Using Nursing Students as Open Airways Facilitators Through a Community Partnership to Influence Asthma Outcomes

Abstract

In conjunction with a community partnership with the American Lung Association, the Broome County Health Department, the Asthma Coalition of the Southern Tier, and the Decker School of Nursing, the American Lung Association’s Open Airways for Schools program was integrated into a nursing curriculum and implemented by nursing students in several local elementary schools. Analysis of pretest/posttest data demonstrated a statistically significant improvement in asthma self-management for the students enrolled in the program. Improvements included knowing when to take medicine, ability to determine when they might start to wheeze or cough, ability to identify asthma triggers at home or at school, ability to remember the steps to take when having asthma symptoms, ability to stay calm during an asthma episode, ability to talk with their teacher about asthma and classroom triggers, ability to determine when to go to school with asthma symptoms, and ability to know when to contact the doctor or go to the emergency room (P < .05). Feelings about having asthma also demonstrated improvement (P < .05). No significant findings were found for knowing how much asthma medicine to take or being able to tell an adult that they are having asthma symptoms. Results of this study suggest that a collaborative partnership with a school of nursing has the potential to affect the health status of the community and provide sustainability for those activities that created the positive change. Integrating Open Airways into a nursing curriculum addresses a well-documented need for increased asthma management education for the student with asthma.

Keywords

asthma asthma management nursing students community partnerships

Pediatric asthma is a major public health concern. Asthma prevalence is higher in the 5- to 17-year-old age group than any other age group, and asthma attack rates are highest in children less than 18 years old.¹ Asthma that is not well managed results in school days missed for the child and work days lost for the parent, emergency room visits and hospitalizations, and decreased school performance.^2-4 Enhancing the self-management skills of the child with asthma and their parents can result in a decrease in many of these adverse outcomes associated with asthma. Open Airways is an American Lung Association program that teaches asthma self-management skills to school-aged children in the school setting. While school nurses are in the optimal position to teach this content, many barriers exist that prevent them from providing this program. A collaborative effort between the Decker School of Nursing (DSON), Binghamton University, the Asthma Coalition of the Southern Tier (ACOST), and the American Lung Association (ALA) led to the integration of asthma education into the nursing curriculum and training of nursing students as Open Airways facilitators. The purpose of this study was to evaluate the effectiveness of nursing students teaching the Open Airways curriculum in increasing self-management skills for the school-aged child with asthma.

The Community Partnership

Open Airways has been taught in the local community since 1997 under the auspices of United Health Services and ACOST. Being able to sustain delivery of the program was problematic due to the lack of available and reliable facilitators. The Broome County Health Department, through STEPS to a Healthier New York, enhanced and expanded what already existed for asthma management and education. This resulted in the development of a collaborative partnership with stakeholders including Broome County STEPS to a Healthier New York, the DSON, ACOST, United Health Services, and the local ALA. It was determined that an ideal solution to the need for facilitators could be met by training nursing students to fill this role. The ALA supported a professor at the DSON to become a trainer for the Open Airways for Schools curriculum. Nursing students trained as facilitators implemented the program in the local elementary schools. At the same time the school children attended Open Airways, a certified asthma educator from ACOST called the parents of the children enrolled in Open Airways at regular intervals to reinforce the content from the program and to provide additional education as needed (see Tables 1 and 2). Initially, the DSON integrated the Open Airways program into their Baccalaureate Accelerated Track Program (students with bachelor’s degrees in other fields completing their baccalaureate degree in nursing in 1 year) and their registered nurse (RN) to the Baccalaureate RN Program (nurses with associate degrees working toward obtaining their baccalaureate degree in nursing). As part of their community health experience, these students were trained as Open Airways facilitators and implemented the program. Because of increasing enrollments and curriculum changes, aligning the student availability with the elementary school’s availability became problematic. To address this issue, a nursing elective course was developed dedicated to implementing Open Airways.

