Infants And Children: Acute Management Of Asthma Policy By NSW Government Department Of Health
Asthma Management Policy Analysis
Discuss About The Health Policy NSW Policy Asthma Management.
Asthma is a chronic disease that is defined as hyper-responsiveness and inflammation of airways. It is associated with profound yet avoidable morbidity and mortality risks arising ut of considerable societal and individual burden (Fromer, 2010). Infants and Children: Acute Management of Asthma by NSW Government Department of Health is a policy that provides a comprehensive approach for effective and safe management of asthma in children and infants. The policy starts with providing a detailed structure of the initial severity assessment of asthma among the children via accessing the symptoms. According to Lewis et al. (2013) assessment of the severity of asthma via proper analysis of the symptoms provides an opportunity for the long-term management of asthma among children and infants via analysis of the need of compliance with treatment and consideration of preventer medication. The policy also provides enough depth in the domain of acute severity assessment of asthma via indentifying signs/ symptoms and management plan for mild to moderate asthma among children and infants along with detailed information about the effective monitoring and disposition. Ortiz-Alvarez and Mikrogianakis (2012) are of the opinion that the effective treatment of the children with acute asthma depends on the accurate and rapid assessment of the disease severity via effective analysis of the symptoms. This helps to prevent exacerbation along with decrease in morbidity. Further detailing in the policy is highlighted by in-depth asthma action plan for young people. The policy also highlights six important appendix which covers a diverse aspects of children and infant asthma management like: asthma resource pack for parents and carers, parents information sheet about asthma, asthma management in childcare and school, basic educational checklist of asthma, environmental tobacco smoke threat towards asthma and evidence based recommendations for asthma management (NSW Government Department of Health, 2012). According to Walker and Rezni (2014), proper patient education and school interventions for effective paediatric asthma management help to reduce the severity of asthma among the paediatric population and at the same time helps to reduce the mortality and morbidity associated with asthma among the paediatric population.
The policy is extremely important under the Australian perspective because asthma among the children is one of the leading causes for the emergency department admission. According to Marks et al. (2009), within first three years of life, 16.9% of the children develop asthma. Among the non-asthmatic children who are aged between 5 to 4 years, 4.1 % has susceptible in developing asthma by the age of 7 years. According to the International Study of Asthma and Allergies in Childhood (ISAAC), Australia, UK, New Zealand and Republic of Ireland have comparatively high prevalence of asthma among the children. The recent data published by the National Health Survey highlighted that in Australia, asthma is higher among boys in comparison to girls however, and the reason for this remains uncertain (Australian Institute of Health and Welfare, 2009). According to Pawankar (2014), patients with allergic diseases suffer from reduce quality of life of both the children and their parents along with increase in the rate of mortality and morbidity. As asthma continues to affect children, this will gradually become long-term consequences on their education. Infants and Children: Acute Management of Asthma Policy by NSW Government Department of Health has been selected on the basis of high rate of prevalence of asthma among the population of Australian infants and children and its adverse consequences. A detailed analysis of the policy will help to demonstrate a thorough understanding of the policy issues along with evidences behind the selection of policy goals and objectives. This is because procurement of optimal asthma management demands a thorough understanding and proper application of evidence-based guidelines in clinical practice (Fromer, 2010).
Formulate the problem
In summary it can be said that Infants and Children: Acute Management of Asthma Policy by NSW Government Department of Health aims towards achieving best possible paediatric care in asthma under emergency management. Here the emergency management of asthma among the children or infant is based on the analysis of the severity of asthma on the basis of symptoms followed by effective management, monitoring and disposition. The policy also highlights the important aspects of oxygen administration in providing quality care to the asthma patients along with important nursing issues that must be kept into consideration while handling paediatric patients with asthma. The policy also provides a detailed insight about the discharge criteria and parent education.
Althaus, Bridgman and Davis’ Characterisation of the Policy Cycle is based on the Australian context and is consist of a series a steps including identifying issues, policy analysis, identification of policy instrument, proper consultation in order to test strength of analysis, decision, implementation and evaluation. This framework mixes explanatory, ideal-type and normative argument (Althaus, Bridgman & Davis, 2007).
