DNP 851B Module 7 Recommendations for Practice and Future Work Example

Keep It, Reinforce It, Test It Further: Recommendations From a Nurse-Led Pediatric Asthma Program

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 851B: Project Data Analysis

Instructor Name

Month Day, Year

Keep It, Reinforce It, Test It Further: Recommendations From a Nurse-Led Pediatric Asthma Program

Recommendations are where a DNP project turns findings into action, and they must stay within what the findings support. My project gave 104 children with persistent asthma a nurse visit built on the national guidelines' core self-management steps (National Asthma Education and Prevention Program, 2007): a written plan in the family's language, hands-on device coaching, delivery of the plan to the school nurse and a check-in call two weeks later. Over 12 weeks, the proportion of children with well-controlled asthma nearly tripled among the 91 with complete data, and acute care use fell by more than half among all 104. The single-group design cannot prove the program caused these changes, but the pattern, together with clinic-level run charts, supports acting on them. This paper sets out recommendations for the clinic, advice to the health system on spread, questions for future work and recommendations the results do not justify. Each recommendation below names its basis.

Recommendations for the Clinic

Six recommendations follow directly from the results and from how the program was delivered. Each has a named owner, as the table shows.

Reinforcement Deserves Emphasis

Of the six, the recommendation on reinforcement deserves emphasis because it is easy to drop when time is short. The project found that technique slipped in a third of the earliest children by 12 weeks and held better once a check was added to calls and routine visits. That matches a systematic review that found educational inhaler interventions effective in the short term but with effects that wane over time, and that recommended periodic reinforcement (Klijn et al., 2017). A two-minute check at every contact costs little, and without it much of the benefit of the first visit may fade.

Medical assistants can perform it, which spares nurse time for the families who need more.

Recommendations for Nursing Education

The project also has something to say to nurse educators. The nurses who delivered the program were experienced, yet early observation found them accepting inhaler demonstrations that skipped key steps, and simulation with a parent actor proved the most useful part of their preparation. Two recommendations follow. Prelicensure and residency programs should teach inhaler and spacer technique to a checklist standard with return demonstration, not only by description. And continuing education on asthma should include practice in teach-back with children as well as parents, since children aged 8 and older often use their inhalers without an adult present. The clinic will share its simulation scenarios and checklist with the health system's nurse residency program.

Advice to the Health System on Spread

The health system has a second pediatric clinic and has asked whether to extend the program. The recommendation is to spread it with measurement rather than to adopt it everywhere at once. The first clinic's results are encouraging but come from one site and a single-group design. Spreading to the second clinic on a planned start date, while the first continues, would allow the two sites to be compared over the same months, which is a stronger test than the project could provide. The spread plan should carry the lessons of implementation: owners for every administrative step from the first day, technique reinforcement built in and the materials already translated.

A six-month review should then decide on wider use.

Questions for Future Work

Three questions should shape future projects. The first is durability: does the improvement last over a full year, through the winter season, and does acute care stay lower? A 12-month follow-up of the enrolled children would begin to answer it. The second is causation: a stepped start across the health system's clinics, with each clinic beginning at a different time, would provide a stronger comparison than a pre-post design. The third concerns schools. A Cochrane review of school-based self-management programs, most delivered in socially disadvantaged populations, found that they probably reduce hospital admissions and unplanned visits and may reduce emergency visits, and that parent involvement and delivery outside the child's own time helped implementation (Harris et al., 2019). The project's school link was limited to sending the plan; a partnership in which school nurses reinforce technique and check the plan could be tested next.

Each question could become a later student's project.

Recommendations the Results Do Not Support

Some recommendations would go beyond the evidence. The results do not show that the nurse visit alone reduced acute care, since new controller prescriptions and attention may have contributed. They do not show that sending the plan to school improves control, since families who agreed to share it may differ from those who did not. And they do not justify replacing clinician visits with nurse visits for children with severe or complex asthma, who were managed by their clinicians throughout. Stating these limits protects the clinic from overpromising when it reports the program.

Conclusion

The recommendations are to keep the program, reinforce inhaler technique at every contact, keep owners for its administrative steps, spread it with measurement and test its durability, its effect under a stronger design and a deeper partnership with schools. Each is tied to what the project found and to evidence beyond it, and each stops where the findings stop.

Families who took part will receive a plain-language summary of these findings in their preferred language.

References

Harris, K., Kneale, D., Lasserson, T. J., McDonald, V. M., Grigg, J., & Thomas, J. (2019). School-based self-management interventions for asthma in children and adolescents: A mixed methods systematic review. Cochrane Database of Systematic Reviews, 2019(1), Article CD011651. https://doi.org/10.1002/14651858.CD011651.pub2

Klijn, S. L., Hiligsmann, M., Evers, S. M. A. A., Román-Rodríguez, M., van der Molen, T., & van Boven, J. F. M. (2017). Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: A systematic review. NPJ Primary Care Respiratory Medicine, 27, Article 24. https://doi.org/10.1038/s41533-017-0022-1

National Asthma Education and Prevention Program. (2007). Expert panel report 3: Guidelines for the diagnosis and management of asthma (NIH Publication No. 07-4051). National Heart, Lung, and Blood Institute.