An intervention to increase the use of Asthma Action Plans in schools: a MASNRN study.

School nurses, in collaboration with primary care providers (PCPs), can work to better manage asthma by using the Asthma Action Plan (AAP) with peak flow monitoring. The aim of this pilot study was to determine the effectiveness of an intervention to increase the number of AAPs in schools for students with asthma by having school nurses provide the students' peak flow measurements to their PCPs with a request for an AAP. The study found a significant increase in AAPs when school nurses provided PCPs with accurate peak flow data and requested an AAP from the PCP than when school nurses requested an AAP via the students' parents and did not provide peak flow data to the PCP. This study provided data on the importance of collaboration with PCPs in order to affect better care for children with asthma.     

在职护士离职意愿及其相关因素调查分析

目的探讨在职护士的离职意愿现状及其相关因素,为临床制定人力资源管理的相关措施提供依据。方法采用问卷调查法对北京某三级甲等医院的250名护士进行调查。结果在职护士离职意愿属轻中等程度;大专学历的护士离职意愿高于其他学历的护士(P<0.05),偶尔有临床带教的护士离职意愿高于没有及经常有临床带教的护士(P<0.05),工作15年以上的护士离职意愿最低,与其他工作年限组相比较,有统计学意义(P均<0.05)。造成在职护士产生离职意愿的主要原因按程度高低排序前三位为:福利待遇,管理与医院政策,职业本身特点。结论建议医院及护理管理者采取有效措施以降低在职护士离职意愿,并在提高护士福利待遇、调整管理政策、减轻护士工作压力等方面给予足够重视。     

School nurses' knowledge and beliefs about the management of children with ADD.

The purpose of this study was to examine school nurses' knowledge and beliefs about the management of children with attention deficit disorder (ADD). Seven hundred eighty-six school nurses responded to mailed surveys regarding their attitudes and knowledge about the management of children with attention deficit disorder. Surveys were mailed to school nurses randomly selected from the membership of the National Association of School Nurses. School nurses' knowledge of school management of ADD and their attitudes about physicians' participation as part of a team effort in this care were explored. School nurses responded that physicians should increase their efforts to educate children and parents about ADD. Recommendations for school nurses in the management of children with ADD are offered.     

哮喘儿童自我管理教育的评估

目的：评估哮喘儿童自我管理教育的效果。方法：对５４例哮喘儿童自我管理教育前后１ａ的肺功能、哮喘发作情况、医疗费用,以及自我管理知识和技能、治疗依从性进行自身对照研究。结果：病人教育后,呼气峰流速（ＰＥＦ）及其变异率（ＰＥＦＲＶ）有明显改善（Ｐ＜０．０１）。哮喘引起的急性发作和急诊、住院次数、缺课、父母缺勤和使用口服激素、支气管扩张剂日数,以及医疗费用皆显著减少（Ｐ＜０．０１）。结论：自我管理知识和技术（认识哮喘、环境控制、吸入技术、峰流速仪使用和监测）,以及治疗依从性皆显著提高和改善（Ｐ＜０．０１）。     

不同剂量甲基强的松龙治疗重症哮喘的效果

目的评价不同剂量甲基强的松龙（甲强龙）治疗重症哮喘的效果。方法将60例重症哮喘病人随机分为A、B组,分别静脉应用甲强龙40、60mg,均为每8h注射1次,平均治疗3～5d,观察两组病人的临床疗效、肺功能改善及并发症情况。结果两组治疗前后最大呼气流量、用力肺活量、一秒钟用力呼气容积差异有显著性（t=10．74～19．65,P均〈0．01）;两组间治疗效果比较差异无显著性（H=0．068,P〉0．05）;B组并发症明显多于A组,差异有显著性（x^2=11．52,P〈0．05）。结论甲强龙40mg,每8h注射1次治疗重症哮喘病人较为适宜。     

School nurses' experience with administration of rectal diazepam gel for seizures.