Figure: Australian Policy Cycle
(Source: Althaus, Bridgman & Davis, 2007)
The formulation of the problem is effectively discussed in the policy. The main problem area identified in the policy includes asthma in children which is characterised via difficulty in breathing, cough and wheezing. The data on the basis of mortality and morbidity highlight sudden trend in the disease that patterns of asthma in children and this include infrequent asthma, frequent asthma and high risk asthma. Infrequent intermittent asthma is the most common form of asthma. According to NSW Government Department of Health (2012), 70 to 75% of the Australian children suffer from asthma. Children with isolated episodes of asthma mainly lasts for few days or weeks and in the majority of the cases is triggered by upper respiratory tract infection (UTI). Frequent intermittent asthma affects 20 to 25% of children. Children with frequent intermittent asthma may benefit from regular preventive therapy like application of low dose of leukotriene or inhaled corticosteroids. Persistent asthma is common among the 5 to 10% children and has symptoms like disturbed sleep, morning shortness in breadth, activity intolerance and cough. Both the three forms of asthma hampers the quality of life both the children and their parents (NSW Government Department of Health, 2012). This trend in asthma among the children helped the policy to divide the problem into smaller parts like factors that should be taken into consideration during the initial management of acute asthma, severity assessment of asthma and other nursing issues associated by asthma. However, NSW Government Department of Health (2012) is of the opinion that the previously implemented clinical practise guidelines for asthma management cannot be implemented comprehensively and hence the current policy has invited changes in the domain of severity assessment. Olsson et al. (2013) is of the opinion that the effective severity assessment helps in framing person centred care plan, which in turns promote fast recovery of the disease. Gandhi et al. (2013) stated that well-controlled asthma is associated with improved health condition along with less visit to physicians, reduce incidence of hospitalizations and emergency room visits among children. On contrary, poor or in efficient asthma control is directly associated with increase rate of absenteeism in school along with decrease in the quality of life of both the children and their care givers. Thus effective recovery of asthma is important for proper health and well-being of children or infants.
However, in the formulation of the problem, the policy fails to highlight the process of the asthma management from the perspective of physicians. The policy mainly provides clinical guidelines for the effective asthma management but does not highlight the gaps which the clinicians’ experience while treating children or infant suffering from asthma. For example, inability to effectively manage the infant or children to abide by the diagnosis and treatment procedure or gaps in dealing with the poor design of the inhaler devices and improper medication compliance among the group of children who belongs to the poor socio-economic class (Gandhi et al., 2013). Roland and Paddison (2013) are of the opinion that effective interventions highlighted by experienced physicians are an important perspective behind successful policy framework as they are the key stakeholders in the policy making process. Other stakeholders in the policy making process include their guardians. The policy though provides importance on the patient’s education but fail to throw any light over whether not the guardians are included in the decision making process in asthma management. However, parent education is an important part in infant or children asthma management because parental health literacy of children with asthma directly contributes towards optimal asthma care for their children (Gandhi et al., 2013).
The main interest group selected for this policy include the paediatric population. The section of the target group is extremely significant under the Australian perspective because according to the reports published by Dunlevy et al. (2017), Australia has high prevalence of paediatric asthma in comparison to the other developed countries. At least 21% of the children who are aged between 0 to 15 years have previous medical diagnosis of asthma and 11% of children at resent are suffering from asthma. Dunlevy et al. (2017) further argued that during the year 2014, more than 13000 children under the age bracket of 1 to 17 years are admitted to NSW emergency department with asthma and this is 2/3rd of all the hospital admission under this age group. Thus the selection of the interest group has a significant rationale under the perspective of Australian health care system.
Figure: Policy Analysis Iteration
(Source: Althaus, Bridgman & Davis, 2007)
As per the Althaus, Bridgman and Davis (2007), decision of the policy and design of its objectives must be taken under wider settings. This is because an ideal healthcare system will consume a significant amount of the national product and thus the health system solution cannot be compromised. The goal of the quality care remains unchanged but under the practice, this objective is effectively balance against other non-health considerations. According to Murphy (2012), proper framing of the goals and the objectives of the policy helps in delivering powerful conceptual framework. This conceptual framework simultaneously helps in the identification of the overarching health care problems and necessary steps that can be utilised to address those problems. The initiation of the policy clearly states the purpose which is, “The Infants and Children: Acute Management of Asthma Clinical Practice Guideline” has been framed in order to provide a definite direction to the physicians and is directed towards achieving ever possible paediatric care in asthma management. However, this object and the aim are not clear. This is because, the aim of the acute asthma management does not provide a particular age bracket of the children for whom this clinical practice guideline has been designed. Moreover, the targets of achievement the best possible paediatric care in the asthma management is also not stated succinctly in the acute asthma management policy statement of NSW government, department of health. Boulet et al. (2012) is of the opinion that adequate management of asthma requires separate interventions for separate group of children along with the time plan for achieving the goals. Boulet et al. (2012) have further opined that interventions in order to improve adherence demand tailoring to the patients via encompassing patient-specific education and at the same time addressing patient misconception and fears, monitoring adherence and development of shared decision process.
