Chronic Obstructive Pulmonary Disease (COPD) Literature

This essay focuses on the search and exploration of three pieces of literature related to Chronic Obstructive Pulmonary Disease (COPD). This includes one government guideline and two research articles covering different nursing angles of the condition. An analysis of how the search was conducted, the main findings and rationale for the chosen articles. Finally, a demonstration of understanding with the use of additional literature to analyse, identify and explore how it will influence the nursing care of patients with COPD.

Search Strategy.

PubMed was the chosen search database as supposed to other databases like Cumulative Index to Nursing and Allied Health Literature (CINAHL) because PubMed presented more articles with clear and precise titles, therefore enabling the writer to identify its significance (Macnee and McCabe, 2008). The writer firstly chose a topic, which was ‘self-management for people with Chronic Obstructive Pulmonary Disease’. Harvard (2007) further suggests that when conducting an effective and valid literature search it is important to identify a topic to enable the search results to be applicable and relevant. In-order to be more specific the writer identified key words from the chosen topic, and implemented Boolean operators, which concluded to ‘Self-Management AND COPD’, this was inserted and resulted to 1127 hits. According to Barker, Barker and Pinard (2011), Boolean operators such as ‘AND, OR, NOT, AND NOT’ are simple words used to join or exclude key words in a search.

PubMed included search options such as full text and abstracts available, language, age range, gender and publication dates which were utilised to enable the user to narrow the search to an optimal amount (refer to Appendix 1 and 2). The search was narrowed from 1127 hits to 95 hits, from which this article was selected, titled ‘Self-management support for moderate-to-severe chronic obstructive pulmonary disease’. This article was chosen because the authors used current evidence to support and justify the outcomes and findings of their study. Boswell and Cannon (2011) suggest that a research study that incorporates current and relevant evidence to analyse their study is more likely to be reliable.

The second research article was selected using different key words, which was ‘Pulmonary Rehabilitation AND COPD’. The writer retained the same search options used to find the first article, this narrowed the search to an ideal amount, from 479 to 38 hits (refer to Appendix 1and 2). This article was selected because it identified the importance of pulmonary rehabilitation in connection to improving quality of life and reduced hospital admissions. The authors validated their aims by analysing current evidence that supports the need to promote pulmonary rehabilitation for COPD patients following a discharge from hospital.

United Kingdom. National Institute for Health and Care Excellence. (2010). Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care. London: NICE.

The National Institute for Health and Care Excellence (NICE, 2011) released a guideline titled ‘Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease for Adults in Primary and Secondary care’. The writer was able to find this Guideline simply by inserting ‘Chronic Obstructive Pulmonary Disease’ into the NICE database, which resulted to 138 hits. The writer then narrowed the search by selecting ‘Guidance’, which is an option provided; this further narrowed the hits to 37, from which this guideline was selected.

This guideline defines COPD as a chronic disorder caused by frequent airflow obstruction with symptoms like persistent and progressive breathlessness, chronic cough and limited exercise ability. It is estimated that COPD is UK’s fifth biggest killer with 3.2 million people living with the condition, this support the importance of delivering high quality care, which NHS England (2014) defines as providing a positive experience of care that is clinically effective and safe. The National Institute of Health (2013) further suggest that there is yet to be a cure for this disease. The aim and objectives of this guideline is to offer the best professional practice advice on a patient centred approach to caring for COPD patients. The British Lung Foundation (2013) additionally suggests that this guideline will help the health care professionals such as the nurses to identify the types of care COPD patients should be receiving, as they are frequently the first point of contact and are involved in all aspects of care. NICE (2011) guideline also defines the symptoms, signs and investigations required to establish a diagnosis. Bellamy and Smith (2007) support that the key to early diagnosis is recognising the signs and symptoms such as frequent coughs, chronic sputum production, breathlessness and a history of exposure to tobacco smoke to aid in diagnosing the patient. The guideline also looks at the necessary factors to assess the severity of the disease and guide best management in both acute and community settings so that it is applicable to all settings and professionals.

This guideline was chosen because it considers most issues that are important in the management of people with COPD, integrates published evidence in areas of uncertainty that could possibly need further research and is useful to all professionals involved in the care of COPD. According to British Lung Foundation (2013) the management of COPD is challenging, as the patients have complex health and social needs requiring long-life monitoring and treatment, Fletcher and Dahl (2013) go further to explain that nurses in comparison to other health professionals are more involved in the care and management of patients with COPD. Therefore, this guideline positively influences the nursing care of patients with COPD by providing information about the basic level of care required and empowering COPD patients to make decisions over their health and care needs (DOH, 2013).