The purpose of this study was to determine school nurses' knowledge of state and school district policies, their experience regarding the administration of rectal diazepam gel in the school, and the perceived benefits and barriers of providing this treatment. Four hundred nineteen nurses responded to a survey conducted during the National Association of School Nurses Annual Meeting. Seventy-one (18%) nurses surveyed had administered rectal diazepam gel in a school setting, while 54 (13%) nurses reported that either their state practice act or school district prohibited them from giving rectal medications in the school. Medication administration benefits, such as early intervention for treatment of acute seizure emergencies, were noted. Barriers were also identified, with lack of privacy as the most frequently listed. Scope of practice as it pertains to administering medication in the school and the extent to which delegation of duties can be used in the situation of administering rectal medication in a seizure emergency remain issues for school nurses.     

Characteristics of subjects with a high frequency of emergency visits for asthma

The determinants of frequent visits to the emergency department (ED) for asthma were evaluated in 30 patients who made 2 or more ED visits for asthma (mean, 3.1; range, 2 to 9) over a period of 1 year. They were matched for age, sex, and medication with a control group of asthmatic patients who had made no ED visits within the same period. Evaluation included measurements of expiratory flows (baseline FEV₁; PEFR 4 times daily for 3 weeks), airway responsiveness to methacholine, perception of induced bronchoconstriction, and questionnaires on quality of life and knowledge of asthma and its management. In comparison with the control group, the study group showed a trend toward inferior socioeconomic status, education level, and technical abilities (eg, inhaler use). Both groups had similar baseline FEV₁, reversibility of airflow obstruction, methacholine-induced changes in expiratory flows, and perception of bronchoconstriction. Diurnal variation in PEFR was slightly increased in the study group. Absenteeism from work or school was higher in the study group but quality of life score was similar to controls. Patients with frequent ED visits showed significantly lesser knowledge of asthma control criteria, as well as an overall trend toward reduced asthma management knowledge and skills. In conclusion, in addition to the previously reported undertreatment of asthma, other factors such as insufficient asthma management knowledge and skills may contribute to frequent ED visits for asthma.     

What Level of Knowledge Do Elementary School Teachers Possess Concerning the Care of Children With Asthma? A Pilot Study

A self-report questionnaire was used to assess the level of knowledge among a convenience sample of 34 elementary school teachers in a rural school district in Illinois. The questionnaire addressed general asthma knowledge and management, including signs and symptoms, triggers, and treatment. The results suggest a knowledge deficit among this sample of elementary school teachers; the average score was 75%. Teachers with an increased exposure/experience with asthma scored significantly higher than did those with limited exposure. Implications of these findings for schools in rural areas are discussed.     

小剂量雷公藤佐治儿童糖皮质激素依赖性哮喘的效果

目的探讨小剂量雷公藤佐治糖皮质激素依赖性哮喘的效果。方法40例糖皮质激素依赖性哮喘病儿随机分为治疗组和对照组（n=20），两组病儿均给予吸人普米克干粉剂，在发作期吸人β2受体激动剂，严重时口服糖皮质激素治疗。治疗组在此基础上加用雷公藤0．5mg／（kg·d），分为2～3次口服，治疗6个月后评定疗效。结果治疗组在糖皮质激素较快减量的过程中峰值流速（PEFR）始终在预计值的80％以上，糖皮质激素的维持量明显小于对照组（t=-4．73，P〈0．01）。治疗后两组肺功能均较治疗前明显改善，治疗组肺功能优于对照组（t=2．493～3．476，P〈0．05）。结论小剂量雷公藤佐治糖皮质激素依赖性哮喘病儿效果满意。     

Family perceptions of medication administration at school: errors, risk factors, and consequences

