Table of Contents
Asthma is a long-term respiratory disease associated with the inflammation of the lung’s airway. Asthma etiological agents are both genetic and environmental which includes the exposure to pollution and allergens. The long-term condition has no proper curative therapy and therefore treatment aims at prevention by avoiding triggers such as irritants and allergens. The causative agents disrupt the normal functioning of the respiratory system. Asthma is usually chronic and proper management is required to give a good prognosis. Asthma poses challenges to the patients and health professionals. The long-term effect of the disease has negative psychological and sociological impacts, therefore, health policies and integrated drug therapy services are required. Management of asthma involves preventing the causes which include avoiding contact to allergens and pollution in the environment. For proper nursing care with professionalism, Nurses have the obligation to adhere to the NMC code with an aim of preventing ill health and promoting of health and well being of individuals. The paper is researched evidence on psychological and sociological impacts of asthma and the relevant health promotion aspects of care required.
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All registered nurses and midwives are expected to align their practice with standards set as detailed in the NMC code of conduct section 5 which requires nurses and midwives to “respect people’s right to privacy and confidentiality” (The NMC code n.d., 6). These standards ensure that nurses and midwives adhere to ethics and uphold professionalism. For that reason, information such as names, location and other sensitive details about the chosen client for this case study will not be mentioned so as to comply with the standards.
The Case study
The patient chosen for this case study is a female who is 45 years old. She was diagnosed with asthma at the age of 12 by assessment of the clinical symptoms which included coughing and dyspnea. The patient complained of shortness of breath and the diagnosis indicated that the condition was brought on by hay fever and dust allergies. The patient was fit and sporty at the young age and trained in karate for over 6 years. However, the developed shortness of breath during exercise led to her quitting martial arts. The patient and her parents did not realize the fact of asthma as a life-threatening situation until she was at the age of 12. In her adulthood, the condition often is brought on by anxiety and stress. This led to her restrictions from attaining her dream job and she often struggles to carry heavy bags and equipment. Lung function assessment followed and medication became a choice after a proper analysis of the symptoms. The patient began to train back into martial arts and started paying attention to the impact of mentality on her asthma condition. She as well minimized exposure to the allergens to prevent trigger of the diseases. Nurses working under Nursing Midwifery Council (NMC) code helped the patient make changes to her diet for effective management of the condition and she attends asthma reviews. The reinforcement of professionalism by providing safety and patient priorities as a result of NMC code structurally influenced the nurse to ensure wellness of the patient. She usually has an emergency inhaler in case she ever needs it and monitors her lung capacity every month as an effective method of management of asthma.
The lungs houses conducting and respiratory regions that perform the exchange of oxygen and carbon dioxide. The lungs are inverted by both parasympathetic and sympathetic nervous system. The innervation helps in the control of levels of dilation and constriction of the airway. As major organs of gaseous exchange, the lungs require a proper blood supply, a defensive mechanism against microbial organisms and protection against physical and chemical injuries (Clancy & Blake 2013, 34-6). A defect in blood supply and innervation indicate an occurrence of a respiratory disease. Asthma is associated with narrowing of the bronchioles limiting the passage of air entering and leaving the lungs. As a result, the long-term condition is associated with clinical signs such as coughing, dyspnea, and chest tightness (Sullivan et al. 2016, 1-5). Asthma affects people at an age and treatment aims at identification and avoidance of allergens that trigger the symptoms. Drug therapy as part of the patient journey provides an effective integral patient care for treatment of asthma.
Physical, social, and psychosocial challenges
The health of a person is the efficiency of a body to function normally and have the ability to cope with physical, mental, psychological and social changes within the environment. According to Tapp, Hebert, and Dulin (2011), psychological and social needs of a person involve the desire to interact with the environment with an aim of satisfying individual’s well-being (2011, 188). The psychological needs are requirements for an individual to find themselves in an environment that promotes positive emotions, optimal experience, and healthy development. According to WHO, people have an association with social determinants of health in which they are born, brought up, live, work and age (Faul & Shah 2017, 40). The social determinants of health include income, social status, and social support networks: education, employment, gender, culture and healthy child development. The social determinants of health assess the circumstances that shape distribution of money, power, and resources required for individual coping to the environment.
