As frontline care providers for COPD, nurses play significant roles in management, diagnosis, reviewing, and monitoring of the advancement of the infection as well as in the treatment process. They also deliver training on treatment modification where needed. Using a literature review design, this study analyses 17 sources from the nurse practitioners’ standpoint on the roles played in the management of COPD in the United Kingdom. It also recommends crucial interventions nurses can employ to enhance patient outcomes. Using the interventions outlined in this study, nurses have the responsibility and capacity to recognise patients with poor suitability to the existing medications. Besides, nurse-led training and empowerment programs can positively motivate patients to adopt these self-management strategies individually. Most of the studies demonstrated that nurse-led patient valuation and self-management training are connected with improved quality of life, self-efficacy, reduction of depression and anxiety, as well as confidence in management and compliance. The United Kingdom should encourage hospital adoption because it can reduce COPD morbidity and promote clinical outcomes.
Chapter 1: Introduction
Nurses are at the forefront of the control of severe infection and are the primary care providers in most cases (Scullion, 2018). In COPD, both non-specialised and specialised nurses provide most of the care at tertiary, secondary, and primary levels, performing integration duties across most of the care programs. In other cases, prescription nurses carry out treatment decisions. COPD is leading remain chronic respiratory diseases, in the United Kingdom, with a range of 33 cases per 1,000 persons according to 2013 data (Merinopoulou et al., 2016). It also attracts significant burden irrespective of treatments and management options already present (Bateman, 2016; Vogelmeier, Criner, & Martinez, 2017). Global prevalence is estimated at 12% for COPD, with an indication of increasing prevalence in recent years (Bateman, 2016; Adeloye et al., 2016). For instance, more than 3 million people succumbed to COPD globally (Hay, 2017). That said, there is a need for studies to re-examine roles played by nurses in COPD management in the United Kingdom. Given the availability of medical conditions but an exacerbation of the conditions, an investigation should establish novel ways that nursing role can have to reduce the prevalence. As frontline care providers for COPD, nurses play significant roles in management, diagnosis, review and tracking of the advancement of the infection as well as in the treatment process. They also deliver training on treatment modification where needed (Spencer, & Hanania, 2013). The availability of treatments options indicates that this burden is avoidable but successful management requires the collaboration of nurses with patients in delivering patient education aimed at patient self-management.
The Problem of the Study
COPD is one of the most common respiratory infections in England as well as across the world with high incidence in adults above 40 years (mortality rate of 9–10%) (Gardiner et al., 2010). An estimation is that more than 3 million in the United Kingdom contracted this infection by 2015 (Raluy-Callado et al., 2015). COPD was a cause of death for at least 27,000 people by 2004 in the country. This mortality rate accounts for 5.1% of all infections. Poor diagnosis and management are some of the factors increasing this spread as most patients continue with this infection up to age 50 and above before receiving diagnosis and treatment. The vulnerability multiplies with an increase in age. Prognosis in COPD is inadequate based on the report that at least half of the patients succumbed under two years of hospitalisation due to the worsening of the COPD. It is estimated that 72% of women and 78% of men have COPD in mild state and that 24% women and 30% men have severe forms of COPD (Gardiner et al., 2010). Treatment options should focus on sustaining the nurse and patient relationships and delivering patient education that would improve self-management to enhance both the physical and emotional recovery of patients.
Justification/Rationale
Chronic illness such as obstructive pulmonary infection is a burden in many countries throughout the world. There is an increase in this health condition due to the increase in the life expectancy of people and indulging in lifestyles that are unhealthy (Coates, 2017, p.42). Chronic obstructive pulmonary disease is very prevalent in the UK and is the second most common lung disease in the country after asthma. Therefore, this study is critical because it seeks to identify the role that nurses play to help those people with chronic disease, particularly chronic obstructive pulmonary disease. As well, chronic disease is the leading cause of death in the United Kingdom and Europe at large. Therefore, there is a need to explore the role of nurses in the management, treatment, and prevention of COPD. Nurses play a role in offering support to patients to manage their chronic disease by themselves (Coates, 2017, p.42). The research will be crucial in shedding light on the actual support that is offered, which will also be a basis for informing future nursing practice. This study will help to formulate a framework that will lead to proper management of the disease in the United Kingdom.
Objectives of the Study
- To explore the activities performed by a practice nurses in the management of COPD in the UK in 2010 to 2020
- To examine the psychological role of nurses in assisting patients with COPD in the UK from 2010 to 2020
- To assess the relationship between better nursing practice and effective prevention, management, and treatment of COPD in the UK
Research Questions
- What activities performed by practice nurses in the management of COPD?
- What is the psychological role of nurses in assisting patients with COPD?
