Non-pharmacological management of breathlessness: a collaborative nurse--physiotherapist approach

Patients' experiences of a new integrated breathlessness support service for patients with refractory breathlessness: Results of a postal survey

BACKGROUND

We developed a new single point of access to integrated palliative care, respiratory medicine and physiotherapy: the breathlessness support service for patients with advanced disease and refractory breathlessness. This study aimed to describe patients' experiences of the service and identify the aspects valued.

DESIGN

We attempted to survey all patients who had attended and completed the 6-week breathlessness support service intervention by sending them a postal questionnaire to self-complete covering experience, composition, effectiveness of the BSS and about participation in research. Data were analysed using descriptive statistics and thematic analysis of free text comments.

RESULTS

Of the 70 postal questionnaires sent out, 25 (36%) returned. A total of 21 (84% (95% confidence interval: 69%-98%)) responding patients reported that they definitely found the breathlessness support service helpful and 13 (52% (95% confidence interval: 32%-72%)) rated the breathlessness support service as excellent. A total of 21 (84% (95% confidence interval: 69%-98%)) patients reported that the breathlessness support service helped with their management of their breathlessness along with additional symptoms and activities (e.g. mood and mobility). Four key themes were identified: (1) personalised care, (2) caring nature of the staff, (3) importance of patient education to empower patients and (4) effectiveness of context-specific breathlessness interventions. These were specific aspects that patients valued.

CONCLUSION

Patients' satisfaction with the breathlessness support service was high, and identified as important to this was a combination of personalised care, nature of staff, education and empowerment, and use of specific interventions. These components would be important in any future breathlessness service.

Individual experiences and impacts of a physiotherapist-led, non-pharmacological breathlessness programme for patients with intrathoracic malignancy: a qualitative study

BACKGROUND

Non-pharmacological breathlessness management programmes have been shown to be beneficial in the management of lung cancer-related dyspnoea for more than 10 years. What is not so clear is how they work.

AIM

To evaluate how patients with intrathoracic malignancy (lung cancer or pleural mesothelioma) undergoing the non-pharmacological breathlessness management programmes benefited from the programme, using a qualitative methodology.

DESIGN AND SETTING

Consecutive patients completing the programme were invited to be interviewed (semi-structured and audio-recorded) about their experiences of the programme, what had helped them and how. Interviews were transcribed and analysed using interpretative phenomenological analysis.

RESULTS

Nine patients were interviewed. Seven major themes emerged, they are summarised as follows: (1) Mixed prior expectations of the programme, (2) flexibility of delivery and additional support needs, (3) physiotherapist attributes and skills in developing an effective helping relationship, (4) adoption of new techniques, (5) the effects and impact of the programme and new techniques, (6) difficulties and barriers to achieving change and (7) facing an uncertain future beyond the programme.

CONCLUSION

The non-pharmacological breathlessness management programme appears to offer a wide range of benefits to patients, including improving functional capacity, coping strategies and self-control. Such benefits are most likely to be due to a combination of breathing control, activity management and the therapist qualities.

Physical therapy in palliative care: from symptom control to quality of life: a critical review

Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings such as hospice and palliative care centers where as part of a multidisciplinary team of care, they address the physical and functional dimensions of the patients’ suffering. Physiotherapy treatment methods like therapeutic exercise, electrical modalities, thermal modalities, actinotherapy, mechanical modalities, manual physical therapy and assistive devices are useful for a range of life-threatening and life-limiting conditions like cancer and cancer-associated conditions; HIV; neurodegenerative disorders like amyotrophic lateral sclerosis, multiple sclerosis; respiratory disorders like idiopathic pulmonary fibrosis; and altered mental states. The professional armamentarium is still expanding with inclusion of other miscellaneous techniques which were also proven to be effective in improving quality of life in these patients. Considering the scope of physiotherapy in India, and in palliative care, professionals in a multidisciplinary palliative care team need to understand and mutually involve toward policy changes to successfully implement physical therapeutic palliative care delivery.

Innovative Educational Collaboration between Colleges to Improve Disabilities and Enhance Learning

Interdisciplinary collaboration in higher education can produce valuable learning experiences beyond that of a single discipline approach. The University of Detroit Mercy College of Engineering and College of Health Professions have effectively collaborated yielding results that benefit not only the student but physically challenged individuals living in the Detroit area. Teams of engineering students and nursing students work together on projects to build assistive devices that improve the lives of people in need. This paper describes the techniques, goals and objectives used in multidisciplinary collaborative education. Students who have completed the course have described an enhanced understanding of how to effectively collaborate with members of other disciplines. Clients who have worked with the multidisciplinary teams have benefited by receiving assistive devices that have significantly improved their activities of daily living.

Dyspnea in the thoracic trauma patient: a human response to illness

Dyspnea is one of the most common presenting symptoms in thoracic trauma patients; therefore, trauma nurses require extensive knowledge of this symptom. The Human Response to Illness model provides an organizing framework to establish a comprehensive understanding of the human response of dyspnea following thoracic trauma. The model is used to describe the physiological, pathophysiological, behavioral, and experiential perspectives of dyspnea in thoracic trauma, while considering personal and environmental factors. This comprehensive overview will provide the trauma nurse with appropriate evidence-based rationale for interventions in the management of acute dyspnea in the thoracic trauma population.

Death, dying, and last wishes

Issues regarding patient care near the end of life can be challenging and rewarding for emergency physicians. Knowledge of the patient's wishes is essential, and may be accomplished by advance directives or communication with patients and surrogates. Resuscitative efforts are appropriate for many patients, but inappropriate for others. The goals of medicine remain the following: providing optimal health care, provision of the best possible symptom control, communication, empathy, and caring. As death approaches, provision of the best possible medical care, in accordance with the patient's wishes, can be rewarding for patients, families, and health care providers.

Nursing role in the multidisciplinary management of motor neurone disease

Motor neurone disease (MND) is a debilitating and progressive neurological disorder in which degeneration of the motor neurones results in muscle weakness and wasting. Recent high-profile media coverage about assisted suicide and euthanasia has increased awareness of MND and yet still relatively little is known or understood about it, even among the healthcare profession. This article looks at the key areas in management of patients with MND, including the role of the nurse and the importance of a well-coordinated multidisciplinary team. Ways to deal with communication problems, respiratory dysfunction, feeding and nutrition, and legal and ethical issues are examined. Good management of patients with MND involves a hospital and community-based multidisciplinary team. The essence of care is good symptomatic management of respiratory failure and nutritional problems that result from difficulties in swallowing and increasing dependency. Palliative care should be introduced before the terminal stages after careful discussion with the patient and carers. Most patients with MND die from pulmonary infections or respiratory failure, but contrary to popular belief, death by choking attacks is rare and the final stages of MND are usually peaceful and dignified.