Improving Palliative Care Services: Chronic Obstructive Pulmonary Disease (COPD)
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Introduction
In the United States, up to 90 million citizens have been diagnosed and live with the seriousillnesses. The numbers are anticipated to double in the next 25 years (Center to Advance Palliative Care, 2014). Palliative cares are services offered to patients with serious medical conditions. The medications are aimed at offering reprieve to both the family and patients who suffer from stress and symptoms because of serious illnesses (WHO). The utmost goal of a palliative care is to improve the quality of patient’s life. Thecare services can be provided by healthcaregivers such as nurses and doctors. About 6 million patients in the US have benefited from palliative care (Center to Advance Palliative Care, 2014).Palliative symptoms are resultant from numerous causes depending with what patients are ailing from, and as such, they would require management from care providers. Usingan example of the “chronic obstructive pulmonary disease” (COPD) as Palliative condition, this analysis indicates the various palliative care dynamics and how nurses or health care providers, can improve care and contain the rising palliative illnesses and deaths in the United States and across the globe.
Synopsis of problem
Clinical setting in which it occurred
COPD (Chronic Obstructive Pulmonary Disease) is a term that describes progressive lung conditions such as chronic bronchitis, emphysema, bronchiectasis, and non-reversible asthma. COPD has been observed to cause disabilities and death.
Globally, a 2015 report by the WHO(World Health Organization) estimates that over 3 million deaths were caused by COPD (a 5% representation of the total worldwide deaths). Of the total deaths, 90% are from middle and lower income regions or populations.
In the United States, COPD has been ranked as the third most dangerous disease causing death that has infected up to 16 million (6.4% of the total population) of the populace. Over 50% of the adults with lower pulmonary functionalities acknowledges of not being aware of having contracted COPD. A 2013 report by the CDC (Center for Disease Control) indicates that people aged between 65-74 and above years; Women; Alaska Natives/American Indian and multiracial non-Hispanics; retired/unemployed/unable to work; widowed/divorced/separated; former/current smokers; asthmatic people are most likely to have COPD (National Heart, Lung, and Blood Institute, 2017; CDC).
Primarily, the cause of COPD is linked with smoking of tobacco either as a second hand or in an active smoking. Other causes include exposure to occupational fumes and dusts, outdoor and indoor air pollution.
The continued prevalence of COPD has been linked with high ageing populations and smoking prevalence across the affected countries. Most cases of the COPD can be prevented through early cessation or absolute cessation from smoking. There is no cure for COPD, rather, treatments can be administered to improve the quality of patient’s life, relieve symptoms, and their risk death.
Most of the COPD becomes apparent among the populace aged 40 to 50 years. Common symptoms related with the underlined condition include breathlessness, sputum production, and chronic cough. A patient who ails from the condition may have difficulties performing basic tasks like climbing a staircase, carrying a suitcase and many more, as their conditions deteriorate. Therapeutically, Sufferers from the underlined conditions can be diagnosed by testing their breathing.Nevertheless, available medications could help improve exercising capacity, relieve symptoms, reduce death risks, and general life quality improvement.
Family members of patients who suffer from the underlined conditions apart from contending with the financial expenses on their beloved one’s medications, they should be able to deal with the patient’s experiences like high anxiety rates, psychological distress, impaired cognitive functioning, and depression. Other supportive cares, the society can offer to these patients entails emotional and psychological support. Although viable medications for the COPD are limited, nurses have a demanding role to play in the management of COPD.
Nurses’ involvement with COPD streams from all stages. For example, the role of a nurse would include prevention, provision of caring services in distinctive settings like offering therapeutic guidance to the patients’ families and running awareness campaigns about COPD and preventions, and in hospitals (Fletcher and Dahl, 2012).
The government and other stakeholders such as local and international health servicing support providers also have a responsibility to play in the prevention and provision of supportive care services such as health infrastructures for patients affected with COPD. Just to mention, the US federal government has spearheaded the COPD prevention by establishing stringent measures aimed at regulating smoking of tobacco through programs such as the COPDNational Action plan in on 2017, May 22nd through the National Heart,Lung and Blood Institute (NHLBI).
In sum, from the above outline, COPD as a palliative condition needs some level management since it has no medication. In this regard, nurses, doctors, government, patients’ family members, and other support groups can provide the management services.
Literature review
A clinically controlled study by (Moriyama et al,. 2015) aimed at examining the effectiveness of nurses in the comprehensive management of pulmonary rehabilitation program in a IV stage chronic obstructive pulmonary conditions on patients receiving oxygen therapy at home. The review entailed conducting of telephone and face-to-face interviews with intervention groups,and administration of conventional education to control groups. Moriyama and colleagues analyzed 15 participants in this regard.