Table 1.

Open Airways Parent Handout Topics

What is asthma?

Peak flow meters

Asthma medications: rescue versus controller

Asthma action plan

Asthma emergency signs

Asthma triggers

Ways to stay active

Deciding to go to school or to stay home

Table 2.

Questions Asked by the Certified Asthma Educator

1. In the past 6 months, or since our last call, how many times did your child have an emergency room visit for asthma, wheezing, cough, bronchitis, or other breathing problems?

2. In the past 6 months, or since our last call, how many times did your child have to stay overnight in the hospital for asthma, wheezing, cough, bronchitis, or other breathing difficulties?

3. In the past 6 months, or since our last call, how many days of school have your child missed due to asthma or other breathing difficulties?

4. In the past 6 months, or since our last call, how many days of work have you missed due to your child’s asthma or other breathing difficulties?

5. Are your immunizations up to date?

6. In the last month, did you (your child) use a rescue inhaler?

7. In the past 6 months, or since our last call, has your child had an attack that has been severe enough to limit speech to only 1 or 2 words at a time between breaths?

8. When thinking about your child’s breathing difficulties over the past 6 months, please describe how often has your child experienced a wheeze or whistling in the chest?

9. When thinking about your child’s breathing difficulties over the past 6 months, please describe how often your child has woken up at night from wheezing, coughing, or trouble breathing?

10. Has a doctor or other health professional EVER given you an Asthma Action Plan for your child who has asthma?

11. Does your child with asthma or other breathing difficulties know asthma triggers?

The need to provide asthma education is evident. Asthma continues to be a problem for the school-aged child. Results of a survey of school nurses conducted in New York State elementary schools indicated that few schools provided asthma management education for the student with asthma. Less than 25% of schools used Open Airways and less than 3% used the US Environmental Protection Agency’s (EPA) Tools for Schools. Only 28% of students with asthma had a written management plan at school. Of the students with asthma, 64% visited the health office, 26% were absent from school, 20% had physical limitations, and 7% needed urgent care, indicating a large group of children with uncontrolled asthma.⁵ These statistics illustrate the importance of improving asthma management for this cohort.

Asthma burden for the local community highlights the necessity for improving asthma management skills. While the community where the DSON implements the Open Airways for Schools curriculum has lower asthma rates than New York State (excluding New York City), the pediatric asthma hospitalization rate for children aged 0 to 4 years has nearly doubled in the past years from 15.3 per 10 000 in 2004 to 26.6 per 10 000 in 2008.^6,7 It is in this population that will be entering the school system where there is an opportunity to provide asthma management education and gain control of this disease.

Adverse Asthma Outcomes

Asthma burden for the childhood population has been well documented. More than 10 million children in the United States less than 17 years old have ever been diagnosed with asthma and almost 7 million children still have asthma.² According to the ALA,¹ in 2008 the highest asthma prevalence rate (107 per 1000 population) was for ages 5 to 17 years. Asthma attacks occur more often in those younger than 18 years, with prevalence rates of 56.0 per 1000 compared with 38.1 per 1000 in those older than 18 years. The disproportionate impact on children with asthma is further evidenced by the fact that approximately 33% of all asthma hospital discharges in 2006 were for children less than 15 years even though they comprise only 20.1% of the US population.¹

The economic cost of uncontrolled asthma at the national level is staggering. Asthma adds 50 cents to every health care dollar spent on children with asthma compared with children without asthma. The nation spends $8 billion on treating childhood asthma, which is more than almost any other childhood condition. Prescription drugs represent the largest single direct medical expenditure at $5.6 billion.¹ An additional $10 billion in indirect costs is related to school absenteeism and missed work.⁸

