Living with chronic obstructive pulmonary disease (COPD): Part II. RNs? experience of nursing care for patients with COPD and impaired nutritional status

Primary care patients with mild or stable chronic obstructive pulmonary disease need more support in disease management: a secondary analysis of a cluster randomized controlled trial

OBJECTIVE

Patient education based on the patient's individual needs and circumstances is known to be associated with positive changes in clinical outcomes in chronic obstructive pulmonary disease (COPD). We aimed to assess the levels of patients' subjective needs for information about COPD before and after their general practitioners had taken part in a COPD education.

DESIGN

A secondary analysis of a cluster randomized controlled trial.

SETTING

22 PHCCs in Stockholm, Sweden.

SUBJECTS

Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n = 293).

OUTCOME MEASURES

Scores in the Lung Information Needs Questionnaire (LINQ) at baseline and 18 months, spirometry results, and self-reported, descriptive patient data.

RESULTS

GPs' improved skills in COPD did not affect patients' self-management skills over time. In general, patients' information needs remained great in issues concerning diet, exercise and self-management. However, 43% of the patients reported reduced and 57% increased or unchanged information needs, over time. Reduced information needs were mainly associated with a high level of information needs at baseline (OR = 3.17 [95% CI 1.93-5.23], p < .01) and establishing contact with a physiotherapist (OR = 2.26 [95% CI 1.05-4.86], p = .038). Patients in a mild or stable phase of COPD with no recent exacerbations reported greater needs than those with unstable, deteriorated COPD.

CONCLUSION

Patients' information needs are substantial in most areas of self-management of COPD, and seem to covary with the patient's current clinical status. Care providers should thus continuously be vigilant about offering all patients with COPD support and education.

TRIAL REGISTRATION

Clinicaltrials.gov, 10 August 2014, Identifier NCT02213809.

Targeting malnutrition in patients with COPD in the community

The number of individuals living with chronic obstructive pulmonary disease (COPD) is increasing, but nutritional care can be inconsistent, especially in those with stable COPD. Historically, poor appetite and weight loss have been considered the norm during the progression of COPD into the later stage. However, it is imperative that nutritional assessment, support and management is undertaken from diagnosis, because malnutrition can lead to exacerbations of COPD and increased hospitalisation. Poor nutrition in individuals with COPD has been shown to predict an increase in mortality and with the care of patients taking place principally in the community, the nutritional aspects of care should be assessed, monitored and managed, in accordance with the latest guidance. The lack of a nutritional Quality Outcome Framework indicator for COPD can leave nutrition overlooked, but evidence shows that screening, assessment and planning can have an overall positive impact.

A concept analysis of shame in the field of nursing

AIM

The study aimed to conceptually define "shame" within the field of nursing.

BACKGROUND

Many nurses sometimes experience and struggle with shame in their professional lives. It reduces their sense of self-worth and hampers emotional well-being and efficacy at work.

DESIGN

The conceptual analysis was performed using Walker and Avant's method.

DATA SOURCES

We searched using Academic Search Complete, CINAHL, PsycINFO, MEDLINE, and Psychology and Behavioral Sciences Collection databases for literature published between 1980 and 2020.

REVIEW METHODS

We searched for keywords "shame," "nurse," and "nursing," with the condition that the keywords must be included in the title or abstract.

RESULTS

Shame in the nursing field was defined as a negative emotion, an experience of self-blame and anger, an emotion accompanied by social anxiety, loneliness, and influenced by society and culture. Shame in the nursing field has three antecedents: negative evaluation, the involvement of others, and social and affiliated-group norms. Consequences of shame in nursing include decreased senses of self-esteem and self-efficacy, escape through defense mechanisms, depressive states, and alleviation of distress through reaffirmation of self-promotion and reflection leading to personal growth.

CONCLUSIONS

We clarified the significance of self, others, others' evaluations, and differences in socio-cultural contexts while defining shame.

Mirror of shame: Patients experiences of late-stage COPD. A qualitative study

AIMS AND OBJECTIVES

This study aims to shed light on patients with late-stage COPD and their experiences of shame.

