Capstone Project Milestone 2
Asthma is the most common cause of in-patient admissions in acute care hospitals. Poor education and training of patients with respect to self-care and symptom management has led to an increase in the number of asthmatic patients reporting to the emergency department (ED) or acute care hospitals. It is empirical to understand the cause or trigger factors that relate to acute exacerbations of asthma. Some of the common triggers that causes asthma include exercise, infections, allergens, smoking, infection, gastric problems, hear burns, and indigestion. Based on current evidence, food allergens are considered as the most common form of allergens that cause acute exacerbations of asthma at home.
The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model helps in improving the clinical decision-making skills of nurses by focusing on research and problem solving strategies. Nurses would enhance their knowledge and skills which would in-turn increase standard of care and patient satisfaction (Parkosewich, 2013). The JHNEBP comprises of practice, research, and education where nurses would improve their clinical decision-making skills while applying EBP to their practice (Aarons, Farahnak, Ehrhart, & Sklar 2014).
Practice Question
Inter-professional Team
The inter-professional team would comprise of a physician, nurse, clinical nurse educator, registered dietician, unit manager, physiotherapist, and caregiver. Each of the experts would have their own professional roles which would not only help prevent acute exacerbations of asthma but also improve the overall quality of patients. The benefit of having an interdisciplinary team on-board helps provide scientific expertise and healthcare services to the patient to manage their symptoms. In this case, the registered dietician and clinical nurse educator would play a major role in educating patients on food allergens and asthma symptoms.
EBP question
Does the implementation of an educational food allergen program compared to no educational program result in a 10% reduction in asthmatic attacks within a six-month period?
Scope of EBP
Based on current evidence, children and adults who have food allergies are twice or four times more likely to suffer from asthma compared to those without known food allergies (Wang & Liu 2011). Asthma and food sensitization often co-exist during infancy and early childhood (Caffarelli, et al. 2016). Most of the anaphylactic symptoms have been associated with asthma due to unknown or unreported food allergies (Wang & Liu 2011). Based on the National Health and Nutrition Examination Survey (NHANES) 2005–2006 on 8,203 participants, there is clear evidence of specific food allergies and asthma among children and adults. Researchers have also stated that patients with food allergy and asthma have a higher risk of developing life-threatening serious adverse events (Caffarelli, et al. 2016).
Responsibility of team members
The registered dietician would assess, educate, and train the patient on food allergies, symptoms associated with food allergic reactions, and diet plans. The clinical nurse educator would co-ordinate with the dietician to educate and train the patient on assessing signs of unknown or potential signs of an asthmatic attack. The physician and nurse would help the patient with respect to pharmacological management while the physiotherapist would provide exercise regimen that may prevent or help asthmatic exacerbations. The unit manager would be involved in managing inventory and infrastructure needs (Saini, et al. 2011).
Review and appraisal of evidence
There many qualitative and quantitative studies that focus on the need for education and training among patients with known food allergies and prevention of acute exacerbations of asthma. Most of the available research are based on systematic review of clinical studies, reports, and case series. The research available can be classified from Level 1 to Level II evidence with only 1 book which is Level IV evidence. The quality of evidence is good in most cases, with Grade A ranking for all the research-based articles (Dearholt & Dang 2012).
Summary of evidence
There is proven evidence that food allergy and asthma have a direct correlation. There are common risk factors that may often co-exist in the child leading to acute exacerbations of asthma. Food sensitization may influence the risk for asthma during early childhood. In severe cases, food allergy could lead to anaphylactic symptoms in children. There is a need for educating children on food allergy along with their parents. The PICO is based on providing educational program on food allergy and asthma which is the main objective of the authors in the article as well (Friedlander, et al. 2013). Nurse-led education on allergies and asthma may reduce the overall risk of anaphylaxis. Nursing is an evidence-based practice and this requires the use of research findings in shaping practice activities (Dearholt & Dang 2012).
Recommendations based on current evidence
A key recommendation is that educating and training children and their parents on food allergy and asthmatic symptoms can prevent acute symptoms and life-threatening anaphylactic symptoms. Parents, caregivers, and nurses should be educated and trained to assess the child’s known food allergies or symptoms that may have arose due to an allergy. Implementing education and training to patients would reduce the risk of acute exacerbations or anaphylaxis associated with asthma. Nurses should be involved in evidence-based practice, assess patient feedback, implement new proven and effective strategies, specifically in educating patients.