Financial, transport, and accessibility to medication are the challenges experienced by asthma patients. The feeling that someone has difficulty in breathing interferes with the individual ability to undertake normal daily activities (O’Connor 2006, 17). Chronic and persistent lung disease requires an individual to have a continuous access to medication, therefore, should be stable financially and have a quick access to transportation in case of emergencies (Bousquet et al. 2005, 553). Prevalence of asthma is fatal and reduces the productivity of individuals. For example, parents will limit their children to physical and social activities because of the worry about their safety. As a result, close supervision is initiated and such parents lose their sense of job security. The medication therapy requires finances which upon exhaustion because of basic activities result in a challenge to the patients. Transport difficulties increase the risk of patient’s therapy, therefore, a challenge to asthma patients.
Asthma patients are associated with symptoms of depression and stress. According to Crickmore et al., the prevalence of the disease causes mental health problems because of increased costs of treatment and management (2002, 25-7). For example, children suffering from the disease are limited to sports and other activities. A change in healthy habit and limitation to opportunities for social interaction and growth creates a feeling of loneliness as in the case of my chosen patient. Such children miss school for treatment appointments. Adults, on the other hand, both carers, and patients develop mood disorders because of failed strategies to control the diseases and lot of finance allocated to the medication. Lack of job security and the choice of changing career paths alter the mood of the patients and affect their overall quality of life (Leroyer et al. 1998, 267-70). The stressful events of the disease cause loss of control, embarrassment, denial, fear, and confusion lead to mental disorders that upset the patients, therefore, a psychological and emotional challenge to the care givers and the asthma patients.
Medication used and side effects
Asthma therapy aims to control the disease, minimize symptoms and reduce the risks of long-term morbidity. According to Zahradnik the medication of Asthma involves administration of corticosteroids and long-acting beta2-agonists to patients and managed byu inhalers incase of emergency (2011, 334). However, a significant portion of patients does not respond to the regular treatment with inhaled corticosteroids and long-acting beta2-agonists (Shen et al. 2011, 450). Asthma has a burden in management, therefore, subjecting patients to mental disorders, for example, depression and anxiety. The challenges experienced by the patients also include mobility, financial, transport, access to treatment and stress. Social and physical needs impact upon person’s status level of health and fitness. Socioeconomic factors, as well as the physical environment and individual behavior interactions, pose the challenges experienced by asthma patients. Asthma patients have the inability to adjust to the circumstance because of the delayed response of the disease to drug therapy (Steuten et al. 2007, 186). Mobility, therefore, becomes a challenge for the patients to move from different health levels in the society.
Policies and drivers for effectiveness of care and public health for long-term conditions of asthma
Management of Asthma as a long-term condition should be proactive, patient-centered and preventive. Policies and drivers coordination create an effective care which incorporates a collaborative role of support to the asthma patients. The need to improve the treatment and management of long-term conditions is important and as a result, the National Policies which include National Service Frameworks, NICE guidelines, Care pathways, Framework for Personalized Care and Population for Nurses, Midwives, Health Visitors and Allied Health professionals. Long-term management recognizes a re-designed service delivery that allows patients to develop a responsive system. The policies and drivers for the effectiveness of care and public health tend to be as clinician responsibility as well as a collaborative endeavor with active patient involvement (Fortin et al. 2013, 132). Health and social care professionals identify the needs which help in deciding on priorities for information sharing, decision-making, and action planning to support asthma patients.
Long-term conditions especially asthma cannot be currently be cured and patients with the diseases often have a high susceptibility to suffer from another condition. The care for such patients becomes complex and supporting such people require plans from policies and drivers to effective care and public health (Fuller 2015, 20). The National Service Framework, for example, marks a change in health and social care of patients by creating policies which ensure delivery of services required by the patients suffering from the conditions. NSF has an improvement plan with an objective of putting people at the heart of public services. The objective sets a new strategic model that manages long-term conditions for self-care, disease and care management. The policies and drivers under NSF give people choices through services planned and deliver individual needs (Savoli & Barki, 2017, 71-79). The policies support patients to live independently and play a role in the society and coordinate partnership working between health and social services with other local agencies to ensure proper care plans are delivered to the patients.
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National Institute for Health and Care excellence has standards and pathways that focus on improving health and social care. NICE acts as a driver for the provision of guidelines and advice for health and social care quickly and easily. For asthma patient, diagnosis and monitoring is the first step, followed by management and regular reviews (Savoli & Barki, 2017, 129). Asthma management according to NICE involves administration of inhaled corticosteroids. The drug therapy ensures the effectiveness of the patient management and close follow-ups are required for effective care. The stages for ideal care involve drug therapy while the competence for treatment and management involve liaising with primary care of the condition and control of the cause of the diseases (Fortin et al. 2013, 132). The personal management ensures that the patient is isolated from the allergens and factors that contribute to symptoms of asthma. Immediate medical attention and follow-ups ensure that patient assessment is managed for analysis of effective care.
