Date of Graduation

Spring 5-17-2024

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Family Nurse Practitioner

First Advisor

Dr. Jo Loomis, DNP, FNP-C, CHSE, CLC, ANLC, NCMP, CNL

Second Advisor

Dr. Juli Maxworthy, DNP, Ph.D. (c), MSN, MBA, RN, CNL, CPHQ, CPPS, CHSE, FNAP, FSSH

Abstract

Background: Asthma exacerbations are consequences of poor asthma control. Asthma guidelines-grounded interventions can improve adherence to asthma guidelines and assessments in primary care settings. The goals of asthma management are to optimize asthma control, minimize the risk of asthma exacerbations, and minimize the adverse effects of asthma medications.

Local Problem: A primary care practice in Northern California had frequent office visits for acute asthma symptoms. Ongoing asthma control monitoring is a key performance indicator of high-quality asthma care.

Methods: The quality improvement evidence-based observational project examined the effectiveness of interventions. The pre-and post-survey assessments collected clinician knowledge and adherence, and results were analyzed with descriptive statistics, paired t-test, and the binomial test. SPSS version 29.0.2.0 was employed for all calculations.

Interventions: Implement the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines-based clinician education and asthma toolkit to improve adherence and promote elements of asthma guidelines.

Results: In terms of self-efficacy, the mean difference in comfort level increased from 7.00 to 9.17, and was statistically significant (p = 0.041, p < 0.05). For knowledge, all participants achieved perfection on all knowledge questions, which was statistically significant from chance expectations (p<0.031). There was already a strong agreement with over 80% alignment on the vital instrument ongoing monitoring and 100% advocacy towards adherence to asthma guidelines. The degree of agreement and advocacy were sustained post-intervention, which indicates a commitment to asthma guidelines-grounded interventions.

Conclusion: The multimodal interventions of clinician education and asthma toolkit exemplified the necessity of quality improvement efforts to improve comfort level to abide by asthma guidelines and promote elements of asthma guidelines, especially when faced with barriers to adherence. Future endeavors should build upon these efforts, concentrating on a chart review and asthma guidelines-grounded education across a larger sample size.

Keywords: Asthma guidelines, peak flow, asthma severity, asthma assessments, asthma control, asthma management, primary care, quality improvement

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