Running head: EPINEPHRINE AUTO-INJECTOR TEACHING 1 ...

Running head: EPINEPHRINE AUTO-INJECTOR TEACHING

Epinephrine Auto-Injector Teaching at Banta Elementary

Melissa L. and Jennifer L. Rouse

California State University, Stanislaus

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Epinephrine Auto-Injector Teaching at Banta Elementary

In community health nursing, one of the main goals is to teach about healthy behaviors

and lifestyles and to prevent serious illness or life-threatening emergency situations. The Center

for Disease Control and Prevention (CDC) explains community health as working at the

community level to promote healthy living and preventing chronic disease which will bring great

health benefits to those in need (CDC, 2014). One serious and life-threatening situation that can

occur anywhere in the community is anaphylaxis. The Mayo Clinic (2015) defines anaphylaxis

as a severe and potentially life-threatening allergic reaction, which can occur within seconds or

minutes of encountering an allergic trigger (Mayo Clinic, 2015). Anaphylactic shock cannot

always be prevented because many people are not aware of what they are allergic to, but if

treatment is addressed quickly and promptly, lives can be saved. In a study done by Morris,

Baker, Belot and Edwards (2011), it was found that 4%-8% of children have food allergies and

of those children 40%-50% are at risk for having an anaphylactic reaction. The risk for exposure

to a food allergen is higher in school because children are exposed to many different foods in the

classroom. Out of the children who have food allergies, 84% of children have a reaction at

school. Preventing fatalities has been linked to quick recognition of symptoms and intervention

with epinephrine (Morris, Baker, Belot & Edwards, 2011). A great stride in community health

nursing was the implementation of a new bill, SB 1266. This bill, known as the Epinephrine

Auto-Injectors Bill of 2014, is new legislation making it mandatory that school districts, COE¡¯s

and charter schools have epinephrine auto-injectors (EAI) available for use in the event of

anaphylaxis (Pupil Health: Epinephrine Auto-Injectors Bill of 2014). The purpose of teaching the

staff at school sites is to prevent the serious side effects and harm of going into anaphylactic

shock and knowing how to administer epinephrine safely and effectively. In research done by

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Kr?nke, Schuster, Wiednig and Reiter (2012), the efficacy of the EAIs greatly depends upon

their proper use; therefore, correct training is essential for using epinephrine in the event of

anaphylaxis (Kr?nke, Schuster, Wiednig & Reiter, 2014). This paper will address the teaching of

Give Every Child a Chance (GECAC) after-school staff at Banta Elementary School in Tracy,

CA.

Nursing Theory

Community health relies heavily on teaching to promote healthy behaviors. One of the

nursing theory models used in community health is the Health Belief Model. According to

Montanaro and Bryan (2013), this model recognizes five categories that help determine a

person¡¯s health-related behaviors. The first, perceived susceptibility is a person¡¯s perception that

the health issue or problem is relevant to them or if it is even regarded as accurate. The second,

perceived seriousness follows the first in that if a person believes they are susceptible, action will

not occur unless they believe that the issue is serious enough to have major consequences. The

third category is perceived benefits, which is the belief that actions or behavior will either help to

cure or treat the problem. The fourth category, perceived barriers are the issues that affect a

person¡¯s ability to access cure or treatment based on affordability, resources and education on the

matter. The fifth is self-efficacy, which is a person¡¯s perception of his or her own ability of to

take action (Montanaro & Bryan, 2013). This model can be applied to the teaching of

anaphylaxis and EAIs. By teaching school staff the susceptibility to and cause of anaphylaxis,

they will learn that the condition is serious and can have life-threatening consequences. They

will then perceive that the benefits of prevention and early treatment using the EAI can save lives

and prevent complications. In this example, the perceived barriers may be if the school has not

been supplied with EAIs or if there are not people or resources to train the staff. Self-efficacy

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would be based upon the staff¡¯s personal beliefs that if someone went into anaphylactic shock,

they would know how to identify the situation and properly act by administering epinephrine.

Objectives

The goal for the teaching session with the EAIs is to train the after school staff at Banta

Elementary on being able to identify anaphylaxis and know how to act in the event that someone

needs epinephrine. By the end of the teaching, the trainers hope to meet the following objectives:

describe the elements of SB 1266 and training requirements, define anaphylaxis and recognize

the sign and symptoms, describe acquisition, storage and maintenance of epinephrine, identify

emergency follow-up and documentation procedures and demonstrate the use of an epinephrine

auto-injector.

Hunter¡¯s Eight Essential Elements for Effective Instructional Delivery

The presentation of the EAI information and assessment of the staff members¡¯ learning

were performed using the steps of Hunter¡¯s Eight Essential Elements for Effective Instructional

Delivery. Hunter¡¯s eight essentials include an anticipatory set, purpose and objectives, input,

modeling, guided practice, checking understanding, independent practice, and closure (Herr,

2007). Using these steps helps to ensure that instruction is comprehensive and effective (Herr,

2007). In addition to using these eight essentials, effective teaching methods for each of the three

major learning styles were incorporated in the presentation.

Anticipatory Set

The anticipatory set for this educational presentation was a set of questions directed at the

learners. These questions were created and utilized to create interest, thought, and dialogue in the

learners. The questions included, ¡°Have you ever had to call 9-1-1?¡±, ¡°Do you know what this

(EAI) is?¡±, ¡°Do you know any students with serious allergies?¡±, and ¡°Who knows what

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anaphylaxis is?¡±. Most learners were eager to answer the questions. For all learners except one,

this anticipatory set seemed to create adequate interest to move forward to instruction.

Purpose and Objectives

Once the interest of the learners was gained, the instructors explained the reasoning

behind this new instruction. As discussed previously, the purpose of this lesson was to train the

school staff on being able to identify anaphylaxis and know how to act in the event that someone

needs epinephrine. The objectives were more specific, as discussed in the objectives section.

Both the purpose and objectives were made known to the learners through the PowerPoint

presentation, the printed PowerPoint slides (given to each learner), and orally, as the instructors

spoke of them. All learners expressed basic understanding of the reasoning for this instruction.

Input

The initial input of related vocabulary, concepts, and skills took place using a PowerPoint

presentation on a computer screen, printed PowerPoint slides, and spoken word. These methods

addressed both auditory and visual learning styles, which are two of the three major learning

styles (University of Massachusetts Dartmouth [UMass], 2015). Auditory learners learn best

through listening, while visual learners learn best using visual observation (UMass, 2015). The

third major learning style is tactile learning, which is primarily learning by physical experience,

or ¡°doing¡± (UMass, 2015). Tactile learners were more effectively addressed during later steps.

During the input step, extra emphasis was placed on certain important concepts, through

repetition and direct explanation of importance.

Modeling and Guided Practice

The next step was modeling, in which the instructors gave a visual demonstration of how

an EAI is used, while explaining each action. This step was promptly followed by guided

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