Asthma in Evidence-Based Practice


Asthma is a chronic condition that affects airways and results in difficulty breathing. In patients with asthma, the disease causes the inflammation of air passages that is followed by the significant narrowing of airways. In the United States of America, bronchial asthma is one of the most common chronic diseases in children with the prevalence rate ranging from 6% to 9%. In the adult population, the share of those who are affected by this disease amounts to 7,5%. This paper will provide a theoretical framework of reference for understanding patients with asthma, explain how it shapes individual dimensions, and discuss the role of a case manager using EBP.

Theoretical Framework of Reference

Studying stress and adaptation theories might enhance a nurse’s understanding of what it is like to live with a chronic illness. Within the stimulus-based model, stress is seen as a trigger to physiological and psychological reactions ranging from standard to morbid. Both positive and negative life events are seen as stressful and contributing to human body’s vulnerability to diseases (Smith & Liehr, 2018). For instance, in the case of asthma, psychological factors have been defined as “the enemy within” – something that exacerbates the gravity of the condition (Vliagoftis, 2014). According to the response-based model, stress is a natural reaction to an overload. The adherents of this model claim that there is a need to differentiate between a stressor as a trigger and stress as a response. Lastly, the adaptation theory explains that humans are capable of adapting to many changes in their lives and environment. This theory lays a foundation for asthma-management educational programs.

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Dimensions of Affected Individuals

Chronic illness affects many, if not all, aspects of an individual’s life. According to American Lung Association (2018), asthma makes the airways of lungs red, swollen, and hypersensitive to a variety of triggers which vary from person to person. Common triggers include cold, stress, changing weather, aggressive smells, dust, and pet fur. Once airways are triggered, a person goes in what is called an asthma flare-up or an asthma “attack.” Oxygen cannot be carried directly to the lungs, and a person with this condition experiences coughing, wheezing, shortness of breath, and tightness in the chest area. Once a flare-up occurred, an asthma patient is likely to experience it once again in the next several days. Parents should monitor their young children closely and not leave them unattended for lengthy periods. They should also be aware of the phenomenon called airway remodeling – permanent scarring of lung tissue if the condition is neglected. As for developmental issues, among common comorbidities are anxiety, depression, and learning disabilities (Tay et al., 2016).

In clinical practice, the psychosocial, cultural, and physical dimensions of living with a chronic illness are often overlooked as health practitioners prioritize addressing physiological symptoms. Children with asthma might develop body image issues: even though asthma does not affect their appearance, they might start seeing their body as broken (Sirois, Molnar, & Hirsch, 2015). Another problem is gaining independence from parents or guardians when they need care. These feelings of “otherness” might lead to alienation from peers.

The cultural dimension of living with asthma is shaped by the dominant perception of pain and illness in a patient’s culture. Pillay, Zyl, and Blackbeard (2014) argue that some cultures (primarily Asian) are more stoic and do not encourage sharing about chronic illness experiences. If a child with asthma belongs to the second type of cultures, he or she may be praised for being vocal. Religion might affect how an individual with asthma interprets the purpose of his or her condition. For instance, a Christian would believe that everything happens for a reason, and chronic illness is part of God’s plan.

Development of the Case Manager Role Using EBP

A case manager role nurse is a registered nurse that develops a custom treatment plan for patients and their families. At that, he or she plays the role of a social worker, patient advocate, and a mediator between families and health providers. In terms of asthma, as a case manager, a nurse might want to offer the following evidence-based options: patient education, guided self-monitoring, and patient follow-ups. For instance, introducing self-monitoring tools such as lung assessment applications and encouraging a patient to use them regularly and independently might result in a reduction in readmission rates. Evidently, for this, he or she would have to gain both parties’ – families’ and providers’ consent. In this case, it is critical that a nurse uses his or her leadership and management skills.

Conclusion

Asthma is a chronic disease that puts a strain on an individual’s life. First, asthma flare-ups might be painful, traumatizing, and in some cases, even fatal. It is a condition that might give rise to a variety of comorbidities which affect a person’s development. Depression, anxiety, and body image issues associated with a chronic illness are emotionally daunting and limit a patient’s social life. Cultural and spiritual beliefs shape a person’s perception of asthma to a certain extent. Stress and adaptation theories might help a nurse find an approach to patients with this chronic condition. As a case manager, she or he should advocate for the implementation of evidence-based practice and play the role of a mediator and patient advocate.

References

American Lung Association. (2018). How asthma affects your body. Web.

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Pillay, T., Zyl, H. A., & Blackbeard, D. (2014). Chronic pain perception and cultural experience. Procedia – Social and Behavioral Sciences, 113, 151-160.

Sirois, F. M., Molnar, D. S., & Hirsch, J. K. (2015). Self-compassion, stress, and coping in the context of chronic illness. Self and Identity, 14(3), 334-347.

Smith, M. J., & Liehr, P. R. (2018). Middle range theory for nursing. Nashville, TN: Springer Publishing Company.

Tay, T. R., Radhakrishna, N., Hore‐Lacy, F., Smith, C., Hoy, R., Dabscheck, E., & Hew, M. (2016). Comorbidities in difficult asthma are independent risk factors for frequent exacerbations, poor control and diminished quality of life. Respirology, 21(8), 1384-1390.

Vliagoftis, H. (2014). Psychological stress and asthma: A new enemy within. International Archives of Allergy and Immunology, 164(2), 109.

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