Asthma is a leading cause of chronic illness among school-aged children and adolescents. Current trends have led to school faculty and staff becoming increasingly responsible for managing student asthma, often without optimal training or resources. The purpose of this project was to establish whether facilitated access to personalized student asthma action plans (AAPs), education, proper use, and school nurse support improved reported self-efficacy regarding student asthma exacerbation prevention and management in elementary and preschool faculty and staff. Thirty-five participants from an urban, underserved Connecticut school were surveyed to determine perceived self-efficacy regarding student asthma exacerbation prevention and management. AAPs were then placed with students’ asthma inhalers, and all participants were instructed on their use. Three months later, participants were resurveyed. A statistically significant difference after both the initial education and 3-month survey was identified. Providing elementary and preschool faculty and staff with facilitated access to student action plans and education on their use can improve perceived self-efficacy regarding student asthma exacerbation prevention and management.
asthma, self-efficacy, school, teachers, asthma action plan, AAP, school nursing
Asthma is a leading cause of chronic illness among schoolaged children and adolescents (Centers for Disease Control and Prevention [CDC], 2018). Over 7 million children under the age of 19 have a diagnosis of asthma in the United States, with incidence increasing daily (CDC, 2018). Of these, 3 million children reported experiencing one or more asthma exacerbations in 2015 (Asthma and Allergy Foundation of America [AAFA], 2015).
Elementary school children are especially prone to asthma, as the highest prevalence falls within the age range of 5–14 years old (CDC, 2018). In some urban schools, rates of asthma are as high as 20% of the student population (Jaramillo & Reznik, 2015). It is estimated that every classroom in the United States contains an average of two to four children with asthma (Jaramillo & Reznik, 2015).
Many U.S. schools have an assigned nurse, and in most instances, it is he or she who is primarily tasked with providing elementary and preschool student asthma medications (Svavarsdottir et al., 2013). However, lack of adoption of national standards for nurse to student ratios can mean that one nurse is responsible for hundreds, or even thousands, of children (Svavarsdottir et al., 2013). Sometimes, one nurse manages multiple schools (Svavarsdottir et al., 2013). Furthermore, nurses are often not in attendance when students leave the building for field trips or when participating in after-school programs (Jaramillo & Reznik, 2015).
Connecticut (CT) state law stipulates that in the absence of a school nurse, unlicensed school personnel who have completed annual medication administration training may be delegated as the providers of prescribed student medications (Connecticut State Department of Education, 2015). In such cases, faculty and staff may be the only available choice to medically manage students who experience asthma exacerbation symptoms (Jaramillo & Reznik, 2015).
The National Heart, Lung, and Blood Institute (NHLBI, 2007) guidelines stress that without proper school asthma training to faculty and staff, students’ asthma care can be greatly compromised. School personnel are often provided with basic medication administration training by the school nurse, but usually this training is not asthma-specific (Getch & Neuharth-Pritchett, 2009). Low levels of asthma knowledge among teachers have been identified in numerous studies (Bruzzese et al., 2010; Cain & Reznik, 2016; Gau & Hung, 2014; Jaramillo & Reznik, 2015). One study suggests that as high as 80% of teachers do not feel confident in their capability to manage school asthma exacerbations (Gau & Hung, 2014). These studies particularly identified poor asthma knowledge in the areas of identification of symptoms, treatment of symptoms, asthma medications, and prevention of asthma exacerbations (Bruzzese et al., 2010; Cain & Reznik, 2016; Jaramillo & Reznik, 2015). Although intermittently the designated managers of student asthma, a selfreported lack of knowledge exists within school faculty and staff in regard to this task (Bruzzese et al., 2010; Cain & Reznik, 2016; Jaramillo & Reznik, 2015). Despite the knowledge and comfort deficit of teachers, research supports that most are generally receptive to learning more about student asthma management (Bruzzese et al., 2010; Cain & Reznik, 2016). As school faculty and staff often become the responsible caregivers of students with asthma, it is imperative that they possess the knowledge and tools to appropriately identify asthma symptoms and correctly manage exacerbations when they arise.