Medications are administered every day in schools across the country. Researchers and clinicians have studied school nurses' and educators' experiences with medication administration, but not the experiences of children or their parents. This study examined medication administration from the child and parent perspectives to (a) determine problems children experience with medicines at school, (b) clarify risk factors for medication errors, and (c) examine the perceived impact of medication errors on school performance and social relationships. Participants included children ages 8 to 18 years (n=157) being treated at a large Midwestern Children's Hospital in diabetes, asthma, and Attention Deficit Hyperactivity Disorder (ADHD) clinics. Findings suggest that forgetting a dose and running out of medication were the most common problems. Missing a dose was more frequent in students with ADHD than in students with diabetes or asthma. Medication nonadherence at school, which includes medication administration errors such as missing a dose, may potentially lead to a variety of educational, social/emotional, and physical consequences. These results indicate that the impact of missing medication on children with ADHD appeared to have a greater effect on schoolwork and friendships, while the physical consequences appeared to vary widely based on health condition. Interestingly, children with more self-responsibility for medications were less likely to report medication errors. School nurses will want to include students when planning for medication management at school.     

Nurses' attitudes towards perinatal bereavement support in Hong Kong: a pilot study

The purpose of this study is to explore nurses' attitudes towards perinatal bereavement care and to identify required support and training needs for nurses on bereavement care in Hong Kong. Data were collected through a structured questionnaire, and 110 nurses were recruited from the obstetrics and gynaecology unit in one of the largest public hospitals in Hong Kong. The majority of nurses held a positive attitude towards bereavement care. A significant difference in nurses' attitudes towards bereavement support was found in terms of demographics, practical experiences and training factors. The results showed that only 25.5% (n = 28) of nurses had bereavement-related training. In contrast, 90.9% of nurses showed a positive response to grief training and 90.0% would share experiences with colleagues and seek support when feeling under stress. The findings also suggest that nurses' attitudes towards bereavement care are positively correlated with bereavement care training needs (r = 0.53) and hospital policy support (r = 0.55). Hong Kong nurses' attitudes towards perinatal care emphasized their need for increased knowledge and experience, improved communication skills, and greater support from team members and the hospital. These findings may be used for Hong Kong health care professionals to improve support of nurses, to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.     

Empowering students on medication for asthma to be active participants in their care: an exploratory study.

This article is part of a larger study of young students with asthma. It focuses on the observations of school nurses and comments from parents and students pertinent to school nursing practice. The study shed light on the educational needs of 9- to 11-year-old students with asthma and identified some areas where the school nurse could easily enhance the health management of these students. Responses from students and parents about asthma provided insight into the daily challenges faced by students with asthma. Students with asthma may or may not fully understand the seriousness of their chronic condition or how to recognize and treat symptoms. The purpose of this pilot study was to identify strategies school nurses might use to determine the knowledge level of students and to determine the effects of asthma education programs. School nurses who participated in the study were provided with a comprehensive package containing current asthma information and an education program to update knowledge and skills. These school nurses also received Open Airways for Schools, an American Lung Association education program for students in grades three to five. The study was a two-group exploratory, quasi-experimental design. Questionnaires were prepared for students, school nurses, and parents to collect information on knowledge and perceptions about asthma. Students who participated in the educational program were reported by their school nurses to have increased knowledge and management skills related to their disease.     

Trends in hospital-based management of acute asthma from a teaching hospital in South Asia

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved care included frequent use of pulse oximeter, preference of inhaled over systemic bronchodilators and increased use of systemic steroids. Significant deficiencies were identified in hospital-based management of acute asthma. Most aspects of asthma care continued to fall short of asthma guidelines.     

