School Nurse Shortage Hinders Efforts to Manage Asthma in Schools
Millions of California children headed back to school this fall
amidst growing concern that there may not be enough school nurses
to properly manage the asthma epidemic sweeping this country.
Schools play a large role in how well children are able to cope
with the chronic lung disease because children spend a large part
of their day at school.
Asthma is an inflammatory disease that causes the airways to
become constricted (smaller), blocking the free flow of air to
the lungs. Symptoms include wheezing, coughing, and tightness
of the chest. While there is no cure for asthma, it can be controlled
with medication and by avoiding lung irritants that trigger asthma
symptoms, including air pollution, smoke, mold, dust mites and
animal dander. Without proper control, asthma can be deadly.
'Do the Math'
There were a total of 2,725 school nurses in California public
schools during the 2002-2003 school year, with a total student
population of 6.2 million. That adds up to 2,291 students for
each school nurse. Compare that to the National Association of
School Nurses' recommendation of 750 students per school nurse.
"Do the math and you come up with a rather abysmal figure
of how many pupils there are per school nurse," says Linda
Davis-Alldritt, RN, PhN, MA, FNASN, school nurse consultant with
the California Department of Education.
In some schools, other staff members are assigned healthcare
duties secondary to their main jobs, which doesn't ensure that
children with asthma receive the consistent care they need to
help them keep their asthma under control. A trained health professional
should be monitoring children at school to determine whether they
are using their inhaler medications, how often they are absent,
and if they are able to participate in regular activities.
"School nurses are the only ones who really have the expertise
to manage chronic disease," Davis-Alldritt says.
Asthma Can Disrupt Learning
Children who don't have their asthma under control miss more
school days. Asthma is the number one cause of school absenteeism
due to chronic illness with an estimated 14 million school days
missed each year nationwide.
"For children to benefit from their education, they need
to be healthy. If you're not in class you're missing the opportunity
to learn," Davis-Aldritt says. "Asthma is also a significant
problem in schools because if students aren't feeling well in
class, they can't focus on the schoolwork."
According to a national sample of members surveyed in 2003 by
the National Association of School Nurses (NASN), asthma is more
disruptive of school routines than any other chronic condition,
has a significant impact on absenteeism, and many school staff
may lack awareness of the causes of an asthma attack.
An overwhelming majority (85 percent) of the school nurses think
there are students with undiagnosed - and thus uncontrolled -
asthma in their schools. More than half found asthma more disruptive
to students' routines than any other chronic health condition,
with more than one-third having had to respond to an acute asthma
attack or episode at least 11 times in the last school year.
Instant Access to Medications Needed to Control Asthma
To keep asthma symptoms under control and avoid potentially
deadly asthma attacks, children need instant access to their asthma
medications at school, especially "rescue" inhalers
that quickly open up the airways. The American Lung Association
of California is working with the California Department of Education
to secure a statewide policy recommending that schools allow children
to carry their own asthma medicines. Currently, each school district
in California sets its own policy.
"When an asthma attack occurs, having rescue medication
in hand for immediate use, not wasting breath struggling to the
school office, can mean the difference between life and death,"
says Anne Kennedy, RRT, RCP, who serves on the American Lung Association
of California's Asthma Technical Advisory Group and its board
of directors. "We need to help children manage their asthma
by teaching them how and by working to reduce asthma triggers."
The American Lung Association has a variety of educational programs
to help manage asthma in the schools, including its new Asthma-Friendly
Schools Initiative that assists schools in developing asthma management
plans. Its Open Airways For Schools program teaches children how
to control their asthma symptoms by taking medications properly
and avoiding asthma triggers. Indoor Air Quality Tools For Schools
is designed to assess indoor air quality in schools and work toward
reducing lung irritants that trigger asthma symptoms in the school
environment.
Air Pollution Can Trigger Asthma Attacks
Indoor air quality in schools, especially in portable classrooms,
is a growing public health issue. In fact, a recent state study
of portable classrooms identified several potential environmental
health risks, including inadequate design, operation, and maintenance
of ventilation systems; contaminants present at undesirable levels
in the air and floor dust; as well as mold and moisture problems.
Improving air quality in school classrooms is an important part
of managing asthma because it reduces exposure to potential lung
irritants that can trigger asthma symptoms.
Outdoor air quality around schools is also an issue. The American
Lung Association of California supported new regulations last
year that reduce the amount of time diesel buses can idle near
schools and is continuing to advocate for policies to reduce the
use of dirty diesel engines. Diesel exhaust is a toxic air contaminant
that can trigger asthma attacks and cause other serious health
problems.
The American Lung Association of California also supported legislation
(SB 352, Escutia, D-Whittier) that prohibits placement of new
schools near freeways and busy traffic corridors.
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