The Challenge Before Us:The Challenge Before Us:Development, Development,

Implementation and Implementation and Evaluation of a Paediatric Evaluation of a Paediatric Asthma Resource Nurse Asthma Resource Nurse

WorkshopWorkshop

Tracey Marshall and Jane GauciTracey Marshall and Jane GauciAsthma EducatorsAsthma Educators

The Department of Respiratory MedicineThe Department of Respiratory MedicineThe Children’s Hospital at WestmeadThe Children’s Hospital at Westmead

ChallengeChallenge

• To build capacity of the existing To build capacity of the existing nursing workforce at The Children’s nursing workforce at The Children’s Hospital at Westmead (CHW) and Hospital at Westmead (CHW) and Western Child Health Network Western Child Health Network (WCHN) (WCHN)

• To develop a comprehensive and To develop a comprehensive and interactive Paediatric Asthma interactive Paediatric Asthma Resource Nurse Workshop (PARNW)Resource Nurse Workshop (PARNW)

DevelopmentDevelopment

Why was this workshop needed?Why was this workshop needed?• No asthma workshop that met the No asthma workshop that met the

needs of nurses working in paediatric needs of nurses working in paediatric clinical setting in our Area Health clinical setting in our Area Health ServiceService

Funding:Funding:• From WCHN and Department of From WCHN and Department of

Respiratory Medicine CHW for the Respiratory Medicine CHW for the Asthma Education and Management Asthma Education and Management ProjectProject

DevelopmentDevelopment

• Asthma education and management Asthma education and management is a vital part of our role in caring is a vital part of our role in caring for the child and family with asthmafor the child and family with asthma

• Improving organisational culture: Improving organisational culture: Team approach from nursing, Team approach from nursing, medical, allied health staff and the medical, allied health staff and the communitycommunity

ImplementationImplementation

• Pilot workshop in 2002Pilot workshop in 2002

• 2 -3 workshops per year2 -3 workshops per year

• PARNW is a two day workshop - PARNW is a two day workshop - held on consecutive days held on consecutive days

• Offered free of charge to nursing Offered free of charge to nursing staff at CHWstaff at CHW

Challenge and ChangeChallenge and Change

• Overcome perception that asthma Overcome perception that asthma education is one person or one service education is one person or one service responsibilityresponsibility

• Asthma education and management is a Asthma education and management is a part of our everyday clinical practicepart of our everyday clinical practice

• Underpin clinical and educational Underpin clinical and educational practice with Practice Developments practice with Practice Developments conceptsconcepts

• Advanced accreditation for Registered Advanced accreditation for Registered Nurses on Medical Wards to stretch Nurses on Medical Wards to stretch Inhaled VentolinInhaled Ventolin

Aim and ObjectiveAim and Objective

Aim:Aim:• Increase the knowledge, skills and Increase the knowledge, skills and

confidence of nurses caring for children confidence of nurses caring for children with asthma in an acute settingwith asthma in an acute setting

Objective:Objective:• Identify and address clinical, Identify and address clinical,

community issues related to paediatric community issues related to paediatric asthma management and educationasthma management and education

Program DesignProgram Design

• Developed using feedback from Developed using feedback from nursing staff at CHWnursing staff at CHW

• Frame work is the NAC six step Frame work is the NAC six step asthma management planasthma management plan

• Modules Modules contextualisedcontextualised to paediatric to paediatric setting using case studiessetting using case studies

• Pre and post confidence, knowledge, Pre and post confidence, knowledge, skills assessment and process skills assessment and process evaluationevaluation

Program DesignProgram Design

• Based on adult learning principlesBased on adult learning principles

• Small and large group workSmall and large group work

• Interactive teaching sessions and Interactive teaching sessions and role playrole play

• Comprehensive resource folderComprehensive resource folder

Program Content-Day Program Content-Day OneOne

• Registration and welcomeRegistration and welcome• Overview of National Asthma Overview of National Asthma

Council Council • Pathophysiology reviewPathophysiology review• Assessing asthmaAssessing asthma• Asthma medicationsAsthma medications• Monitoring asthmaMonitoring asthma• Asthma in the communityAsthma in the community• Respiratory assessmentRespiratory assessment• HomeworkHomework

Program Content-Day Program Content-Day TwoTwo

• Stretch inhaled ventolin- asthma care Stretch inhaled ventolin- asthma care pathpath

• Inhalation devicesInhalation devices• Triggers Triggers • AdherenceAdherence• Reducing medication and asthma Reducing medication and asthma

action plansaction plans• Asthma educationAsthma education• Knowledge to practiceKnowledge to practice• EvaluationEvaluation

ResultsResultsAsthma Knowledge ScoreAsthma Knowledge Score

0

10

20

30

40

50

60

70

80

90

100

Knowledge (Newcastle Knowledge questionnaire)Pre PARNW One month post PARNW

Results Results Confident & Very Confident in:Confident & Very Confident in:

0

10

20

30

40

50

60

70

80

Teachingspacer use

Talking tocolleagues

about asthmamx

Talking tochildren abouttheir asthma

Pre PARNW One month post PARNW

Results Results Example of some performed steps Example of some performed steps

correctly when using a puffer with spacercorrectly when using a puffer with spacer

0

10

20

30

40

50

60

70

80

90

SkakeInhaler

Inspiration SlowInspiration

DeepInspiration

Pre PARNW One month post PARNW

Process EvaluationProcess Evaluation

• Interactive sessionsInteractive sessions• Increased skills and confidence Increased skills and confidence

using inhalation devicesusing inhalation devices• Understanding of asthma severityUnderstanding of asthma severity• Understanding of asthma action Understanding of asthma action

plansplans• Great workshop and should be a Great workshop and should be a

part of new graduate education dayspart of new graduate education days

Self Reported Confident Level-Day Self Reported Confident Level-Day OneOne

XXXXX

Not at all Confident

Very Confident

ConfidentXXX

XXX

Self Reported Confident Level- Day Self Reported Confident Level- Day TwoTwo

Not at all Confident

Very Confident

Confident

XXXXXXXXXXX

Future DirectionsFuture Directions

• Continue to challenge existing Continue to challenge existing practicepractice- Stretching of Inhaled VentolinStretching of Inhaled Ventolin- Asthma Care PathAsthma Care Path- Underpin workshop with Practice Underpin workshop with Practice

Development conceptsDevelopment concepts

• Evidence based practiceEvidence based practice

• 5 year outcome evaluation 5 year outcome evaluation

Future DirectionsFuture Directions

• Publication of resultsPublication of results

• Capacity building at CHW and Capacity building at CHW and SWAHSSWAHS

• Clinical assessment tools for:Clinical assessment tools for:- Asthma education sessionsAsthma education sessions

Child and Child and FamilyFamily

Research

Education lies at the interface of research, clinical and community

management

Clinical Management

Health Professionals

Community Management