Title of Study:Barriers in Asthma Education Among Pediatric Respiratory

Care Practitioner’s

MELINDA MARSHALL

Introduction:

This quantitative research study will examine experiences of barriers faced by respiratory therapists in providing pediatric asthma education to caregivers. At Children’s HealthCare of Atlanta, which is a 200 bed non-profit hospital with a Level II Emergency Department, where Registered Respiratory Therapists conduct asthma education prior to patients being discharged home. Therefore, caregivers are responsible for the compliance, education and management of their child’s disease state.

Why This Topic?

The study may help to improve parental and caregiver knowledge on asthma prevalence and management when interacting with health providers. Consequently, Georgia is 6th in the United States for asthma prevalence (CDC, 2014).

Pediatric Georgians have increased hospitalizations and admission rates among pediatric asthmatics in Georgia.

The need and recognition for national programs under nurse-respiratory leadership and training models (similar to COPD approved out patient programs) Currently, pediatric asthmatic educational programs among Georgians can help: targeted populations by seeking behavioral change agents in respects to managing daily asthma symptoms and diminishing barriers in caregiver training.

Objectives:

Does an inpatient interventional program meet the needs of the limited-resource audience for increasing knowledge about asthma, the importance of limitations and therapist culture in relation to asthma education, efficacy and compliance?

The study will attempt to validate the association in respiratory caregiver barriers with job burnout, staff education.

Do factors associated with caregivers moderate possible risks in pediatric asthma outcomes? Are respiratory therapists educationally prepared for asthma educational program planning and

teaching?

Statement of the ProblemRespiratory healthcare professionals are experiencing barriers in asthma educational modeling systems when educating caregivers.

Children with asthma have difficulties with eco-social and environmental factors that affect asthma maintenance and compliance.

  A 2014 report from Georgia’s Healthcare Cost and Utilization Project Center claimed asthma as the leading diagnosis for emergency room visits and diagnosis for hospitalizations among children ages 2-5 years in Georgia costing the state over 60 million dollars in 2014 (AHRUP, 2014).

There are 356,000 children suffering from asthma in Atlanta, Georgia Metropolitan area, giving the region fifth rank in asthma prevalence nationally (CDC, 2014). 

Background

According to a 2014 report from the American Lung Association, 4.9 million children were suffering from asthma in the United States. Thus, there is a clear need for a viable action plan, including the need to educate caregivers, in order to reduce asthma prevalence in the United States (CDC, 2014)

Asthma is the 6th leading cause of debilitation and missed school days among U.S. children and pediatric Georgians.

A 2013 study, uncovered therapists burnout as a leading cause of poor educational outcomes among respiratory care practitioners. Which affects the vitality of educational systems and parental impact on health. Consequently, children with asthma have difficulties with eco-social environments and learning skills as well as learning experiences that can improve long-term healthcare needs.

Background

A 2013 report from Georgia’s Healthcare Cost and Utilization Project Center claimed asthma as the leading diagnosis for emergency room visits and diagnosis for hospitalizations among children ages 2-5 years in Georgia. 

 There are 356,000 children suffering from asthma in Atlanta, Georgia Metropolitan area, giving the region fifth rank in asthma prevalence nationally (CDC, 2014).

 According to a 2014 report from the American Lung Association, 4.9 million children were suffering from asthma in the United States.

Theories Supporting this ResearchThe theories that I will be utilizing in the study are as follows

Trans theoretical Model of behavioral change; suggests individuals readiness to act on a new healthier behavior and provides strategies or processes of change to help guide us through change by increasing self actualization

While Bandura’s Cognitive Social Theory will be instrumental in seeking pivotal changes among participants and educators in the study.

Both can be utilized in changing caregiver attitudes from parents to practitioner’s

Stages of change in TTM; pre-contemplation, contemplation, determination, action, relapse, maintenance

Methodology-Description Sample Sample Information: The study included pediatric respiratory care practitioner’s within an inpatient hospital setting. Therapists from various departments in the organization provided feedback in this study. For example, Pediatric, Transitional, Rehab, Clinic, Emergency Services and Floor therapists teach asthma education and management to caregivers.◦ Inclusion Criteria: The participating staff should have a year as a pediatric-neonatal

respiratory therapist in order to participate in the study.◦ Also, participants should be ages 18-75 years of age to assess experiences.◦ Have a minimum of an educational diploma for the profession◦ At least 50 participants will be recruited for the study on asthma barriers.

◦ Exclusion Criteria: Therapists without a year of pediatric asthma clinical practice and patient education were excluded from the study

Methodology-Data Collection

Instrumentation: the data collection instrument used in the study was a 34 question survey based upon a Likert scale of “strongly agreeing or strongly disagreeing”. That the researcher modified from the CDC’s Asthma Call Back Survey”. In which, the researcher emailed the survey monkey link to the respiratory staff at CHOA. In an effort to collect information on experienced barriers when educating caregivers.

Methodology-QuestionsThe questionnaire asks participants questions relating to: sex ageeducational background hours spent teaching asthma related topics specialty certifications held.Based upon a Likert scale of strongly agree-strongly disagree

Data Collection PlanData collection will allow the tracking of demographic information to ensure that the target audience is being reached.

Questionnaires track knowledge and behavior changes experienced and among RRT’s during asthma education.