- Is there a relationship between better nursing practice and effective prevention, management, and treatment of COPD?
Literature Gap
According to the National Asthma Education Prevention Plan (NAEPP), nurses have to create a solid connection with their patients by communicating effectively, responding to queries, and supporting promoting successful infection management (Rance, 2011; Spencer, & Hanania, 2013). Such collaborations also indicate that nurses occupy primary positions in the identification of poor illness management and recommend and deliver improved specialist referral for high-risk patients (Rance, 2011). Nurse-patient relationships also serve to deliver patient education, an important required to equip patients in self-management techniques (Soriano et al., 2017). However, most of these associations are rarely explored in the United Kingdom perspective. There is a need to establish these roles through a thorough review of the literature to suggest patient improvement and recovery.
Many studies have explored the research topic in different ways. Some studies report on the health of the people, while others focus on the role of nurses in managing chronic conditions. However, there is a gap in the literature, as most data touches on chronic diseases in general. However, this study will explore the literature that examines the role nurses play in assisting patients with a specific disease, which is a chronic obstructive pulmonary disease in the UK. This research topic covers both physical and psychological role nursed play in the lives of patients with chronic obstructive pulmonary disease in the UK. Chronic disease is related to a substantial economic and social burden to the society at large. For example, about 210 million people have chronic obstructive pulmonary disease, which has many costs associated with it.
Role of Nurses in Disease Management
Nurses can play a vital role in the management of the disease through their contact with the patients. They offer palliative care frequently. This study also indicates that nurses contribute to the continuity of care in chronic illnesses. The study also indicates that nurses in disease management, such as from the provision of end of life care in different settings. Some of these include at the community level and the hospital settings (Fletcher & Dahl, 2013, p.230). Furthermore, nurse-led interventions and consultations help to extend the care of the doctors in the care settings, thus, bettering the life quality of patients with chronic disease. However, this study does not explore the gap between expectations for health and the actual experiences among patients.
Quality of Life Measures
Some studies have explored the measures of quality of life. There is a gap between the expectations about health and the experience. This implies that the role of nurses can be measured in terms of the experience that the patients have regarding the care services as they struggle with chronic disease. This is variable between individuals. For example, adaptation is a vital measure of the quality of life that is led by people with chronic diseases. This occurs when the effect of the disease can be lowered and hence, helps the patients to adjust their expectations and adapt to the changing experiences (Carr, Gibson & Robinson, 2001, p.1245). In the end, the patients can manage their usual roles and routines. There is a gap in this literature that I will intend to cover. For instance, specific adaptation strategies have not been highlighted.
The Health and Wellbeing strategy highlights the health challenges facing the people in the UK. One of these is breast cancer, which was 68 per cent compared to the London average from the screening that was conducted in 2015. Besides, this study indicated that there is a prevalence of the musculoskeletal disorder that causes a chronic pain condition. This accounts for over 80 per cent of the people who experience chronic pain that mostly leads to other medical conditions. This literature is essential for the research because it sheds light on one of the chronic diseases that is disturbing the people in the UK. There seems to be a gap that should be addressed.
Roles in Patient Education
Another study indicates that nurses play a vital role in patient education when it comes to chronic illness. This plays an essential role in the life of such patients since the patients have a vital role in the healthcare delivery team. Doctors may specify and provide a prescription of the medicines that patients need to take to manage their condition, but this is not enough as some of the patients do not understand such information of the doctors (Halcomb, Davidson, Salamonson, Ollerton & Griffiths, 2008, p.6). Thus, nurses intervene to administer medications and offer educational support on what to do once they are discharged. Patient education is also vital in the management of the chronic condition since the patients require sustained treatment over time, and there is a need for a check-up to ensure that the diseases do not become threats to life. The study also indicates that nursing practice is the foundation of primary care provision, and the development of this practice in the United Kingdom has been enhanced by policy environments that are conducive for nurse roles. Furthermore, there has been immense financial support from the relevant authorities. In some cases, the nurses can develop their roles depending on the local needs of people with chronic disease (Halcomb et al., 2008, p.10).
Implementation of Patient Care Strategies.
Moreover, other literature has explored the impacts of the protocols managed by nurses on adults with chronic conditions. One of the significant concern is put on the provision of accessible care that is of high quality. For instance, people with chronic conditions such as diabetes and hypertension require long-term management of their illness by nurses. Thus, a nurse bridges the gap between recommended care and provided care. According to Shaw et al. (2014), nurses are regarded as vital when it comes to the implementation of patient care strategies. They apply the well-defined protocols and training to do that, and indeed, this improves the lives of the patients. The protocols were found to have a positive impact on the life of people with chronic conditions; however, there may be differences in treatment (Shaw et al., 2014, p.114). Also, the nurses are helpful when it comes to the facilitation of lifestyle changes among people with chronic disease. Similarly, the study showed that nurses collaborate with other healthcare provision teams to ensure effective chronic condition management. This study is in agreement with the other studies about the role of nurses, for example, it coincides with Halcomb et al., (2008), who states that nurses address the needs of patients with chronic disease.
