Health Promotion Strategy for Asthmatic Children - Essay Example

Health Promotion Strategy for Asthmatic Children: Taiwan and the United Kingdom YOUR FULL THE OF YOUR SCHOOL OR Health Promotion Strategy for Asthmatic Children: Taiwan and the United Kingdom In incidence of asthma in children is a serious health issue over the entire world, both in terms of public policy and personal suffering. For the two countries under comparison here, the impact of asthma is dramatic and requires that the respective governments undertake appropriate health promotion strategies to attenuate the effects. In Taiwan, respiratory illnesses like asthma are the tenth leading cause of death within the general population, and Taiwan is experiencing an increasing incidence of the condition in children (Bureau of Health, 2003, p. 2). Similarly, the United Kingdom has "one of the highest rates of people with asthma of any country in the world," with the estimated number of affected citizens being over five million (Asthma UK, 2006, p. 3). The scope of this paper is to discuss the pathophysiology of asthma in children regardless of their location, the psychosocial and cultural impact upon both the children themselves as well as caregivers, analyze the nurse's role in promoting self management, discuss the health promotion strategies of both Taiwan and the UK while applying them to patient needs and, finally, to provide an overview of the pharmacological agents available for treatment. Although they have different approaches, both Taiwan and the UK have workable health promotion strategies to assist asthmatic children. Pathophysiology Breathing is a process that most people take for granted; airway passages automatically carry air into our lungs where blood is oxygenated and, in a normal person, this process is only challenged under acute circumstances like smoke inhalation (Clark, 2003, p. 44). Asthma, however, "is a condition involving the branches (bronchioles) of the bronchial tree...in asthma, these bronchioles become narrowed for many reasons" (Lieberman, 1999, p. 10), making breathing something that cannot be taken for granted. Asthmatics have airways that are hyperreactive, and become inflamed in response to: ...seemingly modest irritants. In allergic asthma, substances that would normally not affect breathing (dust mites, pet hair, pollens, etc.) can produce an extensive hyperreactive response. The linings of the airways swell, excessive amounts of mucus are produced, and the smooth muscle tissue of the airways tightens or constricts (Clark, 2003, p. 44). Whether they reside in Asia or Europe, these characteristics in asthmatic children are the same. Accordingly, when assessing, planning and evaluating the care of the asthmatic child, the nurse must be especially aware of these conditions because the constriction of the circular muscles surrounding the bronchial tube can happen very quickly and, in severe cases, cause asphyxiation. Assessment should be based upon symptomatic presentation and observable behaviors of the child, paying particular attention to excess mucus production which con-tributes to wheezing and difficulty in breathing. Planning and evaluation of the care for the child should include not only an awareness of the generalities, but also any specific allergens or other causative agents that aggravate an asthmatic response. Since asthma is chronic condition, the bronchial tube wall can thicken over time, and aggravated edema of the lining can ultimately lead to fibrosis and tissue destruction (Lieberman, 1999, p. 12). Accordingly, the nurse must be "alert to the early signs of asthma and have a definite medical regimen to follow when an attack begins" (Zamula, 1990, p. 15). The key to addressing the physical condition of the child is having a plan in place; thus the need for a health promotion strategy. Psychosocial and Cultural Impact There is a significant impact on asthmatic children, as well as those who care for them, from psychological, social, and cultural points of view. Understanding the psychology of asthmatic children is in some ways intuitive. The constant fear associated with not being able to breathe, combined with panic during an episode, can have long-term negative effects on the psyche of the child. Further, the impact extends to the family-and this particular impact is not different between the countries of residence. Families who care for asthmatic children tend to be understandably overprotective and, especially mothers, often overindulge the child. In some families, their lifestyles are "based on the family's adaptive response to the stresses and burdens imposed by the asthma," while in the more severe cases of familial reaction, the "child's condition is used to maintain or buttress the dysfunctional patterns of family communication and problem solving" (Holden, Mailick, & Walther, 1994, p. 104). Socially, the children and families can become isolated and insular, contributing to the overall negative effects of the