissions others. [6][7][8][9] Howland et al commented that many were significantly reduced in the interof the studies do not stand up to rigorous vention group from 25% to 8% in individual scientific scrutiny. 8 Limitations included small follow up periods that ranged from two to 14 months ( 2 =9.63; p=0.002). This re-sample sizes, lack of a control group, and a duction was not accompanied by any in-reliance on a select population of volunteers. crease in subsequent emergency room There was also substantial variation in the attendances nor, in the short term, by any asthma education programmes used and their increase in urgent community asthma duration. A more recently published me...

Management of acute childhood asthma: a prospective multicentre study

“…Education and discharge planning are extremely important in the management of childhood asthma. Improving children's and parents' awareness and understanding of asthma, contributes to a positive outcome [19,20]. The proportion documented as receiving education in this study was low, as has been found in other recent studies [21].…”

A Matched-Cohort Evaluation of a Bedside Asthma Intervention for Patients Hospitalized at a Large Urban Children’s Hospital

“…[11][12][13] This low-cost, high-volume intervention was easily integrated into routine discharge planning for patients at the hospital. Although similar to the smaller programs in intensity, approach, content, and objectives, it differed in its selection of patients and staffing.…”

“…[8][9][10] Three other studies, each reaching fewer than 100 children, focused primarily on patient/caregiver education and support in the hospital during the child's stay. [11][12][13] These latter studies demonstrated a reduction in repeat ED visits and hospitalizations among participants.…”

Audience, Content, Media: A Literature Review about Factors to Consider When Designing Technology Based Asthma Education Programs for Children

“…Most programs target children's self-management, which is not an appropriate intervention for preliterate children [13][14][15]19,22,24,33,35,68,85]. None of the programs focused on young children's self-regulation of thoughts, feelings, and behaviors.…”

“…Following diagnosis, children with asthma must learn effective medical self-management [13]. Since studies have suggested that selfmanagement of asthma is essential to minimizing asthma exacerbations, teaching behavioral elements (avoiding triggers) and the proper use of tools (inhalers and peak flow meters) could have a substantial effect on children's asthma morbidity [1,33,34].…”