Care and Management of Asthma

Asthma is a common incurable disease that affects the small tubes carrying air in and out of the lungs in the airways; it is more common at childhood stage but can also occur at a later age (British Lung Foundation, 2011). The major cause of asthma has not been determined but it is believed that some factors as allergies, exercise and common cold contribute to its development. In the United Kingdom, asthma is being handled primarily by a General Practitioner or nurse. Healthcare can be provided in three major means: Primary, Secondary and Tertiary. They are delivered depending on the severity of an individual’s condition. General Practitioners (GPs), Pharmacists, Nurses, Dentists and Optometrists are the main classes of healthcare providers that deliver Primary care. It is the basically the first point of contact for most individuals (National Health Service Choices, 2010). Care distinctively provided in local hospitals is usually on referral from primary care health providers, such type of care is basically referred to as Secondary Care. The third aspect of care is the tertiary care which is provided by specialist such as neurologist and cardiologist in a majorly specialised hospital centre for long term treatment.

EPIDEMIOLOGICAL OVERVIEW OF ASTHMA

Major facts that make Asthma a major health issue in the UK are:

In 2008, a total number of 1,204 deaths were recorded from asthma in the UK, out of which 29 were children aged 14 years and under.

1 person every 7 hours or 3 people per day die from asthma

146,000 adults and 36,000 children currently are on treatment for asthma in northern Ireland making it a sum total of 182,000 people (1 in 10)In Northern Ireland 182,000 people (1 in 10) are currently receiving treatment for asthma. This consists of 36,000 children and 146,000 adults.

In Scotland 368,000 people are currently receiving treatment for asthma. This consists of 72,000 children and 296,000 adults.

In Wales 314,000 people are currently receiving treatment for asthma. This consists of 59,000 children and 256,000 adults (Asthma UK, 2011).

the number of adults with asthma in the UK has increased by 400,000 since the last audit of UK asthma in 2001

about 2% of adults consult their GP annually with asthma

ASTHMA CARE AND MANAGEMENT AND LOCALITY STUDY OF UK

Asthma exists in various forms hence; its heterogeneity has been well established by a variety of studies that have proven the disease risk from early environmental factors and susceptibility genes, inflammation and therapeutic agent response further induces accompanying diseases (Lang et al., 2011). Risk factors associated with asthma are family history of atopic disease, for example

Allergic rhinitis

Allergic conjunctivitis

Male sex, for pre-pubertal asthma, and female sex, for persistence of asthma from childhood to adulthood

Bronchiolitis in infancy

Parental smoking, including passive smoking

Premature birth, especially in extreme-preterm infants who required ventilatory support, with consequent chronic lung disease of prematurity (NHS Choices, 2011)

In the UK, asthma is more common among children than in adults and also has an increased rate in women than men (NHS choices, 2010). A condition referred to as acute asthma exacerbation could occur and could sometimes be life-threatening but is mostly rare. Asthma patients are treated with care by GPs and nurses trained for asthma management and such treatments are specific to the symptoms portrayed by each patient. This treatment (Primary care) basically involves:

• A personal asthma procedural plan concurred with your GP or nurse
• An annual regular check ensuring proper control of the patient’s treatment and positive response to the treatment
• Proper seeking of the patient’s consent ensuring his/her decision is involved in decision making of his/her treatment

Comprehensive detailed information about how to control and manage the patient’s condition; while a Secondary or Reactive care is enforced in emergency cases to regain control of more high-risk symptoms.

In treating asthma, reliever inhalers are given to every patient by the GP; these inhalers serve as immediate relievers and ensure restoration of normal breathing. It functions effectively due to its composition of a short-acting beta2-agonist that works by relaxing the muscles surrounding the narrowed airways (British Medical Journal group, 2011). This further ensures the airways are opened wider, making it easier to breathe again. Salbutamol and terbutaline are common types of this inhaler. They have been proven to be generally safe except when their use is abused although they possess very few side effects. If the asthma is well controlled, then their usage will be minimal; if a patient uses the inhaler for up to three times or more weekly then it is advised that the treatment be reviewed

Secondary care and management of asthma is implemented when Patients exhibit a combination of severe asthma, behavioural and psychosocial features, they hence are at risk of developing near-fatal or fatal asthma. (BTS and SIGN, 2009).

