Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Elise Schaller


Elise Schaller, DNP, MHA, APRN, CPNP-PC

Roxanne Reid, DNP, MSNEd, RN

Tifuh Amba, PhD, DNP, ACNP-BC


Problem: Asthma is the leading chronic disease of children and the leading cause of childhood emergency department (ED) visits, hospitalizations, and missed school days. Asthma action plans (AAPs), including photographs or pictures of asthma medications, symptoms, triggers, and devices, have improved parents’ understanding of their child’s asthma and have increased their comfort level in caring for their child.

Methods: An interventional pre-post study with a mixed-method research design, at a large, urban, primary care pediatric clinic with two locations, evaluated the effectiveness of a pictorial AAP on a child’s asthma control. A pictorial AAP was provided, and a childhood asthma control test (C-ACT) tool was completed when a child was enrolled in the study from January-February 2023. Two months later, another C-ACT and the Pictorial AAP Perceptions Questionnaire were completed. During March-May 2022 and March-May 2023, retrospective and prospective chart reviews were completed to examine how many asthma-related ED visits occurred.

Results: Eighteen participants completed the study. A paired sample t-test determined the significance between the C-ACT scores pre-post intervention (p=0.002), and the scores improved by a mean of 5 points. There were eight ED visits before the pictorial AAP was given and two occurred after. Although the reduction in ED visits was not statistically significant, there was a clinically significant reduction in ED visits. Based on the responses to the Pictorial AAP Perceptions Questionnaire, most parents endorsed the pictorial AAP.

Conclusion: The pictorial AAP intervention may be a favorable standard to decrease asthma morbidity and mortality.