The impact asthma has on the lives of children and their families is profound. Adverse outcomes of uncontrolled asthma include loss of health, emergency room and hospital admissions, school days lost for the child resulting in work days lost for the parent/guardian, as well as significant disruption of social and family life. A substantial number of children with asthma (49%) who are younger than 18 years report their current health status as fair or poor.² In 2005, there were approximately 679 000 asthma-related emergency room visits for persons aged 15 years and younger. In 2008, asthma accounted for an estimated 14.4 million lost school days, potentially resulting in decreased test scores on standardized examinations.^3,4

Poor outcomes may be attributed to a lack of understanding of asthma symptoms and not knowing when to seek medical assistance. Children and their families often have difficulty determining whether or not asthma is under control. If a child is experiencing mild asthma symptoms not disruptive to the family life, there may be little impetus to seek care, increasing the risk for poor outcomes. Price and colleagues⁹ surveyed 687 parents of children with asthma who were less than 14 years old and 579 children aged 9 to 14 years with asthma. Sixty-five percent of respondents reported at least weekly symptoms of difficulty breathing, nocturnal waking, dry cough, or difficulty speaking because of asthma. Despite these symptoms, these individuals described their asthma as well controlled. Similar findings were noted by Dozier and colleagues,¹⁰ who found that parents of children with asthma (n = 352) thought their children’s asthma was under control despite high asthma-related morbidity. Ninety percent of the parents considered their child’s asthma well controlled despite the fact that more than 50% of these children missed school, experienced asthma symptoms, required an unscheduled office visit, or needed to use a rescue inhaler. For parents reporting good control, more than 40% of the children used a rescue inhaler, experienced symptoms, and missed school. Forty-two percent of the children surveyed had parents whose report of symptoms did not match their assessment of control. Carlton and colleagues¹¹ found that when comparing parent and child scores on the Childhood Asthma Control Test, children perceived their asthma to be less well controlled than their parents or adult caregivers.

The Need for School-Based Asthma Education

The need to increase the availability of school-based asthma education has been highlighted by several prominent agencies. The Centers for Disease Control, in Strategies for Addressing Asthma within a Coordinated School Health Program, emphasizes the need for schools to provide asthma education and awareness programs for students as well as the need for coordinated efforts between the school, family, and community to better manage asthma symptoms and reduce school absences among students with asthma.¹² The ALA, the National Asthma Education and Prevention Program (NAEPP), and the EPA have all recognized that asthma management education is an important part of making schools asthma friendly.¹³

The Expert Panel Report 3: Summary Report 2007: Guidelines for the Diagnosis and Management of Asthma (EPR3),¹⁴ developed by the NAEPP and the National Heart, Lung, and Blood Institute, supports these recommendations for school-based education. The EPR3 highlights the need for self-management education to achieve asthma control and improve patient outcomes. Emphasis is placed on the need for patients to monitor their asthma control and to be taught to recognize when inadequate asthma control is occurring. A multifaceted approach to patient education using settings other than the traditional medical office visit is encouraged. Implementing the Open Airways curriculum in school-based settings is an appropriate way to address the need for alternative settings to reinforce education and self-management.

Open Airways for Schools

Open Airways for Schools curriculum is an ALA program designed to teach asthma self-management to children aged 8 to 11 years with asthma. Open Airways for Schools is an extension of the Open Airways program, which was originally designed for delivery in health care settings with Black and Latino children from underserved communities. The Open Airways for Schools curriculum is typically taught during the school day in 5 to 6 weekly sessions. Topic areas taught in the Open Airways curriculum include basic facts about asthma and understanding what happens to the airways during an asthma attack; understanding the role of medications, when to take them, and correct medication administration; trigger awareness and trigger avoidance; recognizing early signs and symptoms of worsening asthma; and seeking medical care as appropriate. Weekly parent handouts and at-home activities help increase family communication about asthma and encourage children to practice their newly learned skills at home.

