Evaluation of a nurse-run asthma school

Acceptance and Dropout Rates of Individuals with Asthma Approached in Self-management Interventions: A Systematic Review and Meta-analysis

Objective

The objectives of this systematic review were to assess the acceptability of self-management interventions for people with asthma and identify contributing factors.

Methods

A systematic literature search was conducted using PubMed, MEDLINE, EMBASE (OVIDWEB), CINAHL and Cochrane databases. Clinical trials design was included if they met specified criteria. A random-effect meta-regression analysis was conducted to estimate the overall acceptance and drop-out rates and to assess the potential factors that may influence the outcomes.

Results

A total of 64 studies were included and 8,092 participants were recruited and participated in the trials. The estimated acceptance rate was 51.1%, while the estimated drop-out rates in the intervention and control groups were 18.2% and 15.6%, respectively. Lack of interest was the main reported reason for refusing to participate and dropping out from the program. Study-related and program-related factors influenced the acceptance and drop-out rates statistically and clinically.

Conclusion

The acceptance rate of self-management programs among asthmatic people was not high and the dropout rate was somewhat low. The review suggests optimizing the design of self-management studies and modifying the implemented self-management programs to increase the acceptance rate and decrease the dropout rate.

Management of acute severe asthma

Asthma is a chronic inflammatory disorder that results in recurrent episodes of reversible airflow obstruction. Lung hyperinflation results from obstruction or dynamic airway collapse during exhalation. Obstruction and dynamic hyperinflation both play a deleterious role in asthma. Patients who present with asthma have increased inspiratory work of breathing due to lung hyperinflation and auto-positive end-expiratory pressure (auto-PEEP). The goal of acute care treatment is to reverse bronchoconstriction and inflammation, thus reducing dynamic hyperinflation, so that breathing is restored to baseline, unlabored, quiet breathing.

Childhood smoking: the research, clinical and theoretical imperative for nursing action

BACKGROUND

Tobacco smoking is a major international health issue which nurses are ideally positioned to address. Childhood represents a critical period for intervention to prevent/reduce smoking. During childhood, the majority of smokers first experiment with smoking, are initiated into the smoking subculture and become addicted to tobacco. Children are highly susceptible to smoking as a result of developmental factors, which promote or facilitate high-risk behaviours, limited coping skills, limited defences and inadequate legal protection against youth-focused marketing of tobacco.

AIM

This paper is intended to sensitize nurses to the magnitude of childhood smoking as an international health problem and to familiarize them with current intervention approaches and care issues pertinent to child and adolescent populations.

METHOD

An extensive literature review was conducted to determine the impact of childhood smoking at the personal and community level, characteristics of child smokers, the processes associated with smoking cessation, intervention approaches and intervention models for use by nurses across the spectrum of clinical settings.

FINDINGS

Evidence exists that behaviourally based interventions by nurses for smoking prevention/cessation are effective with children. Key components of effective behaviourally based antismoking approaches for smokers include addressing self-efficacy to quit, providing social support, resisting temptation to smoke and discussing issues related to relapse and relapse prevention. For all children, the reinforcement of non-smoking behaviour is essential. Intervention models, which can be incorporated into routine clinical care of individual children or with groups, emphasize the importance of parental involvement, routine screening for tobacco use and provision of a clear message that smoking and tobacco use is unhealthy.

Need for change in patient education: a Finnish survey from the patient's perspective

This study aims to find out how hospital patients in Finland perceive and evaluate the education they receive. It represents the first part of a patient education project at one university hospital in which the ultimate goal is to support patients' decision-making and self-care and in this way to facilitate the independent empowerment with health problems. The survey comprised of 754 patients from 63 of the hospital's 100 wards during a randomly selected week in spring 2001. The results show that most patients described the patient education they had received as sufficient, although some did indicate they had not learned enough about the possible side effects of care, problems of care and future care. Patients were not content with the education they received in support of social, experiential, ethical and financial aspects. The methods used in patient education should also be more diversified and patient-centred.

Self-management approaches for people with chronic conditions: a review

The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.

Self-management approaches for people with chronic conditions: a review

The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.

Model for community health nursing care: application to an integrated asthma intervention program

The article describes the use of a model for community health nursing care applied to an integrated asthma intervention program in an inner-city context. Asthma is a chronic childhood disease with broad physical, social, and economic impact on children, families, and communities. Despite recent advances in asthma understanding and treatment, morbidity and mortality continue to rise. This model suggests ways to combine individual, family, school, and community interventions to enhance coordination and increase the impact of services. It outlines needs and opportunities for collegial collaboration between professional nurses in varied practice settings. Application of the model to the management of asthma in the urban setting demonstrates the potential to produce significant improvement in the management of conditions such as asthma and highlights the key role that school nurses play.

The effect of telepharmacy counseling on metered-dose inhaler technique among adolescents with asthma in rural Arkansas

The increased prevalence, morbidity, mortality, and health costs associated with asthma among children suggest the need for accessible asthma education. This study examined the effect of telepharmacy counseling, using interactive compressed video, on metered-dose inhaler (MDI) technique and patient satisfaction among adolescents with asthma in rural Arkansas. The telepharmacy counseling provided accessible education regarding MDI technique for adolescents in this study. Twenty percent of the adolescents who participated had never been shown the appropriate use of an MDI. The study used an experimental design with random assignment of participants to a telepharmacy counseling group (n = 15) or a control group (n = 21). Both groups participated in pre-test, post-test, and 2- to 4-week follow-up assessments for MDI technique and patients satisfaction (follow-up assessment only) via interactive compressed video. Results indicated that from pre-test to follow-up the telepharmacy counseling group showed more improvement in MDI technique than participants in the control group (p < 0.001). There was no significant difference between the telepharmacy counseling group and control group in satisfaction with the instructional sessions (p = 0.132). Both groups had high levels of satisfaction with the telepharmacy sessions. The study findings demonstrated that patient education provided by pharmacists via interactive compressed video was superior to education provided via written instructions on an inhaler package insert. Interactive compressed video is an effective medium for teaching and improving MDI technique in this rural, adolescent, predominantly African-American population.

The health-related quality of life of patients suffering from the late effects of polio (post-polio)

In Sweden alone, there are today approximately 10 000-16 500 polio survivors. Between 60% and 80% experience new symptoms several years after the initial attack of poliomyelitis. The aims of this study were to investigate and describe the self-rated health-related quality of life and functional status of a group of Swedish patients with post-polio, to investigate whether any differences within the group could be related to demographic or disease-specific data and to compare the post-polio patients with individuals sampled from the general population. Data were obtained by using two questionnaires, the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL) and the Sickness Impact Profile (SIP). A total of 150 patients, 86 women and 64 men with median age 61 (20-82) years, were consecutively included. The study showed that the patients mainly reported that their physical, functional status was affected by their post-polio condition. Factors found to be associated with the physical, functional status were age and the number of parts of the body affected by the polio. On comparing the post-polio patients with two samples from the Swedish general population, it was found that the patients reported a poorer functional status and health-related quality of life. The women with post-polio reported more pain, as compared with both the men with post-polio and the women in the general population sample. The family life of the patients - in contrast to their physical abilities - did not seem to be affected by the new deteriorating condition. It is concluded that, owing to the wide range of symptoms, the patients with post-polio need care and support from multidisciplinary teams, including nurses and occupational therapists.