Asthma care is dependent on the age of the patients in that children have a different mode of care as compared to adults, a critical look at the adult care is elaborated below. Prior considerations are basically that the patient is registered with his GP, will have to book for an appointment with his GP before visiting (except in emergencies as acute exacerbations), confirmation with the patient of their understanding of the role of treatment, adherence to treatment, inhaler technique, and appropriate elimination of trigger factors as: exercise, drugs foods, emotional factors, weather changes, allergens etc (Shiang et al., 2009)

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In analyzing the delivery of care to asthma patients in the UK, data from Office for National Statistics shall be addressed. Table 1 below signifies that there was a remarkable decrease in hospital admission in 2000 for asthma; it showed a 45 percent decrease among children between ages 5 and 14 years and a 52 percent decrease among children below 5 years (Office for National Statistics, 2004).

TABLE 1

The management of asthma is patient-specific and is delivered by either the GP or asthma nurse; a respiratory nurse specialist works closely with the GP and the patient serving as the best form of encouragement to the patient in the procedural management of his/her asthma condition. The respiratory nurse specialist has a critical role in the management of asthma as elaborated that he/she:

• Explains the need for various inhalers (ensuring the best is offered to the patient) and provides the patient with information on treatment administered
• Advices on triggers and how to keep off them
• Assists the patient in quitting smoking (if applicable)
• Explicates on how to monitor the condition
• Provides the action plan of treatment and explains it to the patient.
• Is always available for assistance both at home and on the phone (NHS Choices, 2006)

Nurses are generally recruited into the NHS through the website www.nursebank.co.uk , the Association of Respiratory Nurse Specialists offer courses for development and training of nurses and promote clinical excellence in respiratory care delivery (Association of Respiratory Nurse Specialist, 2010). The selection of a professional nurse in a recruitment procedure is dependent on factors as Years of experience, area of expertise and personal record check.

CRITIQUE ON ASTHMA CARE

Asthma management involves a wide range of services including primary care, routine follow up, hospital inpatient and outpatient care, proper education and advice of patient, emergency calls and prescribed drugs; these services when combined with the intensity and level of use result to a high cost (Department of Health, 2011). In 2001, England recorded a net ingredient cost of £442million and around £33million for inhaled therapy Brocklebank et al (2001). In prescribing drugs, the patient is considered as whether or not to use the drug/device appropriately; the most effective and clinically proven cost effective drug is also reasonably considered. However, restrictions imposed on manufacturers make some inhalers commercially unavailable hence the use of more expensive drugs.

The British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) have clinical guidelines on the use of inhalers for asthma (BTS and SIGN, 2009) however; there are inconsistencies or absence of recommendations for inhaler devices from these guidelines. Evidence-based guidelines are currently being prepared by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN). There are criticisms on the effectiveness of the inhaler which largely depends on technique of administration by patient considering experience, physical ability and education on usage (NHS centre for reviews and Dissemination, 2003)

CONCLUSION

The role of a nurse in quality care delivery cannot be overruled especially in a health condition as asthma which could be critical and possibly fatal. The initial primary care given to asthma patients and subsequent secondary care has been proven to be appropriate in that the health status of patients is being improved. The incorporation of a respiratory nurse specialist has been a major milestone in achieving a better health status for asthma patients in the United Kingdom.

REFERENCES

Association of Respiratory Nurse Specialist (2010) professional development Available at: http://www.arns.co.uk/pages/professional%20development.html (Accessed: 11 March 2011).

Asthma UK (2011) For Journalists: Key facts and statistics Available at: http://www.asthma.org.uk/news_media/media_resources/for_journalists_key.html (Accessed: 5 March 2011).

British Lung Foundation (2011) Asthma, Available at: http://www.lunguk.org/you-and-your-lungs/conditions-and-diseases/asthma (Accessed: 9 March 2011).

British Medical Journal group (2011) Asthma in adults Available at: http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/531553.pdf (Accessed: 12 March 2011).

British National Formulatory (2010) NICE Technology Appraisal. Available at: http://bnf.org/bnf/extra/current/450034.htm (Accessed: 9 March 2011).

British Thoracic Society, Scottish Intercollegiate Guidelines Network (2009) British Guideline on the Management of Asthma: A national clinical guideline. Available at: http://www.sign.ac.uk/pdf/sign101.pdf (Accessed: 10 March 2011).