Personalized care and population health for nurses, midwives, health visitors and allied health professionals contain a framework for caring for populations across the life course. The framework consists of a national program for nurses, health visitors and allied health professionals to impact on improving health outcomes and reducing inequalities in asthma patients (Segundo et al. 2013, E1-E3). The framework designed supports and promotes practices that develop personalized care and population across all ages of the population suffering from asthma. The support is resources based and has developed services that use the knowledge of nurses, health visitors and allied health professionals for management of asthma patients. Framework for asthma patients focuses on activities for promoting population health, assessments of determinants of health, development of strategies for health improvement, patient health protection, public health care and facilitating independence and well-being of people along the life course.
The activities of population health as a framework measures outcomes underpinned by NICE, research, education and professional engagement in asthma management. The framework provides staff with tools that support the delivery of services as enlisted in asthma patient care pathways to facilitate the role of population health elements (Eberhart et al. 2014, 838-43). Professionals develop services useful for delivering services that ensure patients receive proper care and management. Guidance as a developed policy provides information to the patients for protection from contact with other conditions and reduction of negative feelings about the primary asthma disease. As a result, the framework has a contribution to population health to achieve well-being and health equalities among the asthma patients. The framework additionally aims at making every contact count to help people live healthy lifestyles, make healthy choices and reduce health inequalities (Eberhart et al. 2014, 843). The healthcare professionals use skills such as motivational interviewing and behavioral insights that aim at an initiative of the wellbeing of the asthma patients as well as people providing the care for the patients.
People with long-term and life-limiting illness such as asthma in the past have experienced fragmented care when it should have been organized around their needs. Integrated care is an approach that has a high degree of collaboration and communication among health professionals which is dedicated to bringing together inputs, delivery, management, and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion (Zahradnik, 2011, 326). Integrated acre is one of the initiatives required to develop life care of asthma patients. The care consists of pathways with specific activities that indicate compliance or non-compliance trajectory of care. Integrated care seeks to close traditional divisions between social and health care (Shields et al. 2011, 161-64). As a result, the integrated methods address the changing demands for care arising from aging population, offer person-centered care for interdependent outcomes, facilitate social integration of vulnerable society’s groups to access of flexible community services and finally lead to better system efficiency through better coordination of care.
The integrated healthcare has benefited my patient in this case study on various occasions. The models utilized by the patient indicate substantial challenges that occur at political, organizational and service delivery levels (Carmichael et al. 2016, 252-6). However, my patient has benefited from the integrated care system because of development of ownership, involvement, proper communication and recognition of needs of the condition for effective overall management of asthma. The system has benefited the patient to have proper guidelines in decision-making for the social care setting that impact on her health care. After a diagnosis of asthma as the condition causing shortness of breath for my patient, functional integration approach followed for financing and regulation of care, prevention, and social services (Clarke & Calam 2012, 750). The integrated healthcare modeled the strategy of what was required for the patient to navigate through the proper channels of management of the condition.
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Despite the benefits of the integrated care, my patient lacked knowledge about the asthma condition from an early age. The poor coordination and integration across health and social care resulted in waste and inefficiency for service delivery (Flanagan et al. 2017, 4). Fragmented information system results in extra administration costs and this may lead to family members from falling ill with stress, anxiety and even depression. However, for the case of my female patient, the realization of hay fever and dust allergies prompted to the appropriate development of targeting care and resources for preventing duplication of treatment. The community health centers poor coordination creates gaps in care pathways. In this case, my patient developed proper care decisions with the help of her parents which have resulted in care undertaking by right professionals. The integrated care, therefore, has benefited my patient by improving the quality and continuity of care.