The study revealed that there were no physiological improved outcomes although dyspnea’s severity, walking distance, and social activities greatly improved. The study observed that three patients within the intervention groups received therapy for cold-like signs, while two needed hospitalization. The research’s conclusion concluded that the nurses’ comprehensive management of pulmonary rehabilitation program in the IV stages contributed to patient’s acquiring self-management learning skills, social activity level, walking distance, improved dyspnea, and the overall life quality.
This indicates that whereas there are no definite therapeutic mechanisms aimed at healing the COPD related disease, just by proper management through the support of caregiver like nurses the quality of life would be improved via social activity level, walking distance, improved dyspnea and more.
(Ann-Britt Zakrissona et al,. 2011) research dubbed “Nurse-led multidisciplinary programme for
patients with COPD in primary health care: A controlled trial” and objected at investigating the effects from a nursing-led multi-disciplinary programmes (NMP) as rehabilitation of pulmonary condition as a primary health care in relation to functionality capacity, patients axacerbations , and quality of life (QoL), among patients who suffer’s from the chronic obstructive pulmonary disease (COPD). Hence,Ann-Britt Zakrissona and the team used a one-year longitudinal research approach in a quai-experiemental designwas taken with COPD patients. 54 controlled and 49 invention groups were engaged in the study’s design. The team also using a 6 minute walk testing assessed the funtionality capasity and quality of life by the use of clinical COPD questionaire. Patients records were used to calculate exacerbations.
The reseachers’ findings showed that the six weeks NMP programme had a positive effect in the deterance of the COPD condition by improvement of the quality of life and functional capacity by up to 1 year within the intervention group.Further,Ann-Britt Zakrissona and colleagues explains that if performed within hospital settings the parameter’s positive effects would mostly show as early the 6th month. Nevertheless, a review by Chavannes et al.,also done within the analogy of primary care indicated the the same quality of life (QoL) longitudinal effects as the Ann-Britt Zakrissona and team’s study.
A key positism with the QoL could be linked with the COPD teams build up by the PHC centers that resulted to the staff’s education on how best manage patients who ail from COPD related conditions. In totality, the research found out that even smaller contribution like the six weeks’ NMP programms have the potential to reduce the exacerbation of COPD frequency. With the establishment of a multidisciplinary approach to counter COPD, patients have to been able to acquire improved livehoods.
(Mills,Rosenberg, and McInerney, 2014) review on palliative care “Building community capacity for end of life: an investigation of community capacity and its implications for health promoting palliative care in the Australian Capital Territory.” sought to review the various community-based issues revolving around palliative deaths. Mills and collaegues’ study aimed at seeking altenative means of boosting the community’s capabilities to prevent the death through the enactment of the health promoting palliative care (HPPC).
The team wanted to test the viability of the HPPC in Australia. Thus, a qualitative research was used to engage the locals groups with the Australian Capital Territory (ACT). In that aspect,eight community groups of interests were identified and purposive sampling done to elect the respondents.Indepth interviews was the administered using Semi-structured questionnaires to the respondents.
The Mills and team’s review identifies that about 9 in every 10 women in the community holds the caring responsibility in medical diagnosis. Also, Mills et al,. observed that building themes like “Support, Respect and Responsiveness and Connection and Empowerment” as major approaches the society has used to limit or eliminate the underlying death causing illnesses. Moreso, building the community or society’s capasity was also identified as a cornerstone for protecting life from palliative related conditions. The study also indicated that coexisting communities’ capacities as illustrated in activities which encourages socialization, and peer support.
Neverthelless, HPPC was underlined to concede as the best option in the events which mainly happens in response to an illness,preparative or proactive. The research concluded that buliding that buiding the capsity of the community to handle or restore agency to end of life concerns, and more so, the approach has been idenfied as a leeway for collaborative partnership with other stakeholders. Mills and colleagues colludes by recommending that whereas buiding capasities would be vital at this juncture, all players should adhere to certain stipulated guidelines, the guidelines can either be from a proffesional body, governments or international bodies such as the United Nations or WHO.
