1.  EBP team recruitment-Months 1 & 2  EBP team meet, present ideas, identify resource requirements, and create vision/goal-Months 2 & 3  EBP team review evidence-based research, information, and expertise-Months 3 & 4  EBP team synthesize data and determine elements to be utilized-Months 5 & 6  EBP team create intervention plan, gain approval, notify parents-Months 7-11  Implementation-Month 12  Evaluate-One End of one year of implementation PICO Question Do students ages 5-18 with an asthma diagnosis, who receive asthma case management services by a school nurse, have improved health and academic outcomes when compared to students ages 5-18 with an asthma diagnosis who do not receive asthma case management services? Introduction Background/Significance Childhood asthma is a significant, chronic disease affecting more than 6.8 million children in the United States and negatively impacting health and life outcomes for children and their families by causing countless emergency room (ER) visits, hospitalizations, and school absenteeism (American Health Consultants, 2015). Asthma symptoms, and asthma attacks, disrupt learning and can limit student participation in classroom activities, physical education, and school events resulting in below optimal health, academic, and life outcomes (National Hearth, Lung, & Blood Institute, 2014). Studies (Engelke, Guttu, Warren, & Swanson, 2008; Engelke, Swanson, & Guttu, 2014; Levy, Heffner, Stewart, & Beeman, 2006; Moricca, Grasska, Marthaler, Morphew, Weismuller, & Galant, 2012; Sterling & Linville, 2015; Woods, et al., 2012) have shown that case management can be an effective strategy to minimize the negative impacts of childhood asthma and improve outcomes. Outcomes/Evaluation Tools After one school year of implementation students receiving school nurse asthma case management services will have/measured by:  improved asthma control  Asthma Action Plan Assessment form  patient/family/physician report  individual health record  improved quality of life  PedsQL3.0 Asthma Module  decreased school absences  Skyward data base attendance records  decreased hospitalizations  facility electronic record data References American Health Consultants. (2015). Case managers can improve asthma management in children. Case Management Advisor, 26(8), 85-88. Duff, C. L. (2016). School nurses setting the stage for wellness and success. NASN School Nurse, 216-217. Engelke, M. K., Guttu, M., Warren, M. B., & Swanson, M. (2008). School nurse case management for children with chronic illness: health, academic, and quality of life outcomes. The Journal of School Nursing, 24(4), 205-214. Engelke, M. K., Swanson, M., & Guttu, M. (2014). Process and outcomes of school nurse case management for students with asthma. The Journal of School Nursing, 30(3), 196-205. Haycock, K. (2010). The education-health link why success in school matters to health throughout life. NASN School Nurse, 116-119. Levy, M., Heffner, B., Stewart, T., & Beeman, G. (2006). The efficacy of asthma case management in an urban school district in reducing school absences and hospitalizations for asthma. Journal of School Health, 76(6), 320-324. Moricca, M. L., Grasska, M. A., Marthaler, M. B., Morphew, T., Weismuller, P. C., & Galant, S. (2012). School asthma screening and case management: attendance and learning outcomes. The Journal of School Nursing, 29(2), 104-112. National Collaborative on Education and Health. (2015). Brief on chronic absenteeism and school health. National Hearth, Lung, & Blood Institute. (2014, December). Managing asthma a guide for schools. Retrieved from National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/files/docs/resources/lung/NACI_ManagingAsthma- 508%20FINAL.pdf Sterling, Y. M., & Linville, L. J. (2015). A qualitative study of case management of children with asthma. Professional Case Management, 20(1), 30-39. Woods, E. R., Bhaumik, U., Sommer, S. J., Ziniel, S. I., Kessler, A. J., Chan, E., et al. (2012). Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care. Pediatrics, 129(3), 465-472. Zeller, D. (2014). Mythbuster: demystifying school nursing. Virginia Nurses Today, 22(1), 1 & 8. School Nurse Asthma Case Management Amy Counts, RN, BSN MidAmerica Nazarene University Literature Review Implementation The databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), Pubmed, Medline, Cochrane Database of Systemic Reviews, and the member publication database for the National Association of School Nurses (NASN) (nasn.org), were searched using the keywords asthma, school, school-based, case management, care coordination, and school nurse. The inclusion criteria were publications dated 2008-2015, available in full text and written in the English language and included articles that focused on nurses providing case management to children and their families in schools. Evidence-Based Model Education is an essential determinant of lifelong health and well-being and few medical interventions can match the impact of education on life expectancy (Haycock, 2010). The less education an adult has, the more likely they are to smoke, be overweight, have diabetes, and die at a younger age from chronic health complications (National Collaborative on Education and Health, 2015) With education as a vital component to individual and societal immediate and long term success, it is essential to optimize the academic environment and student achievement. A student’s health status is directly linked to their ability to learn and healthy students are better able to engage in the learning process and meet their education potential (Zeller, 2014). Students with unmet health needs fall short of their academic potential and are less likely to achieve their full life’s potential (Zeller, 2014). Case management is one intervention that can positively impact students with chronic disease and school nurses have access and the opportunity to provide interventions that optimize the student’s health and academic outcomes (National Association of School Nurses, 2015; Sterling & Linville, 2015). Intervention Population  104 students with asthma diagnosis  Poor asthma control  Grade 6-8  Age 10-15 years  Diverse religious, ethnic, and socioeconomic backgrounds  Parent educational background varied EBP Team  Physicians  general practice  pediatrician  Allergy/asthma specialist  translation/application  evaluation  Pharmacist  Elementary & Secondary Principals  Attorney for the District  Parent Representative  Administrator of Student Services  Nurse coordinators Case Management Components Delivered by a BSN prepared school nurse  Assessment  Planning  Facilitate  Coordinate  Advocate  Evaluate Findings 5 articles met the inclusion criteria, addressed the PICO question, and were applicable to this author’s school nursing practice. A 6 th study (Sterling & Linville, 2015) is included as it inadvertently answered the PICO question. Each of the studies considered the effect of case management on one or more outcome of health, academic or quality of life. All found case management to have a positive effect on at least one outcome measure (Appendix A & B). Improvement in the variables of quality of life and school attendance, and decreases in the variables of emergency department (ED) use and hospitalizations, were the most common findings attributed to asthma case management. Stetler Model.  Five step process designed to facilitate effective evidence-based nursing (Melnyk & Fineout-Overholt, 2015).  preparation  validation  comparative evaluation/decision making  translation/application  evaluation  Practitioner-oriented, making it an appropriate model for this EBP intervention Implementation Steps/TImeline