Integrated health care system created a primary center organized for its professional network where communication and exchange of information are useful for understanding about asthma. From this perspective, the patient has knowledge about the perspectives of the diseases and what is required as a demand for care (Fries et al. 1998, 72-6). The system of integrated care addresses the changing demand for care of the asthma patient. The interdependent health and social care outcomes recognition by the integrated care allows the patient to develop the better mentality that reduces the vulnerability of the condition. Additionally, the integrated care addressed the complexity of patients needs by responding to multiple conditions associated with asthma. My patient has received better insight as to how she should live. As a result, she changed her diet and engaged in activities that do not cause mental health problems which usually accelerate the asthma condition (Jones, & Ku 2015, 2028-30). Care has improved the living conditions of the patient and this led to her training back to martial art. The insight also has allowed the patient to frequent lung capacity checks and the use of inhaler in case of emergencies.
Role of nurses in preventing ill health and promotions of health and wellbeing
Asthma affects around 235 million people worldwide of young and old ages (Eberhar et al. 2014, 847). Nurses are the front runners that help in the battle against the effects of asthma on patients. Nurses play an important role in the management of the condition to promote health in the population. The role of nurses is the identification of asthma triggers which provides the knowledge of initiating proper treatment measures. The nurses explore techniques that improve patient education and self-management of the disease. Nurses form management plans of asthma to highlight the importance of promoting health in a population in relation to the long-term condition which is life-threatening. Patient education and health promotion are the key areas for asthma management (Gannon & Davin 2010, 499). Asthma being both heterogeneous and acquired requires knowledge of the symptoms that ensure proper diagnosis and implementation of management procedures that facilitate a good prognosis.
Nurses have knowledge about asthma triggers which have adverse effects such as psychological problems. The problems are as a result of lack of asthma control. According to Leverenz et al., a nurse needs to be aware that patients’ exposure to certain triggers can cause the patient to recall the previous memory of the causative agents of asthma and their effects (1983, 9-12). The effects associated with asthma require an early diagnosis for the establishment of controlling psychological factors that reduce the severity of their symptoms. Early diagnosis helps the nurses to establish management systems of the disease. Nurses, therefore, form a primary care system which is the building block of public health. The primary care, according to Malone and Armstrong, occupies a unique position to health care and promotes the well-being of patients (2001, 178-80). Nurses are key agents in addressing the needs of patients for preventing ill health conditions and promoting the well-being of the patients.
Apart from facilitating drug therapy for treatment of asthma, nurses have a management plan which outlines the guidelines for self-management on symptoms and peak flows. The plan constitutes patients to have follow-ups. The management plan focuses on inhaler use techniques for cases of emergencies. The follow-up involves checking lung capacity and improvements if any. The nurses educate the patients on the importance of minimizing direct effects of allergen. For example, nurses advice patients on complete avoidance of pet allergens, environmental allergens as well as stopping smoking for improvement of patients’ health. O’Reilly explained that nurses have a clear understanding of health psychology, social psychology and social cognition theories (2015, 11). The role of educating patients in relation to the compliance of smoking cessation regimes promotes public health and facilitates achievement of the fundamental goal to encourage patients to have healthier choices.
Nurses are involved with health promotion activities which comprise a process of enabling people to increase control over their lives. The health education delivers information that influences people’s behavior, attitudes, and knowledge about the long-term condition, therefore, person-centered care establishment (Naik-Panvelkar et al. 962-5). The nurses have a management plan which endorses health values for example empowerment and awareness about asthma. The health promotion principles include building policies that create supportive movements, enhance the development of personal skills, and strengthen community action and re-orientation of health services. Nurses enhance empowerment as a fundamental belief to meet patient’s needs, resolve difficultness and locate resources required by individual control of their survival. Nurses aim to improve patient’s condition since asthma has no cure. The responsibilities delegated to the patients help to intake of control over their lives as well as giving an outline of the opportunities available within their communities. Nurses, therefore, regard health promotion and education to elicit set of competencies and certain personality characteristics for management and control of asthma.
Health promotion aspects of care
The well-being of patients is the responsibility of nurses. Nursing and Midwifery Council have goals, objectives and professional practices that have preventive and management approaches for the concern of population (Crown et al. 2003, 45-8). Nurses foster personal and familial development to support self-defined goals of individuals, families, and community. In the process, patients with asthma have a feeling of an integrated care through the supportive practices of the nurses. Supporting patients towards modification of relationships or the environment upkeep health systems, address patterns for preventing asthma as well as secondary diseases. Nurses, therefore, play an important role to ensure that the wellbeing of asthma patients is attained (Hofmarcher et al. 2007, 29). For example, in the case of my patient, under the guidance of NMC code 3 subsection 1 which requires the nurses and midwifes to “pay special attention to promoting wellbeing, preventing ill health and meeting the changing health and care needs of people during all life stages” (The NMC code n. d., 5), lung capacity check-up is done on monthly basis. The counseling programs reduce stress in the individuals, therefore, facilitating the reduction of the adverse effects of the condition. The close attending and care received by the patient was also informed by the rights to patients and public and NHS pledge to them that “you have the right to receive care and treatment that is appropriate to you, meets your needs and reflects your preferences” (The NHS Constitution 2015, 6). Therefore, both the NHS constitution and the NMC code assisted in promoting the patient’s wellbeing.