condition. From a cultural perspective, the difference between Taiwan and the UK becomes more distinguishable. Most cases of childhood asthma are addressed at home. As one author notes, "Taiwanese homes express ideals of family relationships, hope for family prosperity, and the desire to live in harmony with the natural world" (Reed, 1998, p. 123). The cultural expectation of these values can be challenged by the stressors associated with caring for the asthmatic child due to the need for vigilance regarding allergens and the regimen of treatment; yet still the traditional Taiwanese home emphasizes peace and continuity. Conversely, in the UK, there tends to be a more westernized approach to family life, including the prevalence of non-traditional, non-nuclear families. The significantly higher number of single-parent homes has caused a cultural redefinition of family, which adds stress to daily life and can impact the overall health of everyone, especially asthmatic children. In fact, "where stress is concerned, family life could have a more direct effect on health than either material factors or cultural influences" (Childs & Storry, 1999, p. 493). The care of asthmatic children is not conducted in a vacuum and, unless an acute attack causes a trip to a medical facility, it is primarily focused in the home; where psychosocial and cultural influences exert their greatest force. The Nurse's Role The nurse does not act independently in the care of an asthmatic child; he or she is part of a team that includes doctors, therapists, and family members. The nurse's role, then, can be focused on assisting with the patient's self-management of medications, aggravating condition avoidance, and general palliative care. One of the key roles played by the nurse in assisting the patient is to provide information. The more the child understands about the condition, its causes, and effects, the less fearful he or she will be. Knowledge is power, and in this case it is the power to calm and give assurance. Additionally, the nurse can oversee the treatment protocols as prescribed by the doctor, thereby ensuring that the medication regimen is understood and followed. Children, especially older ones, are perfectly able to manage their condition and treatment through the use of inhalers or other methods. This independence is healthy, and can be furthered by a nurse's input. Finally, the nurse can play a key role in communication regarding all aspects of self-treatment. Whether serving as a liaison between the patient and the doctor regarding treatments, helping the patient communicate changes in condition or allergen exposure, or serving as a bridge between family members or other caregivers, the nurse has a critical opportunity to share information among all parties. This role is perhaps the most important, as it serves to bring together all elements of the multi-disciplinary team with the patient and his or her family. Health Promotion Strategies While it is important to apply health promotion strategies to an individual patient's needs, the strategies themselves must be initiated at the public policy level. The reason for this is clear; some direct contributors to childhood asthma are only able to be solved through governmental action. For example, "[s]everal risk factors for these chronic respiratory symptoms have been identified. Children...have shown disproportionate rates of such chronic conditions as asthma (quoting Malveaux)..., a condition shown to be traffic related (quoting Guo)" (Korenstein & Piazza, 2002, p. 10). The control of traffic, and all housing or school proximity to pollutants, is beyond the scope of any individual patient or medical professional. It is for this reason that governmental action is required, and where a comparison between Taiwan and the UK demonstrates somewhat different approaches; yet with key similarities. It is generally understood that there are three fundamental areas for the concentration of health promotion strategies: "Identify a range of policy actions...that could improve childhood asthma outcomes nationwide; select a subset of policies to create a [national policy]; and outline alternatives to implement these policies" (Genovese, et al., 2001, p. 2). The Taiwanese have chosen to address their health promotion strategy with a direct, five-point plan: "Enhance health education; promote asthma counseling services; promote asthma care personnel training; implement asthma case management programs; and conduct asthma epidemiological research" (Bureau of Health, 2003, p. 2). In the UK, the plan is more similar to the generalized guidelines, but reflects the same fundamental principles: "Partnerships between people with asthma and their healthcare professionals; guideline-based care of people with asthma; NHS implementation of a national strategy; political action to address the issue" (Asthma UK, 2006, p. 6). In both countries, the real power of health promotion strategies begins far above the level of nursing. Once