Moving toward Preventive Education - Chronic Obstructive Pulmonary Disease - Research Paper Example

 Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death and the second leading cause of disability in the United States. It entails chronic bronchitis or emphysema or at times both. While twelve million people in the US have been diagnosed as positive with COPD, there are another twelve million who are living in without knowing that they are suffering from the disease (Felner & Schneider, 2008). With such high figures of people living with COPD in one of the most developed countries in the world, and the disease causing such a high mortality rate in a country with one of the most advanced health care system and easy access to health care, there is an increased need for preventative education. COPD does not develop over a very short period of time. It is a progressive disease meaning that it takes time to manifest itself and gets worse over the passage of time. Felner and Schneider (2008) are of the point of view that one reason why COPD is not diagnosed at an early stage is because physicians confuse the symptoms of the disease with other diseases such as asthma. Treatment for COPD and asthma differs although both have some symptoms common. Therefore, if one is being treated for asthma when actually he is suffering from COPD, chances are the patient would show very little improvement. This further augments the importance of preventative measurements in hospitals for COPD. In many health care institutions, supportive measures are emphasized upon than preventative measures for the management of COPD. Consequently COPD does not only exist in the past but also moves into the future. The high prevalence of COPD, as mentioned in the statistics above, necessitate that organizations take concrete steps to address preventative care and patient education for people with COPD. The paper suggests the strategies and measures that can be employed by nurses to facilitate the process of preventative management of COPD and the benefits that can be achieved from it. Moreover the paper explores the theories, concepts and strategies in preventative education and recommends the strategies that would be the most effective in a health care institution. Amongst the strategies that could be employed by nurses to enforce and extend preventive measures, one of the strategies is patient education. This involves a comprehensive approach. There are many rumors and myths about COPD. Patients should be briefed about the disease and their views should be corrected. One of the misconceptions about COPD is that it has no cure. Nurses need to educate the patient about the etiology of the disease and the treatment that can be followed. Although there is no denial of the fact that the damage incurred on the lungs due to smoking or other factors cannot be reversed, the symptoms of the disease can be substantially mitigated with effective and timely treatment. One of the beliefs that people have about COPD is that it is a rare disease and is commonly seen as a smoker’s disease. Patients need to be educated about the prevalence of the disease in not only smokers but also in non-smokers. Moreover, myths such as COPD is a man’s disease or that giving up smoking can reverse the effects of COPD need to be denied and proper education need to be given to the patients. An important preventative measure is to encourage the patients to quit smoking. People believe that if they get COPD there is no reason to quit smoking; this attitude should be discouraged in patients. Giving up smoking does not reverse the damage but continuing smoking would further exacerbate the conditions of the patient. In a research on nurse-conducted smoking cessation in patients with COPD using nicotine sublingual tablets and behavioral support concluded that the long-term use of nicotine replacement therapy for cessation of smoking in patients with COPD proved to be successful (Tønnesen, Mikkelson, Bremman, 2006). Many of the diseases are the result of the lifestyle of the patient. Poor dietary habits and a sedentary lifestyle can make the individual at risk to a variety of diseases. Smoking, obesity, alcoholism and environmental factors can play an important part in the tendency of an individual to develop a disease or in the follow-up of the treatment after the person have been discharged from the hospital. Therefore medical treatment from the nurses should be equipped to manage the education of patients with regard to the reduction of hazards that their habits or the environment pose to their health condition. Active prevention can include motivating people to contribute to their health by applying prevention measures based on their information and data. Taking a start from their change in lifestyle, patients should be administered proper and timely doses of chronic medication as well as good nutrition (Unger, 2004). Day, Paul and Williams (2009) are of the point of view that the management of chronic illness is a collaborative project that involves the combined efforts of the patient, family, nurse and other health care professionals. Collaboration is not confined to the hospital setting; rather it extends in all settings and throughout the course of the disease. The role of a nurse in preventive management of people with COPD is highlighted in the fact that keeping the disease stable over a long period of time requires the monitoring of the symptoms of the disease and attention to medical regimens. The Chronic Care Model is a model that has been accepted internationally and emphasizes upon six key elements that can play an integral role in the care of chronic patients. The Chronic Care Model aims to promote the positive attitudes in health care providers in order to support evidence-based clinical and quality improvement across a wide-variety of health care milieus. The Chronic Care Model includes treatment and management on two levels: community and health systems. Community management includes community resources and policies and self-management support. On the other hand, management in health systems entails the organization of the health system along with delivery system design, decision support and clinical information systems. This will lead to an informed active patient as well as a prepared, proactive practice team. Productive interactions between the two groups will result in improved outcomes (“The Chronic Care Model”, 2010). Nurses are bound professionally to improve the health of the community and to mitigate the incidence and influence of a chronic disease. The Canadian Nurses Association code of ethics states that nurses should be able to identify and work to “address