Debra Forster and Claire Winser discuss how collaborative working in an asthma service has improved the care of children with asthma in Nottingham.
Author Debra Forster, BSc, RSCN, RGN, is children’s respiratory and community nurse, Nottingham University Hospitals NHS Trust; Claire Winser, RSCN, RGN, is asthma school link nurse, West Bridgford Health Centre, Nottingham.
Abstract Forster, D., Winser, C. (2007) The role of asthma link nurses for schools. Nursing Times; 103: 45, 52–53.
Of the 5.2 million people in the UK with asthma, one million are children (Asthma UK, 2004). There is currently no cure for asthma, although it can be controlled with effective treatment and management plans (British Thoracic Society, 2005).
Following staff reorganisation in the children’s outpatient clinic at Nottingham City Hospital in 1996, the opportunity was taken to look at new ways of working. After discussions between the managers of the school nursing service and the children’s community nursing team, it was decided that a school nurse would attend the asthma clinic to work alongside the asthma nurse specialist as a link nurse. It was hoped that having a nurse from the primary care team working in a secondary care clinic would have beneficial effects on the care of children with asthma and their families.
The health of children and young people is high on the government policy agenda, and the role of nurses is seen as crucial in driving these policies forward (Department of Health, 2004). School nurses and the specialist nurse have an ideal opportunity to work together and guide children through their often disjointed care. The collaboration between hospital and community nursing services has led to a seamless service for childhood asthma. This concept is advocated by the National Service Framework for Children, Young People and Maternity Services (DH, 2004), which highlights the need for health services to be created and implemented around the needs of the child through high-quality, child-centred services and care pathways.
The current service
In Nottingham, the team has developed from having one school with a nurse with a particular interest in asthma to having a team of six asthma link nurses for schools. These nurses take it in turns to attend the weekly asthma clinic, so providing continuous term-time support for the clinic.
In clinic, the asthma link nurses for schools and the asthma nurse specialist see the children before the doctor to assess how they are managing their asthma and ask them about their current treatment. The nurses check each child’s inhaler technique and give advice on how to improve it if necessary. There is also an opportunity for the nurses to offer the children support and to make suggestions on how to manage their asthma at school, as well as in general.
In February 2005 the multidisciplinary team developed an asthma clinic pro forma to be used jointly by the clinic nurses and paediatricians. This has enabled standardisation of best practice and has also been a tool for auditing the asthma clinics.
At the end of each clinic the nurses and doctors discuss the patients and initiate further action as necessary. Although the asthma nurse specialist is able to liaise with individual school nurses, it is the asthma link nurse who has the expert knowledge.
To aid and formalise the role of the asthma link nurses for schools, a standard was produced in 2003. The aim was to improve the quality of care by stating the training, work commitment and responsibilities necessary for the role. The standard statement expects the asthma link nurses to provide a first-line resource for colleagues in the school nursing team. Such specialist knowledge can be most useful in the management of asthma policies in schools.
All schools in Nottingham are required by the Office for Standards in Education (Ofsted) to have an asthma policy. This was also recommended in guidelines produced by the DH and Department for Education and Skills (DH and DfES, 2005).
Each school nurse has now been given a standard asthma policy that can easily be individualised. The support of the asthma link school nurses has been helpful in implementing these policies and individual care plans.
A requirement of the standard is that the link nurses undertake a paediatric asthma course within a year of taking up the role. Their regular attendance at the asthma clinic enables them to keep up to date. Monitoring and evaluation of the standard is undertaken regularly through surveys. Team meetings take place each term, which allow the nurses to learn from each other, act as a forum for new ideas, and help interprofessional working.
The standard also requires that all new school nurses should update their knowledge of asthma care for children within six months of starting employment by working in the asthma clinic. There is also a requirement that they attend asthma training every two years. This training has been offered by both primary and secondary care trusts and is supported by the asthma link nurses for schools and the asthma nurse specialist. The link nurses must also be available to go into schools to give talks about the management of asthma and advice on the care and use of inhalers.
Evaluating the service
The quality of the services provided by asthma link nurses for schools has been audited through questionnaires, anecdotal feedback from school nurses, other professionals, parents/carers and children themselves. Since the ratification of the standard, a short questionnaire has been used as part of the audit mechanism. Questionnaire surveys were carried out in 2002 and 2005 with a response rate of 90. The results (Table 1) show that most school nurses continue to know the identity of their asthma link nurse and they can help with asthma education in schools. Asthma resource boxes, which include placebo inhalers, instruction sheets and an example of a school asthma policy, are available for use by every school nurse and the results showed that most school nurses are aware of where these are sited. In 2005, 84% of school nurses felt their schools had working asthma policies, a 14% rise from 2002. Interestingly, only 22% of school nurses had been approached by their school for asthma training.
The success of the policy of integrating services and of cross-boundary working has been helped by formal presentations and workshops held at respiratory study days and conferences for primary and secondary healthcare workers.
The service is still running successfully despite the current financial climate and PCT reconfiguration. There are an increasing number of centres that offer health services for the local community. The advent of children’s centres in the community could provide further opportunities. For example, the asthma link nurses could offer drop-in sessions and initiate a referral system into secondary care.
The team needs to promote asthma as a health and social issue by offering health days and first aid training. In addition, school asthma policies and teachers’ knowledge should be audited annually, and quick refresher sessions offered regularly for new and experienced teaching staff.
This article has been double-blind peer-reviewed.