According to Althaus, Bridgman & Davis (2007) identification of the decision parameter mainly deals with the analysis of the relative priority of the problem, period required to obtain additional resources and obtaining suitable results. However, acute asthma management policy for children and infant by NSW department of health provide a clear representation of the period that will be used to obtain the additional resources or what practices may be capable of obtaining suitable results within a sudden time frame. According to Fassl et al. (2012), stating the proper time frame of the research helps in evaluation of the policy outcome after that definite period of time, this further helps in doing necessary amendment in the policy. Cabana et al. (2014) stated that the main resource that is required for the proper clinicians’ education in effective management of pediatric asthma is training and dissemination of the information related to symptoms and subsequent treatment approaches that can be used in order to address the problem on the basis of the chronicity of the symptoms. However, the policy does not provide detail illustration for the proper funding source in order to provide effective training and education to the healthcare professionals towards adopting the acute asthma management guidelines. According to Dimick and Ryan (2014), source of the proper funding against implementation of the particular healthcare policy is important in order to achieve quality health outcomes. The policy also fails to highlight proper funding source in order to provide through parent education. The policy though includes resources for the effective parent education. This resource is defined as resource pack for parents and carers. The relative priority of the problem however has been effectively discussed based on the differentiation of asthma into various subtypes.
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Asthma Resource Pack |
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1. Discharge and Introduction Checklist |
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2. Information about what is asthma, asthma among the young children |
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3. Assessing the severity of child’s asthma attack |
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4. Proper response to asthma symptoms |
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5. Asthma triggers factors |
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6. Common medication used for children |
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7. Helpful tips for managing child’s asthma |
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8. Skills to use puffer and spacer device |
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9. Daily asthma symptom diary |
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10. Child or student asthma first aid information record |
(Source: NSW Government Department of Health, 2012)
This is the best practice for effective management of asthma because it vouches for effective monitoring and disposition. Carroll, Wildhaber and Brand (2012) is of the opinion that continuous oxygen saturation and continuous heart rate monitoring helps in pre and post treatment analysis. The policy also highlights parent education in asthma management. According to Carroll, Wildhaber and Brand (2012), asthma knowledge and education to parents mainly encompass skills of child’s inhaler techniques along with smoking cessation in front of children. Carroll, Wildhaber and Brand (2012) further opined that asthma education must begin as soon as possible in order to avoid unnecessary delay in the discharge.
In the domain of expert opinion in asthma management, it can be said that parents and patients must be educated optimally in order to manage the disease under effective collaboration of the healthcare professionals. Proper identification and avoidance also holds significance importance. Monitoring as assessment in pediatric asthma should be performance periodically in order to re-evaluate and fine-tune the overall treatment. Apart from education and disease awareness, pharmacotherapy is the cornerstone for managing pediatric asthmas it helps the patient to control the symptoms and to reduce the risk for upcoming morbidity. Though there is a trend towards considering phenotype-scientific treatment choices the successful goals is yet to be achieved (Papadopoulos et al., 2012).
The stakeholders who are involved in policy framing mainly forms lobby group of any particular policy. Below is the detailed structure of the lobby group is infant-children asthma management (Buse, Mays & Walt, 2012).
(Source: Buse, Mays & Walt, 2012)
Conclusion
Thus from the above discussion, it can be concluded that the Infants and Children – Acute Management of Asthma Policy (2012), drafted by the NSW government, department of health mainly aims towards framing a specific clinical practice guideline for the best possible paediatric care in all parts of the state. The main focus group of the policy is extremely significant in the present day scenario of paediatric health condition in Australia and thus the formulation of the problem is succinct. However, the policy fails to provide a detailed guide towards the source of the funding that can be used in order comprehensively implement the healthcare policy. The policy main stakeholders are the patients (children), their parents and the doctors or the healthcare professionals who are involved in the quality of care. An important aspect of the policy is it helps to provide a detailed illustration about how the parent education (one of the prime stakeholder) is important in order to effectively reduce the rate of occurrence of asthma among the paediatric population. However, the policy does not provide any reference towards whether the policy framing procedure is based on the effective decision making process which involved both the health care professionals and the parents.
The main recommendations that can be highlighted for the further success of the asthma management plan include a detailed consideration of the asthma management procedures among the Australian aboriginals and the Torres Strait Islanders. According to Gubhaju et al. (2013), Australian aboriginal people have considerable shorter life expectancy and experience higher burden of disease and disability throughout their life in comparison to the non-aboriginal Australians. Aboriginal people residing in Australia are more prone to survive under the poor social determinants in health along with increase in the amount of smoking and this make their children more prone towards developing asthma (Zhang, Valenti & Britt, 2014). Effective policy planning and its implementation among of the asthma management over the Torres Strait Islanders population have certain enablers and barriers (Gibson et al., 2015). The asthma management policy planning must effectively target those enablers and barriers in order to comprehensively reduce the chances of occurrence and effective control of asthma among the aboriginal population. Like incorporation of the indigenous workforce, culturally competent nurse, multiple funding sources.
References
Althaus, C., Bridgman, P., & Davis, G. (2007). The Australian policy handbook (pp. xii-268). Sydney: Allen & Unwin.
