"We give every single student [who has asthma] an asthma action plan to take [it] to their clinical providers and then return it to the school where the school nurse will help address control with the student....”
Roberta Villanueva, R.N., C.P.N.P., M.S.N., A.E.-C., former Project Manager, Los Angeles Unified School District
Roberta Villanueva, R.N., C.P.N.P., M.S.N., A.E.-C., discusses how Los Angeles Unified School District's school nurses help students control their asthma in school and at home.
The Enhanced Strategies for Schools (ESS) project of the Los Angeles Unified School District (LAUSD) Nursing Services Asthma Program produced a Web-based Tools for Effective Asthma Management training that put evidence-based strategies and validated tools directly into the hands of school nurses. By focusing on school nurses who work with students and their families, the project intended to reach a broader number of students who have asthma.
A major focus of the training was increasing utilization of user-friendly tools to help students and their families assess and monitor asthma control, use written asthma action plans, and control environmental exposures, all priority recommendations of the Guidelines Implementation Panel (GIP) Report. The training also showed school nurses how they can promote awareness and management of asthma by using these tools in their interactions with students, families, clinicians, and school staff.
The LAUSD promoted its Tools for Effective Asthma Management training to school nurses throughout the district. Since the training’s tools and lessons are applicable to other school and community settings, the program is also available through the LAUSD Asthma Program Web site.
To increase the number of students in the LAUSD who utilize a written asthma action plan to improve asthma management.
To use validated and user-friendly tools to assess and monitor asthma control for better asthma management.
To reduce exposure to allergens and irritants that trigger asthma at home and in the school.
Raymond Kohl of the LAUSD Nursing Services Asthma Program
Challenges & Solutions
Challenge: Increasing use ofasthma management tools consistent with GIP messages. The project presented an earlier version of its Tools for Effective Asthma Management training at statewide and LAUSD school nurse meetings. While the school nurses were generally receptive to using the tools presented, they also shared a number of challenges, including insufficient time to use the tools because working in multiple schools makes it difficult to monitor large numbers of students who have asthma; clinical providers who are resistant to filling out asthma action plans; and difficulties in getting parents to return forms or to bring their child’s quick-relief inhaler to school.
Solution: Demonstrating practical strategies to use tools with key audiences. The projects used this feedback to refine the training, incorporating tutorials on how school nurses could use the tools to engage various audiences. One tutorial, for example, demonstrated how to engage a parent and child in using asthma action plans, setting personal goals for asthma control, and monitoring progress. It also revised the training feedback forms to ask participants for feedback on the usefulness of the tools in addition to knowledge gained. Finally, by focusing on the GIP messages, the training validated the key role of school nurses in asthma management and strengthened the focus of their work with students and with other school nurses.
The LAUSD completed development of a Tools for Effective Asthma Management Web-based training for school nurses and promoted it to the district’s 550 school nurses.
The LAUSD shared and collaborated with additional NACI-funded projects to advance asthma care best practices. For example:
Gary Rachelefsky, M.D., President of the National Asthma Campaign Foundation (NAC), a NACI Strategic Partner, introduced the LAUSD Asthma Program to Fight Asthma Now® (FAN), an asthma management program for children and teens developed by the Respiratory Health Association of Metropolitan Chicago. NACI sponsored the training of the LAUSD staff in the use of this program and helped with them to obtain FAN kits. The FAN program has been offered to almost 200 students.
The LAUSD used communication, systems integration, and patient and provider support to meet its project goals.
Other NACI-funded projects that used LAUSD-type approaches are: