Rural school nurses' asthma education needs.

School nurses play an important role in identifying children with asthma and providing care during school hours. Educational programs designed to improve nurses' asthma knowledge and practices have concentrated on urban settings. The purpose of this investigation was to determine asthma-related practices and educational needs of rural school nurses. A survey about asthma was mailed to school nurses in all counties of the state of Maryland and in Washington, D.C. Responses were compared between rural Maryland counties and counties from the remainder of Maryland and Washington, D.C. The survey addressed attitudes and beliefs, function and roles, medication administration, and educational needs about asthma. We found that rural nurses used peak flow meters less often to assess and monitor asthma, requested fewer referrals for asthma, had fewer interactions with health room assistants, and had reduced access to asthma educational resources. Also, they provided less asthma education in the schools than other school nurses. These results suggest a need for comprehensive asthma educational programs in rural areas that are based on national guidelines, and that address the unique needs of rural school nurses. These programs should also emphasize the need for open communication between rural school nurses, health room assistants, primary care providers, and parents/caregivers.

Role of rural school nurses in asthma management.

Environmental, socioeconomic, psychological and familial factors in rural communities predispose children to asthma. This is not only the case in the US but also in the UK, New Zealand and other Western countries. Asthma prevalence ranges from 2.2 to 15%. Because children spend at least 6 hours of their day in school, school health personnel must be attentive to, and skilled in managing the needs and issues faced by children with asthma while at school. Rural school nurses or their deputies need to advise children with asthma about avoiding aeroallergens from hay, smoke, dust, grain in silos and animal dander from cattle and sheep. In the case of children with asthma in rural areas, symptoms may be accepted as long as the child can go to school and play. Parents in rural areas may not believe in routine preventive care for asthma as part of public health practice. Rural nurses need to be aware of current asthma guidelines and apply the concepts to prevention. They need to be proactive and engage in primary, secondary and tertiary prevention. Rural school nurses can begin by using existing resources and adapting these resources for use in rural school environments. Worldwide asthma education is fundamental to asthma patient management.

Asthma education in rural communities.

Asthma is a common disease of airway obstruction in school-aged children. Adequate management of asthma in children leads to fewer missed school days, fewer hospitalizations, fewer emergency room visits, and an increase in quality of life. Most asthma educational programs and evaluations have focused on urban rather than rural populations. The purpose of this study was to identify parental asthma needs, develop rural asthma education materials, and evaluate the effectiveness of these educational materials in improving the knowledge and asthma care effectiveness of parents of children with asthma in a rural community. Seven parents were contacted by telephone and administered a pre- and posttest questionnaire analyzing their level of knowledge about asthma and their quality of life. Asthma educational materials were mailed to all parents in the study before administering the posttest. Results indicated that all parents needed additional education about asthma, especially regarding medications. Pre- and posttest scores showed improvements in three areas of knowledge: long-term asthma medications, controlling roaches in the home, and daily peak flow monitoring. There was a significant improvement between pre- and posttest results from the activity domain of quality of life. Eighty-five percent of the parents reported that they had either initiated changes in their home, or planned to in the future, from reading the educational materials. The parents' response to the educational materials that they received by mail was positive, indicating that they may not have received enough information about how to care for children with asthma before our study. The data suggest that distribution of asthma educational materials in rural communities can increase parental knowledge about asthma and lead to positive changes in behavior that can improve their children's health.

Factors associated with medication self-administration in children with asthma.

This study investigated factors associated with early self-administration of inhaled asthma medications by minority children. Specifically, the study evaluated: (1) the reasons parents allow early administration of inhaled medications, (2) childhood activities associated with early medication administration, (3) parent's perception of the child's ability to use a metered-dose inhaler (MDI), (4) the child's actual ability to use an MDI, and (5) concordance/discordance between physician-parent reports and parent-child reports of asthma medications. Study results indicated that 93% of the children were taking inhaled asthma medications without adult supervision. Early self-administration of asthma medications was related to the parent's employment status and the performance of other childhood behaviors such as completion of homework independently and crossing the street alone. Only 7% of the children had effective MDI skills, but 60% of the parents rated their child's MDI skills as excellent. Twenty percent, 67%, and 50%, respectively, of the parents' reports of beta-agonists, daily inhaled steroids, and cromolyn were discordant with the physician's actual prescriptions. Sixty-two percent, 57%, and 79%, respectively, of the children's reports for inhaled beta-agonists, daily inhaled steroids, and cromolyn were discordant with their parents' reports. Implications for anticipatory guidance, future educational strategies, and supervision of MDI technique are provided.

Asthma knowledge, roles, functions, and educational needs of school nurses.

In October 1997, 790 school nurses in Maryland and the District of Columbia were surveyed to determine their attitudes, knowledge, and beliefs about asthma. Results for 550 (70%) nurses indicated school nurses possess a generally appropriate level of knowledge concerning asthma, and most asthma myths have been replaced with knowledge. However, school nurses also have varied responsibilities that affect their ability to provide health education and support services to children with asthma at school. Little time is available for a proactive role. Concerns about the criteria and follow-up for delegating medication administration within the school setting were reported. A lack of communication existed with parents about the child's asthma. Open communication between school nurses and the family is recommended to establish a partnership and improve asthma management outcomes. In addition, school policies and procedures should be updated to meet the demands of children with asthma.