Chapter 3: Methodology
Introduction
This study adopts a qualitative approach involving analysis of previous reports and academic articles. The focus of this research is to analyse data related to the role of nurses in enhancing patients with COPD in the United Kingdom. The study target people with chronic illness.
Study Approach
The study used a Realism Approach as it aims to examine qualitative data that has already been published. Besides, the approach enables the research to analyse and inform on the actions that are measured by quantitative research.
Search Strategy
The researcher conducted a systematic analysis of data from various databases index according to the year. Google Scholar was one of the sources used for obtaining up-to-date reports. The focus was on critical terms related to COPD and studies conducted in Europe, particularly in the United Kingdom. There was an exception for high authority studies that had valuable information on COPD and nursing roles, although not published in Europe or the UK.
Government reports offer valuable primary research and are deemed trustable sources of information. Moreover, they are of high authority because they are commissioned by authorities such as the ministry of health. There are many reports published by the relevant authorities about the topic of chronic disease in the London Borough of Ealing that this study includes.
Inclusion and exclusion criteria.
Inclusion. The study integrated mostly original research articles, although exceptions are also for some secondary studies from high authority websites. The objective was to ensure that only credible information is represented in such sources. Examples of databases used to source articles included EBSCO, JUSTOR, ERIC, SAGE JOURNALS, and ProQuest.
Exclusion. Old papers published before 2010 were not included since they have become obsolete. Also, those that did not contain themes of COPD and nurse roles were excluded.
Data Collection
This research utilised a secondary method of analysis. Sources published from 2010 to 2019 were used for this analysis. The data obtained aimed at responding to crucial variables related to the roles of nurses in COPD patients and management techniques.
Data Extraction and Analysis
The researcher used Microsoft Excel to extract and organise data, placing it into group findings based on the author, participants demographics, follow up period, activities aimed at activating patients, activities aimed at health literacy, results, and outcomes. Most of the analysis is conducted through a comparative approach of the summaries of each article based on key terms identified in each study.
Summary of the Reviews
Seventeen studies were included in this review focusing on the role of nurses in the management of COPD conditions. The studies focused served to answer the three research questions. The themes of the studies were overarching across the studies. Four studies examined the self-management roles of nurses. They include Hernandez et al., 2015 (high), Taylor et al. (2012) (high), Mitchell et al., 2014 (low); and Ng et al., 2017 (high). Four studies (Steurer-Stey et al., 2018 (high); Aboumatar et al., 2019 (high); Bucknall et al., 2012 (low); and Howard & Dupont, 2014 (low) focused on home-based respiratory service and other activities for daily living. Seven sources comprising Bucknall et al., 2012 9 (low); Bischoff et al., 2013 (low); Freund et al. (2016) (low); Steurer-Stey et al., 2018 (high); Ko et al., 2017 (high); Aboumatar et al., 2019; and Ng et al., 2017 (high) examined the quality of life indicators. Regarding the theme of patient happiness and health and psychological wellbeing, two sources examined the role of nurses in supporting health and happiness (Wilson 2019; Vincent, & Sewell, 2014). Three studies (Ng et al., 2017; Ko et al., 2017; and Billington, 2015) analysed the relevance of telephone-based interviews. Four studies assessed the effects of self-efficacy of nursing interventions (Steurer-Stey et al., 2018; Ng et al., 2017; Poureslami et al., 2016; Bucknall et al., 2012). The effects of depression and anxiety were assessed by two studies (Hernandez et al., 2015; and Bucknall et al., 2012. Four studies reported disease knowledge (Ng et al., 2017; Hernandez et al. 2015; Poureslami et al., 2016, and Aboumatar et al., 2019).
Figure 1. Quality assessment of articles
The assessment of the quality of included sources was in the form of percentages indicating sources with a high bias risk. The medium grey bar represents low-risk articles, the light grey bar represents those with unclear risk of bias, while the black bar shows a high risk of bias.
The Activities Performed by Practice Nurses in addressing COPD
This section responded to the first objective of “To explore the activities performed by a practice nurses in the management of COPD in the UK from 2010 to 2020. Nurses treatment options presented in the results entailed either nonpharmacologic or pharmacologic therapies. Individual activities for nonpharmacologic options included smoking cessation, pulmonary rehabilitation, complementary therapies, treating and positioning techniques, and ongoing evaluation. Nurses also participated in the diagnosis and differentiation roles involving assessment of airflow limitation, the coughing condition, analysis of exercise intolerance, production of sputum, and an extended history of dyspnea. The general roles as found in studies are described below.