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Asthma is a long-term respiratory disease associated with the inflammation of the lung’s airway. Asthma poses challenges to the patients and health professionals. Asthma is associated with narrowing of the bronchioles limiting the passage for air entering and leaving the lungs because of allergens. The long-term effect of the disease has negative psychological and sociological impacts, therefore, health policies and integrated drug therapy services are required. The rationale used for choosing the patient based on the NMC code and confidentiality. The patient chosen for the case study is a 45-year-old female who started feeling difficulty in breathing at the age of 12 because of hay fever and dust allergens. The condition limited her to attend to certain jobs as well as pursue her career. Asthma affected the patient both psychologically and physically. However, drug therapy as part of the patient journey provided an effective integral patient care for treatment of asthma.
Psychological and social needs of a person involve the desire to interact with the environment with an aim of satisfying individual’s well-being. Asthma has physical and psychological effects because of its severity. Financial, transport, and accessibility to medication are the challenges experienced by asthma patients. The feeling that someone has difficulty in breathing interferes with the individual ability to undertake normal daily activities. Asthma patients are associated with symptoms of depression and stress. Management of Asthma as a long-term condition should be proactive, patient-centered and preventive. Policies and drivers coordination create an effective care which incorporates a collaborative role of support to the asthma patients. Integrated care is an approach that has a high degree of collaboration and communication among health professionals which is dedicated bring together inputs, delivery, management, and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Nurses play an important role in the management of the condition to promote health in the population. The nurses explore techniques that improve patient education and self-management of the disease.
- Bousquet, J, Bousquet, P. J, Godard, P & Jean-Pierre, Daures 2005, “The public health implications of asthma”, World Health Organization.Bulletin of the World Health Organization, vol. 83, no. 7, pp. 548-54.
- Carmichael, F, Fenton, S. H, Pinilla-Roncancio, M, Sing, M, & Sadhra, S 2016, “Workplace health and wellbeing in construction and retail”, International Journal of Workplace Health Management, vol. 9, no. 2, pp. 251-268.
- Clancy, J, & Blake, D 2013, “Pathophysiology and pharmacological management of asthma from a nature-nurture perspective”, Primary Health Care, vol. 23, no. 7, pp. 34-41.
- Clarke, S & Calam, R 2012, “The effectiveness of psychosocial interventions designed to improve health-related quality of life (HRQOL) amongst asthmatic children and their families: a systematic review”, Quality of Life Research, vol. 21, no. 5, pp. 747-64.
- Crickmore, K, Jones, A, Engelke, M. K, & Mott, J. A 2002, “Managing pediatric asthma”, Health Forum Journal, vol. 45, no. 6, pp. 24-30.
- Crown, W. H, Berndt, E. R, Baser, O, Finkelstein, S. N & Witt, W. P 2003, Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?, National Bureau of Economic Research, Inc, Cambridge.
- Eberhart, N. K, Sherbourne, C. D, Edelen, M. O, Stucky, B. D, Sin, N. L & Lara, M 2014, “Development of a measure of asthma-specific quality of life among adults”, Quality of Life Research, vol. 23, no. 3, pp. 837-48.
- Faul, J. & Shah, W. 2017, “Asthma control in general practice – tips for busy GPs to help sufferers”, Irish Medical Times, vol. 51, no. 23, pp. 40.
- Flanagan, S, Damery, S, & Combes, G 2017, “The effectiveness of integrated care interventions in improving patient quality of life (QoL) for patients with chronic conditions. An overview of the systematic review evidence”, Health & Quality of Life Outcomes, vol. 15, pp. 1-11.
- Fortin, M, Chouinard, M, Bouhali, T, Dubois, M, Gagnon, C & Bélanger, M 2013, “Evaluating the integration of chronic disease prevention and management services into primary health care”, BMC Health Services Research, vol. 13, pp. 132.
