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Capella University

NURS-FPX6026 Biopsychosocial Concepts for Advanced Nursing Practice 2

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Analysis of Position Papers for Vulnerable Populations

Pediatric asthma is one of the common chronic conditions that affects many children in the United States and is responsible for many visits to the emergency department and for children missing school. Many children who live in urban areas in racially and ethnically marginalized, low-income communities have the worst asthma outcomes resulting from inadequate environmental conditions, use of medications, and access to preventive health care, transportation, and social services, including insurance (Grant & Wood, 2022). There are many barriers to the control of asthma, such as limited language and low health literacy. The control of asthma can be improved by the use of asthma controller medications, asthma action plans, education about avoidance of asthma triggers, and regularly scheduled follow-up appointments. This paper reviews available position statements on asthma care equity and conditions and presents the position of the interdisciplinary team and the available arguments in order to identify the barriers and possible solutions to improve the outcomes of this vulnerable population.

Position on Health Outcomes

The interdisciplinary team believes that equitable opportunities to participate in comprehensive asthma management programs will reduce use of the emergency department, reduce hospitalization and school absences, and reduce chronic respiratory morbidity in the racial and ethnic minority children of lower socioeconomic status (Tyris et al., 2021). This model promotes a shift from a reliance on remedial or curative health care to proactive or preventive health care, involving a combination of eco-health interventions, culturally appropriate design and delivery of health interventions, and health policy advocacy. Asthma control will be better, acute attacks will be less, adherence to asthma medications will be better, and the quality of life of the children and their families will be improved. This model and approach to asthma management is an expression of health equity and social justice in the systemic and deliberate disruption of structural racism, chronic and endemic in the built environment, health insurance, and health care systems, and the deliberate and systemic disruption of health outcome inequities that are chronic and endemic.

Current State

Children from poor, urban, racially and ethnically diverse communities today experience excessive visits to the emergency department, greater absenteeism from school, and poor management of their asthma symptoms. The limited availability of services offered by pulmonologists, as well as low-cost asthma controller medications, environmental interventions, and service clean-up of the home, contributes to the unstable condition. Most care coordination across schools, primary care, emergency services, and public health is fragmented, which results in inconsistent management plans and follow-up. Undocumented individuals bear out-of-pocket expenses for prescription and non-prescription asthma control medications, which is a barrier to effective management (Poureslami et al., 2022). Additionally, there are substantial barriers to management because the asthma care and control literacy of caregivers is poor. This is a result of inadequate and inconsistent health education and communication provided to asthma caregivers by health care service providers.

Outcomes

Current inequities in asthma care negatively impact patients and the overall healthcare system. Patients suffer from lung damage and poor performance in school. Hospitalization contributes to increased system costs. Caregivers bear the burden of increased supplemental care, and patients are less likely to receive reimbursement for care. Environmental inequities, including insufficient healthcare and pollution in urban areas, contribute to the worsening inequitable asthma situation. Asma care inequities impact chronic respiratory health. These issues are further compounded by unstable housing, urban pollution, and inadequate preventive health care (Smith et al., 2022).

Improvement of the Care and Outcome

Asthma care can be improved for this population by providing easy (preferably free) access to asthma controller medication. School-based and community asthma clinics with mobile units should be established. Standardized asthma action plans should be developed cooperatively by community clinics and schools. Environmental interventions should be supplemented with home visits to check for poor ventilation, mold, and pests. Unsafe housing should be mitigated by referring to the housing authority and the public health agency. Community health workers are key within this model of care to deliver health care and education in culturally and linguistically appropriate ways (Jayaram et al., 2025). Complete shifts in the system of asthma care will be achieved through policy advocacy for improved environmental conditions and safe transportation. Lessen the burden of inequities in the asthma care system. Follow-up care and other specialty services will be offered through telehealth.

