Solutions: Education and Advocacy
Education is power to influence beliefs and change the behaviors of people in position to influence policies. Advocacy involves actions taken to change systems. Nurses are natural and passionate educators and advocates. Nurses are, therefore, able to influence community change at both the family and policy-development levels. Both education and advocacy are instrumental in empowering families and communities to ensure the health of children with asthma and allergies in schools.
Nurses can help prevent school deaths due to asthma and anaphylaxis by taking a multi-faceted approach. In addition to teaching children and their families about asthma management, nurses can teach parents about school laws, policies, and codes affecting student medication use. Nurses should stress to parents the critical importance of filing required medication permission forms properly before the school year begins.
To educate families about interfacing with the schools around these issues, nurses can share necessary information with parents. In addition, nurses can also channel parents to organizations and services that will help them prepare students with asthma and anaphylaxis each school year:
Families, educators, and health care providers can use "Asthma and Allergies at School," a kit developed by Allergy & Asthma Network Mothers of Asthmatics (AANMA) to ensure a safe and healthy learning environment. The kit includes how-to instructions, promotes interaction and communication, provides practical examples and problem solving strategies, and contains tips and checklists (see Table 1). The kit can be ordered for $10.00 (plus $3.00 shipping and handling) by calling AANMA at (800) 878-4403 or visiting the Web site at http://www.breatherville.org in the "General Store."
The "School House" section of the AANMA Web site (http://www.breatherville.org) offers tips and printable pages for families.
The Food Allergy and Anaphylaxis Network (http://www.foodallergy.org) also offers tips for parents of schoolchildren with food allergy reactions.
The Environmental Protection Agency's comprehensive Indoor Air Quality Tools for Schools (EPA TfS) kit was designed to help schools take low-or no-cost measures to improve indoor air quality and remove common classroom allergens and irritants known to produce symptoms. The kit is complete with an individual Problem Solving Wheel, videos, and worksheets. The entire kit (except for the videos and IAQ Problem Solving Wheel) can be down-loaded from the following Web site: http://www.epa.gov/iaq/schools/scfaqs.html (Single kits are free and can be ordered by calling [800] 438-4318). Congressman Cliff Stearns (R-FL) sent kits to all schools in his district. In follow-up, he found that many schools were simply not aware of the potential for indoor air quality problems, but those with school nurses were more likely to enthusiastically support the program.
It is also possible for nurses to work with AANMA and local American Lung Association (ALA) volunteers to implement educational programs for students in the schools. The ALA Open Airways programs are a great way to teach young children about asthma and allergies while reinforcing existing treatment plans.
Nurses and parents separately, or ideally together, can educate school system personnel on asthma and allergy-related issues. In-service programs tailored to educational needs of a school board, local teachers, and/or school administrators can address issues of air quality in the schools, the life-threatening nature of asthma and allergies, medication use, and the like.
Key points in presenting can include:
Descriptions of asthma and anaphylaxis
Importance of using the prescribed treatment plan and self-management skills in the school setting as well as at home for students with these conditions
Simulation of asthma and anaphylaxis symptoms (Distribute coffee stir straws to school personnel and ask them to breathe only through the straw for as long as possible during the presentation.)
Importance of clean indoor air
Classroom pets such as dogs, cats, bunnies, hamsters, or chicks
Carpeting that retains mold spores, odors, and dust mites
Regular inspection, cleaning, and air filter changes on airhandling systems to prevent circulating allergens and irritants
Common myths and concerns about these conditions are found in Table 2.
Nurses and parents can unite with their communities to ensure school boards, principals, and state and local lawmakers create better policies. To begin direct advocacy efforts, nurses, together with families, can call local school principals, the school board, and the public health department to determine:
if a full-time registered nurse staffs each school's clinic.
policies regarding student rights to carry lifesaving medications.
the process for maintaining allergen-and irritant-free indoor air quality.
Based on what is learned, a coalition of nurses, physicians, parents, teachers, and others can be formed to promote greater awareness of the issues uncovered and to propose possible solutions to elected officials.
Key approaches in advocacy include the following:
Every state, school district, and locality is unique; locate the public health department and the school nurse consultant to learn about state and local laws and policies referencing children with asthma and anaphylaxis. You may find that there is no law or policy or that the language is vague. You may find policies or laws exist but they are not enforced at the school level.
Where they exist, examine laws and policies carefully. Do they protect a student's right to carry and use prescribed lifesaving medications? Look for words such as "may" or "can," as these are the eternal loopholes many schools cite when restricting student access to medications. Work with legislators and policy makers to change these words to "shall" and "will."
Laws and policies should make provisions for students who may not be emotionally or physically capable of detecting early warning signals, or responding to symptoms, to have immediate access to medication via the student's teacher.
Contact the local school board and ask to be put on the agenda for their next meeting. Make a presentation about asthma and anaphylaxis, common myths (see Table 2), and opportunities to improve school policies affecting student health.
Form local coalitions with teachers, physicians, respiratory therapists, and others to improve laws and policies affecting students with life-threatening, chronic health conditions. Such groups can rally support for placing a school nurse in every school building within the district.
Contact the local press each "back-to-school" season to remind parents it is time to revisit the child's asthma and anaphylaxis treatment plan and coordinate health needs with school administrators.
Join in the national effort to address these concerns. AANMA, a leading, nonprofit patient education and advocacy organization, is dedicated to eliminating death and suffering due to asthma, allergies, and related conditions. AANMA along with the National Association of School Nurses; the American College of Allergy, Asthma, and Immunology; the American Academy of Allergy, Asthma and Immunology; and others are working with members of Congress to change laws and protect student rights. Current issues include efforts to increase the number of school nurses in schools, protect student rights to carry lifesaving medications while at school, and establish clean indoor air standards for our nation's schools. Nurses and parents can join this effort. For more information, contact AANMA at (800) 878-4403, E-mail mmagnetti@aanma.org, or visit "City Hall" on AANMA's patient education Web site: http://www.breatherville.org
No child should die of an asthma attack or anaphylactic reaction at school without the chance to use life-saving medications in a timely, prescribed manner. Nurses and families can make the difference.
Pediatr Nurs. 2002;28(6) © 2002 Jannetti Publications, Inc.
Cite this: Making the Grade With Asthma, Allergies, and Anaphylaxis - Medscape - Nov 01, 2002.
Comments