Asthma Dissertation

I have finally (somehow!) entered my third and final year of my nursing degree, and I have to start thinking about what to do for my dissertation. That bit was easy - I want to do a literature review on asthma, as this is where my passion and knowledge lie. In particular, I want to look at brittle and difficult asthma, not only because of my own experiences but because I realise that there hasn't been a huge amount of notice taken of this minority group in the world of research.

But what to look at within this topic, now I'm stuck! I initially though about community care provision for brittle and difficult asthmatics, but then thought why not emergency treatment of these conditions? The psychological aspects? Specialist tertiary care? Improvements that need to be made to these services? Or practical nursing care for these patients?

So, my point is: what matters to you? In your experiences as people with brittle or difficult asthma (I'm not using these terms interchangably but including both), what needs highlighting or working on? What needs to change? Do you find tertiary care to be fine but emergency care a nightmare? Or do you find that a general raising of awareness of these conditions is what matters?

I hope this all makes sense - feel free to PM me for more details or with suggestions, or post below. I am aiming high and would love to get this piece of work published, and in doing so I wish to raise awareness of such a dangerous and life-limiting illness amongst both healthcare professionals and patients.

Thanks a bunch

Emz x

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hi

that sounds like a fantastic idea. i think emergency care. i find that the care i get at home is miles better than what i get in hospital, this is probabley because when i at home people know me but when in hospital because brittle or difficult does not always follow text book it is a nightmare. ie people with no wheeze or silent chest seem to get sent home and that is really dangerous!

i think emergency care personally. wish i was sciency so i could do research,

well done for getting this far!

plumie

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I would tend to agree with plumie. I have not been suffering as long as a lot of people, but have found my routine care to be good. On the occasions when I have gone to A&E I have found the doctors to be really good, but my lack of wheeze seems to me to undermine the level of my discomfort. Last time I was told by the triage nurse that I could not possibly be having an asthma attack because it had not come on suddenly. Fortunately my husband was there to speak up for me and put her straight. Once she took my peak flow her attitude changed, but it is a time when you are feeling vulnerable, not sure if you should have hung on at home, whether you are being a nuisance or overrreacting etc.

[Asthma-girl]

Like the other have already mentioned I also find that because I do not have the usual asthmatic wheeze I sometimes have caused confusion in A&E and with some Paramedics

[Skee-skee]

That sounds a really interesting dissertation to do! If it is purely literature based I guess you might be limited by the amount of information already out there (obviously!). Was there any part of the Asthma UK report on living with severe asthma that really interested you, and you would want to find more about, because that could be a good starting point?

I am also a non-wheezy asthmatic! but haven't had too many problems with emergency care (touch wood). It would be great to increase people's knowledge that not all asthmatics wheeze. Do a lot of difficult/brittle asthmatics have direct access to the respiratory ward - if so will this be a problem when talking about emergency care??? Not sure if it would be an issue might be worth thinking about though.

Had you thought about how you would define 'difficult asthma' - I don't think there is a textbook definition unlike 'brittle' asthma? I had a conversation with one of the respiratory consultants here about the definition of 'difficult asthma' and by the end all I knew was that I have it, but not what the definition is!!

Good luck with it and let us know how you get on.

Bryony

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great topic, my bug is people perception of brittle or servere asthma even in medical or nursing profession. i got asked by a nurse manager when was my asthma gonna be cured !!!! because i was off sick too much.... so many sub topics u could concentrate on just dont know how much literature support u may get.

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Hi Firstly congratulations on getting this far; I'm just starting the 5th year of my 3 year degree...

Sounds like a great topic; whatever you choose, make sure it's doable, not going to give any unnecessary extra pressure and is carefully topic limited rather than drifting (I've written far too many dissertations...!!)

You've got some good ideas here; if you wanted to do some empirical research use what you have easy access to, perhaps looking at nurse education in Brittle Asthma. Is nurse education universal / the same wherever you train? - if not, maybe you could compare the different education on asthma different trainees get? Or compare training of different professionals in the same setting, i.e. who knows what in A&E from reception to nurse to consultant? Or could you do an international comparison?

I've just been in hospital (our favourite 'major teaching hospital'!!) but not with asthma, and it was interesting to hear different professionals' reactions to my medical history, from a nurse who had never heard of Brittle Asthma, to a pharmacist who said, 'oh that's just normal asthma isn't it' and tried to change my meds, to an Australian consultant who knew exactly what it was and took it very seriously (yeah, took me by surprise too!!) - maybe I was just lucky? Maybe education is different in different countries?

Good luck!

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Well done on reaching your final year! Your determination and enthusiasm shine through...keep it up

My asthma has been very severe/difficult to control since April - I've been in hospital twice, the first for 3 days and the second for 6 days and I've had numerous attacks in between. My biggest concern with hospital care is the lack of consistency, particularly in terms of peoples understanding/opinon of asthma.

On my last visit, the receptionist failed to note how bad I was and I was put at the back of the queue. When I was seen 45 minutes later, it was realised how bad I really was (oxygen levels less than 79) and the nurse kicked another patient out of a wheel chair, so I could take it and be whisked to Majors.

People don't always know how severe the attack is - especially when you have a silent chest and arent wheezing. Like others have said, sick lungs don't show and that makes it hard too.

On the ward, my medication wasn't adminstered on time (sometimes hours late) and sometimes, I wasn't given any at all. I was meant to be on back to back nebulisers, one every 2 hours. If they could have given me the squirty things to pop in the machine, then I would of happily done it myself. You feel like a right pain always buzzing for your nebs. I also wanted to take my steroid medication earlier in the morning, so I could reap the benefits later in the day, but found they'd only give the pills to me around lunch time.

I was told that I couldn't go home until my peakflow increased to 300. My peakflow readings weren't consistently recorded - often the nurse would take the pre-neb reading, forget the post-neb or vice versa. Sometimes they just forgot. Most times I would take the reading and record them myself on a bit of paper.

My biggest upset is my GP surgery - I'd been seeing them almost every week for months asking for a blue inhaler each time and they never said anything. They never thought to review my medication or refer me to a specialist. I think I was going through one ventolin a week at one point. Since I've had my appointment with the consultant, I now realise I wasn't being properly managed in the first place.

I think some GPs/nurses etc become too complacent about asthma. I must admit I had that attitude too, before my symptoms became harder to control. It was always a case of 'just take your blue inhaler' and get on with it. I never realised how serious it could be - life threatening.

In a nutshell, I think more work needs to be done on raising awareness of the life-threatening aspects of asthma. Better guidance for healthcare professionals to identify those asthmatics most at risk, which in turn may help ensure the right treatment is given swiftly and effectively to those most in need.