Research suggests that Open Airways is an effective intervention to improve the health status of children with asthma. In 1987, Evans and colleagues¹⁵ evaluated third-, fourth-, and fifth-grade students (mean age = 9.1 years) in New York City completing the Open Airways curriculum. Follow-up data obtained 1 year after the program ended demonstrated that intervention students had statistically significant higher scores on an index of asthma management, greater self-efficacy with respect to asthma management skills, more influence on parents’ asthma management decisions, better grades in school, and fewer episodes of asthma compared with students who had not participated in Open Airways. In 1998, the ALA of the City of New York and Columbia University compared postparticipation and prior year attendance records of 649 children who participated in Open Airways for Schools. Results showed that there were nearly 2 fewer absences per year for the children who participated in Open Airways for Schools program.¹⁶

In 2001, Evans and colleagues¹⁷ evaluated the impact of the Open Airways weekly at-home activities and parent handouts on parental asthma management skills. Analysis of 1-year follow-up data showed that children’s participation in Open Airways was a significant predictor of parental self-management skills. Their findings illustrate that health education activities brought home from school by children can positively influence parents’ asthma self-management. In 2000, Spencer and colleagues¹⁸ evaluated a revised version of Open Airways in 8 school districts in New York State and found results similar to that obtained in the study by Evans et al.¹⁷ The program was found to be effective in improving children’s asthma self-management and their feelings about having asthma, as well as decreasing use of health care services (emergency room visits, hospital stays, and doctor visits), decreasing the number of days parents missed at work, and significantly decreasing the number of missed school days.

Bruzzese and colleagues,¹⁹ in their 2001 study, demonstrated that Open Airways can be successfully administered by undergraduate health education students who were provided asthma education and training for group facilitation. Analysis revealed that the curriculum taught by the college students improved asthma knowledge, self-efficacy, self-management skills, social support, and perception of well-being. Nursing students, who already have a strong background in group process, anatomy, physiology, and pathophysiology, should be excellent candidates to implement asthma education programs and achieve successful outcomes.

Lack of asthma knowledge among students with asthma has been identified as a barrier by school nurses to be able to provide adequate care for these students.²⁰ Students were unaware of their illness, were not able to identify triggers or warning signs, and were not able to properly use their medications when these were available. Unfortunately, implementing asthma education in the school setting is problematic. While school nurses are in the optimal position to provide this education, several studies have identified lack of time as a barrier for managing asthma.^5,21,22

We proposed that eliminating this barrier might be accomplished through the partnership between the DSON, ACOST, the ALA, and the local school districts using nursing students to implement Open Airways. The purpose of this study was to evaluate the effectiveness of nursing students teaching the Open Airways curriculum in increasing self-management skills for the school-aged child with asthma. The research hypothesis is that children with asthma who complete the Open Airways curriculum taught by nursing students will demonstrate an increase in asthma self-management skills.

Methodology

Design

The ALA provides the pretest and posttest that is a required part of the Open Airways curriculum. The nursing students administered these tests to each child enrolled in Open Airways prior to beginning the first session and at completion of the last session. These data were given directly to the ALA. The ALA de-identified the data for the students who completed the Open Airways program taught by the DSON nursing students for the 2007-2008, 2008-2009, and 2009-2010 school years. The data were provided in an Excel spread sheet. Binghamton University’s Human Subjects’ Research Review Committee approved the study (Protocol No. 1536-10).

Subjects

All subjects were children in grades 2 through 6. All these children were from school districts considered urban, as defined by the US Census Bureau as residing in a county in a metropolitan area of 250 000 to 1 million population. A total of 13 school districts participated. Due to the de-identification of the data, gender, race, age, grade level, and socioeconomic information for this sample is not known.

Procedure

School nurses were queried about participating in the Open Airways for Schools program. The role of the school nurses who agreed to have Open Airways implemented in their school was to identify students with an asthma diagnosis. Once these students were identified, the school nurses sent home invitations to participate, as well as information about the program and an informed consent to sign. The consent contained 2 items needing a signature. The first was for their child to participate in the Open Airways program and the second was for phone calls to the parents from a certified asthma educator to reinforce the information taught in the classes. Parents had the option of consenting for both, either, or none. Only those students with signed consents for Open Airways were allowed to attend, resulting in 166 students attending Open Airways. Of these 166 students, 124 parents agreed to and received phone calls from the certified asthma educator.