BACKGROUND

Patients with COPD often experience shame for bringing the disease into their lives due to smoking. Knowledge about patients with COPD and their feelings of shame is crucial, but limited, however.

DESIGN

The study has a qualitative and explorative design. We interviewed twelve patients with late-stage COPD. The data were analysed using Kvale and Brinkmann's three interpretative contexts. The COREQ checklist was used.

RESULTS

Three main themes were defined; the body as a mirror of shame; a sense of being unworthy, invisible and powerless; and that sharing the burden is too difficult. The participants experienced that the disease defined their value as human beings and that made them feel vulnerable, ashamed and more socially isolated.

CONCLUSIONS

The participants experienced feelings of shame, guilt and self-blame due to their own perceptions of themselves. They were in doubt about whether they were worthy to receive care and comfort from both health professionals and, their family and friends. The participants seemed to have internalised the moral norms of contemporary society and the understanding that the disease, and especially a 'self-inflicted' disease, is a personal weakness.

RELEVANCE FOR CLINICAL PRACTICE

Findings from this study show that patients struggle with feelings such as shame and misery. The nurses who work bedside are in continuous contact with the patients and have an opportunity to gain knowledge of these feelings in order to meet the patients' needs for comfort and care. They have an obligation to ask patients about their feelings and meet them with empathy and respect. Moreover, it is necessary to have interdisciplinary fora in clinical practice where health professionals reflect, discuss and challenge themselves according to attitudes towards patients with so-called 'self-inflicted' diseases.

COPD patients need more information about self-management: a cross-sectional study in Swedish primary care

Objective: In Sweden, patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), often receive education at specialized nurse-led clinics at primary health care centers (PHCCs). Identifying patients' needs for information about COPD is the key to individualized care. This study aimed to assess self-reported needs for information about COPD in primary care patients with either moderate (GOLD 2) or severe (GOLD 3) COPD and identify patient characteristics and exacerbation patterns associated with the findings.Design: A cross-sectional study.Setting: Twenty-four PHCCs in Stockholm, Sweden.Subjects: Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n = 542).Main outcome measures: The Lung Information Needs Questionnaire (LINQ) was used to assess perceived information needs. Spirometry results and descriptive, self-reported data on patient factors such as exacerbation history, treatment, smoking, weight/height, comorbidities, health care contacts, education and symptoms were collected.Results: Overall, the greatest reported needs were for information about self-management and diet. GOLD 2 patients (68%) expressed greater needs for information than GOLD 3 patients (32%). We found significant associations between high information needs and patient-related factors such as 'No assigned GP' (OR = 4.32 [95% CI 2.65-7.05]) and 'No contact with COPD nurse in the past 12 months' (OR = 1.83 [95% CI 1.19-2.81]).Conclusion: COPD patients felt they knew too little about self-management of their disease. Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. These associations were strongest in patients with moderate COPD.Key points: As patients with COPD often have multimorbidity, identifying patients' needs for information about COPD is essential to providing individualized patient education and care. In this study of 542 patients from 24 Swedish primary care centers, we found that:Patients with COPD, particularly those with moderate airflow limitation (i.e. GOLD 2) felt they needed more information about COPD than currently provided by health care professionals in primary care.Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. GPs' part in COPD patient education should not be overlooked, as individualized COPD care relies on GPs' expertise in managing patients with multimorbidity.

Important, misunderstood, and challenging: a qualitative study of nurses' and allied health professionals' perceptions of implementing self-management for patients with COPD

Background

In light of the growing burden of COPD, there is increasing focus on the role of self-management for this population. Currently, self-management varies widely. Little is known either about nurses’ and allied health professionals’ (AHPs’) understanding and provision of self-management in clinical practice. This study explores nurses’ and AHPs’ understanding and implementation of supported COPD self-management within routine clinical practice.