Brocklebank, D., Ram, F., Wright, J., Barry, P., Cates, C., Davies, L., Douglas, G., Muers, M., Smith, D., White, J. ‘Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature’ Health Technology Assessment 5 (26) pp. 1-149. Pubmed [Online]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11701099 (Accessed: 4 March 2011).

Department of Health (2011) Prescription Cost Analysis 2001. Available at: http://www.doh.gov.uk/stats.pca2001.pdf (Accessed: 11 March 2011).

Lang M., Erzurum S., C., Kavuru M. (2011) Asthma. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/bronchial-asthma/ (Accessed: 12 March 2011).

Medicines and Healthcare Regulatory Products Agency (2007) vol (1) drug safety update. Available at: http://www.mhra.gov.uk/Publications/Safetyguidance/DrugSafetyUpdate/CON2033216 (Accessed: 12 March 2011).

NHS Centre for reviews and dissemination (2003) 8 (1) ‘Inhaler devices for the management of asthma and COPD’ Available at: http://www.york.ac.uk/inst/crd/EHC/ehc81.pdf (Accessed: 10 March 2011).

National Health Service Choices (2010) About the NHS. Available at: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx (Accessed: 5 March, 2010).

National Health Service Choices (2010) Acute asthma in adults-management in primary care. Available at: http://healthguides.mapofmedicine.com/choices/map/asthma_in_adults2.html (Accessed: 9 March 2011).

National Health Service Choices (2006) The role of your Respiratory Nurse Specialist. Available at: http://www.chelwest.nhs.uk/documents/patientLeaflets/Asthma%20-%20The%20role%20of%20your%20Respiratory%20Nurse%20Specialist.pdf (Accessed: 11 March 2011).

Office for National Statistics (2004) Asthma and allergies: Decrease in hospital admissions in 90s. Available at: http://www.statistics.gov.uk/CCI/nugget.asp?ID=722&Pos=1&ColRank=1&Rank=192 (Accessed: 8 March 2011).

Shiang, C., Mauad, T., Senhorini, A., De Araújo, B., Ferreira, D., Da Silva, L ., Dolhnikoff, M., Tsokos, M., Rabe, K., Pabst, R. (2009) ‘Pulmonary periarterial inflammation in fatal asthma’ Clinical and Experimental Allergy 39 (10) pp. 1499-1507 Wiley [Online]. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2009.03281.x/abstract (Accessed: 11 March 2011).

LEARNING OUTCOME 2

LEADERSHIP IN NURSING AND ASSOCIATED PROFESSIONS

A Leader is someone who guides or chairs a group of people or an organisation; it is common practice that a leader portrays some leadership skills to enable him/her be productive and effective. Cook (2001) describes a clinical nursing leader as someone who endlessly gets involved in direct patient care hence improving care by being of positive influence to others. All nurses (from those who provide direct care to the managers) need potent leadership skills. Mahoney (2001) emphasises that anyone (e.g. a nurse) who gives assistance to others or is responsible for other people is considered a leader; however, good leadership is reproducible superior performance targeted towards a long term benefit to everyone called for.

John, (2011) has defined a manager as an individual with the sole responsibility to plan and direct the work of a group of people, ensuring proper monitoring and directives are followed. Management in nursing involves regarding leadership functions of administration and making appropriate decisions within organisations that employ nurses.

SIMILARITIES BETWEEN LEADERS AND MANAGERS

Leaders and managers go hand in hand, none of them tend to possess abilities that make them stand on their own, and there is no unique or particular way of managing people. Some basic similarities between managers and leaders are:

People development: An effectual manager and leader have skills and abilities that tend towards the development of the people.

Partnership working: the work of both a manager and a leader tend to be of a partnership level (Mather, 2009).

Motivators: both leaders and managers are motivators of their subordinates

DIFFERENCES BETWEEN LEADERS AND MANAGERS

Thinking pattern: A major difference between a leader and manger is in their level of reasoning, Managers think incrementally, whilst leaders think radically; managers always work towards doing things rightly while leaders work in the perspective of doing the right thing (Richard, 1990).

Loyalty: Subordinates are mostly subordinate to their leader than to their manager; this applies often because the leader takes credit in times of achievement and allocating merit to subordinates (John, 1990).

Competencies: A nursing manager allocates resources and sets timetables while a nursing leader is someone who clarifies the big picture created by the manager and simplifies it, making the hospital/nursing home’s vision more understandable to the staff and patients (Kristina R, 2009).

