In Pediatric Asthma, Communication Between Parents, Providers, and School Nurses Is Key

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A new review article highlights the importance of developing asthma action plans and clear lines of communication.

The presence of asthma action plans (AAPs) and deliberate communication between primary care providers, school nurses, and parents can improve outcomes for children with asthma, though a new review article finds such communication does not always happen.

About 7.5% of youths in the United States have asthma. Corresponding author Emma Slas, RN, BSN, of the Johns Hopkins University School of Medicine, said school nurses have a primary role in the care of these children, both because of their daily proximity to the patients and because many children do not regularly see a primary care physician.

Writing in the Journal of School Nursing, Slas and colleagues said school-based asthma programs can differ in their makeup, but generally include care coordination with primary care providers, case management, and age-appropriate patient education. Yet, the investigators said such plans are not always implemented to their full potential.

“Unfortunately, only a small proportion of school nurses feel they have effective communication with healthcare providers about students with asthma,” the authors wrote.

For instance, they said school nurses do not routinely have access to patients’ electronic health records, usually due to logistical or legal barriers.

In hopes of finding better strategies to reduce communication barriers, Slas and colleagues conducted an integrative literature review, identifying a dozen articles published between 2016 and 2020 that examined communication between school nurses and primary care providers. Using those studies, the authors described several themes regarding optimal communication.

First, Slas and colleagues reported that AAPs are a critical but under-utilized component of children’s asthma care. The plans describe asthma management for the individual patient and can also include authorization for the school to provide emergency administration of medication. Yet, the existing literature suggests that less than half of schoolchildren with asthma, and possibly as few as 1 in 10 children, actually have an AAP available in school. That rate can be improved by communication between nurses and providers, Slas and colleagues found.

“Two studies demonstrated that direct communication between the school nurse and [primary care providers] increased the AAP prevalence rate by 40–60%,” the authors said. Interventions that focused on communication between parents and providers were less successful.

Yet, that is not to say communication with parents is not important.

“Inclusion of parents is imperative to successful care coordination as school nurses need consent forms signed by guardians of the child to exchange information with a student‘s healthcare providers,” the authors found. The research shows many school nurses feel they suffer from a lack of communication with parents.


One solution, Slas and colleagues said, was for school nurses to reach out directly to providers.

“Many of the studies reviewed showed that interventions are more successful when school nurses initiate communication with providers, rather than waiting for the provider to initiate, or talking to the provider through the child’s parents,” they wrote.

When that happens, and when communication in general is more robust between parents, providers, and nurses, children benefit, the studies show.

“The reviewed articles show that improved communication between school nurses and [primary care providers, regardless of the intervention that led to the improvement, has a positive effect on outcomes for students with asthma,” they wrote.

Students with well-managed asthma have fewer medical visits and lower health care costs, for instance, Slas and colleagues said.

In their conclusion, the authors noted that while the evidence is clear that breakdowns in communication are common, the literature is less clear about which interventions can fix these problems.

“Additional research is needed to determine potential evidence-based interventions to improve communication as well as clinical outcomes in individual students with asthma,” they wrote. “Completion of this research has the potential to significantly improve asthma control and quality of life for children with asthma.”


Slas E, Nguyen Y, McIltrot K. Communication between schools nurses and health care providers on students with asthma: An integrative review. Published online 2021 October 7, 2021. J Sch Nurs. 2021;10598405211045693. doi:10.1177/10598405211045693