- Fries, J. F, Sokolov, J, Beadle, C. E & Wright, D 1998, “Beyond health promotion: reducing need and demand for medical care”, Health Affairs, vol. 17, no. 2, pp. 70-84.
- Fuller, S 2015, “Illness prevention in the NHS five year forward view”, Nursing Management (2014+), vol. 22, no. 3, pp. 20.
- Gannon, B & Davin, B 2010, “Use of formal and informal care services among older people in Ireland and France”, The European Journal of Health Economics: HEPAC, vol. 11, no. 5, pp. 499-511.
- Hofmarcher, M. M, Oxley, H & Rusticelli, E 2007, Improved Health System Performance through better Care Coordination, Organisation for Economic Cooperation and Development (OECD), Paris.
- Jones, E. B, & Ku, L 2015, ‘Sharing a playbook: integrated care in community health centers in the United States’, American Journal of Public Health, vol. 105, no. 10, pp. 2028-2034.
- Leroyer, C, Lebrun, T, Proust, A, Lenne, X, Lucas, E, Rio, G, Dewitte, J & Clavier, J 1998, “Knowledge, self-management, compliance and quality of life in asthma: a cross-sectional study of the French version of the asthma quality of life questionnaire”, Quality of Life Research, vol. 7, no. 3, pp. 267-72.
- Leverenz, Cynthia J, RN, M. S, C.-A.N.P. & Skelly, Anne, H, RN, M.S, C.-A.N.P. 1983, “Assessment of thorax and lungs”, Occupational health nursing, vol. 31, no. 6, pp. 9-16.
- Malone, D. C & Armstrong, E. P 2001, “Economic burden of asthma: implications for outcomes and cost-effectiveness analyses”, Expert Review of Pharmacoeconomics & Outcomes Research, vol. 1, no. 2, pp. 177-86.
- Naik-Panvelkar, P, Armour, C, Rose, J. M & Saini, B 2012, “Patient preferences for community pharmacy asthma services”, PharmacoEconomics, vol. 30, no. 10, pp. 961-76.
- O’Connor, C. J 2006, Visioning the future: health care for the elderly, Arizona State University, Tempe, AZ.
- O’Reilly, N 2015, “Evolution of occupational health 1: pioneers and 21st-century challenges”, Occupational Health & Wellbeing, vol. 67, no. 10, pp. 10-13.
- Savoli, A & Barki, H 2017, “Effective use of patient-centric health information systems: the influence of patient emotions”, Systèmes d’Information et Management, vol. 22, no. 1, pp. 71-96.
- Segundo, G. R, Silva, M. D, Ribeiro, J. L, Clark, N. M, & Lachance, L, 2013, “A successful asthma treatment program in Brazil/Clark and LA chance respond”, American Journal of Public Health, vol. 103, no. 10, pp. E1-E3.
- Shen, J, Johnston, M, & Hays, R. D 2011, “Asthma outcome measures”, Expert Review of Pharmacoeconomics & Outcomes Research, vol. 11, no. 4, pp. 447-53.
- Shields, M. C, Patel, P. H, Manning, M, & Sacks, L 2011, “A model for integrating independent physicians into accountable care organizations”, Health Affairs, vol. 30, no. 1, pp. 161-72.
- Steuten, L, Palmer, S, Vrijhoef, B, Van Merode, F, Spreeuwenberg, C, & Severens, H 2007, “Cost-utility of a disease management program for patients with asthma”, International Journal of Technology Assessment in Health Care, vol. 23, no. 2, pp. 184-91.
- Sullivan, A, Hunt, E, MacSharry, J, & Murphy, D. M 2016, ”The Microbiome and the Pathophysiology of Asthma”, Respiratory Research, vol. 17, pp. 1-11.
- Tapp, H, Hebert, L, & Dulin, M 2011, “Comparative effectiveness of asthma interventions within a practice-based research network”, BMC Health Services Research, vol. 11, pp. 188.
- The NMC code n. d., Professional standards of practice and behavior for nurses and midwifes, viewed 12 October 2017, <https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf>.
- The NHS Constitution 2015, The NHS belongs to us all, viewed 12 October 2017, <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/480482/NHS_Constitution_WEB.pdf>.
- Zahradnik, A 2011, “Asthma education information source preferences and their relationship to asthma knowledge”, Journal of health and human services administration, vol. 34, no. 3, pp. 325-51.