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A Partnership in Treating Childhood Asthma
of three different types of inhaler – the turbo haler, the metered dose inhaler (MDI) with built-in spacer, or the disk haler. In other cases, some children and families prefer to use pills. When using oral medications, the family should be given choices regarding dosing times, rather than the nurse dictating dosage times. Keeping these findings in mind, medication plans can be formulated that maximize adherence while meeting the needs of the child and family (“Strategies”, 2002).
Nurses teaching children and families about asthma should address the issue of how the child/parent will remember to use the medications directly. One strategy to promote adherence is to help the patient associate daily activities with the medication; for example, keep medications in plastic bags attached to the refrigerator by magnets. Families should also be reminded not to leave medications in the car or in climates with extreme temperatures. Some families may seek alternative medicine therapies for asthma, many of which are well accepted in their culture. Therefore, it is important that the nurse asks specific questions about any therapies the family is using in addition to what has been prescribed by traditional healthcare providers. If these treatments are not harmful, they can be incorporated into the medical plan (“Strategies”, 2002).
While the management plan is essential, it is important to limit the written material to a manageable amount for the child and family. All handouts should be concise and written at the patient’s reading level. One way to check appropriateness is to ask patients and parents to read material you give them while they are still at the visit, and then ask them to restate what they read. It is important to review the written materials with the patient, stressing the most important points. It is also helpful to have handouts with space available so the nurse can write individualized information for the child or parent (“Strategies”, 2002).
Developmentally appropriate reinforcement strategies should be devised in any asthma program. Some have successfully used contingency contracts, whereby the child and the nurse decide upon specific behavior, which result in a reward. If a contingency contract is used it should be clear, positive and consistent. Rewards can be given for completion of peak flow or medication charts as verified by the responsible adult. For the school-age child, the asthma program can sponsor a skating or pizza party for those who successfully complete their charts. Some programs offer scholarships to asthma camps as rewards (“Strategies”, 2002).
Parent education should include discussion of cognitive aspects of the child development and age-appropriate expectations for school age children. Nurses should avoid the use of the term “self-management” and include the term “partnership” to stress the importance of the supportive role of parents in the treatment plan. Nurses should teach parents assertive communication strategies for promoting collaboration with the school. Nurses need to send a written copy of the treatment plan to the school and provide periodic in-service education, ensuring key personnel, such as physical education coaches, are included. Parents should also be taught [next page]