A minimum of 3 students from each school was required to hold the classes. The days and times for the sessions were negotiated between the elementary school and the DSON. Two to 4 nursing students were assigned to each school. Students were trained as Open Airways facilitators in their nursing course prior to teaching the program. Once the students with asthma were identified and enrolled in the program, the entire Open Airways curriculum was implemented by the nursing students.

Data Collection and Measurement

The ALA’s Open Airways curriculum includes a pretest and a posttest as part of the curriculum. These tests are administered to all children who attend the program, which consist of 13 items with a 3-point Likert-type scale (can do it, might be able to do it, and can’t do it). An additional question assessed the student’s feelings about having asthma using picture faces of “very happy,”“happy,” “sad,” and “very sad.” Because of the varying levels of reading ability of the students enrolled, the nursing students read each question aloud and the children circled the answer that best described them.

Data Analysis

Using PASW (Predictive Analytics Software) Statistics 18, a Wilcoxon signed-rank test was conducted to evaluate whether students who attended Open Airways taught by student nurses demonstrated increased self-efficacy with asthma self-management. A preset p value of .05 was used. Only those subjects who answered all the questions on both the pretest and the posttest were included in the analysis, resulting in a final sample size of 162.

Results

After completing the Open Airways for Schools curriculum, students demonstrated an increase in self-efficacy in 11 out of 13 measures. Significant findings included knowing when to take medicine (Z = −2.856, P = .012), being able to determine when they might start to wheeze or cough (Z = −3.895, P = .004), being able to identify asthma triggers at home (Z = −4.020, P = .000) or at school (Z = −4.760, P = .000), being able to remember the steps to take when having asthma symptoms (Z = −2.678, P = .003), being able to stay calm during an asthma episode (Z = −4.201, P = .000), being able to talk with their teacher about asthma (Z = −3.498, P = .002), being able to talk to the teacher about classroom triggers (Z = −4.205, P = .000), being able to determine when to go to school with asthma symptoms (Z = −3.579, P = .023), and being able to know when to contact the doctor or go to the emergency room (Z = −3.005, P = .020). Feelings about having asthma also demonstrated improvement after completing the Open Airways sessions (Z = −3.190, P = .004). No significant findings were found for knowing how much asthma medicine (Z = −1.920, P = .130) to take or being able to tell an adult that they are having asthma symptoms (Z = −1.572, P = .298). See Table 3 for response percentages for the pretest and posttest questions.

Table 3.

Response Percentages to OAS Pretest/Posttest Questions^a

Topic	Can Do It		Might Be Able To Do It		Can’t Do It
	Pre	Post	Pre	Post	Pre	Post
When to take asthma medicine^b	75.9	86.4	19.8	11.7	4.3	1.9
How much asthma medicine to take	54.3	61.1	34.0	30.2	11.7	8.6
Anticipating asthma symptoms^b	31.5	47.5	40.1	31.5	28.4	21.0
Identifying asthma triggers in the home^b	54.3	75.3	24.7	19.1	21.0	7.4
Identifying asthma triggers in school^b	33.3	55.6	31.5	30.2	35.2	14.2
What to do when having asthma symptoms^b	70.4	85.2	20.4	11.1	9.3	3.7
Telling an adult when having asthma symptoms	83.3	87.0	13.0	9.9	3.7	3.1
Relax and stay calm when coughing or wheezing^b	51.9	71.0	34.0	23.5	14.2	5.6
Talking to teacher about asthma^b	58.0	71.0	26.5	21.6	15.4	7.4
Talking to teacher about triggers in the classroom^b	31.5	54.3	43.2	30.2	25.3	15.4
Deciding to go to school when having asthma symptoms^b	53.7	67.9	27.8	22.8	18.5	9.3
Deciding to go to the doctor or hospital^b	54.3	65.4	29.6	25.9	16.0	8.6
	Very Happy		Happy		Sad		Very Sad
	Pre	Post	Pre	Post	Pre	Post	Pre	Post
Feelings about asthma^b	11.1	21.6	32.1	36.4	33.3	21.6	23.5	20.4

N = 162.

