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A Partnership in Treating Childhood Asthma
for children with asthma to attain (1999)
The child ignored early symptoms, and this may be viewed as a desire to be “normal” since ignoring early warning signs results in worsening of symptoms and ultimately, greater interference with activities of daily living (Meng & McConnell, 2002). It seems as though she perceives her parents’ constant treatment reminders as negative or controlling feedback. It is possible that the child and parents perceive feedback from healthcare professionals as evaluative or controlling, as well. If this is the case, lack of internal motivation may lead to continued non-adherence decisions if not properly managed by the nurse.
In addition, the parents failed to recognize that nocturnal symptoms as an indicator that asthma is uncontrolled; hence they failed to make decisions that resulted in the child asthma classification raising from mild-intermittent to mild-persistent and a need for controller medication. Her parents also reported difficulty distinguishing a pseudo attack (common cough) from a true attack (asthma cough). Despite this inability, her parents were not using a peak flow meter consistently as an objective measure (Meng McConnell, 2002).
Both parents and child underutilized trigger avoidance strategies. The child’s behavior may be a reflection of the parent’s behavior since parents reported little active trigger avoidance decisions. Since her parents failed to make trigger avoidance decisions, it is unlikely that they proactively supported the children in this behavior (Meng McConnell, 2002).
The child was clearly concerned about having an attack at school, and not having access to medication or having to prove a need for it. The child’s greatest concern was exercise-induced asthma while at physical education class. The distance from the gym to the opposite side of the building where the medications were stored in the clinic caused anxiety that they would not have her medication in time of need. She recognized that slow warm-ups could prevent exercise-induced attacks but she pointed out that she did not always have control of this decision since many coaches direct otherwise (Meng McConnell, 2002).
The inhaler possession issue is crucial to this age group. Parents recognized the need to adhere to school policies, yet at the same time found the need to have the inhaler with the child. The children had learned to depend on the inhaler being with them or their mothers at all times, and this school policy represented a break in that security. Forcing children to “prove” their need for an inhaler to an adult before they can access it is challenging. According to Erikson, loss of control is a major stressor for school aged children, and the loss of the inhaler is, thus, a major event for some children (Palmer, 2001).
A study conducted by Horner revealed that there are important implications for nurses who work with children who have asthma. Clearly, nurses should create opportunities to educate teachers, coaches, school office staff, and others about the signs, symptoms, and seriousness of childhood asthma (1999). School nurses could partner with families to develop individualized asthma management plans for each child. These plans should include [next page]