Chicago Public School nurses examine barriers to school asthma care coordination

Abstract

Objective/Design: Well documented asthma disparities in Chicago pose a continual challenge for the Chicago Public Schools (CPS). Coordinated Healthcare for Complex Kids (CHECK) is a health care demonstration project funded by a Centers for Medicare and Medicaid Services Health Care Innovation Award. A collaborative partnership was formed between CHECK and CPS. With CHECK support, CPS administered a survey to 160 nurses to understand the asthma problems nurses perceived and interest in intervention. Results: Seventy-five per cent (n = 120) completed the survey. While asthma was the top diagnosis managed by 95%, 72% reported gaps in asthma understanding. Appropriate communication between school nurses and providers occurred 33% of the time; 18% believed they received sufficient support to follow-up on deficient paperwork. The barriers mentioned were lack of medications (73%), time (67%), and communication with providers (61%). When asked their opinions on potential interventions, 78% of nurses supported web-based applications, 66% community health workers (CHW), and 66% stock albuterol in schools. Conclusions: The greatest barriers for CPS nurses with asthma management are time and communication. Potential interventions such as web-based communication applications and CHW in schools were well received. K E Y W O R D S asthma, Centers for Medicare and Medicaid Services, community health worker, communitybased participatory research, health disparities, nurse, pediatric asthma, school-based asthma, schools, survey, vulnerable population

School nurses' perceptions regarding barriers and facilitators in caring for children with chronic diseases in school settings: A mixed studies review

“…Lack of parental support (Liberatos et al, 2013; Seki, Kakinuma, Kuchii, & Ohira, 2017), parental knowledge, and parental contact information were revealed as barriers to school health care (Rivkina et al, 2014). Second, school nurses also identified communication with health care providers as a barrier (Liberatos et al, 2013; Pappalardo et al, 2019; Quaranta & Spencer, 2016; Svavarsdottir et al, 2013; Williams et al, 2019). The lack of collaboration between school nurses and primary care providers often meant that school nurses had to rely on parents' daily management decisions (March et al, 2020).…”

“…Third, school nurses reported difficulties in care coordination due to knowledge gaps regarding asthma among school staff (Pappalardo et al, 2019). School staff being unprepared for emergencies was a barrier in anaphylaxis management (Morris et al, 2011).…”

“…Recently, school nurses have been required to be skilled with modern devices and receive increased training (March et al, 2020). In six articles, nurses also reported having insufficient supplies (Gibson‐Young et al, 2020; Liberatos et al, 2013; Pappalardo et al, 2019; Quaranta & Spencer, 2016; Svavarsdottir et al, 2013) as barriers in managing chronic diseases in students. A lack of school programs for stocking epinephrine and providing annual training (Morris et al, 2011) were also perceived as obstacles.…”

“…They perceived current forms and policies to be barriers that prevented effective communication between nurses and primary care providers (Pappalardo et al, 2019). Second, there were inequities in how school health care was provided for students with chronic disease.…”

Preventing Asthma Emergencies in Schools

“…Although data on the direct impact of stocking asthma rescue medication are lacking to date, nurses in Illinois schools support stock albuterol legislation. 40 Improvement of processes to coordinate care among all aspects of a child's life to ensure that asthma is properly diagnosed, an asthma action plan is initiated and disseminated, a Section 504 Accommodations Plan is developed, and asthma rescue medication is available in all of the student's environments are necessary. Stock asthma rescue medication policy does not replace the need for proper asthma diagnosis and management, but the policy allows for trained staff to administer asthma stock rescue medication when necessary.…”