Promoting Asthma Health In Low-Income Populations

Brandie Weidman

In the United States economically disadvantaged and minority populations are at a greater risk for asthma due to health service deficits

In Alabama 49-59% of the population with asthma have at least one health service deficit leading to disproportionately high levels of asthma related morbidity and mortality (Lurfiyya et al., 2011).
Health service deficit is defined as experiencing at least one of the following 4 conditions:

1. 2. 3. 4.

Does not have own physician Does not have health insurance Has deferred medical care in the past 12 months because of cost Has not had a routine medical checkup in the past 12 months

Low-income, uninsured, and minority patients have a higher prevalence of adverse asthma outcomes due to a combination of social, environmental and economic factors (Vargas, Robles, Harris, & Radford, 2010). Low-income populations (LIP) also have higher rates of asthma related hospitalizations and emergency room visits compared to the general population. Asthma is a high-disparity disease and improving asthma care in LIP may be accomplished through educating patients on medication maintenance through the use of an asthma action plan (AAP) and asthma trigger avoidance.

There is an overwhelming need for patient education relating to asthma control and management in LIP. The goal of the project was to educate a group of 4 staff nurses working in the clinic on how to effectively and efficiently teach the patients about asthma self-management and to reinforce compliance at each office visit.

4 nurses met during working hours for an informational presentation about how to effectively teach asthma patients. The group admitted to having minimal knowledge about educating patients on asthma medications and rarely if ever attempting to assess a patients knowledge about his or her current asthma management. The group was given a handout with information about asthma and also an example of a completed AAP.

Using their rescue inhaler more frequently than their control inhaler. Many patients only had one inhaler or did not have an inhaler at all due to financial issues or simply lack of concern or knowledge for the need of more than one inhaler. Patients often come to the clinic as a walk-in (without an appointment) for breathing treatments because they are wheezing and are out of home medication to self-manage or treat the symptoms. None of the patients were aware of an AAP or how to independently self-manage their own asthma according to symptom severity.

Educational Handout

Self-care involves an individuals own desire to continue to exist through the contribution of deliberate actions aimed toward the regulation of health, functioning, and development. The interpersonal relationship between a nurse and patient may enable the patient to act responsibly in matters of health by alleviating any stress the patient may experience related to health maintenance (Orem, 2001).

5 different methods are available to help patients when using Orems theory. For the purpose of this project the method chosen is referred to as: *Training The Individual*
Three subscales were then chosen which included: 1. Self-care related to medication use 2. Self-care related to AAP use 3. Self-care related to asthma trigger avoidance

The success of asthma treatment is dependent upon a patient properly using the medication and regularly using the medication. Regular use of asthma drugs is essential to keep the disease under control (Altay & Cavusoglu, 2013). most commonly inhaled corticosteroids. Long-acting bronchodilators also can be used as controller medications. Control medications relax the muscles of the airways for up to 12 hours. Not to be used for quick relief of symptoms because they do not work immediately. do work immediately and are used for breakthrough symptoms not relieved by the control medication. However, they do not have a long-term effect and are often overused when proper guidance has not been given (American Academy of Allergy Asthma & Immunology, 2012).

Control medications: used daily;

Rescue medications:

AAPs are one of the most important elements for successful self-care in asthma patients. An AAP simplifies self-managing asthma into a one page reference sheet and directs patients in what steps should be taken according to asthma symptoms. The goal of this community service project was not to implement AAPs to asthma patients, but to educate the staff about asthma management by using an AAP as an educational guide.

Considering asthma is caused by triggers, patients must be aware and educated on what triggers affect them and how to avoid them.

Triggers include:

allergens * dust mites * cigarette smoke * cold air cockroach * mouse antigens * air pollution * exercise

Although these may be avoidable triggers for some populations, LIP are at a higher risk for the above triggers and may not have the resources available to avoid them. Unavoidable triggers, decreased number of visits with specialists, inadequate use of inhaled corticosteroids, and not receiving an AAP are the main factors associated with LIP experiencing a higher prevalence of asthma exacerbations and emergency room visits (Law, Oraka, & Mannino, 2011 ).

Once the group was provided information on the essentials required for patients to adequately self-manage asthma, the next step according to Orems model is to incorporate nursing agency and nursing system.

Nursing agency is a method for nurses to compensate for or to overcome known limitations of patients for self-care (Orem, 2001).
As an activated nursing agency the nurses will serve as both educator and facilitator in directing asthma patients toward successful outcomes.

A nursing system is the interaction between the nurse and the patient that assists in the development of the patients self-care agency. Orem identifies three types of nursing systems (Kumar, 2007). 1. Wholly Compensatory 2. Partly Compensatory 3. Supportive Educative

Supportive Educative project.

nursing system chosen for the

As participants of a supportive educative nursing system the nurses will perform actions which support and educate patients about asthma. By providing information about asthma selfmanagement and providing educational support to each patient, the nurses will enhance the self-care agency of each asthma patient they care for.

Rate the following five questions as follows: (1) Strongly Disagree; (2) Disagree; (3) Unsure; (4) Agree; (5) Strongly Agree. 1. The presentation was effective in increasing my knowledge about asthma self-management. 2. I now have a better understanding about the medications used to treat asthma. 3. I now have a better understanding about identifying asthma triggers and how to avoid them. 4. I have a clear understanding about the purpose of an AAP and how to use one appropriately. 5. I will use the knowledge I learned today to provide self-management education to patients with asthma.

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