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From gum in a student’s hair to cardiac arrest, school nurses are expected to know how to handle any situation. Clinical practice guidelines help them navigate many of these problems. Yet for asthma, a chronic disease affecting more than 6 million U.S. children, these guidelines were nonexistent — until now.

To enhance the care of asthmatic children in schools, Associate Professor Judith Quaranta ’79, MS ’98, PhD ’13, and Bartle Professor Rosa Darling ’07, MS ’09, PhD ’10, from ��������’s Decker College of Nursing and Health Sciences co-authored the first comprehensive asthma-management guidelines for school nurses. This pioneering work, commissioned by the National Association of School Nurses (NASN), addresses a critical gap in school healthcare resources.

“This endeavor was a huge undertaking. We had never written guidelines before and, at times, felt overwhelmed. But we were honored to be asked,” says Quaranta, who was first approached by the NASN about the task in the summer of 2023. “Knowing that our work will significantly impact the health and well-being of schoolchildren with asthma was very motivating. With assistance from Laura Lipke, health sciences librarian at ��������, we were able to navigate the project through completion.”

Asthma is the leading chronic disease among children and the primary cause of school absences. It requires precise management strategies for each individual. But school nurses are often responsible for hundreds of students and being so outnumbered comes with a lot of pressure.

“School nurses may be the sole healthcare provider for 750 students,” Darling says. “So having a guideline that’s a quick reference tool is valuable. If they have a student who’s having an asthma attack in one building and a student who’s having a hypoglycemic attack in another building, and they’re the only provider, they need a guideline they can trust. That’s where we come in.”

Science-based, practical guidelines

The process of developing the guidelines was rigorous. The team started with more than 1,100 scientific articles, which they reviewed and filtered using a program called Covidence. Then, they evaluated each article. Ultimately, they were left with the most relevant information, and their guidelines were backed by the latest research.

“The guidelines not only outline asthma-management protocols but also include a toolkit to help school nurses implement these practices,” Darling says. “They feature practical resources like step-by-step instructions and videos, which can be useful in high-pressure situations. If used properly, the guidelines can take a lot of anxiety away because you don’t need to know everything. I think sometimes, as nurses, we feel we should know everything, and you can’t.”

Quaranta and Darling say they have always worked well together. However, they quickly realized the enormity of their task and were grateful for the NASN’s assistance.

“Working with people at the National Association of School Nurses was really special for both of us,” Quaranta says. “Their level of support and the way they worked with us was amazing. Their goal was to have published guidelines that had never been covered before, so we were very grateful for the collaborative relationship that guided the successful development of these guidelines.”

With the guidelines completed and in the early phase of distribution, Quaranta and Darling say they are proud of their work and hope it will contribute to better healthcare for everyone with asthma.

“There are so many avoidable emergency room visits and hospital admissions when it comes to asthma,” Quaranta says. “If we can get on top of teaching children with asthma and their parents and responsible adults how to manage it, the outcomes will be phenomenal. That we were able to contribute is very rewarding.”