Translation
Action Plan
The pilot project would last for 6 months, with the first 30 days on training the nurse and physicians on food allergies and asthma (Parkosewich 2013). The nurse staff would be trained to learn new skills and adopt to educate and train patients. The next 30 days would include a demo analysis of nurse-patient education and interaction. Since the scope of the project would be new to both, patient and nurse, there is a need to assess flaws or drawbacks of the intervention. A post-program meet would be held for nurses while patient feedback would help the staff in identifying limitations of scope of the problem. In the 3rd month, an analysis of incidence of food allergy associated asthma attacks prior to the intervention (education) would be assessed. The final program would last for the next 4 months, wherein post-intervention analysis on the rate of acute asthma attacks associated with food allergies would be identified (Aarons, Farahnak, Ehrhart, & Sklar 2014).
Evaluation and reporting of outcomes
The education and training of patients is associated with reduced risk and prevention of acute exacerbations of asthma (Parkosewich 2013). The intervention is aimed to reduce the number of hospitalization for patients with asthma due to food allergies. The secondary outcomes for the study includes enhanced knowledge of patients on food allergy, symptoms of asthma, and preventive management or self-care for acute asthma attacks. Patients are also expected to manage and report anaphylactic symptoms and suspected food allergies.
Identification of next steps
The current study is based on an analysis of a small target population. Replicating the study on a large target population across multiple centres and cities would provide a better scope for the expected outcomes. A prospective observational study to identify the benefits of education on food allergy and asthmatic attacks is the next step for the project (Parkosewich 2013). However, it is empirical to continue with the research and make the project a permanent. Advertisements would be used to attract patients, physicians, and researchers interested in collaborating with the work process and research agenda. Collaborations with scientific committees, organizations, and panels would strengthen the scope of the project (Aarons, Farahnak, Ehrhart, & Sklar 2014).
Disseminate findings
It is empirical to disseminate the findings of the research within the organization and outside the organization. A 15-minute slide show would be presented to the stakeholders of the program followed by a video on the various processes identified and implemented for the project. A comprehensive report would also be submitted to the scientific committee of the organization for appraisal of evidence. The findings of the study would also be circulated to other departments of the organization to inculcate the need for scientific research. It would also motivate and encourage other departments to participate in evidence-based practice. A scientific publication would be developed to be published in a reputed journal which would help other research personnel and organizations to learn and reflect on the findings. An interview with the team members of the project would be published in the district scientific magazine which would build a reputation and recognition for the organization with respect to scientific research and developmental capabilities (Dearholt & Dang 2012).
Conclusion
In the past decade, there is clear evidence that asthma is the most common cause of in-patient admissions in acute care hospitals. Implementing educational and training programs would help patients and healthcare providers understand the preventive and management strategies more effectively. Patient education is aimed to improved health outcomes.
References
Aarons, G. A., Farahnak, L. R., Ehrhart, M. G., & Sklar, M. (2014). Aligning Leadership
Across Systems and Organizations to Develop Strategic Climate to for Evidence-Based Practice Implementation. Annual Review of Public Health, 35, 255–274.
Caffarelli, C., Garrubba, M., Greco, C., Mastrorilli, C., & Povesi Dascola, C. (2016). Asthma
and Food Allergy in Children: Is There a Connection or Interaction? Frontiers in Pediatrics, 4, 34.
Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model
and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.
Friedlander, J. L., Sheehan, W. J., Baxi, S. N., Kopel, L. S., Gaffin, J. M., Ozonoff, A.,
Phipatanakul, W. (2013). Food Allergy and Increased Asthma Morbidity in a School-Based Inner-City Asthma Study. The Journal of Allergy and Clinical Immunology in Practice, 1(5), 479–484.
Parkosewich, J. A. (2013). An Infrastructure to Advance the Scholarly Work of Staff
Nurses. The Yale Journal of Biology and Medicine, 86(1), 63–77.
Saini, B., Shah, S., Kearey, P., Bosnic-Anticevich, S., Grootjans, J., & Armour, C. (2011). An
Interprofessional Learning Module on Asthma Health Promotion. American Journal of Pharmaceutical Education, 75(2), 30.
Wang, J., & Liu, A. H. (2011). Food allergies and asthma. Current Opinion in Allergy and
Clinical Immunology, 11(3), 249–254.