The concept of “self-efficacy” was introduced by Bandura (1986), and it refers to one’s confidence in the ability to correctly perform a particular action and to achieve a certain result. Bandura (1986) believed one’s behaviors, motivation levels, and thoughts regarding stressful situations are affected by self-perception of his or her abilities. Perceived self-efficacy levels can alter how one feels and acts when managing acute asthma episodes (Gau & Hung, 2014). Management of a child experiencing asthma symptoms can be an extremely terrifying experience, especially when a lack of perceived knowledge and support exists (Gau & Hung, 2014). This knowledge deficit can hinder one’s ability to take correct and rapid action in the event of an asthma exacerbation (Getch & Neuharth-Pritchett, 2009). As heightened self-efficacy in both parents and school nurses has been shown to improve health outcomes in children with asthma (Egginton et al., 2013) in the absence of these caregivers, it is essential to maximize efforts to improve selfefficacy within school faculty and staff.
A valuable tool that has been shown to significantly improve asthma outcomes is the use of an asthma action plan (AAP; AAFA, 2015). An AAP is a written one-page template designed for, and primarily used by, patients, families, and school nurses (Hanson et al., 2013; McCabe et al., 2018; Seiler & Sarver, 2016). It is personalized by a child’s health-care provider to guide asthma management both when symptoms are well controlled and during varying degrees of exacerbation (Egginton et al., 2013). Within elementary-aged students, AAP use has been proven to significantly reduce the number of asthma exacerbations experienced (Hanson et al., 2013). National asthma guidelines recommend all caregivers of children with asthma are provided, and become familiar with, an AAP to ensure the correct management approach and congruency of care (AAFA, 2015). These guidelines also recommend routinely updating classroom teachers on individual student AAPs (NHLBI, 2007). It is further suggested that a copy of each student AAP be easily accessible in the classroom (NHLBI, 2007). A classroom AAP for school faculty and staff utilization can facilitate role recognition in asthma management (NHLBI, 2007). As reported by school nurses in two separate studies, AAP utilization positively influenced their efficiency of student asthma management (Hanson et al., 2013; McCabe et al., 2018). These studies also reported that the majority of participating school nurses felt AAPs increased their confidence and self-efficacy caring for students with asthma, particularly in determining when to administer asthma medications and seek emergent care.
As asthma is one of the most prevalent chronic conditions in children under 18 years of age (CDC, 2018), achieving maximum self-efficacy in managing this condition is essential.
Educating all caregivers on interpreting and following AAPs serves as a critical element of asthma care (Bruzzese et al., 2010; Jaramillo & Reznik, 2015). Parents, school personnel, and health professionals all agree that utilization of personalized AAPs in school is necessary to achieve optimal asthma management and that classrooms currently have insufficient information to thoroughly support students with asthma (Egginton et al., 2013). In the absence of a school nurse, it is imperative that elementary and preschool personnel have all the available resources to provide emergent student medical care. School-based student AAPs are often routinely available to, and sometimes required by, school nurses (Cain & Reznik, 2016; Jaramillo & Reznik, 2015). Despite this, elementary school faculty and staff report rarely being educated on what AAPs are or how to use them and that they are seldom accessible (Bruzzese et al., 2010; Jaramillo & Reznik, 2015).
An area for enhancement was identified to improve elementary school faculty and staff self-efficacy regarding student asthma care based on the results of relevant literature. By educating faculty and staff on AAPs and providing them easy access to this tool for all preschool- and elementaryaged students with asthma, asthma management selfefficacy was predicted to be enhanced. The purpose of this project was to assess the self-efficacy of elementary and preschool faculty and staff when managing student asthma and to establish whether education about, and availability of, student AAPs improved reported self-efficacy in preventing and managing student asthma with the support of a school nurse.
The University of Alabama in Huntsville Institutional Review Board approval for this quality improvement project was obtained in February 2019.
The project took place in an underserved community public school with grades ranging from prekindergarten through sixth in urban CT. Of the school’s students, 74% identify as African American, 20% as Hispanic, 5% as Caucasian, and 1% as Asian. Similar to other schools within the state, asthma has long served as a major source of morbidity for its students. However, Asthma in Connecticut 2008: A Surveillance Report identified the region this school serves as having the highest prevalence of school-aged asthma and asthma-related pediatric hospital admissions across the state (Egginton et al., 2013; Peng et al., 2008). Of the school’s 397 students, 62 (16%) had a diagnosis of asthma at the time of this project.
This percentage is notably higher than the CT statewide average of 11.3% (Peng et al., 2008). Of the 62 students with asthma, 49 students required asthma medications in school. In the absence of a nurse, standing school protocol delegated any nurse-trained teacher or school employee with classroom supervision responsibility for administering medications. These employees were provided, or had access to, a list of students with medical conditions requiring medications and the medications, themselves. This delegation also applied to all school field trips, before and after school programs, and after-school events.
