Practice Recommendations

Recommendation

Level of Evidence

Assessment of Asthma Control

1.0 All children identified, or suspected of having asthma will have their level of control determined by the nurse.

Level IV

1.1 During a nursing assessment of respiratory health, every child should be screened to identify those most likely to be affected by asthma.

• Have you ever been told you have (your child has) asthma?
• Have you (has your child) ever used a puffer/inhaler or any type of medication for breathing problems? Have you experienced any improvement with these medications?

Level IV

1.2 If a child is identified as, or suspected** of, having asthma, the level of control should be assessed based on :

• short-acting ß2-agonist use
•  daytime symptoms
• night-time symptoms
• physical activity
• absence from school/work
• exacerbations

** If suspected of having asthma, further evaluation by a physician is required.

Level IV

1.3 For children identified as potentially having uncontrolled asthma, the level of acuity needs to be assessed by the nurse and an appropriate medical referral provided (i.e., urgent care or follow-up appointment).

Level IV

Medications

2.0 Nurses will understand the pharmacology of medications used to treat asthma in children.

Level IV

2.1 Nurses will be able to discuss the two main categories of asthma medications (controllers and relievers) with the child and their family members/caregivers, tailoring information for the developmental age of the child.

Level IV

2.2 All children with asthma should have their inhaler/device technique assessed by the nurse at each visit to ensure accurate use, as well as appropriateness of device for the developmental level of the child.

Children with sub-optimal technique will be coached in proper inhaler/device use or switched to a more appropriate delivery device/system.

Level Ib

2.3 Nurses will be able to assess for potential barriers to asthma management. The nurse will be able to offer strategies to meet families’ needs and support them in overcoming issues leading to treatment failure.

Level IV

Asthma Education

3.0 The nurse will provide asthma education, in collaboration with the health care team, as an essential part of care.

Level Ia

4.0 Child/family knowledge of asthma should be assessed by the nurse at each patient contact. Asthma education should be provided when knowledge and skill gaps are identified.

Level Ia

4.1 Tailor asthma education to the needs of the child and family by being developmentally appropriate, sensitive to cultural beliefs and practices, and by using a variety of teaching methods (e.g., video,

pamphlets, websites, group, role playing, problem-solving).

Level IV

5.0 The nurse can use a structured framework to build both the child’s and family’s knowledge of asthma and self-management skills by providing basic asthma education. A partnership between the nurse, child and family is important to engage the child and family in an interactive educational process.

Level IV

Action Plans

6.0 All children will have an individualized asthma action plan for guided self-management, based on the evaluation of symptoms, with or without peak flow measurements, developed in partnership with a health care professional.

Level Ia

6.1 The action plan must be reviewed, revised and reinforced in partnership with the parent/caregiver, child and health care professional during every contact. The nurse will coach the parent to act as an advocate for their child, ensuring that the action plan is kept up to date.

Level Ia

Referral and Follow-up

7.0 The nurse should facilitate follow-up assessments and education to achieve and maintain control of asthma for the child diagnosed with asthma.

Level Ia

7.1 The nurse will determine the child’s primary care asthma management provider by asking “who do you see for your asthma management?”

Level IV

7.2 Nurses should advocate for a referral to an asthma specialist (respirologist, allergist, paediatrician, Certified Asthma Educator, etc.) for the following: frequent visits to the emergency department; poor

understanding of asthma self-management; symptoms are not responding to usual treatment; and/or uncertainty of diagnosis.

Level IV

7.3 Nurses should advocate for referral to an asthma education program and/or link to community resources, if available.

Level IV