Materials and methods

Nurses and AHPs participated in face-to-face semistructured interviews to explore their understanding and provision of COPD self-management, as well as their perceptions of the challenges to providing such care. Purposive sampling was used to select participants from a range of professions working within primary, community, and secondary care settings. Three researchers independently analyzed each transcript using a thematic approach.

Results

A total of 14 participants were interviewed. Nurses and AHPs viewed self-management as an important aspect of COPD care, but often misunderstood what it involved, leading to variation in practice. A number of challenges to supporting self-management were identified, which related to lack of time, lack of insight regarding training needs, and assumptions regarding patients’ perceived self-management abilities.

Conclusion

Nurses and AHPs delivering self-management require clear guidance, training in the use of effective self-management skills, and education that challenges their preconceptions regarding patients. The design of health care services also needs to consider the practical barriers to COPD self-management support for the implementation of such interventions to be successful.

Predictors' factors of nutritional status of male chronic obstructive pulmonary disease patients

Chronic obstructive pulmonary disease (COPD) is a systemic disease that leads to weight loss and muscle dysfunction resulting in an increase in mortality. This study aimed to determine the prevalence rate of malnutrition and nutritional status and also factors associated with nutritional status. A total of 149 subjects were involved in the cross-sectional study. The study was conducted at two medical centers in Kuala Lumpur, Malaysia. The results of the study showed that malnutrition was more prevalent (52.4%) in the subjects with severe stages of COPD as compared to mild and moderate COPD stages (26.2%) (P < 0.05). Fat-free mass depletion as assessed using fat-free mass index (FFMI) affected 41.9% of the subjects. Plasma vitamin A, peak expiratory flow (PEF), and handgrip were the predictors for body mass index (BMI) (R(2) = 0.190, P < 0.001). Plasma vitamin A and force expiratory volume in one second (FEV(1)) were the predictors of FFMI (R(2) = 0.082, P = 0.007). BMI was the predictor of respiratory factors, that is, FEV(1)% predicted (R(2) = 0.052, P = 0.011). It can be concluded that there is a need to identify malnourished COPD patients for an appropriate nutrition intervention.

Education in advanced disease

CONTEXT

In advanced disease, the management of symptoms and lifestyle are essential for the maintenance of patients' quality of life. Appropriate education by health professionals can help patients to better manage their disease. Although the provision of education by health professionals for patients with advanced cancer is reasonably well documented, much less is known about how health professionals facilitate education with patients with other advanced progressive diseases.

OBJECTIVES

The aim of this review was to synthesize qualitative research examining health professionals' knowledge of, attitudes toward, and ability to deliver educational interventions for symptom and disease management to patients with advanced progressive diseases other than cancer.

METHODS

The synthesis was conducted using meta-ethnography. Systematic searching of five electronic databases (CINAHL, Medline, PsycInfo, Web of Science Social Science Citation Index, and EMBASE) was performed. Included studies were data extracted and assessed for quality.

RESULTS

Systematic searching of four electronic databases identified 911 records; 17 studies met review inclusion criteria and underwent data extraction and quality appraisal. Three key factors were identified that influenced the delivery of education by health professionals to patients with advanced disease: capacity (to educate and aid decision making), context (of educational delivery), and timing (of education).

CONCLUSION

Health professionals identify and acknowledge a range of factors that influence their ability to deliver education to patients with advanced disease. The types of circumstantial factors identified in this review can influence the successful delivery of educational interventions and need to be considered when such interventions are being developed.

'Feelings of guilt due to self-inflicted disease': a grounded theory of suffering from chronic obstructive pulmonary disease (COPD)

The aim of this grounded theory study was to illuminate the main concern of people suffering from chronic obstructive pulmonary disease (COPD) and how they handle their everyday life. Data were collected through interviews with 23 people with COPD at different stages, from mild to severe. A substantive theory was generated showing that the main concern was feelings of guilt due to self-inflicted disease associated with smoking habits. This core category was related to five managing strategies termed making sense of existence, adjusting to bodily restrictions, surrendering to fate, making excuses for the smoking-related cause and creating compliance with daily medication.