Australian Institute of Health and Welfare. (2009). Asthma in Australian children Findings from Growing Up in Australia, the Longitudinal Study of Australian Children. Access date: 5th June 2018. Retrieved from: https://www.aihw.gov.au/getmedia/4e1c453a-d2dd-41c2-8320-6efc2abfc498/acm-17-10771.pdf.aspx?inline=true
Boulet, L. P., Vervloet, D., Magar, Y., & Foster, J. M. (2012). Adherence: the goal to control asthma. Clinics in chest medicine, 33(3), 405-417.
Buse, K., Mays, N., & Walt, G. (2012). Making healthcare policy. McGraw-Hill Education (UK).
Cabana, M. D., Slish, K. K., Evans, D., Mellins, R. B., Brown, R. W., Lin, X., … & Clark, N. M. (2014). Impact of physician asthma care education on patient outcomes. Health Education & Behavior, 41(5), 509-517.
Carroll, W. D., Wildhaber, J., & Brand, P. L. P. (2012). Parent misperception of control in childhood/adolescent asthma: the Room to Breathe survey. European Respiratory Journal, 39(1), 90-96.
Dimick, J. B., & Ryan, A. M. (2014). Methods for evaluating changes in health care policy: the difference-in-differences approach. Jama, 312(22), 2401-2402.
Dunlevy, G. (2017). Babies with severe respiratory illness have double the risk of childhood asthma. Access date: 5th June 2018. Medial Press: University of New South Wales. Retrieved from: https://medicalxpress.com/news/2017-11-babies-severe-respiratory-illness-childhood.html
Fassl, B. A., Nkoy, F. L., Stone, B. L., Srivastava, R., Simon, T. D., Uchida, D. A., … & Maloney, C. G. (2012). The Joint Commission Children’s Asthma Care quality measures and asthma readmissions. Pediatrics, 130(3), 482-491.
Fromer, L. (2010). Managing asthma: an evidence-based approach to optimizing inhaled corticosteroid treatment. Southern medical journal, 103(10), 1038-1044.
Gandhi, P. K., Kenzik, K. M., Thompson, L. A., DeWalt, D. A., Revicki, D. A., Shenkman, E. A., & Huang, I. C. (2013). Exploring factors influencing asthma control and asthma-specific health-related quality of life among children. Respiratory research, 14(1), 26.
Gibson, O., Lisy, K., Davy, C., Aromataris, E., Kite, E., Lockwood, C., … & Brown, A. (2015). Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review. Implementation Science, 10(1), 71.
Gubhaju, L., McNamara, B. J., Banks, E., Joshy, G., Raphael, B., Williamson, A., & Eades, S. J. (2013). The overall health and risk factor profile of Australian Aboriginal and Torres Strait Islander participants from the 45 and up study. BMC Public Health, 13(1), 661.
Lewis, T. C., Robins, T. G., Mentz, G. B., Zhang, X., Mukherjee, B., Lin, X., … & Parker, E. A. (2013). Air pollution and respiratory symptoms among children with asthma: vulnerability by corticosteroid use and residence area. Science of the Total Environment, 448, 48-55.
Marks, G., Zinoviev, A., Poulos, L., Ampon, R., & Waters, A. M. (2009). Asthma in Australian children: findings from growing up in Australia, the longitudinal study of Australian children. Australian Government, Australian Institute of Health and Welfare.
Murphy, K. (2012). The social pillar of sustainable development: a literature review and framework for policy analysis. Sustainability: Science, practice and policy, 8(1), 15-29.
NSW Government Department of Health. (2012). Infants and Children – Acute Management of Asthma. Access date: 5th June 2018. Retrieved from: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2012_056.pdf
Olsson, L. E., Jakobsson Ung, E., Swedberg, K., & Ekman, I. (2013). Efficacy of person?centred care as an intervention in controlled trials–a systematic review. Journal of clinical nursing, 22(3-4), 456-465.
Ortiz-Alvarez, O., & Mikrogianakis, A. (2012). Managing the paediatric patient with an acute asthma exacerbation. Paediatrics & child health, 17(5), 251-256.
Papadopoulos, N. G., Arakawa, H., Carlsen, K. H., Custovic, A., Gern, J., Lemanske, R., … & Zar, H. (2012). International consensus on (ICON) pediatric asthma. Allergy, 67(8), 976-997.
Pawankar, R. (2014). Allergic diseases and asthma: a global public health concern and a call to action.
Roland, M., & Paddison, C. (2013). Better management of patients with multimorbidity. BMJ, 346, f2510.
Walker, T. J., & Reznik, M. (2014). In-school asthma management and physical activity: children’s perspectives. Journal of Asthma, 51(8), 808-813.
Zhang, C., Valenti, L., & Britt, H. (2014). General practice encounters with Aboriginal and Torres Strait Islander people. Australian family physician, 43(1/2), 15.