Taylor, S., Sohanpal, R., Bremner, S. A., Devine, A., McDaid, D., Fernanded, S. L., et al. (2012). Self- Management Support for Moderate-to-severe Chronic Obstructive Pulmonary Disease. British Journal of Medical Practice, 62. (603), 687-695.

The authors study is focused on the importance of self-management education and its contribution to a better quality of life and reduced hospital admission. According to The Health Foundation (2014), self-management education is aimed at improving how people with COPD are supported and empowered to self-manage.

The authors aim was to explore the cost effectiveness of self-management programmes and education for COPD. The author’s findings suggest that COPD patients feel useless and helpless to self-manage their condition, therefore the programmes plays a vital role in improving the patient’s quality of life, exercise tolerance and empower them to take control over their health which in turn will reduce exacerbations and rapid deterioration. The outcome of this study has a good chance to meet the UK National Health and Clinical Excellence (2010) criteria on cost-effective approaches to managing COPD.

This information could be useful to nursing patients with COPD by underlining the importance of Self-management education, which may include working closely with primary care teams and educating the patients on self-management techniques, like learning to control breathing, being mindful of tiredness due to over exertion on daily activities and eating a well-balanced diet. This would contribute towards living better with the condition (COPD Education, 2014). The authors recognise that nurses play an important role in educating, equipping and supporting the patients to merge their everyday life to suit their long term condition, such as dealing with an altered view of the future and the frustration and depression that may result (Redman, 2004). Part of the nursing care, with patient participation includes creating a short-term personalised action plan, which would be closely monitored to enable the nurse to identify the strengths and areas of development. Fletcher and Dahl (2013) acknowledges that the purpose of self-management education is to empower patients to improve their health and to restore the highest level of function regardless of the disease stage or following an exacerbation.

Cosgrove, D., MacMahon, J., Bourbeau, J., & O’Neil, B. (2013). Facilitating education in pulmonary rehabilitation using the living well with COPD programme for pulmonary rehabilitation, 13. (50), 13-50.

The author’s presentation of their study, based on the importance of facilitating education in pulmonary rehabilitation was clear and precise as the reader was able to gain a good understanding of the study. Galin and Ognibene (2012), go further to support that a good clinical research study should not be full of medical terminologies, and should be presented with clear and accurate information enabling the reader to grasp the key elements.

The author’s aims of the study were to adapt a self-management programme which was Living Well with COPD (LWWCOPD) through pulmonary rehabilitation and then to evaluate its impact. They identify that pulmonary rehabilitation administered after an exacerbation can reduce hospital re-admission and improve the patient’s quality of life as supported by Seymour et al (2010). The author’s findings suggested a positive outcome for the patients, as they felt they were in a friendly and supportive environment to be empowered to manage their condition, especially coping with breathlessness. The British Lung Foundation (2013) supports this evidence as they additionally suggest that pulmonary rehabilitation programmes are designed to help people with COPD to cope with breathlessness and to feel stronger to manage with activities of daily living such as walking, personal care and eating, as they often feel disempowered to self-care.

This information could be beneficial to nursing patients with COPD by emphasizing on the importance of evidence based nursing practice to enable accurate and useful information when recommending relevant programmes, which contributes to their on-going care (Deutschman and Neligan, 2010). It is estimated that most patients with COPD will experience at least one hospital admission due to an exacerbation of their condition within three months (DOH, 2012). Therefore based on the information from the Study which suggests that pulmonary rehabilitation reduces hospital re-admission, the nurse plays an important role in encouraging the patients to join the programme which is designed to suit the individual. British Lung Foundation (2013) goes further to suggest that the course will teach the individuals how to increase their exercise tolerance, cope with breathlessness and manage periods of stress and panic. Additionally pulmonary rehabilitation can be beneficial to COPD patients socially, as it involves interacting with trained professionals and other COPD patients, as due to the nature of the condition social interaction may be difficult (Bellamy and Booker, 2011).

In conclusion, this essay has explored three pieces of literature related to COPD with additional evidence to analyse identify and explore how it will influence the nursing care of patients with COPD.