The challenges experienced by Iranian war veterans living with chemical warfare poisoning: a descriptive, exploratory study

This exploratory, descriptive study investigates the experiences of Iranian war veterans living with chronic disease acquired as a result of chemical warfare. Sulphur mustard (SM) is considered one of the most important agents of chemical warfare and was widely used during the Iran-Iraq conflict in 1980-1988. There are approximately 100 000 Iranian SM casualties who suffer from serious long-term progressive health problems involving their respiratory organs, eyes and skin. Seventeen male Iranian war veterans aged between 30 and 59 years and four victims' family members participated in the study. Data was generated during individual in-depth interviews that used open-ended questions. Grounded theory techniques, including the constant comparative method of concurrent data generation and analysis, were employed in the analysis of data. Preliminary results indicate two main thematic categories: social isolation and physical disability. It is argued that a lack of knowledge about the outcomes of SM poisoning, physical restrictions and difficulty in adjusting socially decreases war veterans' functional capacity and levels of independence.

A successful way for performing nutritional nursing assessment in older patients

AIM

The aim of this study was to obtain increased knowledge and understanding about what can be promoting and facilitating for nurses to perform nutritional nursing assessment in older patients.

BACKGROUND

The frequency of older patients at nutritional risk or suffering from undernutrition is high in hospitals. Studies have shown frequent lack of awareness about signs of undernutrition as all patients are, for example, not weighed. Nurses' descriptions about nutritional problems have also been found to be often vague and unspecific.

DESIGN

A qualitative design was used.

METHODS

Ten conveniently chosen registered nurses, working with older patients in two hospitals in western Sweden were interviewed. Four of the interviews were performed during 2003 and six during 2006. The interviews were analysed according to a Gadamerian-based hermeneutic research method.

RESULTS

The analyses revealed that promoting aspects for performing nutritional nursing assessment in older patients were to get information by dialogues, by observations and controls, by collaboration with other caregivers and professionals and by performing continuous follow-ups. Necessary conditions, beside knowledge and consciousness about nutritional issues, were to have interest, give time to listen to the patient's story and furthermore, be sensitive to the patient's wishes, be able to assess the patient's motivation to eat and have an ethical awareness.

CONCLUSIONS

A successful way that promoted the performance of nutritional nursing assessment in older patients was to use different approaches as interactive dialogues, observations, controls and collaboration in team. Such a nutritional nursing assessment was an ongoing process during the patient's hospital stay.

RELEVANCE TO CLINICAL PRACTICE

These results highlight that nurses have an important role in identifying eating problems in older patients, which has to be a prioritized issue in the care of older people.

Living with chronic obstructive pulmonary disease: developing conscious body management in a shrinking life-world

AIM

This paper is a report of a study to explore the changes experienced by the person living in a body with chronic obstructive pulmonary disease.

BACKGROUND

Chronic obstructive pulmonary disease is the world's fourth leading cause of death, and the World Health Organisation predicts further increases in prevalence and mortality. Despite a growing body of associated knowledge, there remains much to learn about patient and family-driven goals for medical and surgical treatment to guide nursing practice, to support self-management strategies, and to provide a context for therapeutic outcomes.

METHODS

Merleau-Ponty's philosophy of the body provided a framework for this Heideggerian phenomenological inquiry with 15 people with emphysema and 14 of their family members. The participants were drawn from three Australian teaching hospitals. Hermeneutic analysis was used to interpret 58 in-depth interviews conducted between 2003 and 2005.

FINDINGS

People with severe emphysema experience a shrinking life-world shaped by breathlessness. This diminishes the predictability and automatic nature of their bodies and their perceived effectiveness as a person. They develop a number of strategies of conscious body management to facilitate breathing, mobility and task completion.

CONCLUSION

Understanding of the person's changed body and the resulting expertise that those living with chronic illness bring into care and assessing and facilitating this expertise are central to planning sensitive and appropriate care and evaluating outcomes for medical or surgical therapies that are perceived as meaningful to the person.