Nursing Care in Patients with Brittle Asthma - Essay Example

?Nursing Care in Patients with Brittle Asthma Death is a common phenomenon in health care facilities especially those which caters to the needs of elderly and chronically ill patients. Yet the familiarity of this concept still brings chaos to psychosocial and emotional behaviours of both the carer and the patient. One of the major causes of mortality in UK is asthma as Anderson, et al. (2007, p.85) stated in their review that the current trend in prevalence of diagnosed chronic asthma continues to increase since 1950s. This leaves the hospitals and care homes with the dilemma of facing the multidisciplinary issues adjunct with chronic asthma and other debilitating disorders. These circumstances influenced the creation of this paper where the author will discuss chronic asthma, emerging issues relative to the disease, and nursing approach to the identified issues to facilitate nursing care. Asthma attacks take the life of over 1,100 patients every year (Anderson 2007) and 0.05% of this population comprises of patients who suffered from brittle asthma (Ayres 1998). Brittle asthma is a phenotype classification of asthma coined by Turner-Warwick in 1977 as an asthmatic condition with maintained wide variation in peak expiratory flow (PEF) despite high doses of inhaled steroids. After Turner-Warwick’s revelation sprung several more definition from authors who aims to give the condition a more precise identity. Garden and Ayres (1993) claim that a more concise manner to define it would be “patients with a defined and persistent marked diurnal variation in PEF despite multiple drug treatment.” Nevertheless, this implies a chronic illness with no effective treatment available leaving the patient filled with pain and suffering from dyspnoea. Ayres (1998, p.315) classified brittle asthma into two. The first one is Type 1 brittle asthma, which is characterised by a sustained wide PEF variability over a period of at least 150 days regardless of extensive medical treatment. The other one is Type 2 brittle asthma considered as abrupt acute attacks taking place in less than three hours. This type may occur even on a seemingly normal airway function or a well-controlled asthma. Between the two, Type 1 patients are more likely to be on emergency and admitted on hospitals due to its severe acute attacks and its need for a more intensive treatment. This group of patients with brittle asthma requires greater amounts of medications compared to the other forms of asthma. Most needs prolonged oxygen therapy and higher doses for steroids and bronchodilators. Biomedical management mostly involve steroids, subcutaneous ?2 antagonist, long acting inhaled ?2 antagonist, and adrenaline, which are all costly if given in a longer period and higher doses. On the course of therapy, the patients often suffer from the effects of prolonged drug exposure such as osteoporosis, weight gain, and oesophageal reflux to name a few (Ayres 316). Physical morbidity is tantamount to all chronic illness and its psychosocial counterpart is always present too. Garden and Ayres (1993, p.503) discussed the psychosocial effects of brittle asthma to a person. They suggested that prolonged chronic illness develop traits such as anxiety, nervousness, sensitivity, denial, lower self-esteem and obsession. These trait alterations acclaimed to be due to extremely difficult management. Many of them have run out of therapeutic options and patience and eventually stop seeking medical consult from their physicians. Poor compliance and worsening condition follows from these actions of hopelessness. Studies found out that these patients lacks self confidence in managing attacks, believes their doctors less, and has an increased feeling of disgrace. Another testified that patients with highest morbidity from asthma often time hesitate in seeking help from clinicians during acute attacks while others do not strictly comply on usage of bronchodilators or still continue to do prohibited habits such as smoking or exposure to allergens (Smith, et al. 2005). “Near miss death experience” from severe acute attacks also increases the psychosocial instability and reduces their perception on the quality of life (Garden & Ayres 1993). Some authors claim that personal behaviour and certain environmental factors also affect the prognosis and health condition of a patient with brittle asthma. A common factor that triggers attacks is the exposure to allergens such as peanut, heat or dust. There were reported cases that extreme feeling, such as bereavement, can trigger attack and can lead to hospitalization (Ayres 1998). Though psychological behaviour does not directly affect asthma; compliance to treatment and perception to the illness are fairly influenced (Brinke, 2001). This was reflected by poor treatment compliance, more frequent hospitalization, and poorer quality of life for those with psychological dysfunction compared to those with none. Like in other chronic illness such as cancer, pain is a symptom experienced both physically, psychologically and spiritually (Sugden 2001). This multi-aspect experience of pain and distress called “total pain” is one of the greatest challenges faced by health care professionals in rendering care for this kind of group (Clark 2000). Patients with chronic lung diseases experience significantly impaired quality of life and are deprive to receive holistic care relevant to their special needs (Gore 2000). Researchers found out that the main reason for inadequate health care is the traditional medical philosophy focused on treatment of illnesses to be cure and to prolong life. This philosophy deviate the concentration from providing quality life, allowing the patient to live at optimum level, and relief of suffering. This principle dictates that comfort care will be given only after all possible treatments to prolong life are exhausted. On contrary, what the chronically ill patient needs is simultaneous delivery of cure for illness and palliative care for better quality of life (Morrison & Meier 2004). Nursing care plays a major role in tending to the needs of the chronically ill yet up to the 1990s the practice finds it hard to wean from acute care. UK nurses were urged by national policies and global demand for chronic disease management to develop a specialized care model and adapt innovative practices from other countries such as US (Kendal 2010) thus creating an enhanced nursing role