Assumptions

This plan assumes that community members will engage in culturally tailored asthma-related educational activities. This plan also assumes that community clinics will be adequately staffed and will develop the funding and long-term partnerships needed to implement these initiatives. It is assumed that some progress will continue to be made in the area of policy to allow reimbursement for preventive and environmental services. Lastly, it is assumed that school partnerships and the use of telehealth will enhance asthma care and management.

Role of the Interprofessional Team

This plan emphasizes an interprofessional approach as the integration of all services of asthma management is essential to achieve the best outcome. The nurse is the primary educator concerning the proper use of inhalers, the monitoring of symptoms, and asthma management, as well as the coordinator of asthma management. The primary care provider adjusts the asthma management plan by prescribing medication to control asthma and monitoring asthma control. The pulmonologist is the specialist of choice for asthma, and the pharmacist is the specialist of choice for asthma medication and support of the patient’s medication adherence. The social worker is the specialist of choice for the social determinants of health, while the community health worker is the educator of choice for home and culturally appropriate asthma education. School nurses manage the monitoring and management of asthma symptoms as well as the provision of first aid.

Challenges in Interprofessional Collaboration

Interprofessional communication within the school–healthcare worker network, along with privacy law data restrictions, barriers to communication and data flow, and pressing time constraints, all caused by staff workload, are some of the barriers to the collaboration of services and interventions. The barriers of limited funding and insufficient community resources can restrict the services and interventions. There may be a misunderstanding of the culture and a lack of role clarity, which may impede effective teamwork and the coordination of care (Persson et al., 2022). Barriers to transportation may be experienced by families, which can further restrict compliance and the continuity of care; thus, new, innovative, and flexible methods of care are required.

Supporting Evidence and Positions for Improving Care

Numerous organizations are working to improve equity-based asthma care and reduce the gap experienced by vulnerable populations of children. The American Academy of Pediatrics recommends the development and implementation of school-based asthma care management programs to reduce the use of emergency services and improve access to asthma control medications, while the CDC’s Asthma Control Program advocates the reduction of environmental asthma triggers through community-based efforts and surveillance to improve the health of the population (Staten et al., 2025). The American Lung Association endorses policy initiatives that improve the scope of asthma care, including low-cost asthma medications and the improvement of indoor air quality, while the NIH supports the long-term implementation of asthma care (Rochester et al., 2023).

School-based programs for asthma management have been able to reduce hospital visits as well as improve adherence to asthma medications. Environmental remediation measures decrease exposure to asthma-causing agents and improve asthma symptoms. Community health workers assist caregivers to become more active participants in the control of asthma. Models of integrated care that combine elements of health care, education, and public health improve the management of asthma and reduce the incidence of asthma attacks (Ugwu et al., 2025). The approved policies also allow the extension of Medicaid, improvement of housing conditions, and funding of preventive services. These are the primary strategies aimed at reducing health inequities and managing asthma in the long term.

Identified Knowledge Gaps and Areas of Uncertainty

Equity-focused asthma interventions are based on substantial evidence, but numerous gaps continue to exist. Longitudinal studies on the sustainability and the cost-benefit assessment of community-based programs and environmental remediation initiatives are almost nonexistent. The ability to expand these initiatives will greatly differ among the different communities based on the differing availability of funding, infrastructure, and community assets. Currently, literature on telehealth services for pediatric asthma management is almost nonexistent, especially for low-income families that do not have access to technology (Kamp et al., 2023). Lack of comprehensive services on a national level and insufficient studies on culturally oriented services create further concerns regarding the long-term implications and the equity of these services.

Conclusion

Urgent action is needed to resolve asthma inequities for low-income and minority group children to lessen the likely future burdens of worsening asthma on them, healthcare, and escalated utilization of healthcare services. School-based asthma programs and environmental and community-based initiatives, especially those employing integrated models of asthma care, have shown positive outcomes. The coordination of care to address social inequities along the continuum of prevention and management of asthma will particularly require multi-disciplinary teams. Health policy advocacy will be needed to serve at-risk children and will be complemented by the necessary research and community-based efforts to improve access to health services, health outcomes, and long-term outcomes, and to promote health justice.