P < .05.

Discussion

The results of this study suggest that a collaborative partnership with a school of nursing has the potential to greatly influence the health status of the community as well as provide sustainability for those activities that created the positive change. Integrating Open Airways into the nursing curriculum of the DSON addresses a well-documented need for increased asthma management education for the student with asthma, resulting in greater self-efficacy, which may lead to improved health outcomes.

An increase in the self-efficacy of behaviors needed to maintain control of asthma was noted after completion of the Open Airways program. Being able to identify early warning signs, being able to stay calm while experiencing asthma symptoms, knowing when to take medicine, understanding symptom severity and taking appropriate actions, understanding triggers, and being able to advocate for oneself in the classroom can lead to enhanced asthma management that can reduce the adverse outcomes associated with poorly managed asthma. These results are consistent with the 1987 and 2001 studies of Evans and colleagues^15,17 and the 2000 study of Spencer and colleagues.¹⁸

Self-esteem also improved after completing Open Airways. Educators noted that many of the students are initially surprised to find out that other classmates also have asthma. Students are able to share their feelings and concerns and establish a sense of identity where they no longer feel so different from their peers. In addition, attending Open Airways is seen as a unique experience; not everyone has the opportunity to attend. This might be the first time that having asthma made the student feel special. This increased sense of self-esteem may persist into the middle school adolescent years where their sense of identity is becoming internalized. Ayala and colleagues²³ found that students in middle school did not want to be different than their peers, resulting in ignoring asthma symptoms and noncompliance with medications. Clay and coleagues²⁴ reported students feeling embarrassed for having to take asthma medication in school. If these students had received Open Airways training and developed a sense of community with other students with asthma from which they derive their peer identity, better asthma management and subsequent control might be achieved.

Two areas that did not show any change after completing the Open Airways curriculum were knowing how much medication to take and being able to tell an adult when having asthma symptoms. Because of the developmental level of the participants in Open Airways (ages 8-11 years), they may be dependent on the adults in their lives who are responsible for their care. These adults maintain control of the medications and may be highly conscious of worsening asthma symptoms. Because only those students whose parents/guardians consented could attend Open Airways, this might be a select group where the parents are actively involved in their child’s asthma care. Therefore, no change in these management areas was noted as these may be activities already in place.

Benefits of the Community Partnership

Providing Open Airways through the community partnership with the DSON benefits many stakeholders. Students with asthma benefit from an increase in asthma management skills that significantly enhance their quality of life. Parents benefit as they become empowered though education and support and have healthier children. They also benefit by missing less work days due to their child’s asthma. The elementary schools benefit because they receive free programs. They also are likely to receive additional funding because their asthmatic students learn how to manage their asthma and miss less school days. Test scores may also increase because students spend more time in class and less time out sick and at the nurse’s office. The ALA benefits because Open Airways is implemented on a yearly basis and is now sustainable in Broome County and surrounding areas. The DSON benefits because they are able to teach and implement a community program and provide practical real-life experience for their students. The nursing student is given the opportunity to apply the concepts of teaching/learning theory, growth and development theory, pathophysiology, and pharmacology to the care of the student with asthma in the community. Society benefits from more nurses being trained as Open Airways facilitators who can now implement the program throughout the United States after graduation. The nursing student’s enhanced understanding of asthma also has the potential to be applied in other health care settings as the new nursing graduate gains employment in other health care areas. In addition, the improved asthma management and skill development from Open Airways graduates has the potential to reduce the incidence of children needing emergency treatment for uncontrolled asthma, ultimately reducing health care costs and taxpayer money.