During a routine school staff meeting, the purpose and anticipated process of this project were presented to all attending faculty and staff. Fifty-six school staff members were invited to take part in the project, and 35 agreed. Staff invited consisted of prekindergarten teachers, elementary school teachers (grades kindergarten through sixth), prekindergarten and elementary paraprofessionals, specials teachers (art, music, technology, library, and physical education), support faculty (reading coaches, math coaches, and special education personnel), and support staff (principal, vice principal, guidance counselor, social worker, and facilities director). Participation was voluntary, and there was no penalty for nonparticipation. No physical incentives were offered for participation; however, the group was educated on the benefits of likely improved knowledge regarding student asthma management that would be obtained by completing the project. The population of participants was between the ages of 19 and 80 years, included both males and females, and was of various races. Inclusion criteria were faculty and staff working directly with students in the school setting and who were 19 years and older. Exclusion criteria included nonschool employees, children (aged 18 or younger), and any school staff member who declined to voluntarily participate in the project.
AAP. Our project’s AAP (Figure 1) was developed by the CT Department of Public Health (CTDPH) and is widely used by schools across the state. This AAP is very similar to many other AAPs developed by various organizations. It is a symptom-based AAP for school use that includes asthma indicators, asthma management instructions, and a provider authorization for asthma medication in school. Students’ primary care provider, pulmonologist, or the school-based health center provider complete this form, and it is required by the school district to authorize any in-school student asthma medication. Consent for use in our project was obtained from the Chronic Disease Director at CTDPH.
Modified Teacher Asthma Management Self-Efficacy Survey. The survey used in this project (Table 1) to measure the level of participant self-efficacy regarding student asthma exacerbation prevention and management was a modified version of the Teacher Asthma Management Self-Efficacy Survey (TAMSES). This questionnaire is an adaptation of the Parent Asthma Management Self-Efficacy Scale (PAMSES), originally developed by Dr. Brenda Bursch. The original PAMSES has a Cronbach’s α of .87 (Bursch et al., 1999). The TAMSES was designed to evaluate teachers’ asthma comfort level or their beliefs regarding their capability to avoid and manage an asthma exacerbation in a child (Rodehorst, 2003). The TAMSES was first reported in 2003 (Rodehorst, 2003). Because instruments that measure overall self-efficacy may not provide valid results specific to asthma, this tool was selected due to its concentration on self-efficacy directly related to asthma management. More so, this tool was expressly designed for use within the teacher population.
The TAMSES is composed of 12 questions that ask participants to rank their comfort level assisting students with various levels of asthma control utilizing a 6-point Likerttype scale. It includes two different subscales, asthma exacerbation management and asthma exacerbation prevention (Rodehorst, 2003). Answer choices are 1–6, but only 1–5 are scored, as Option 6 is “does not apply.” The ranking choices range from not sure at all (Score 1) to completely sure (Score 5). The higher the total score, the higher the selfefficacy of the participant. Like the PAMSES, the TAMSES questionnaire has a Cronbach’s α of .87 (Rodehorst, 2003). Two questions of the TAMSES discussing medication provision specifically in school were modified for this project to reflect use both in school and during school-related functions.
Consent was obtained for use of this tool and for its modification. This instrument served as the preintervention preeducation, preintervention posteducation, and postintervention assessment tool for this project.
The purpose and methodologies of the project were introduced to all participants during a regularly scheduled staff meeting later that same month. After obtaining their informed consent, participants completed a questionnaire about their demographics and previous asthma knowledge. They also completed a paper copy of the modified TAMSES (Time 1) to establish their baseline level of self-efficacy regarding student asthma care immediately following the educational session. All participants were provided a blank copy of the CTDPH AAP for reference. A 30-slide PowerPoint presentation developed by the implementer regarding importance, components, and use of AAPs in the school setting was then provided. The school nurse and student clinic nurse practitioner were available for staff support prior to, during, and following the entire duration of this project. The educational session concluded with the administration of the second modified TAMSES (Time 2). Staffs were away from their daily work duties for a total of 15 min to complete participation in this project.
Immediately following the educational session, a copy of each asthmatic student’s AAP was inserted into a clear bag with that student’s asthma inhaler. Project participants who completed annual school medication administration training and who were authorized by the school nurse to deliver student prescriptions had access to the AAPs whenever responsible for administering medications. The bags containing students’ AAP and asthma medications were made available for participant use and reference before and after school, during class field trips, throughout after-school events, and any other time a school nurse was not available.
