Factors Associated with School Nurses’ Self-efficacy in Provision of Asthma Care and Performance of Asthma Management Behaviors: A Descriptive Cross-sectional Study

Background: Asthma is a chronic lung disease that affects approximately six million children in the United States and accounts for nearly 14 million missed school days. Asthma management behaviors (AMBs) are recommended clinical activities of assessment, advice, support, and referral regarding asthma care that aid students with asthma. School nurses’ performance of AMBs requires exploration, as these behaviors may reduce exacerbations, which in turn may reduce emergency visits and hospitalizations, and increase school attendance. Self-efficacy (SE) has been demonstrated to have a positive effect on performance of behaviors. Yet there has not been significant exploration of the interplay between environmental factors in the school nurses’ work setting, SE in providing asthma care (hereafter “SE in asthma care”), and performance of AMBs. Objective and Design: To examine the empirical relationships between the variables above, using a descriptive, cross-sectional online survey. Social Cognitive Theory (SCT) served as a guide for the proposed relationships and study variables. A link to a web-based survey was provided to a professional school nurse organization that disseminated the survey via email and its website. The survey included self-report items on SE in asthma care, characteristics of the nurse and school environment, and performance of AMBs. Results: SE in asthma care and student-nurse ratio were significantly associated with performance of AMBs. Self-efficacy may be considered a positive contributor to school nurse behaviors that promote health. Conclusion: Schools and school nurses need stronger efforts to strengthen SE in asthma care, with the goal of increasing nurses’ performance of AMBs. Future research should continue to build work models that demonstrate positive environments for nurses and students, and activities that promote SE in asthma care. School nurses can actualize their full potential in asthma management when they gain skills that increase their SE in asthma care and improve performance of AMBs