Feedback about Open Airways has been very positive. Parents report satisfaction with the program when speaking with the certified asthma educator. At the graduation celebration at the end of the program, parents have expressed their appreciation that this program is offered and comment on the improvement of the child’s management of their asthma. The children are pleased with having attended the program and express sadness when it is over. The school nurses are also complimentary about the program. Emails from school nurses demonstrate their satisfaction with the program:

Your nurses are great and they do a great job with our asthma students . . . the students love the program and are so into it at every session. The classroom teachers stop by and tell me how the students boasted about Open Airways. So, for the students to go back to class and tell their teachers and all the other students how much they enjoy it—that’s great!

I think the students who participated got so much out of the education. Thanks again for allowing us to take part in this worthwhile program.

Thank you for the opportunity to have the student nurses here to do Open Airways. I am very impressed with what I am hearing in between seeing children in the health office. We are so fortunate to have you collaborating with the school districts in this way. Thanks again!

In evaluating their experience with Open Airways, the nursing students are also very positive. Comments written on the course evaluation highlight the impact of implementing Open Airways.

The most important aspect of the class is actually getting a chance to go out and educate the children. We are getting hands on skills for this and not just learning what it would be like in the real world.

I liked getting to know the students over a 5 weeks period. . . . It’s rewarding for both ends because they get to “graduate” as asthma experts and we feel good because we taught them the information.

I enjoyed the hands on experience and actually making a difference in the lives of the children I worked with.

Limitations

Data were obtained immediately following the last Open Airways session, so it is unclear how long the positive effects of the program will be sustained. Only student report was measured, which is prone to responder bias. There is also the possibility of selection bias, as this was a self-selected sample. The children and families who participated in the program may have already identified a need for change and were more motivated to learn the information. No actual behavioral change was evaluated. There was no measurement of asthma severity prior to attending Open Airways to know if attending the program made a difference in asthma control with a subsequent change in severity. All participants were from one small geographical region, which may limit generalizability to other regions of the country.

Future Recommendations

Nursing students successfully implemented the Open Airways for Schools curriculum in a sample of elementary schools. Other schools of nursing could benefit by integrating the Open Airways curriculum into their course content and using the implementation of the program as clinical hours for pediatric rotations. This could alleviate the problem of a lack of inpatient pediatric beds for clinical experiences. The nursing students establish a long-term therapeutic relationship with the Open Airways participants, are able to apply principles of growth and development to their teaching, gain practical experience in teaching a client how to manage a chronic condition, and apply their knowledge of pathophysiology and pharmacology.

Future research should include longer term follow-up to see if Open Airways made a sustained change in asthma self-management behaviors for these students and their families. Determining the impact on school attendance, school performance, emergency room visits, and hospitalizations would further strengthen the evaluation of a nursing student–led intervention.

Community partnerships can be formed with schools of nursing that address the health needs of the local community. Many coalitions exist that are dedicated to reducing the impact of diseases that burden a community. Obesity, tobacco, violence, and bullying are some areas that would be well suited for the undergraduate nursing students to augment their education and experience in working with children in the community.

Conclusion

The use of nursing students to fill the need for Open Airways facilitators has been shown to be effective in increasing the self-management skills for the school-aged child with asthma. Working collaboratively with the ALA, the local asthma coalition, and the local schools has benefitted not only the student with asthma but also the local community. Community partnerships with schools of nursing can address gaps in service in the local community and reduce disease burden.

Footnotes

Acknowledgements

This research was supported by a grant from the New York State Department of Health—Bureau of Child and Adolescent Health “A Systems Approach to Reducing the Burden of Asthma.” RFA No. 0502100917. The authors would like to thank Dr Susan Seibold-Simpson and Jenny English, RN, AE-C, for their contributions to this project.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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