Three months after the initial educational session, participants were asked to again complete the modified TAMSES (Time 3) and a project completion questionnaire. This questionnaire aimed to determine the primary source of changes in self-efficacy and whether student AAPs were utilized by participants. It included two questions, the first being, “Which intervention do you feel improved your selfefficacy related to student asthma exacerbation management?” with the selection choices of educational asthma PowerPoint only, facilitated access to AAPs, both the educational asthma PowerPoint and facilitated access to student AAPs, and neither. The second question was “Since the original asthma educational PowerPoint presentation, how many times do you feel you referenced students’ AAP when in charge of student asthma medications?” with responses of never, 1–5 times, 5–10 times, 10–15 times, and more than 15 times.
Preintervention packets, informed consent, postintervention packets, and the numbered roster used for this evidencebased project were kept in a locked box in a locked office. The numbered roster was destroyed upon aggregation of data. Only the project implementors had access or viewed data related to this evidence-based project, and all nonaggregated data were held confidential. Completed surveys were made available only to those researchers directly involved within this project, ensuring strict confidentiality. No project data were shared with or disseminated to the participants’ peers, colleagues, stakeholders within the school district, or management. Only results of aggregated data were presented in the final article.
Demographic data, project completion questionnaire responses, and overall mean scores of all participants’ preeducation (Time 1), posteducation (Time 2), and postintervention (Time 3) responses were entered into the Statistical Package for the Social Sciences Version 26 statistical software. Descriptive statistics were used to analyze both the demographic and project completion data. The repeated measures one-way analysis of variance (ANOVA) test was used to evaluate the overall mean TAMSES test score of all combined participants at three different points of time (Times 1–3). The results of the one-way ANOVA were then used to determine statistical significance.
Of 35 participants, most were certified teachers between the ages of 22 and 69 (Table 2). Regarding participants’ level of previous asthma knowledge, 8 (23%) had a diagnosis of asthma themselves and 15 (43%) reported previously caring for someone outside the classroom with asthma. When asked about previous asthma learning, 10 (29%) stated they received most of their asthma education from the school nurse, while two reported never having any previous asthma education at all. Whereas 19 (54%) reported caring for students with asthma on average of 3–5 times a year, only 4 (11%) reported never having to manage a student with asthma (Table 3).
A one-way repeated measures ANOVA compared mean total self-efficacy scores at Time 1 (baseline, prior to education, or intervention), Time 2 (immediately following AAP education, preintervention), and Time 3 (3 months after implementation of the intervention). α was set at .05. Participant selection of Option 6 (does not apply) on the Likert-type scale was not included in data analysis or when calculating the mean, median, and mode. Including Option 6 would have minimal impact on the median; however, it would have skewed the mean values and affected the remaining Likert choice distribution.
Mean overall scores for each time period included Time 1 (μ = 2.54, SD = .70), Time 2 (μ = 3.48, SD = .67), and Time 3 (μ = 4.37, SD = .39). There was a statistically significant difference for effect of total time, Wilk’s lambda = .13, F(2, 33) = 107.6, p < .000, multivariate partial η2= .86. Pairwise comparison between Time 1, Time 2, and Time 3 was conducted to identify whether one group outperformed the other. There was a statistically significant difference between Time 1 and Time 2 (p ≤ .000), between Time 1 and Time 3 (p ≤ .000), and between Time 2 and Time 3 (p ≤ .000).
A one-way repeated measures ANOVA was also conducted to compare mean scores of each asthma Self- Efficacy subscale, prevention, and management, and a was again set at .05. Each had a statistically significant difference. For the Prevention subscale, Wilk’s lambda = .258, F(2, 33) = 47.5, p < .000, multivariate partial η2= .74. Mean scores for each time period included Time 1 (μ = 2.95, SD = .84), Time 2 (μ = 3.59, SD = .75), and Time 3(μ = 4.43, SD = .37). Pairwise comparison between Time 1, Time 2, and Time 3 was again conducted to identify whether one group outperformed the other. There was a statistically significant difference between Time 1 and Time 2(p ≤ .000), between Time 1 and Time 3 (p ≤ .000), and between Time 2 and Time 3 (p ≤ .000). Within the Management subscale, Wilk’s lambda = .12, F(2, 33) = 121.4, p < .000, multivariate partial η2= .88. Mean scores for each time period included Time 1 (μ = 2.25, SD = .72), Time 2 (μ = 3.41, SD = .70), and Time 3 (μ = 4.34, SD = .47). Pairwise comparison between Time 1, Time 2, and Time 3 was conducted. There was a statistically significant difference between Time 1 and Time 2 (p ≤ .000), between Time 1 and Time 3 (p ≤ .000), and between Time 2 and Time 3 (p ≤ .000; Table 4).
