Use of Standards of Care by Nurse Practitioners in Providing Care to Adolescents with Asthma at an Academic Nurse-Managed Primary Care Clinic

Abstract

Asthma is a chronic disease that affects 8.4 million children in the United States (American Lung Association [ALA], 2007). Adolescents with asthma need tailored management of their care with attention given to particular developmental concerns. Standards of care, such as the National Heart, Lung, Blood Institute [NHLBI] 2007 asthma guidelines (NHLBI, 2007), exist to guide patient care and in this case, also address specific adolescent needs. Advanced practice nurses should incorporate "national standards of care as a framework for managing patient care" (American Association of Nurse Practitioners [AANP], 2007, p. 2). There is a lack of research about nurse practitioner use of standards of care, especially in caring for adolescents with asthma.The purpose of this practice inquiry was to explore patterns of practice and perceptions of practice by the nurse practitioners who care for adolescents with asthma, and to evaluate the current patterns of practice in comparison with national standards for providing care to adolescents with asthma at the Larry Combest Community Health Wellness Center [LCCHWC]. The design for this practice inquiry was descriptive retrospective, using mixed methods for process evaluation of a program through description of nurse practitioner practice at an academic nurse-managed primary care clinic.The nurse practitioners addressed all components of the process of care recommended by the AANP (2007), which includes assessment, diagnosis, development and implementation of a treatment plan, and evaluation of the patient status. However, despite comments about the importance of using evidence based practice in the form of guidelines, results from health records review indicate that nurse practitioners have not fully integrated the NHLBI 2007 asthma guidelines into providing care to adolescents with asthma. This study establishes a baseline measure of adoption of the NHLBI 2007 asthma guidelines by nurse practitioners at this clinic site. The results of this study may ultimately contribute to nurse practitioners' awareness of use of standards of care and improved quality of care for adolescents with asthma.