自我管理教育在门诊胃食管反流性哮喘患者中的应用

目的：探讨门诊自我管理教育在胃食管反流性哮喘患者自我管理中的应用效果。方法便利抽取呼吸科门诊的胃食管反流性哮喘患者71例为研究对象,按就诊单双号分为观察组35例和对照组36例,对照组给予常规药物治疗和门诊指导,观察组在药物治疗的基础上给予系统性门诊自我管理教育,总管理时间为6个月。比较教育前后两组患者的胃食管反流症状、哮喘控制水平、肺通气功能改善程度。结果干预后,观察组患者胃食管反流症状评分为（5．1±1．2）分,低于对照组评分（6．8±1.6）分,两组比较差异有统计学意义（t＝5．07,P＜0．01）;观察组哮喘控制自评得分为（23．5±0．6）分,高于对照组自评得分（22．7±0．9）分,两组比较差异有统计学意义（ t＝4．41,P＜0．01）;观察组在肺通气功能指标方面1秒用力肺活量占预计百分比（ FEV1％）为（87．4±3．9）％、1秒率（ FEV1/FVC％）为（86.7±3．1）％、峰流速（PEF）为（8．8±1．8）L/s,分别高于对照组的（83．4±4．6）％,（84．3±4．2）％,（7．7±1.2）L/s,两组比较差异有统计学意义（t值分别为3．96,2．74,3．05;P＜0．01）。结论门诊自我管理教育能提高胃食管反流性哮喘患者的自我管理水平,可缓解患者的临床症状,提高患者的肺功能。     

Swedish school nurses' view of school health care utilization,causes and management of recurrent headaches among school children

The present survey was addressed to a representative, nationwide sample of Swedish school nurses and 174 (69%) responded. They were asked about their views on: (i) the most usual problems for students that prompt attendance at school nurses' offices; (ii) the causes and management of school children's headaches and (iii) the school nurses' own education with respect to headaches. Headaches were reported to be one of the most common problems among adolescents visiting the school nurses' offices and tension-type headaches were regarded as a more serious school health problem, compared with migraine. Various stressors such as family and peer problems were regarded as important causes of recurrent headaches. In addition, the school nurses mentioned too little physical activity, sleep problems and poor eating habits as related factors, in particular among students with tension-type headaches. Common management approaches used by the school nurses were to provide information about headaches or supportive discussion, recommend follow-up visits, perform vision tests and refer students to a school physician. About one-fifth to one-third of the school nurses often gave analgesic medication to students because of headaches, most commonly used were paracetamol followed by various NSAIDs. Most of the school nurses regarded relaxation training as an "effective or very effective" treatment for both migraine and tension-type headaches, whereas palliative and prophylactic drug treatments were seen as more effective for migraine. It is suggested that school nurses, who often provide the first line of treatment for school children and adolescents with recurrent headaches, also should administer a cost-effective treatment such as relaxation training in school settings, where many of the headache episodes occur. However, school nurses also need to be properly trained to ensure quality in delivering such treatment approaches.     

Enabling overweight children to improve their food and exercise habits - school nurses' counselling in multilingual settings

Aims and objectives. The study aimed at analysing school nurses' counselling of overweight and obese children in settings with many immigrants, focusing on content concerning food and physical activity and how this was communicated. Background. For people with a predisposition for overweight, the weight control process requires cognitive skills. School nurses' counselling of overweight children has the potential to support this process by enabling personal resources in the children and their families. However, there is uncertainty among nurses about how to conduct supportive counselling. Design. An explorative design was used when collecting and analysing data. Method. Twenty-two counselling sessions between eight school nurses and 20 overweight children were audio-recorded and analysed using qualitative content analysis. Most of the participating schools represented areas with low socioeconomic status and a high proportion of immigrants and refugees. Results. Less adequate skills in enabling resources in the children and their parents were observed. Concurrently, school nurses provided inadequate explanations about food and physical activity. Topics related to general nutrition models were frequently communicated as general advice instead of individually tailored counselling. Counselling families with other languages and food cultures than the traditional Swedish created additional difficulties. Conclusions. Improved nutritional knowledge for nurses may enhance their skills in enabling children's and families' resources. School nurses should be provided with opportunities to cooperate with other professions in counteracting overweight. Relevance to clinical practice. Our findings demonstrate a relationship between content skills and person-centeredness in the counselling. This highlights the importance of inter-professional collaboration to ensure a high quality of lifestyle counselling. School health authorities should give high priority to facilitating school nurses' evidence-based continuing education.