At the completion of the project, participants were provided a final questionnaire to summarize average self-reported use of student AAPs by participants and to determine which component of the project participants felt increased self-efficacy. Majority (83%, n = 29) reported both the educational asthma PowerPoint and facilitated access to student AAPs increased their self-efficacy managing student asthma. None of the participants reported neither the educational session nor facilitated access to AAPs helped asthma management self-efficacy. When discussing how many times AAPs were referenced, 28% (n = 10) reported using student AAPs 5–10 times, 23% (n = 8) reported 10–15 times, and 26% (n = 9) reported more than 15 times over the project course of 3 months. Only 6% (n = 2) reported not using a student AAP at all since the educational session was provided (see Table 5).
The main purpose of this project was to improve participant sense of self-efficacy regarding student asthma exacerbation prevention and management through education about, and provision of, personalized student AAPs. While previous studies of AAP use have clearly demonstrated improvement in pediatric asthma management (Akhter et al., 2017; Khan et al., 2014; Lakupoch et al., 2018; Srinivas, 2015), their focus has been on use primarily in the home setting. Studies specific to school-based AAP use have generally concentrated on improving school nurse AAP initiation within schools (Egginton et al., 2013; Hanson et al., 2013; Jaramillo & Reznik, 2015; McCabe et al., 2018; Richmond et al., 2011). No studies that examined how the exclusive use of AAP education and utilization by elementary and preschool faculty and staff affected their self-efficacy concerning asthma care could be identified.
The findings strongly suggest the education and facilitated access to AAPs significantly increased participant student asthma management self-efficacy, both in the areas of asthma exacerbation prevention and management. There was a significant rise in self-efficacy mean scores between Time 1, Time 2, and Time 3. An increase in self-efficacy scores indicates a positive outcome, showing improvement in the comfort level experienced by participants. Of the two subscales, both prevention and management of asthma exacerbations were statistically significant. The improvement in mean scores between Time 1 and Time 2 indicates that AAP education provided to participants increased their self-efficacy both preventing and managing asthma exacerbations. The upsurge in mean scores between Time 2 and Time 3 shows that utilization of AAPs further increased participant self-efficacy preventing and managing asthma.
Maybe the most important outtake from this project was the recognition that when school personnel were provided both the knowledge and tools to treat student asthma, both components were extremely well received and adequately utilized. School faculty and staff verbally expressed eagerness to learn more about student asthma management during the initial project presentation and were extremely engaged within the PowerPoint educational session. During the 3 months of facilitated student AAP access, participants frequently asked questions regarding asthma care to both the school nurse and the student clinic provider. These conversations often started because personnel were referencing correct understanding and use of the AAPs from the educational presentation. These educational conversations were ones that would not have taken place without AAP education and access. This project demonstrated that school personnel not only utilized student AAPs, but they referenced them frequently. Nine participants reported they utilized student AAPs over 15 times over the duration of the project, and only two reported not using a student AAP at all. This means that 33 participants who would previously not have had access to student AAPs utilized them during the course of this project. Toward the end of the project window, one teacher came to the school health clinic for another copy of a student AAP because it had been misplaced during a field trip, and she reported she didn’t feel as prepared to be responsible for that student’s asthma care without it.
Two administrators and three teachers asked that facilitated AAP access and annual AAP education become standard practice, as they noticed an improved confidence of staff managing student asthma during field trips.
Based on findings of this project, it would be beneficial to implement both AAP education and provision in all elementary and preschools. As this project utilized paper AAPs, the cost of implementation was negligible. Minimal time away from work by project participants also maximized implementation potential. As the majority of participants reported their principal source of asthma education was through the school nurse, a platform already exists to replicate this intervention in any school setting staffed by a school nurse. Given the literature supporting discomfort and lack of confidence in school faculty and staff when managing student asthma, this intervention serves as an easy support modality.
