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Principles of Nursing Management of Patients or Clients with Chronic Obstructive Pulmonary Disease

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Principles of nursing management of patients/clients with chronic obstructive pulmonary disease.

 

Contents

Introduction. 3

Management of COPD.. 3

Evaluation and nursing interventions. 4

Conclusion. 6

References. 7

 

 

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a liberal lung disease that includes emphysema, chronic bronchitis, and asthma. The condition can be described as an increase in breathlessness. Emphysema is the damage in the walls of alveoli, which results in the disappearance of small sacs with a low oxygen-absorbing capacity. Chronic bronchitis is defined as the damage caused to bronchial tubes, which results in coughing and breathlessness. Refractory asthma is different from asthma. It reverses the medicines of asthma. Significant symptoms of COPD include regular coughing with mucus, breathlessness, tightness in chest and wheezing. Smoking can be the primary cause of COPD, and in rare cases, the individuals who have the deficiency of a protein known as alpha one antitrypsin (AAT) can develop COPD. COPD has no cure, but treatment can help in easiness in symptoms and improving the quality of life. If a person has asthma, he/she is more likely to develop COPD. It is estimated that approx. Sixty-five million people have COPD worldwide. The literature discusses the disease pathophysiology, interventions that are taken for the management of the disease, and the role of a nurse in managing a patient having COPD. The aim of the study is to estimate the process of COPD self-management programs and acceptability in primary health care.

COPD comes in the third position, causing death worldwide. There are no medical therapies proved for this disease except supplementary oxygen and smoking termination, which effectively reduces the death rates (Couper et al., 2013). Community nurses can play the role of a team member in caring for patients that are suffering from chronic diseases like COPD. They can develop stronger and efficient care teams. Emphasizing patient care in healthcare systems and nursing implementation involves health promotion, acute and ambulatory care. The patient suffering from chronic disease is physically inactive and also face some mental stress and depression. Therefore it is essential that healthcare professionals understand the condition of the patients from the physical, psychological, and social perspectives for providing effective management. Nursing management helps patients to improve their life quality (Barnett, 2013). Evidence from various clinical trials suggest that the teaching programs are more effective than the patient education of information, self-management can also reduce the cost of chronic diseases most probably for asthma patient, and this program may improve the consequences of the chronic diseases. These programs separate the clinical care of patients from health care professionals but remain in their collaborations, including their attributes such as education levels, social support, and level of confidence to perform a self-management program.

Management of COPD

As the frequency of COPD is increasing, disease management still faces challenges. Despite effective medical treatments, patient devotion is weak. For patient care, nurse practitioners play a significant role in managing COPD. Management of COPD involves both pharmacological and non-pharmacological interventions. As COPD is chronic and requires long term treatment, pharmacological management is complex. Chronic disease management needs a cooperative team with nurse practitioners. For non-pharmacological interventions, one of the most important initial steps for managing COPD is to reduce the risk factors such as smoking, dust, and gases (Spencer and Hanania, 2013). Smoking is the leading cause of COPD; therefore, it can be the intervention for reducing the rate of disease and death cases. For this context, patient education is a very important component of smoking cessation and knowledge about some aspects of COPD.

Some pharmacological therapies are useful in managing the symptoms while some reduce the exacerbations. There is various kind of drugs according to the patient's conditions such as bronchodilators which are needed at all the stages of the diseases. The goal of managing COPD is to recover the patient's activity status and lifestyle by improving the symptoms.

Handling patient worries about the safety and tolerability issue is an important responsibility of nurse practitioners. Nurse practitioners take an active approach to report safety and tolerability issues with patients. A nurse should assess the best method, such as continuing the treatment or discontinuing to avoid the side effects for a patient's well-being. Nurse-led discussion and disease management are essential, which enables a nurse to provide and extend the care delivered by the professionals. Nurses have a positive contribution to delivering hospital-at-home care. Under this patient is cared for by a respiratory nurse with the support of the multidisciplinary team.

Evaluation and nursing interventions

Many studies have shown that nurses are involved in providing respiratory care for the majority of respiratory disease management. Nurses and doctors have produced similar health outcomes. The past studies also show that the care provided by the nurses in the case of acute and chronic disease is safe as given by the doctors. While the patients are advised about self-management and self-medication. The nurse-led care program includes pulmonary rehabilitation, and self-management education can be helpful for a COPD action plan (Fletcher and Dahl, 2013). With the increase in the social and financial burden of COPD, nurses have expanded their practices. Coordination of care among health care professionals is very important for exacerbation, where high morbidity and utilization are there. The interventions of nursing for COPD patients had four elements that are self-management, education, enhance communication, and home monitoring by the nurses (Williams, Wilcox, ZuWallack and Nici, 2016). Respiratory muscle training (RMT) is a drug-free therapy that generates respiratory muscle hypertrophy and improved muscle functioning and loading. The program consists of a warm-up section, upper and lower limb strengthening exercises, cardiorespiratory fitness exercises, and warm down. The training given to the patients is supervised for one or two visits per week. The study helped in improving the COPD self-management programs (Bausek, Havenga, and Aldarondo, 2019). Among all these a patient needs education, as it is much necessary for developing knowledge regarding their health condition and all of the possible management. Healthcare professionals must be trained to make sure the proper skills to assist the patient's behavioral change. These interventions of self-management practices add to medical involvements to older patients. Community nurses can play the role of a team member in caring for patients that are suffering from chronic diseases like COPD. Nurses can develop stronger and efficient care teams. The patients suffering from COPD or other respiratory problems are taken care of by the respiratory nurses that are involved in the development, clinical application, and monitoring of the therapeutic and diagnostic procedures. They play a fundamental role in taking care, providing education, and self-management programs of patients. Coordination of care by the care providers can improve the disease's conclusions. The concept of motivation is very important in self-management programs. The right motivation for COPD patients can help them in leading a healthy lifestyle.

