Disclaimer: This toolkit is intended to provide resources for school nursing practice as it relates to the care of students with asthma in Oregon schools. This is not medical nor nurse practice advice and is not prescriptive as it relates to individual students or individual nursing practice. These resources do not override individual assessment, nor clinical judgement. Nurses are responsible for their own assessment and practice.
Asthma is the most common pediatric chronic disease globally (Carvahlo et al., 2016). It is a heterogeneous group of conditions that impact the inflammation and restriction of the lower airway (Hashmi, Tariq & Cataletto, 2020). Asthma management is not a one size fits all regimen, due to variability in severity and in asthma triggers. Asthma management is critical for school age kids as it relates to physical well being and quality of life, social development, and academic progress specifically related to absenteeism (Toyran et al., 2020; Hsu, Qin, Beavers & Miravell, 2016; Tesse et al., 2018).
Asthma management should ideally focus on maintenance and minimizing exacerbations of “asthma attacks.” While maintenance and therapeutic medication are not typically delivered in the school setting, school nurses can support maintenance of asthma with:
- Education to students, families, and staff
- Promoting healthy school environments
- Monitoring student health status and communicating with families and providers
- Maintaining asthma friendly policies and procedures
- Maintaining updated Individual Health Protocols, Asthma Action Plans, or Emergency Care Plans to address acute exacerbations at school
(Carvallo et al., 2016; Etsy & Phopatanakul, 2018; US Department of Health and Human Services, 2020)
Basic Disease Information
For review of Asthma Pathophysiology:
Legal Practice Standards
At the forefront of nurse case management for school nurses is the understanding of scope of practice as it relates to case management and delegation of nursing tasks in a community setting, as well as knowledge of applicable laws and regulations for health services in the school setting:
Oregon Revised Statutes pertaining to medication administration and written individual plans in Oregon Schools. ORS 339 [School Attendance, Admission, Discipline, Safety]
- 339.866 Self-administration of medication by students
- 339.869 Administration of medication to student
Evidence Based Practice
Public Access Practice Resources
The professional nurse in the school setting should understand the existing resources and framework for care of students with asthma.
Note: the following are national or regional resources that serve as a reference; they may or may not be consistent with Oregon law and do not supersede the Oregon Nurse Practice Act.
National Association of School Nurses (NASN)
Centers for Disease Control and Prevention (CDC)
School Nursing 101
American Lung Association
National Institutes of Health
National Institutes of Heart, Lung, and Blood Disorders
National Asthma Education and Prevention Program
National Jewish Health
Asthma and Allergy Foundation of America
Mayo Clinic
Environmental Protection Agency
Oregon School Activities Association
World Air Quality Index
Professional Development
Nurses must ensure that they have proficiency in areas of practice in which they delegate care tasks. The following include Free Continuing Education resources for Nursing related to asthma:
National Library of Medicine: Continuing Education Activity: Pediatric Asthma
Khan Academy
Asthma and Allergy Foundation of America
Communities in Action
Unlicensed Assistive Personnel (UAP) Training
In the state of Oregon there are specific state trainings required for care of students with medications, including those for asthma. Do note that teaching on inhaler use and nebulizer use, which are not included in the general state Medication Administration training, are also critical elements of UAP education for caring for students with those devices.
Asthma Presentation
Oregon Department of Education (ODE)
Video Training:
Templates
The following templates are modifiable for use by school nurses as it relates to their practice, and should be used in conjunction with Oregon State Board of Nursing delegation laws, and local school district policy.
Population Based Templates
Population based protocols are important for conditions where there may be a large representation of students who do not have individual plans due to lack of health maintenance, lack of medication at school, or no prior diagnosis. For these situations a standardized plan is critical.
In addition, other supporting policies may be prudent for the school environment, such as a fragrance free policy:
Individualized Health Plans
An individualized health plan is the totality of the plan that includes all applicable procedures for students with chronic disease. Because these are intended to be individualized, the attached is an example of a compiled IHP for designated caregivers that can be modified for individual use.
Nursing Care Plan
For districts that use nursing care plans, please find an editable template here:
Teacher Notification
Teacher notifications, sometimes referred to as health status notifications or health information pages, can be used or combined with emergency action plans to ensure that all staff working with a student with asthma are informed of diagnosis and immediate actions when necessary. These are abbreviated documents to provide critical information, but less comprehensive information than a complete IHP. This is a modifiable form for teacher notification:
Procedures
Procedures also greatly vary by student health status, needs, level of care, and type of medication regimen. The following are sample templates for specific procedures. A complete student assessment should be made to determine appropriate procedures:
Asthma History
An asthma history may be used to collect baseline information for new or transfer students with asthma.
Authorizations
Prescriber Order Templates
Self-Management
504 Accommodations
About
Author: Jan Olson
Peer Reviewers:
Lead: Kathryn Carney
Lisa McEntire
Windy Sigler
Madison Morrow
Editorial Reviewers: Wendy Niskanen & Heather Godsey
References
Asthma and Allergy Foundation of America (n.d.) Albuterol in Schools. https://www.aafa.org/albuterol-in-schools/
Carvalho Coelho, A. C., Barretto Cardoso, L. S., de Souza-Machado, C., & Souza-Machado, A. (2016). The Impacts of Educational
Asthma Interventions in Schools: A Systematic Review of the Literature. Canadian respiratory journal, 2016, 8476206.
https://doi.org/10.1155/2016/8476206
CDC (2021). Asthma triggers. https://www.cdc.gov/asthma/triggers.html
CDC (2019). Using an Inhaler. https://www.cdc.gov/asthma/inhaler_video/default.htm
Centers for Disease Control and Prevention. (2017). Strategies for addressing asthma in schools.
https://www.cdc.gov/asthma/pdfs/strategies_for_addressing_asthma_in_schools_508.pdf
Esty B, Phipatanakul W. (2018). School exposure and asthma. Ann Allergy Asthma Immunol. 2120(5):482-487.
doi:10.1016/j.anai.2018.01.028. PMID: 29407419; PMCID: PMC5942597.
Hashmi MF, Tariq M, Cataletto ME. (2021). Asthma. https://www.ncbi.nlm.nih.gov/books/NBK430901/
Hsu, J., Qin, X., Beavers, S. F., & Mirabelli, M. C. (2016). Asthma-Related School Absenteeism, Morbidity, and Modifiable Factors.
American journal of preventive medicine, 51(1), 23–32. https://doi.org/10.1016/j.amepre.2015.12.012
National Institutes of Health [NIH] (2022). Asthma. https://www.nhlbi.nih.gov/health/asthma/children
Sinyor B, Concepcion Perez L.(2022). Pathophysiology of Asthma. https://www.ncbi.nlm.nih.gov/books/NBK551579/
Tesse, R., Borrelli, G., Mongelli, G., Mastrorilli, V., & Cardinale, F. (2018). Treating Pediatric Asthma According Guidelines. Frontiers in
pediatrics, 6, 234. https://doi.org/10.3389/fped.2018.00234
Toyran, M., Yagnur, I.T., Guvenir, H., Haci, I.A., Baheci, S., Btamz, S.B., Topal, O.Y., Celik, I.K., Karaatmaca, B., Misirlioglu, E.D.,
Civelek, E., Can, D., Kocabas (2020) . Asthma control affect school absence, achievement and quality of life: a multicenter study
US Department of Health and Human Services: National Institutes of Health (2020) 2020 Focused on Updates to the Asthma
Management National Guidelines