This project was limited by its small sample size participants and thus could not reasonably expect to be representative of all the ideas, knowledge, concerns, and experience of all such individuals nationally or even within the school district. Furthermore, the sample was comprised of a large variety of educational disciplines and specialties, so occupational subset representation by grade level and occupational position in this project was low. Use of a self-reported survey should also be considered when deducing results, as it relies on user self-perception, which may be subject to response bias. Although most participants (n = 31) had at least a baccalaureate degree, participant understanding or interpretation of particular questions may still influence responses. While significant improvement in self-efficacy was shown to persist 3-month postintervention, further study is necessary to determine how long such positive findings persist and when additional educational sessions may be necessary to adequately maintain this effect.
Another limitation of this project was the lack of evaluation in regard to after-school sports staff. At the time of this project, the school did not have any school-organized sports teams, and so, further investigation into the effect of selfefficacy of coaching staff would be pertinent. It is also important to note that data obtained in the state of CT may not equivalently correlate to other states due to its significantly high prevalence of asthma (Peng et al., 2008).
High student asthma prevalence could increase prior knowledge base and comfort managing asthma due to more exposure. While broader studies may support our finding of improved staff self-efficacy from this form of intervention, it remains to be shown that these gains in staff self-efficacy translate into improved health outcomes for students with asthma. Future studies should encompass a more generalized variety of faculty and staff in the elementary and preschool setting who have a wider range of skills and capabilities to determine effect of AAPs on asthma self-efficacy.
One last limitation worth mentioning involves obtainment of AAPs from primary care providers. The school district this project took place in requires that all students with asthma have an annually updated AAP on file in order to accept any asthma medication for school use.
This particular school also has a school-based health clinic with a primary provider for students. While this made obtaining student AAPs extremely achievable, many school districts do not require AAPs or do not have a provider on site who is able to create them, if needed. This could create difficulty in the school nurse obtaining a copy of each student with asthma’s individualized AAP from their parent or health-care provider. In order to facilitate this, requiring AAPs in order to accept school asthma medications may be of benefit to any school who wishes to implement this protocol.
This project demonstrated positive outcomes through the use of asthma education and facilitated access to AAPs in nonnursing school personnel and availability to school nurses or clinic staff. Its findings can provide schools an easily implemented mechanism to improve the consistency and continuity of care across caregivers of students with asthma and supply schools a foundation for enhanced guidelines on asthma management in the absence of a school nurse. Project participants identified the school nurse as being their primary source of asthma education. Formalizing information the school nurse already provides to staff has the potential to be an effective and efficient method to benefit students with asthma. School nurses who already utilize AAPs can take initiative to educate faculty and staff on their use and to keep a copy of the plans attached to asthma medications. Incorporating AAPs with asthma medications poses no risks, does not disclose confidential information as this information is intended to be shared, is financially feasible as the cost is negligible, and is a simple task to complete. When conducting a risk analysis, schools should recognize the benefits of adopting this action greatly outweigh the detrimental ramifications of not embracing an AAP. It should be noted that delegating tasks to unlicensed personnel should be closely monitored by appointing party to ensure quality of intervention implementation.
Findings indicated that participants experienced increased self-efficacy both preventing and managing student asthma when educated on, and provided access to, individualized student AAPs. It was determined that when given the education and tools, AAPs were frequently utilized. As teachers and other staff are increasingly responsible for providing emergent student medical care in the absence of a school nurse, it is imperative that school districts take all appropriate steps to heighten staff self-efficacy regarding this matter. Because asthma is a leading chronic illness in elementaryand preschool-aged students, chances are most teachers will be responsible for managing this illness at some point in their career. Project participants reported that most manage at least one student with asthma in a year, with the majority reporting 3–5 times annually. To sustain this intervention, annual reeducation on AAPs to all school faculty and staff as well as obtaining and providing annual AAP updates would be required. Providing proven resources to assist teachers with preventing and managing student asthma is thus a logical way to support nonnursing staff delivering medical coverage.
Manuscript written by Krysten Lisella Arekapudi and edited by Casey Norris and Stephen Updegrove.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Krysten Lisella Arekapudi, RN, APRN, MSN, FNP-C https://orcid.org/0000-0001-5905-2030
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Krysten Lisella Arekapudi, RN, APRN, MSN, FNP-C, is a DNP student at the University of Alabama in Huntsville.
Casey Norris, DNP, MSN, RN, PCNS-BC, is a clinical assistant professor at the University of Alabama in Huntsville.
Stephen Updegrove, MD, MPH, is a collaborating physician.
1 The University of Alabama in Huntsville, TX, USA
2 Collaborating Physician, Guilford, CT, USA
Corresponding Author:Krysten Lisella Arekapudi.Email: kxa0009@dcccd.edu