Accessing service is important on the basis of symptoms, which may be severe or mild. Here the interventions are discussed briefly:

Motivation of self-management

Self-management is the central worldwide concept for modern healthcare. Self-management is the ability of an individual to control and organize the action for certain outcomes. Self-management is rooted in the concept of self-care. Day to day activities of the people enhance health and prevent disease. Therefore self-management indicates to minimize the effect of chronic illness and its treatment. The concept of self-management can be outlined with self-care (Jonsdottir, 2013). People suffering from chronic diseases experience extensive changes in their lifestyle. The COPD among the community is enlarging day by day. Dyspnea, breathing difficulty is a symptom in patients with COPD with the problem of fatigue which limits the person from doing daily physical activity which can lead to a problem for a family and they become dependent on their family over time. Therefore the role of the healthcare, family, and caregivers becomes more critical for the management of COPD patients. Healthcare systems should be supportive of the patients for acquiring a good quality of life. The involvement of the family can be a major amount of management of COPD and can improve a patient's care plan (Nyberg, Tistad, and Wadell, 2019). Self-management programs engage the people in activities, for preventing adverse health outcomes and making appropriate decisions. From the perspective of the health care system, the main aim for self-management is to enable the patients to recognize their health conditions and proper time to take the right action against the disease that can be helpful in preventing the widening of the disease. The patient should be monitored timely for an easy distinguishing of the symptoms of the patients. The following components that are employed with self-management programs are advising and supporting smoking cessation, treatment of exacerbation, increase in physical activities and exercises, management of Dyspnea and advice for a healthy diet.

Pulmonary rehabilitation

Physical inactivity is a major feature of COPD patients. The patients of COPD suffer from the problem of skeletal muscle decline, premature mortality, and inactivity. Exercise programs can help in improving the patient's situation and Pulmonary rehabilitation (PR) program includes training by professional trainers, evaluation and counseling, nutrition, smoking termination to the patients of COPD which are coordinated by nursing or pulmonary department and can prove to be helpful and beneficial, as it improves exercise tolerance, improvement in depressive and anxiety symptoms which in turn decreases hospitalizations and increase in recovery time and survival rates become high. Although PR does not have any effect on respiratory function and physiology. PR benefits the positive effects of appearances, maladaptive behavior with chronic respiratory disease.

Care coordination

It can be defined as the organization of patient care for delivering health care services. It has three major aspects, such as continuing clinical management, information, and relational continuity. The intervention is supported by an electronic health record, which usually allows the communication between a patient and healthcare professionals.

Patient-centered medical home

It includes major five principles such as complete care, holistic care, care coordination, and accessibility of care. The patients should be given knowledge about disease severity, complexity, and psychosocial situations. A health care organization is responsible for providing training and resources for benefitting the patients.

Conclusion

The prevalence of COPD is in an increase with financially and increased social burden. Nurse practitioners play a major role in the management of the disease by educating and individualizing the treatments of the patients. They can also help the patients to address the concerns by providing them the relevant information about the disease. Nurses have always shown a positive influence in delivering homely care. Even though more research is needed to develop the effectiveness of nurse-led interventions. Nurses are needed to reinforce their character to deliver more strategies to improve the quality of life of the patients suffering from COPD while self-management remains to be featured for addressing the health issues of people with COPD worldwide. Living with COPD may be the cause of fear, anxiety, depression, and stress level, so a patient needs proper professional counseling and family support. Further research is needed to understand how healthcare professionals achieve a change in organizations.  For future prospective studies are necessary to understand the complicated mechanisms towards change in self-management. COPD self-management is a significant precursor to health conditions for the patients.

References

  • Barnett, M. (2013). Nursing management of chronic obstructive pulmonary disease. British Journal of Nursing, 17(21). Doi: https://doi.org/10.12968/bjon.2008.17.21.31730.
  • Bausek, N., Havenga, L. & Aldarondo, S. (2019). Respiratory Muscle Training Improves Speech and Pulmonary Function in COPD Patients in a Home Health Setting - a Pilot Study. BioRxiv doi: https://doi.org/10.1101/523746.
  • Couper, D., Lisa, M., LaVange, Han, M., Bleecker, R., Hoffman, E.A., Kanner, R. & Kleerup, E. (2014). Design of the Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS). Thorax 69:491–494.
  • Fletcher, M.J. & Dahl, B.H. (2013). Expanding nursing practice in COPD: key to providing high-quality, effective, and safe patient care?Prim Care Respir J; 22, 230-233.
  • Jonsdottir, H. (2013). Self‐management programmes for people living with chronic obstructive pulmonary disease: a call for a reconceptualization. Journal of Clinical Nursing, 22(5-6). Doi:https://doi.org/10.1111/jocn.12100.
  • Nyberg, A., Tistad, M. & Wadell, K. (2019). Can the COPD web be used to promote self management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12-month follow-up. Scandinavian Journal of Primary Health Care, 37(1), 69-82.
  • Spencer, P. & Hanania, N.A. (2013). Optimizing safety of COPD treatments: role of the nurse practitioner. J Multidiscip Healthc. 6: 53–63.
  • Williams, L., Wilcox, D., ZuWallack, R. & Nici, L. (2016). Integrated Care: What does this mean for the COPD patient? Chron Obstruct Pulmon Dis 1(15). DOI: 10.21767/2572-5548.100018.

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