organizational, social, economic and political factors that influence health and well-being within the context of nurses’ role in the delivery of care” (Day, Paul, & Williams, 2009). The three measurements that can contribute greatly to the prevention of COPD, as highlighted by Dr. Padki (2002), are reducing the prevalence of cigarette smoking, improvement in air quality standards and higher uptake on influenza vaccination in people who are at risk. Anzueto (2010) asserts that the two main measures of reduction of COPD exacerbation are active immunizations like for influenza and pneumococcal vaccinations, and chronic maintenance pharmacotherapy. Recent clinical trails have established the role of chronic maintenance therapy in patients suffering from COPD in decreasing the frequency of exacerbations. Bronchodilators form the basis of COPD pharmacotherapy. Nurses should have knowledge of this. Although the use of bronchodilators has not shown a reversal in the damage done by the illness, it serves many other benefits like reduced hospitalization and complications, as well as in improving the quality of life of the patients. Patients who are suffering from mild COPD should be recommended a short-acting inhaled beta2 agonist as well as inhaled anticholinergics in order to reduce the symptoms of the illness (Guidelines and Protocols Advisory Committee, 2009). Also, a development of team of community respiratory specialist nurses to support the management of COPD within primary care can be of great significance. Nurses could be trained on the management of COPD at home. There should be increased emphasis on the prevention of shift towards secondary care as well as identifying patients who can be discharged rapidly from the hospital (Padki, 2002). Nursing interventions for patients with COPD are aimed to reduce the discomfort of the patient and in mitigating the symptoms of the illness. Maintaining a patent airway should be considered top priority by the nurses. Use of a humidifier at night can enable the patient to mobilize secretions in the morning. The nurse should motivate the patients use controlled coughing so that the secretions that have accumulated due to sleeping can be cleared. The patient can be told to sit at the bedside or in a comfortable chair, hold a pillow close to the chest, incline the head downwards, take several deep breaths and cough strongly. An effective tool in preventative measures is the administration of low concentrations of oxygen as ordered. The nurse needs to carry out blood gas analysis to evaluate the patients’ oxygen needs and to rule out the likelihood of carbon dioxide narcosis due to inadequate oxygen. There is general assumption that the more the oxygen the better. However nurses need to inform the patients and their families that excessive oxygen therapy can be detrimental to the health of the patients since it can finish hypoxic respiratory drive and cause confusion and drowsiness in the patients, leading to carbon dioxide narcosis (“COPD”, 2009). Another important measure for nurses to follow is the administration of adequate and balanced nutrition for the patients. The patient might not understand the importance of nutrition. The nurse can contribute to the improvement of diet of the patient and reducing discomfort by administering oxygen by nasal cannula during meals. The nurse should make sure that the patient gets small frequent meals with a high protein content and rich in calories. It is pivotal that the nurse offers full emotional support to the patients and their families in helping them deal with the illness. As the disease worsens with time, the nurse should be able to develop a bond with the patient so that the patient can discuss his or her fears and anxiety with the nurse without any hesitation. Anther nursing intervention that can constitute part of the preventative strategy is emphasizing upon adequate rest and exercise. Nurses should instruct the patients on the resting daily and at sufficient intervals while also exercising and keeping themselves active. The rest periods should be planned according to the activities of the patient such that maximum energy is conserved. Good hydration is also essential to the health of patients with respiratory disease (Long & Phipps, 1995). Moreover, people should be encouraged to seek prompt treatment if they are getting repeated bouts of respiratory infection and have themselves tested for COPD by spirometry and chronic cough evaluation (“COPD”, 2009). In conclusion, COPD is a debilitating illness that requires not only medical attention from the nurses but also emotional support. In institutions, measures such as an increased emphasis on the quality of nutrition as well as on exercise can form the major principles of preventative strategy. Also, encouraging patients on the cessation of smoking is pivotal to the reduction and effective management of COPD. Regulation of the quality of the air and oxygen levels depending on arterial blood gases can also prove to be successful in substantially reducing the manifestations of the disease. These measures can prove to be most effective in any health care institution. In the end, the nurse should be compassionate with the patient throughout the trajectory of the illness and should aim to reduce the discomfort of the patient. Reference List Anzueto, A. (2010). Impact of exacerbations on COPD. European Respiratory Review 19 (116), 113-118. COPD: Nursing Interventions, Nursing Outcomes and Patient Teaching. (2009). Retrieved from http://nurse-thought.blogspot.com/2009/07/copd-nursing-interventions-nursing.html Day, R. A., Paul, P., & Williams, B. (2009). Brunner and Suddarth's Textbook of Canadian Medical-Surgical Nursing, 2nd ed. Lippincott Williams & Wilkins. Felner, K. & Schneider, M. (2008). COPD for Dummies. New Jersey: For Dummies. Guidelines and Protocols Advisory Committee. (2009). Chronic obstructive pulmonary disease (COPD). Retrieved from http://www.bcguidelines.ca/gpac/guideline_copd.html#top Long, B. C., & Phipps, W. J. (1995). Adult nursing: a nursing process approach. Elsevier Health Sciences. Padki, K. (2002). Chronic obstructive pulmonary disease (COPD) in Barking, Dagenham and Havering. Retrieved from http://www.bhha.org.uk/111.pdf The Chronic Care Model. (2010). Retrieved from http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2 Tønnesen, P., Mikkelson, K., & Bremman, L. (2006). Nurse-Conducted Smoking Cessation in Patients With COPD Using Nicotine Sublingual Tablets and Behavioral Support. CHEST, 130(2), 334-342. Unger, F. (2004). Health is wealth: strategic visions for European healthcare at the beginning of the 21st century : report to the European Parliament. Salzburg: Springer. Read More