implemented, however, the nurse plays a key role in applying the strategies to the individual patient. For example, under the Taiwanese model, the nurse could participate in educational activities, undertake all mandated training, work with the patient in the counseling process to ensure understanding and compliance, and participate in case management. Within the concepts framed by the UK model, the nurse would be a key partner in the patient/healthcare professional communication link, follow all guideline-based care protocols, and actively participate in any NHS strategy. Accordingly, while the specific strategies of the two countries may take dissimilar forms, the outcome is quite similar; the nurse has a central place in applying health promotion strategies to the individual needs of the patient. Because of the close contact a nurse has with the patient, he or she is in the best position to strengthen the effect of the strategies employed by either government; through communication, understanding, and empathy. Pharmacological Agents There are a number of pharmacological approaches to the treatment of childhood asthma, with an array of medicines being employed. Note that "[m]ost drugs fall in three major groups: bronchodilators, an anti-allergic mediator agent (cromolyn), and anti-inflammatory agents (corticosteroids) (Zamula, 1990, p. 12). The way each of these drugs works is different: bronchodilators are aimed at keeping the bronchioles open, anti-allergic agents such as cromolyn take a more preventative approach, and corticosteroids are effective in rapidly opening airways. Perhaps the most familiar device for asthmatics is the inhaler, which can be used to deliver all three classes of drugs to the patient. The corticosteroids, which are "marketed under numerous brand names, including Aerobid, Azmacort, Beclovent, and Vanceril," are very effective in controlling airway inflammation and are used to prevent acute attacks.1 These can also be prescribed in tablet form or as a liquid for children (Pediapred, Prelone). Drugs such as cromolyn sodium and nedrocromil sodium are often used to prevent the onset of attacks due to exercise, and the class of bronchodilators such as salmeterol, metaproterenol, albuterol sulfate and others, which do not provide immediate relief of symptoms but do have a preventative effect that lasts for hours, are used to control attacks that might occur during sleep. Most doctors will use a combination of these drugs to control the condition, demonstrating one of the most critical aspects of helping asthmatic children; assisting them in knowing when to take the right medications, in the right dosages, at the right time. As asthmatic conditions change, and the child develops towards adulthood, these combination therapies are often adjusted, making the nurse's ability to observe changes in the patient's condition extremely important. The nurse is a key member of the healthcare team when it comes to caring for asthmatic children, whether in Taiwan or the UK. Given the various aspects of the physiology related to asthma, the nurse must understand and recognize the early signs of onset so that treatment can be given. Given the cultural issues faced by the children and their caregivers, sensitivity to family dynamics and cultural perspective is vital. As the nurse assists in self-management, he or she is in a position to be an educator, medical dosage supervisor, and comforter. These characteristics are important across all cultural boundaries. As a front-line implementer of the relevant health promotion strategy, the nurse is in the position to facilitate the health and healing process in conjunction with a national strategy to address the tragedy of childhood asthma. Finally, being cognizant of the pharmacological elements in use gives the nurse the ability to ensure the health of the patient. These are true regardless of the country where asthmatic children live. References Asthma UK (2006, 30 June). Where Do We Stand Asthma in the UK Today. Retrieved July 22, 2006 from the World Wide Web: http://www.asthma.org.uk/document.rmid=92 Bureau of Health Promotion, Department of Health, Taiwan, R.O.C. (2003). Asthma Prevention. Retrieved July 22, 2006 from the World Wide Web: http://www.bhp.doh.gov.tw/asp/theme/ file/200352115655C91F92/Asthma%20Prevention.ppt Childs, P. & Storry, M. (Eds.) (1999). Encyclopedia of Contemporary British Culture. London: Routledge. Clark, C. D. (2003). In Sickness and in Play: Children Coping with Chronic Illness. New Brunswick, New Jersey: Rutgers University Press. Flieger, K. (1996). Controlling Asthma. FDA Consumer, 30 (9), 18-21. Genovese, B., Lara, M., Morton, S., Nicholas, W., Rachelefsky, G. Redd, S., Vaiana, M.E., & Weiss, K. (2001). Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action. Santa Monica, California: Rand. Guo, Y.L., Lin, Y., Sung, F., Huang, S., Ko, Y., Lai, J., Su, H., Shaw, C., Lin, R., & Dockery, D. 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