DNP 852A Module 4 Implications for Practice, Policy and Education Example

Beyond One Clinic: Implications of a Nurse-Led Pediatric Asthma Program for Practice, Policy and Nursing Education

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 852A: Project Manuscript

Instructor Name

Month Day, Year

Beyond One Clinic: Implications of a Nurse-Led Pediatric Asthma Program for Practice, Policy and Nursing Education

A DNP project matters beyond its site only if its findings are translated into implications for others. This paper drafts the implications section of chapter five for my project, the bilingual nurse asthma visit at a pediatric safety-net clinic. Control improved and acute care fell over 12 weeks, although the single-group design limits claims about cause. The paper sets out implications for practice, policy and nursing education, each tied to a finding and bounded by what the design can support.

Implications for Practice

Four implications follow for pediatric primary care. First, a structured nurse visit is a practical way to close the gap between guidelines and practice. The national guidelines call for a written action plan for every patient with asthma and a check of inhaler technique at visits (National Asthma Education and Prevention Program, 2007), yet fewer than a third of the clinic's children had a current plan before the project. A dedicated visit with a template raised coverage across the clinic, not only among enrolled children.

Second, inhaler technique needs reinforcement, not a single lesson. Technique slipped by 12 weeks in some children until checks were added to calls and routine visits, and a two-minute check by a medical assistant proved feasible. Third, the administrative steps that link care to schools and families need named owners, because they were the steps that failed until someone held them. Fourth, delivering every element in the family's language is feasible and was associated with similar results for Spanish- and English-speaking families.

Implications for Nursing Roles

The project also says something about how registered nurses are used in primary care. The asthma visit drew on skills nurses already have, teaching, assessment and follow-up, yet before the project those skills were spent mostly on triage and rooming. Giving nurses a defined visit with protected time, a template and clear routes back to clinicians allowed them to work closer to the full scope of their license. The clinic's decision to keep the visit suggests that leaders saw value in that shift. Other clinics considering similar programs should expect to protect nurse time explicitly, since the program's steps that depended on spare minutes were the ones most likely to slip.

Implications for the Health System

For the health system, the most direct implication concerns its second pediatric clinic. The project's materials, including the bilingual plan template, the technique checklist, the simulation scenarios and the front-desk process for school plans, can be transferred with little cost. The project's weaknesses point to what the second clinic should do differently from the start: sign off every nurse before launch, assign owners for administrative steps on day one and build technique checks into follow-up from the first week. Starting the second clinic on a planned date would also let the system compare the two sites over the same months, answering questions this project could not.

Implications for Policy

Three policy implications arise, framed as questions for the health system and for policy makers rather than as firm conclusions. The first concerns schools. Sending plans to school nurses depended on parental consent and on up-to-date contact lists, and plans reached schools far more reliably once a process existed. District and health system agreements that set a standard way to share and store asthma plans would reduce that friction. A Cochrane review found that school-based self-management programs, mostly in disadvantaged populations, probably reduce hospital admissions and unplanned visits, which suggests that stronger links between clinics and schools are worth building (Harris et al., 2019).

The second concerns payment. The program ran on about 118 nurse hours for 104 children, time the clinic absorbed during the project. Whether it continues at scale depends on whether nurse-led asthma education visits can be paid for, which varies by payer and state Medicaid program. The third concerns language access. Asthma burden is higher among children in low-income families (Zahran et al., 2018), many of whom speak languages other than English, and the project's bilingual results support funding translated materials and interpreters as part of asthma care rather than as extras.

Implications for Nursing Education

The project also has lessons for how nurses are prepared. Experienced nurses accepted inhaler demonstrations that skipped key steps until a refresher sharpened their checking, which suggests that device technique should be taught to a checklist standard with return demonstration in prelicensure and residency programs. Teach-back is widely used in patient education, most often by nurses, but a systematic review found wide variation in how it is carried out (Talevski et al., 2020); programs should teach it as a defined method, including with children, since many of them take their inhalers at school or with friends, away from any adult. Finally, simulation with a parent actor was the most useful part of the nurses' preparation, and it can be adapted for students at low cost.

These points will be shared with the residency program's educators.

Implications That Should Not Be Drawn

Some tempting implications go beyond the evidence. Nothing here suggests that nurse visits could stand in for clinician care when a child's asthma is severe or complicated; those children stayed with their clinicians throughout. They do not show that sharing plans with schools improves control, since families chose whether to share. And they do not establish the size of benefit another clinic should expect, since the design likely enlarged the apparent effect. Stating these limits protects the credibility of the implications that are drawn.

Conclusion

For practice, the project supports a structured nurse visit with a template, built-in reinforcement of inhaler technique, owners for school and family links and delivery in families' languages. For policy, it raises questions about standard school plan sharing, payment for nurse education visits and language access. For nursing education, it argues for teaching device technique and teach-back to a standard and using simulation. Each implication rests on a finding and stops where the evidence stops.

Chapter five will present them in this order.

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

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.

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), Article e0231350. https://doi.org/10.1371/journal.pone.0231350

Zahran, H. S., Bailey, C. M., Damon, S. A., Garbe, P. L., & Breysse, P. N. (2018). Vital signs: Asthma in children, United States, 2001-2016. MMWR. Morbidity and Mortality Weekly Report, 67(5), 149-155. https://doi.org/10.15585/mmwr.mm6705e1