Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Best Practice Recommendations

1.0 All children identified or suspected of having asthma, will have their level of control determined by the nurse: Controlled, Partly Controlled, or Uncontrolled

1.1 During a nursing assessment of respiratory health, every child should be screened to identify those most likely to be affected by asthma.

Have you ever been told you have (your child has) asthma?
Have you (has your child) ever used a puffer/inhaler or any type of medication for breathing problems?
Have you experienced any improvement with these medications?

1.2 If a child is identified as, or suspected** of having asthma, the level of control should be assessed based on:

  • short-acting
  • ß2-agonist use
  • daytime symptoms
  • night-time symptoms
  • physical activity
  • absence from school/work
  • exacerbations
  • responsiveness to treatment

**If suspected of having asthma, further evaluation by a physician is required.

For children identified as potentially having uncontrolled asthma, the level of acuity eeds to be assessed by the nurse and an appropriate medical referral (i.e., urgent care or follow-up appointment).

2.0 Nurses will understand the pharmacology of medications used to treat asthma in children.

2.1 Nurses will be able to discuss the two main categories of asthma medications (controllers and relievers) with the child and their family members/caregivers, tailoring information for the developmental age of the child.

2.2 All children with asthma should have their inhaler/device technique assessed by the nurse at each visit to ensure accurate use, as well as appropriateness of device for the developmental level of the child. Children with sub-optimal technique will be coached in proper device use or switched to a more appropriate delivery device.

2.3 Nurses will be able to assess for potential barriers to asthma management. The nurse will be able to offer strategies to meet families’ needs and support them in overcoming issues leading to treatment failure.

3.0 The nurse will provide asthma education, in collaboration with the health care team, as an essential part of care.

4.0 Child/family knowledge of asthma should be assessed by the nurse at each patient contact. Asthma education should be provided when knowledge and skill gaps are identified.

4.1 Tailor asthma education to the needs of the child and family by being developmentally appropriate, sensitive to cultural beliefs and practices and by using a variety of teaching methods (e.g., video, pamphlets, websites, group, role playing, problem solving).

Education Framework
5.0 The nurse can use a structured framework to provide basic asthma education to build both the child’s and family’s knowledge of asthma and self-management skills. A partnership between the nurse, child and family is important to engage the child and family in an interactive educational process.

Action Plan
6.0 All children should have an individualized asthma action plan for guided self-management, based on the evaluation of symptoms, with or without peak flow measurements, developed in partnership with a health care professional.

6.1 The action plan must be reviewed and reinforced in partnership with the parent/caregiver, child and health care professional during every contact. The nurse will coach the parent to act as an advocate for their child, ensuring that the action plan is implemented and kept up to date.

Referrals and Follow up
7.0 The nurse should facilitate follow-up assessments and education to achieve and maintain control of asthma for the child diagnosed with asthma.

7.1 The nurse will determine the child’s primary asthma management provider by asking “who do you see for your asthma management?”

7.2 Nurses should advocate for a referral to an asthma specialist (respirologist, allergist, paediatrician, Certified Asthma Educator etc.) for the following: frequent visits to the emergency department; poor understanding of asthma self-management; symptoms are not responding to usual treatment; and/or uncertainty of diagnosis.

7.3 Nurses should advocate for referral to an asthma education program and/or link to community resources, if available.