(Strong et al,. 2014) reseach on “Accuracy of diagnosis and classification of COPD in primary and specialist nurse-led respiratory care in Rotherham UK: a cross sectional study” aimed at measuring the diagnosis of the COPD and airways obstruction’s classification in primary care and from a specialized respiratory center. The review also sought to review linkages between misclassifications and misdiagnosis and various explanatory variables. The research relied on a 1205 refferal data from 2007 to 2010 from respiratory specialists centers. A standardized method of analysis was used to derive on the facts. The study’s findings observed that 20% of the 1044 admitted patients who acquired primary care for the COPD diagnosis had spirometry inconsistencies, this is incomparison to the 933 admissions in specialised treatment centers which limited the inconsistencies in spiromentric to about 65 (6.5%). Study also exposed disagreements between the airflow obstruct based on the spirometric grade and that reflected the patient’s referal. On the other end, there were consistencies between spirometry grade and airflow obstruction in the circumtances of specialized admissions. More so, the determination revealed that men were most likely to acquire definate airflow obstruction from a specialist care. In conclussion the trio assess that, most patients who have been diagnosed with the COPD , may not necessarily have contracted it. This is attributed to common misclasiffications of airflow obstraction grades. Thus Strong and Colleagues in this regard, acknowledges the role specialised services from care providers like nurses a more alternative to that of primary care givers when it comes to handling palliative conditions. For example, they agree that patients who acquire the services of specialists have consistent spiromery and airway obstruction grades.
Summary of the Review
From the above literatures, its clear that the management of palliative condutions like the COPD is an all inclusive process that involves the engagement players such as the medics, the society, health care management, government, patients and their families. There are various medical options that nurses as leaders can take so as to prevent death from palliative diseases. As such the most efficient means is prevention through awareness campaigns on the causes of palliative sicknesses like smoking.
On the other end, for the patients who have already contracted COPD, nurses can offer them supportive cares so as to enhance their quality of life. Amongst the guidances would include emotional, psychological and medical support to both patients and their families. Research indicates that palliative patients who receives specialized treatments are more likely to attain improved life, hence nurses have the responsibility of devising a plan which ensure that the underlined group recieves proper medicare.
Decision making tool
A tree dicision making tool
The medium enables leaders or a team of decision makers to explore the possible options aimed at addressing a situation. The model outlines the problems so that solutions can be debated upon (Mindtool). The tool is good in providing various options to the decision makers. In this regard, the underlined model will be used to determine the possible options a nursing leader would have in enhacing the quality of COPD patient’s life as follows.
Fig:1.A tree decision making tool
Proposed solution
There are several possible options or intiatives at the disposal of a nurse in improving the quality of life for patients who ails from COPD. Such options would include conducting awareness campaigns, the use of the patients’ family members to offer primary care, offering financial support , or provision of specialized treatment.
Generally, depending with the patients’ status there are dinctive approaches in solving their conditions, for example, accessibility to quality of life by patients who suffers from COPD may be varied by their social, physical, and economic status. Most of the patients across the US that have been affected the palliative conditions comes from under prillaged groups such the 65-74 and above years; Women; Alaska Natives/American Indian and multiracial non-Hispanics; retired/unemployed/unable to work; widowed/divorced/separated; former/current smokers; asthmatic. Nurses have to put into perspective how the’re going to accommodate the listed teams based on the current evironmental condtions.
Preventive remedies have been observed to be the best approach in remedying the prevalence of palliative diseases like COPD. In this regard, nurses can use awareness campaigns in partnership with other stakeholders so as to encourage them from participating in behaviours like tobacco smoking which may cause COPD.Primary care by caregivers like family members and health care proffesionals could be used to prolong the life of COPD patients. This can be achieved through giving social, emotional, and pysiological support. Nurse managers can also train their colleagues in delivering best services.
Change Strategies for Implementation of Proposed Solution
Change management is critically important for any manager in ensuring conformity the new environmental dynamics. This dynamics would entail economic, political, or social factors which are also commonly reprentative if health industry.
Kurt Lewin’s ‘freeze and unfreeze” concept of 1940s view change management to be a process that involves testing various aspects in organizational setups. Lewin uses a three step analogy in this aspect. In some, Lewin explains that if one has a ice cube and they want an ice cone they have to remolden it again to look like a cone (Mindtool). Hence, to attain theend result of a cone shape, an unfreezing and freezing process has to be undertaken.
In summary, Lewin’s change management concept explains that;-
By viewing at change as a process with various stages, managers can anticipate on the eventualities and avail probable solution for the transition management
For a manager to initiate a change manage process they must understand why it happened. Meaning change should be spearheaded by certain motivations.
Change managers should be supported in making change through creating assumptions relating them with various factors.
The first stage which is un-freezing, involves preparing the team from impeding changes by breaking the status quo. Change stage, is when the team begin to sought out their uncertainities by looking for alternative means of doing things. Wherase the refreezing stage indicates that the team is ready to embrase the new frameworks.
Perspectively, as a change management for COPD, Lewin’s concept is applicable owing to the fact despite the several concerted effort limit palliative conditions in the USA , many people are still vulnerable to the condition. Nursing managers remains at the center stage as change agents in this regard. Nursing managers can provide viable solutions in how COPD is managed by folowing Lewin’s unfreezing and freezing process. For example, they can assess what makes it hard for COPD patients to access specialized medicare, come up with various recommendations like subsidized servicing,and recommending them for adoption by the management