Design for Change in Practice, Essay Example

Abstract

The importance of education and medication compliance for preventing of asthma exacerbation in adolescents is abundantly documented. This paper presents a detailed plan for change in nursing practice. The problem of poor education and medication compliance in teenagers with asthma is defined. The paper provides evidence-based solution to the problem. Steps from Rosswurm and Larrabee’s model are incorporated. A comprehensive and measurable plan for evaluation is proposed.

Keywords: medication, education, asthma, management, nursing.

Introduction

Asthma is one of the most common chronic health conditions in teenagers (Bruzzese et al, 2008). Teenagers demonstrate higher rates of asthma and face more frequent exacerbations than younger children (Bruzzese et al, 2008). They are more vulnerable to asthma exacerbations, because of poorer adherence to medication and fewer physician visits (Bruzzese et al, 2008). Almost every third adolescent fails to relate his (her) symptoms to asthma (Bruzzese et al, 2008). Early interventions have a potential to reduce and prevent the risks of irreversible airway obstruction (Jonasson, Carlsen, Sodal, Jonasson & Mowinckel, 1999). Therefore, the main problem can be defined as frequent exacerbations of asthma in teenagers, due to poor education and compliance with prescribed medication regimens.

Evidence-Based Solution

The current state of research suggests that education is an excellent way to improve asthma self- management in teenagers. School-based interventions improve medication compliance among teenagers with asthma (Bruzzese et al, 2008). Better medication compliance, in turn, reduces the frequency and severity of asthma exacerbations (Milgrom et al, 1996; Stern et al, 2006; Taddeo, Egedy & Frappier, 2008). Patient follow-up facilitates monitoring medication compliance among adolescents with asthma (Jonasson et al, 1999). Based on the current evidence, the best way to improve medication compliance and reduce asthma exacerbations in teenagers is to implement a broad, school-based program for adolescents and their parents and follow up adolescent compliance with the prescribed medication regimen.

Incorporating Steps from Rosswurm and Larrabee’s model and Evaluation of the Change in Practice

1. “Assess need for change in practice” (Rosswurm & Larrabee, 1999, p.320). Creating and implementing effective change in practice is impossible without having a full picture of the problem (Rosswurm and Larrabee, 1999). The change in practice is justified by the need to prevent asthma exacerbations in adolescents. That adolescents demonstrate poor compliance with prescribed medication regimens cannot be denied. Teenagers are less likely to visit their physicians for asthma care (Bruzzese et al, 2008). They lack medical knowledge and fail to relate their symptoms to asthma (Bruzzese et al, 2008). Factors of poor medication adherence in adolescents include but are not limited to developmental challenges, emotional issues, and family dysfunction (Taddeo et al, 2008). Poor self-management increases the severity of asthma exacerbations in teenagers; as a result, they tend to miss school, experience isolation, and demonstrate lower self-esteem than their healthy peers (Bruzzese et al, 2008).
2. “Link the problem with interventions and outcomes” (Rosswurm & Larrabee, 1999, p.323). Rosswurm and Larrabee (1999) suggest that Nursing Interventions Classifications and Nursing Outcomes Classification can help to define the problem in nursing terms and properly classify the desired interventions and outcomes. Based on the NIC and NOC, the prevention of asthma exacerbations in adolescents is possible through group education and telephone follow-up, which improve asthma self-management among teenagers.
3. “Synthesize best evidence” (Rosswurm & Larrabee, 1999, p.324). Evidence-based research justifies need for change in practice and confirms the relevance of group education and patient follow-up for preventing asthma exacerbations in teenagers. Bruzzese et al (2008) developed and implemented a pilot school-based study, which led to significant health improvements in teenagers. Caregivers reported that they “better solved problems with their children” (p.108). Adolescents recognized that they became more responsible in medication compliance and took more steps to monitor their health state (Bruzzese et al, 2008). Students reported fewer asthma complications during night time and less night wakening (Bruzzese et al, 2008). It should be noted, that repeated education is the factor of crucial importance for teenagers with chronic diseases (Taddeo et al, 2008). Patient follow-up contributes to medication adherence among teenagers with asthma (Jonasson et al, 1999). Improved medication compliance reduces the severity and frequency of asthma exacerbations in adolescents (Milgrom et al, 1996; Stern et al, 2006).
4. “Design a change in practice” (Rosswurm & Larrabee, 1999, p.325). Evidence-based research supports the creation of a new standard of nursing care for adolescents with asthma. According to the new standard/ protocol, nurses reduce the frequency and severity of asthma exacerbations in adolescents, through school-based group education and patient follow-up. Nurses develop and implement school-based group interventions to educate children about the symptoms and risks of asthma and communicate the importance of medication compliance for preventing asthma exacerbations. Nurses repeatedly engage adolescents with asthma and their parents in various education programs. Nurses follow up adolescents with asthma and their parents through telephone and the Internet, to monitor adolescent medication compliance.
5. Implement, evaluate, and maintain change in practice (Rosswurm & Larrabee, 1999). The implementation of the project was not possible, because of resource constraints. Yet, the desired intervention outcomes are obvious: prevention of asthma exacerbations in adolescents. The results of evaluation are based on feedback from nurses, teenagers, and their parents. Nurses report the benefits and problems during the program implementation. Nurses propose ways to facilitate change in practice. Teenagers report the number and frequency of asthma exacerbations before and after the intervention. Parents and teenagers fill out a brief survey and discuss their emotional responses to the project. Reduced frequency and severity of asthma exacerbations in adolescents after the intervention justify and confirm the feasibility of the proposed change in practice. These results necessitate the provision of resources to maintain the change in practice and enhance health outcomes for adolescents with asthma.

Plan for Evaluation

Patient and staff feedbacks are used to evaluate feasibility of the change. The coordinator monitors the process of implementation and reports his (her) questions and concerns (Rosswurm & Larrabee, 1999). Surveys serve the main instrument of data collection related to the evidence-based change and its outcomes. Teenagers and their parents report the number of asthma exacerbations before and after the intervention. Nurses report follow-up results. Quality improvement and cost data are used to make recommendations to adopt or reject change in practice (Rosswurm & Larrabee, 1999).

References

Bruzzese, J.M., Unikel, L., Gallagher, R., Evans, D. & Colland, V. (2008). Feasibility and impact of a school-based intervention for families of urban adolescents with asthma: Results from a randomized pilot trial. Family Process, 47(1), 95-113.

Jonasson, G., Carlsen, K.H., Sodal, A., Jonasson, C. & Mowinckel, P. (1999). Patient compliance in a clinical trial with inhaled budesonide in children with mild asthma. European Respiratory Journal, 14(1), 150-154.

Milgrom, H., Bender, B., Ackerson, L., Bowry, P., Smith, B. & Rand, C. (1996). Noncompliance and treatment failure in children with asthma. Journal of Allergy and Clinical Immunology, 98(6), 1051-1057.

Rosswurm, M.A. & Larrabee, J.H. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322.

Stern, L., Berman, J., Lumry, W., Katz, L., Wang, L., Rosenblatt, L. & Doyle, J.J. (2006).

Medication compliance and disease exacerbation in patients with asthma: A retrospective study of managed care data. Annals of Allergy, Asthma & Immunology, 97(3), 402-408.

Taddeo, D., Egedy, M. & Frappier, J.Y. (2008). Adherence to treatment in adolescents. Pediatrics & Child Health, 13(1), 19-24.