Leadership is a very vital issue in the nursing practice because nursing requires knowledgeable, consistent and strong leaders, who inspire and boost people’s moral and support professional nursing practice. Nurses need to be both leaders and managers for some very key reasons as:

An Advocate for quality care: a head nurse who serves as either a leader has to stand out in ensuring the needs of both the patients and nursing staff are adequately met, sometimes it will require a robust and bold person to stand before the board in defending these needs.

An influential personality: the presence of an influential nurse handling an asthmatic patient will go a long way in guiding the patient in making informed choices; the patient becomes free and open to the nurse when she/he exhibits a high level of positive influence on the patient.

CRITIQUE OF NURSING PUBLICATIONS IN RELATION TO LEADERSHIP AND MANAGEMENT IN ASTHMATIC AND GENERAL NURSING CARE

A report by the Royal College of Nursing (RCN) on the support by Asthma UK on RCN’s frontline campaign published on 14th January 2011 is carefully analyzed highlighting the publisher’s aims of writing, lessons to be learnt, consequences of the article and its impact on positive care delivery.

It was rightly stated in this article that about three-quarters of asthma emergency admissions can be avoided if proper care is delivered (Royal college of Nursing, 2011). This implies that the need for proper managerial skills needs to be adapted by the healthcare leaders to manage asthma patients which will ultimately lead to the reduction of emergency care delivery for asthma patients. He went further to stress that specialist nurses are the cohesive source of support and stability for care for asthma patients; this issue is supported by the Relationship theory of leadership (also known as transformational theory) which highlights the connection between the leader and the led (Kendra, 2011). Leaders that possess this trait tend to motivate and stir their followers to ensure maximum productivity is achieved. Focus is geared towards the performance of the group members. When a leader with such trait is employed, the function of the specialist will be balanced on both as a helper of the patient and a confidant to the patient. He also said that the role of a specialist nurse has reduced hospital admissions from 22% to 6%, hence saving the National Health Service billions of pounds annually.

The writer concluded by turning down the practise of relieving the specialist nurses of their jobs and employing other nurses and ward clerks to fit into their roles which he said the adverse effects were of greater negative impacts as costing the NHS more finance and damage the lives of the patients already receiving care by the specialist nurses.

The lessons from this article cannot be over-emphasized in that there is an immediate need for the employment of more specialist nurses to manage asthmatic patients better and to save the lives of their patients.

A similar report by Akinsanya (2009) on the Exacerbations of severe asthma; psychosocial predictors and the impact of a nurse-led clinic stated that the need for alternate management approaches is paramount in caring for people with severe asthma. He also recommended further findings on the social and psychological aspects of asthma management. Recommendations were also made on the holistic approach for long-term management of asthmatic patients (Akinsanya, 2009).

This report clearly shows the application of the contingency leadership theory that postulates the influence of variables that relate to the environment on the determination of the specific leadership style fit for a situation (Kendra, 2011); it further implies the need for a paradigm shift on the care for acute asthmatic patients towards need for more nurse specialists.

PERSONAL REFLECTIONS ON LEADERSHIP AND MANAGERIAL SKILLS

As a major role player in healthcare delivery, nurses have inevitable functions. This Portfolio has given me an in depth understanding in various areas of my practice as:

Efficiency: I have learnt that my level of efficiency has a vital impact in saving asthmatic patients’ lives; it will help ease the huge financial burden on Government by saving extra expenses.

Leadership skills: According to the ‘great man theory’ of leadership (Management Study Guide, 2011a) which denotes that some people are born with inherent leadership skills which become apparent when great needs arise. I have understood that as a nurse, I can lead rightly and manage people if I can nurture the greatness in me. In enhancing my managerial skills, I will give room for creativity in my area of work by combining both human and non-human resources (Management Study Guide, 2011b) to achieve the designed goal. Team work is also a very good point I learnt from this report in that I cannot be an effective leader if I am regarded as the only member of my team succeeding, there has to be a cohesive effort from all.

Care delivery: The focus is on the nurses to serve as interlocutors between the GP and patient ensuring the patient adheres to prescriptions and that the nurse is always available for assistance by the patient.

CONCLUSION

The difference between a leader and manager is quite small and most leaders tend to end up as managers. Asthmatic guidelines need to be reviewed often to improve its managerial aspect of care. Nurses are relevant care deliverers and all need to develop leadership and managerial skills in order to safe guard the healthcare of the United Kingdom.