A public health project conducted by College of Medicine students in the Class of 2016 that explored barriers to asthma management in Vermont elementary schools has prompted statewide action, leading to increased support for school nurses to care for students with asthma.
Asthma remains a critical issue across the country, but especially in Vermont. According to the Vermont Department of Health, Vermont’s asthma rates are higher than the national average: Roughly ten percent of children in the state suffer from the disease, versus 9.3 percent nationwide. For adults, the rate for Vermont is 11 percent, as compared to 8.6 percent nationally. For their semester-long project, the eight students in the group, faculty advisor David Kaminsky, M.D., professor of medicine, and agency mentor Rebecca Ryan, director of health education and public policy at the American Lung Association-Vermont, developed and distributed surveys via Survey Monkey to 189 nurses using a Vermont Department of Health e-mail list. In addition, the group met with two Burlington-area nurses with experience at the school and state levels.
A total of 114 surveys were completed by nurses responsible for students in grades Kindergarten through 6. Major themes gleaned from the survey and focus group included: a lack of communication between health care providers, parents, and school nurses; a need for parents to provide medications, and physicians to provide Asthma Action Plans; school nurses have limited means in addressing asthma triggers in students’ homes; modifiable asthma triggers exist in schools; and one-on-one teaching and visual aids (for example, posters, brochures) are the most effective tools for asthma education.
In spring 2014, the medical students presented their project to the state’s Asthma Advisory Board, which prompted a needs assessment from the Centers for Disease Control and Prevention-supported Vermont Asthma Program. In cooperation with the state’s school nurse consultant and school nurse advisory committee, the Vermont Asthma Program surveyed 189 school nurses and staff in pre-Kindergarten through 6th grade, and hosted key informant interviews with five school nurses through the fall of 2014 and winter of 2015. The survey and interviews gauged awareness of the state’s asthma policies for schools, and asked about how much training nurses have had in guideline-based asthma management. The assessment also included open-ended questions about what school nurses are currently doing around asthma management, and gathered suggestions on how the state could better support their efforts.
"The work done by UVM medical students changed my view of school nurse receptivity to increased learning and skill building on asthma management," says Sharonlee Trefry, M.S.N., R.N., N.C.S.N., state school nurse consultant for the Vermont Department of Health's Maternal and Child Health Division.
“The medical student's project and findings provided impetus to further explore current asthma management practice among school nurses K-6 in VT and determine what the Asthma Program can do to better support their needs,” says Asthma Advisory Board member and consultant Fonda Ripley, M.H.S. Ripley adds that the needs assessment resulted in an action list, which is currently being implemented and is making good progress.
Kaminsky, the faculty advisor for the public health project group, says the College of Medicine’s public health projects course provides an ideal way for students to make a real difference in the community, as well as develop research and public speaking skills.
“It’s especially nice at the final presentation where we get to see the pride felt by students as they present their finished poster,” he says.
Medical students in the Public Health Project group include Samantha Boyd, Benjamin Farahnik, Anja Jokela, Emily Jones, Russell Landry, Mikaela Lea, Alice Stoddart, and Christopher Ting.
The Public Health Projects, led by UVM Associate Dean of Public Health Jan Carney, M.D., M.P.H., is a required course in the Foundations level of the Vermont Integrated Curriculum during which students learn to apply the science and principles of public health while meeting community needs. Sixteen projects are completed each fall by medical student groups working in partnership with community agencies, and mentored by both College of Medicine faculty and community agency mentors. Each year at least several student leaders present their projects at national professional meetings, such as the American Public Health Association’s (APHA) Annual Meeting.