Methodology-Data AnalysisThe data analysis of the information consisted of the following method. Through descriptive statistics analysis of the data included coding, categorizing, and making sense of the meaning of the phenomenon.SPSS proved to be very instrumental throughout the research. SPSS/Epi-Info are a coding software that the researcher used to evaluate the findings in the data. It was helpful in organizing the data from an excel spreadsheet.Bivariate analysis of questions were categorized in the software to associate belief systems, parental compliance etc. The researcher chose to use raw data received and propelled it into the software, in some cases utilizing 1-5 on a raw scale. When participants answered strongly agree/strongly disagree

Data Analysis

What is your highest level of education that you have completed? 0 0 0 0 0

Are you certified as a neonatal specialist with the AARC? 0 0 0 0 0

Most times parents often allow children to exhibit lackluster attention during asthma education? 8.33 37.5 43.75 10.42 0

Often both parents and caregivers in asthma education are minorities? 6.82 29.55 40.91 20.45 2.27

Analysis

Theme DescriptionEducation Referred to staff Therapists educational background/trainingCompliance Parental compliance to Asthma Action Plan set by Clinical StaffResources Obtained additional materials in educating caregivers/follow-upInterpretation Staff perceptions of experienced barriers when educating parents/caregivers

-

Respiratory staff

Barriers

Social

Education Compliance

Economics

Circumstances that perpetuate Barriers

Results 1. The therapists as frontline educators providing caregivers with the foundational knowledge in managing asthma.

2. After providing the well needed education parents are provided with an Asthma Action Plan for home/prescription for medication.

3. In which, should decreases hospital readmission rates among pediatric asthma inpatients.

4. However, RRT’s saw parental non-compliance, medication availability and social circumstances as significant or very significant barriers in asthma education/maintenance.

5. The asthma clinic at Children’s follow-up with weekly calls to youth at risk for death related to asthma exacerbation.

6. Staff therapists at the clinics provide home care visits when necessary.

7. Participant data found caregivers adversely affected the overall health status of young children via barriers and non-compliance through their belief systems or poor financial outlook.

Study Limitations The limitations of the study consisted of the fact that the barrier study consisted of only respiratory therapy providers within Children’s Healthcare of Atlanta.

The data collected for this study was gathered from only Children’s Healthcare of Atlanta at Scottish-rite RT staff with two years experience.

The use of the information is specific to the organizational processes at Children’s.

Single Table Analysis of Correlational Barriers Most Experienced During Education ClassNotes. Chi-square for R by C table: Chi-square = 20.67, degrees of freedom = 9, p-value* = 0.010. Statistical correlations.

RecommendationsAsthma educational programs should be available to all inpatients that are in need or seek knowledge regarding asthma/allergy indicators and maintenance. RTVISIONPLAN2020 Every 5 years educational revisions on program and among RRT/RN Teams on asthma education

Also, adding a voice to Registered Nurses in the organization that work on pulmonary floors, rehab, and surgical ICU’s may benefit the study in expanding its horizons in asthma educational barriers experienced by caregivers across a gross spectrum of health providers. It is recommended that asthma education be provided via video on demand for all with clinical admissions of shortness of breath regardless of age.

As apart of additional training therapists/nurses would be required to complete annual competencies in asthma education and public health practices during allergy seasonal influxes.

Last but not least, increasing the sample size can only provide a wide spectrum of feelings among healthcare practitioner’s within its other facilities (urgent care centers, asthma clinic, out patient hospital services etc.)

RRT Case Manager Role and Pulmonary Educational Services were created from the studies findings.

Conclusion It is my aspirations that my research findings among Respiratory therapists provide a voice for bedside clinicians attempting to improve upon the staggering readmission rates among young asthmatics. By uncovering barriers experienced by caregivers when educating parents/caregivers of young asthma sufferers. Additionally, the research may improve upon public health practices related to awareness, social deprivation of health care altruism and process improvements among health care organizations. The study can offer a different point of view of allied healthcare professionals experiences in healthcare efficacy, burnout perceptions and overall workplace sentiments.

Questions

References

American Lung Association (2012).  Asthma Educational Program Outcomes Program.  Retrieved from:  http://www.ala.org.gov

Bandura, A. (1976).   Social Theory Social Learning Theory.  Pearson Publishers

Brugnami, G., Curradi, F. & Siracusa, A., (2005).  Does an asthma education program improve quality of life?  A two year randomized trial.  The Journal of Asthma September Vol. 42 Iss7 pp. 577-81Georgia Fiscal Pending

Children’s Healthcare of Atlanta (2013).  Emergency Room Statistics.  Retrieved from:  http://www.choa.org/emergency

References Clark, N. &. (2003). The role of behavioral theories in educational interventions for pediatric asthma. Educational Interventions In Asthma: Pediatric Respiratory Reviews. Michigan, Detroit, United States: Univeristy of Michigan, School of Public Health.

Clore, C. B. (2006, May). Social Skills of Adolescents with Learning Disabilities: An Application of Bandura's Theory Of Reciprocal Interaction. University of Texas. Texas, United States.

Creswell, J.W. (2009) 3rd ed. Research Design: ualitative, uantitative, and Mixed Methods Approaches.  Sage Publications Inc.

Plasko’s, D.S., & DiClemente, J.W.,  (2008)  Trans-theoretical (Clore, 2006) Social Theories.  Pearson Publishing Company

Thank you for your time, guidance and willingness to serve on my committee