Nursing’s role within an Interdisciplinary team treating children with Asthma
When nurses and nurse practitioners work to their full scope of practice in interdisciplinary teams, both patient and organisational outcomes improve. Research has shown that interdisciplinary team-based approach to paediatric asthma care reduces emergency department visits and hospital admissions and that asthma education improves outcomes.
Asthma is a chronic, inflammatory disease of the airways characterized by bronchial hyper-reactivity and variable airway obstruction, resulting in recurrent episodes of wheeze, cough, chest tightness and breathlessness. It affects nearly 300 million people worldwide, and is the most common chronic disease in the paediatric population.
The Children’s Hospital interdisciplinary asthma clinic provides services to children in need of a diagnosis or already diagnosed with asthma, many of whom have multiple co-morbidities and vulnerabilities related to social determinants of health. The clinic may be one of a kind in Canada with nurse practitioners (NPs), certified asthma educator registered nurses, a respirologist, allergists, pediatricians, respiratory therapists, and allergy technicians all working together to provide comprehensive, family-focused, patient-centred asthma services to children. The aim is to improve access to comprehensive asthma services (diagnostics and diagnosis, management and education), and to improve patient outcomes (improve asthma control, reduce impairment and future exacerbations and related sequelae).
The NPs’ function autonomously and provide asthma diagnosis, management and education. As a result, paediatricians are able to focus their attention on asthmatic children with multiple, complex co-morbidities. Certified Asthma Educator Registered Nurses provide comprehensive asthma education to patients and families across all of the above tiers of service within the clinic.
The interdisciplinary asthma clinic is a “one-stop-shop” for comprehensive asthma diagnostics, diagnosis, management and education. Between 2012-16, 5,200 patient/family encounters (including telemedicine) have been delivered with over 60% of these being provided by NPs. The clinic is the provincial centre of excellence for paediatric asthma care. The team structure facilitates appropriate use of clinic resources and has resulted in significant reduction in wait times for new patient visits/consultations from 12-14 months to two-three months. Clinic data demonstrates a significant improvement in asthma control, reduction in emergency department visits and hospitalisations for those who have received care at the asthma clinic.