Parental smoking behavior and passive smoke exposure in children with asthma.

BACKGROUND: Smoking parents of children with asthma frequently report modifying their smoking behavior to reduce their child's smoke exposure. Research has not analyzed the association between parental efforts and the child's smoke exposure. OBJECTIVE: To determine passive smoke exposure and the relationship of self-reported parental modifications in smoking behavior to smoke exposure in children with asthma. METHODS: Parents of children seen in an inner-city Asthma and Allergy Outpatient Clinic completed questionnaires to evaluate their smoking behavior and modifications they made to decrease their child's exposure to cigarette smoke. Urine specimens were collected from the children to determine smoke exposure as measured by urinary cotinine/creatinine ratios. RESULTS: Children from homes with smokers had higher mean urinary cotinine/ creatine ratios than children from smoke free homes (30 versus 4 ng/mg; P = .0005). Cotinine/creatinine ratios increased with the number of smokers in the home. When the parent was the only smoker in the home, the mean urinary cotinine/creatine ratio of children whose parent smoked outside the house was lower than the mean of children whose parent smoked inside (21 versus 51 ng/mg; P = .038). With only one smoker in the home, there was no difference in mean cotinine/creatinine ratios when the primary caregiver was not the smoker versus when the primary caregiver was not the smoker (27 versus 15 ng/mg; P = .10). CONCLUSION: Smoking outside the house was associated with lower urinary cotinine/creatinine ratio only when the parent was the only smoker in the home.

Motivation, social support, and knowledge of parents who smoke and who have children with asthma.

Motivation to quit smoking, social support and knowledge of asthma were investigated in a group of parents (n = 39) who smoked and whose children had asthma. Parents who reported smoking only outside the house had higher rankings on a motivation to quit smoking measure than parents who reported smoking inside the house. Parents who smoked had less knowledge of asthma when compared to parents who did not smoke. Parents who smoked and reported joining a smoking cessation program had more knowledge of asthma than parents who smoked but did not join cessation programs. Analysis of urinary cotinine in the children revealed no associations between urinary cotinine and motivation to quit smoking, social support and/or knowledge of asthma.

Enhancing pediatric health care with music.

The pediatric nurse practitioner can use music therapeutically in a variety of clinical situations. Literature supports the effectiveness of music in reducing anxiety based on psychologic and physiological outcomes. Music also enhances standard therapeutic modalities and increases patient satisfaction. Specific interventions should be based on the child's stage be based on the child's stage of development.

Psychosocial predictors of consumption of sweets following smoking cessation.

The use of a theoretical model to predict consumption of sweet-tasting high-calorie foods following smoking cessation was investigated. The model included eight predictors: habit, intention, attitudes, subjective norms, self-efficacy, perceived barriers, social support, and smoking cessation. One hundred and fourteen individuals completed pre- and post-questionnaires and made pre- and post-snack choices at smoking cessation programs. Pretest consumption of sweets (habit), pretest intention to avoid eating sweets, and posttest smoking status explained 42% of posttest consumption of sweets. Ex-smokers reported eating more sweets and chose more sweet snacks than did subjects who continued to smoke.

A pediatric rehabilitation experience for undergraduate nursing students.

Pediatric rehabilitation is a specialty that will need more nurses in the future. A clinical rotation in this specialty was incorporated into the pediatric experience of junior-year baccalaureate nursing students at the University of Maryland School of Nursing. The experience helped students to learn more about the nursing care involved in pediatric rehabilitation, to appreciate the different disciplines within the specialty, and to view pediatric nursing from a holistic long-range perspective. The experience also strengthened ties between nursing education and practice.

Adolescent smoking: influential factors, past preventive efforts, and future nursing implications.

Every year, one million youths begin to smoke cigarettes. Authorities agree the best approach to adolescent smoking is prevention. However, before nurses can implement any preventive efforts, they must understand the factors that influence adolescent smoking. Recent research indicates that a combination of biological, psychological, and social factors are necessary for the initiation of smoking. Preventive programs that reduce the rate of smoking have combined these factors and have aimed to increase the personal and social skills of adolescents. Nurses who work with adolescents and their families can and should incorporate this information into their practices.

Fostering positive self-concept in the school-age child.

Self-concept provides the basis for personal growth and healthy development in the school-age child. Pediatric nurses working with this age group need to understand this concept and use specific nursing interventions that will enhance and promote the development of a positive self-concept.

Adolescents and rooming-in.

This study was designed to investigate the relationship of two different types of postpartum care (one with rooming-in and one without) in terms of: the infant care instruction received by adolescent mothers, the adolescent mother's perception of her infant, the adolescent mother's comfort in infant caretaking skills, and the adolescent mother's satisfaction with nursing care. Sixty-four postpartum adolescents were interviewed at 2 days and 4 weeks postpartum using six measurement instruments. When compared to adolescents who did not experience rooming-in, adolescent mothers who had rooming-in received more teaching related to cord care (p less than .01). Mothers with rooming-in perceived the average infant as crying less at both 2 days and 4 weeks postpartum (p less than .05). In addition, rooming-in mothers were significantly more satisfied with nursing care (p less than .001). Findings suggest that there may be advantages to rooming-in for adolescents and indicate directions for future study.