|Susan Chaplain, RRT, CPFT, assists George Harrington as he takes a breathing medication.
Photo | Jay Wiley
Reducing Return Visits
"Education is so important and our biggest challenge with this population," said Barbara Pickering, RN, charge nurse in D1, a 43-bed telemetry-med/surg unit. "You're never going to reverse COPD, but our goal is to help [patients] make the kind of accommodations they need to live so it doesn't get any worse, and maybe we won't have as many return visits."
Pickering emphasizes the importance of exercise - to "keep moving as much as they can" and the merits of patients adjusting their diet.
"Smaller, more frequent meals make sense because it takes oxygen to digest food and patients can run out of breath just eating a meal."
Patients need to learn to "slow down as far as how they do things," Pickering said. "Anytime they use their arms and hands or do a lot of movements, they will be short of breath and when they get to that point, they need to sit down." Patients need to "space out the timing on personal needs; if they need oxygen, they need to have it on."
Regret & Resignation
Pickering acknowledges there may be a genetic component to COPD and some patients "never smoked," but she thinks the disease is caused "more by lifestyle," specifically smoking.
"You'll get people who are [diagnosed] COPD and will go home and still smoke," Pickering said. "You wouldn't think so, but it happens. I think sometimes respiratory patients think the damage is already done, so what difference does it make if they smoke?"
Barbara Lewis, RN, CCM, pulmonary medicine, agrees.
"Maybe they smoked for a long time and have a lot of regret they didn't care for themselves better," she said. "They just can't give it up because nicotine is addictive. Sometimes I don't know whether they even want to."
The certified care manager is head of the pulmonary collaborative, a multidisciplinary group which meets monthly. "We review pulmonary/pneumonia/COPD orders to make sure doctors are using core measures and standardized orders and to discuss what we can do better for these patients."
Lewis' biggest challenge is finding a discharge plan so patients can go to a safe environment, whether it is home, to an inpatient pulmonary facility, nursing home or outpatient pulmonary rehab.
Outpatient rehab is only an option, however, Lewis said, "if patients are agreeable, are motivated and have transportation. There are a lot of 'ifs.'" Many patients have a sedentary lifestyle "and just want to go home," Lewis said. "They don't want to exercise. They don't see the need for it."
No matter how many services are in place, Lewis said, "when patients can't breathe, they are going to be panic stricken, call 911 and come back in to the hospital because it's a safe haven."
Lewis personally knows the devastating effects of COPD. Her father died from COPD about a dozen years ago "and he had smoked Camels since his 20s. He finally quit, but the damage was there."
She is not the only one this chronic disease has touched. Bartos' father has mild COPD. Pickering's mother-in-law has COPD, is "oxygen dependent at home, and was a smoker for many years," Pickering said. "She has a hard time accepting what her limits are and what she should do to make herself feel better."
Young said her mother "has never really been diagnosed with COPD, but she's a smoker and it's very easy to see the signs coming down the road."
So Young worries.
"There's nothing so frustrating as ... seeing these struggles at work and knowing your mother is basically signing up for these. It feels so powerless watching that happen," she said.
Bartos considers COPD a "common thread to a lot of patients and something nurses need to be concerned about," both from an acute and chronic perspective.
As Young describes it: "It's life-altering and always a work-in-progress. It's not black and white."
Kathleen A. Waton is a frequent contributor to ADVANCE.