and developing efficient health care models since early 2000s. Palliative nursing has played a part since the health care society recognized its need for the care of chronically ill. It must be rendered to patients simultaneously with medical treatments especially for those with brittle asthma who require continuous compliance to medicines. This type of intervention is base on an interdisciplinary approach where several health care members give close attention to all human aspects in order to render holistic service. Involvement of patients and their families are much needed to acquire better quality life (Morrison & Meier 2004). Caring for the chronically ill requires specialized skills not only in delivering biomedical care but also in communicating with the patient and their families. The nurses working in hospices deal not only with the pain and dyspnoea but also with total pain and psychological implications of near death situations (Morrison & Meier 2004). One of the greatest challenge for nurses is coordinating with other health care professionals such as doctors, therapists, psychologists, dietician, pharmacist, chaplain, etc. which are all involved to attain holistic care for the patient. In healthcare settings such as hospices and care homes where doctor’s presence is not regular, nurses take the role doctors even just partially. Doctor-nurse substitution has been common in these settings because nurses meet previously unmet needs and that demand for care was generated following thorough assessment (Kendal 2010). This required the nurses to utilize several health models such as person-centred care and self-management model which promote better health care delivery. Person-centred care focuses on the needs and subjective desires of the patient (Berry 2003) while the self-management model encourages independence in treatment compliance and management of asthma (Horne 2002). Utilizing this model, asthma nurses renders health education and continues monitoring on treatment compliance. Health education and counselling is essential in chronic illness management (Kendal 2010) as this promotes two-way communication between the patient and the nurse. Moreover, this increases the patient’s awareness on the proper management of his condition thereby conveying a boost in compliance. Kendal and his colleagues (2010) conducted a literature mapping of the barriers and facilitators encountered by nurses in caring for the chronically ill. They stated that major barriers involve: lack of resources, insufficient funding, staff shortage, feeling of isolation, feeling of inadequacy of skill due to lack of training for specialized care. On the other hand, the facilitators of effective health care include: effective communication between nurses and doctors, autonomy of nurses are supported by doctors, effective multidisciplinary collaboration, nurses were seen as approachable and accessible by the patients. Through time, nurses specializing in the care for chronically ill asthmatics focus on converting these barriers to become facilitators for better health care service. For some patient at the end of life state, they perceive the nurses as “life raft” who gave them positive inputs to be able to cope with the complex needs of chronic asthma and the depressing notion of impending death (Kendal 2010). Disheartening as it may sound yet nurses rendering care for the dying faces a morally challenging task where they must remain positive and strong for the patient and their family. In summary of all that transpired in this paper, nursing care for brittle asthma requires an interdisciplinary approach. Nursing care must address not only the physical needs or biomedical requirements but also the needs of other aspect – psychological, social, and spiritual – to achieve a holistic approach to health care. It was understood that brittle asthma is not just an ordinary illness but it required ample attention, medication, and financial support. Patients suffering from brittle asthma experiences total pain brought about by dyspnoea and underlying symptoms of the disease. In addition, some also sulk in depression due to ineffectiveness of available medical treatment. These issues post a huge challenge on the part of nurses in rendering care as it has been said that biomedical intervention must be done simultaneously with palliative care. Specialization in nursing combined with persistent education and training contribute greatly in caring for the chronically ill. As compared to other chronically ill patients, caring for those with brittle asthma extends from giving medicine to health education and even up to counselling during their end of life stage. Asthma nurses may painstakingly deliver these service and at the same time this action greatly alleviated the suffering and total pain of the chronically ill. Bibliography Anderson, R. et al. (2007) 50 years of asthma: UK trends from 1955 to 2004. Thorax, 62 (1), pp. 85-90. Ayres, J. et al. (1998) Brittle Asthma. Thorax, 53, pp. 315-321. Berry, L. et al. (2003) Innovations in Access to Care: A Patient-Centred Approach. Annals of Internal Medicine, 139 (7), pp. 568-574. Brinke, A. (2001) Psychopathology in Patients with Severe Asthma Is Associated with Increased Health Care Utilization. American Journal of Respiratory and Critical Care Medicine, 163 (5) April, pp.1093-1096. Clark, D. (2000) Total pain: the work of Cicely Saunders and the hospice movement. American Pain Society Bulletin, 10 (4). pp. 13-15. Garden, G., & Ayres, J. (1993) Psychiatric and social aspects of brittle asthma. Thorax, 4, pp. 501-505. Gore, J. et al. (2000) How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax, 55 (12), pp.1000-1006. Horne, R. & Weinman, J. (2002) Self-regulation and Self-management in Asthma: Exploring the Role of Illness Perceptions and Treatment Beliefs in Explaining Non- adherence to Preventer Medication. Psychology & Health, 17 (1), pp. 17-32. Kendal, S. et al. (2010) The nursing contribution to chronic disease management: a whole systems approach. Hatfield, England, University of Hertfordshire. Morrison, S. & Meier, D. (2004) Palliative Care. New England Journal of Medicine, 350, pp. 2582-2590. Smith, J. et al. (2005) Clinician-Assessed Poor Compliance Identifies Adults with Severe Asthma Who Are at Risk of Adverse Outcomes. Journal of Asthma, 42 (6), pp.437-445. Sugden, C. (2001) Total Pain: A Multidisciplinary Approach. Scottish Journal of Healthcare Chaplaincy, 4 (2), pp. 2-7. Read More