A qualitative study of case management of children with asthma.

PURPOSE: The purpose of this study was to describe the process of case management delivered to Head-off Environmental Asthma in Louisiana (HEAL) study participants. PRIMARY PRACTICE SETTING: Participants' homes; community facilities (clinic and library meeting rooms, schools) in a post-Katrina environment. METHODOLOGY AND SAMPLE: A qualitative descriptive study consisted of analysis of existing data that describe the case management provided by HEAL asthma counselors to 151 children, aged 4-12 years, with moderate-severe asthma, and their families. The HEAL study (2006-09) was conducted in the New Orleans area after Hurricane Katrina. FINDINGS/CONCLUSIONS: Case management was intensive and comprehensive and consisted of asthma education, symptom management, addressing caretaker/participant/family issues, consistent follow-up, referrals, and goal-setting. Several factors impacted the case management process, including caretaker beliefs, accessibility, and posthurricane issues. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Health care providers must recognize the complexity of case management in a postdisaster environment, consider the influence of social determinants and one's health literacy on asthma treatment adherence and outcomes, and develop models of case management to effectively manage children with asthma and their families.

Implementation of evidence-based asthma interventions in post-Katrina New Orleans: the Head-off Environmental Asthma in Louisiana (HEAL) study.

BACKGROUND: Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma. OBJECTIVES: We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina. METHODS: Children (4-12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre-post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions. RESULTS: Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001). CONCLUSIONS: The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.

Impact of the environment on asthma control.

Asthma is a complex condition that requires individualized interventions. The purpose of this article is to describe the relationship between the physical and social environments with asthma symptoms, present evidence that supports environmental interventions in asthma control and the implications for asthma management. There is evidence that indoor and outdoor allergens relate to asthma morbidity. Knowledge about which environmental exposures present risk is essential because many of these exposures can be modified, reduced, or eliminated. The community health nurse should provide care relative to the client's indoor and outdoor environment and existing allergens.

Targeting prenatal emergency preparedness through childbirth education.

The lack of emergency preparedness planning remains problematic for families, but there is a special concern for prenatal women and families. This article proposes childbirth education as one avenue through which nurses can engage families to prepare for a disaster. Template guides and references are included for community-specific emergency preparedness education for childbearing families. Critical issues unique to childbearing women and newborns related to evacuation, sheltering, birthing in place, and mental health are addressed.

Children's perceptions of asthma: African American children use metaphors to make sense of asthma.

INTRODUCTION: Children's views of their illness often are absent in decisions that affect their lives. This research, which is a component of a larger study, reports how African American children described their asthma. METHOD: The study's design was descriptive and longitudinal, using an ethnographic approach. A subsample of 10 children diagnosed with asthma who resided in one of two study sites spontaneously described their asthma. The study was conducted in various settings where the researchers observed/participated in selected activities. Participants were interviewed several times, and field notes were recorded. RESULTS: The qualitative findings are from participant observation and interviews of 10 children ages 9 to 12 years. Four of the most developed metaphors are reported here. Out of their experiences, children created their own metaphors for asthma that are concrete, familiar, and multi-vocal, allowing for embellishment. DISCUSSION: Not all children use metaphors to explain or describe their asthma. Children who explain asthma in their own terms will feel valued and invested in their own health care as they find that their voices make a difference in decisions about their care.

Wheezing and asthma in early childhood: an update.

Although asthma is the most common chronic disease in children, recent studies show that labeling this condition "asthma," especially in association with chronic wheezing, remains a matter of dispute. Nonetheless, data confirm that wheezing and asthma place great burdens on the caregivers of affected children. A principal source of information on diagnosis and treatment is the practical guide published by the National Asthma Education Prevention Program. The implications for nurses in the management of young children whose wheezing is chronic or who have been diagnosed as having asthma include a need for knowing the program guide's recommendations, assessing the child's family history, teaching primary caregivers an action plan, providing consistent asthma education, encouraging parents to evaluate the child's environment, and identifying related resources.

Lessons learned from a longitudinal qualitative family systems study.

Methodological issues encountered during all phases of a longitudinal qualitative family systems study are described. This article focuses on (1) separate researchers and sites, (2) recruitment and retention of study participants, (3) data collection concerns, (4) family variances, (5) conflicting roles of nurse and researcher, and (6) family disengagement. Achieving and maintaining scientific rigor in longitudinal qualitative studies can be challenging if consistent attention is not given to issues that surface during all phases of the study. From these experiences, guidelines for researchers involved in similar studies are presented.

Characteristics of African American women caregivers of children with asthma.

PURPOSE: To describe the attributes and characteristics of African American women who were the primary caregivers of children with asthma. METHODS: Descriptive qualitative ethnography. Data collection consisted of formal interviews, participant observation, and fieldnotes. Each study participant was formally and informally interviewed (audiotaped) during a 1-year period. The researchers also observed and participated in family activities in various naturalistic settings. RESULTS: Six themes emerged that depict the characteristics of these women: (1) Knowledge about the child's asthma; (2) Gatekeepers to the child's care; (3) Being religious; (4) Support; (5) Roles as teacher, counselor, and advisor to the child; and (6) Self-sufficiency and industriousness. CLINICAL IMPLICATIONS: Nurses should use the information in this study to examine the ways in which they interact with caregivers of asthmatic children. The caregivers personal beliefs, need for information, and previous experiences with asthma and family illness should be assessed. These mothers and grandmothers should be respected as the gatekeeper to the family's healthcare. Nurses should be nonjudgmental and supportive of caregivers when they express their religious beliefs and practices. Nurses who understand how mothers cope can reinforce these coping skills and provide better nursing care.

Explanatory models of asthma from African-American caregivers of children with asthma.

Explanatory models (EMs) were collected from 20 African-American adult primary caregivers, in Seattle and New Orleans, who have children with asthma, to understand asthma from their perspective. Family EMs of asthma shed light on the meaning family members give to the illness, and how they make internally logical decisions related to their healthcare behavior. Study findings show that families have their own EMs of asthma. Families draw on their cultural context to understand asthma. They compare their lived experience with healthcare-provider explanations of asthma. Specifically, the African-American families in this study drew much of their information about asthma from other family members and from personal experience. Collecting EMs of asthma may help healthcare providers know the meaning of asthma as understood by specific families and may reduce unscheduled use of health services. Further research should include encounters which increase the healthcare provider's context for understanding patient and family EMs.