Self-Management Behaviours. Four studies specifically focused on self-management techniques (Hernandez et al., 2015; Taylor et al., 2012; Mitchell et al., 2014; and Ng et al., 2017). Self-management refers to the provision of formalised patient programs that seek to inculcate skills required to conduct medical regiments based on the infection. They also lead and encourages and leads to behaviour change as well as the provision of psychological and emotional support for patients to manage their conditions and achieve a healthy lifestyle. Most of the behaviours assessed were smoking, adherence to medication, diet, and physical activity. Two studies including Ng et al. (2017) and Hernandez et al. (2015) reported on the level of physical activity. The questionnaires adopted comprised HRQOL and depression and anxiety and the self-efficacy tools respectively used by Hernandez et al. (2015) and Ng et al. (2017).
Hernandez et al. (2015) study focused on patient empowerment using with social support and problem-solving skills. Primary care members including the social worker, the nurse, and physician delivered the intervention that consisted of the following. A two-hour educational session integrated with the provision of patient-specific support resources. The intervention also comprised: (i) access to a call centre; (ii) an individualised care plan; (iii) empowering the patient for self-management, and (iv) the coordination across the care levels. The study demonstrated that quality of life determinants improved.
The authors revealed interventions involving individualised care plan; empowering the patient for self-management and a four 40-min homed-based individual training. Mitchell et al. (2014) study utilised a 6-week “Self-Management Programme of Activity, Coping and Education (SPACE) FOR COPD” to examine the role of this approach in the management of COPD and found substantial improvements across the indexes of “CRQ-SR dyspnoea, fatigue and emotion scores, exercise performance, anxiety, and disease knowledge.”
Daily activities Home-based respiratory care. Four specific studies (Steurer-Stey et al., 2018; Aboumatar et al., 2019; Bucknall et al., 2012; and Howard & Dupont, 2014) focused on home-based respiratory service and other activities for daily living targeting mild to critically ill patients. The primary content of these services was the assessment of health, exacerbation management, adoption of a healthy lifestyle such as stopping smoking habits, teaching patients about the infection, identification of COPD symptoms, management of infections, and breathing practises and medications. Other services focused on the provision of telephone interviews and information on service referrals. Steurer-Stey et al. (2018) study focused on COPD self-management plan using the Chronic Care Model. Also called “Living well with COPD.” Intervention approaches comprised a six group module program dealing with (1) defining COPD; (2) pharmacological management and proper inhalation process; (3) breathing practises and coping approaches focused on symptom management; (4) daily conservation of energy and management of activities; (5) the health gains of exercising and identification of obstacles and facilitators of normal exercising plan; and (6) defining exacerbation and prevention skills, identifying and controlling worsening symptoms. Bucknall et al. ‘s (2012) intervention involve nurses in the promotion of self-management. The intervention comprised four 40-min homed-based individual training. This was done for more than two months. It was integrated with more home visits once in six weeks. The individualised COPD self-management support based on the Aboumatar et al. (2019) study enabled patients to take medications properly, keep an active lifestyle, quit smoking, identity exacerbations signs and participate in energy conservation plans, engage in breathing exercises. Howard and Dupont (2014) study examined patients based on COPD breathless manual to enhance their respiratory function.
The Psychological Role of Nurses in Assisting Patients with COPD
Results from this section accomplished the second objective of: “To examine the psychological role of nurses in assisting patients with COPD in the UK from 2010 to 2020.” Findings are associated with telephone management and health happiness and pulmonary rehabilitation.
Telephone form of intervention. As an approach to enhance the psychological wellness of COPD patients, three studies (Ng et al., 2017; Ko et al., 2017; and Billington, 2015) analysed the relevance of telephone-based interviews. Ng et al. (2017) reported the relevance of a monthly telephone follow-up while Ko et al. (2017) indicated 3 monthly phone calls to the patients that boosted their morale. Accordingly, Billington (2015) employed the relevance of telephone intervention to enhance the condition of patients with COPD.
Health Happiness and Pulmonary Rehabilitation. Two sources examined the psychological role of nurses in supporting the health and happiness of patients through pulmonary rehabilitation (Wilson 2019; Vincent, & Sewell, 2014). The rehabilitative approach enables patients to participate in supervised and progressive exercise plans. The focus of these activities, as observed include smoking cessation, social support, a nutritional evaluation, exercise reconditioning, and breathing exercises. In examining 99 outpatients in Manchester, United Kingdom, GPNs including dieticians focusing on offering dietary advice to patients and weight loss and gain training to improve happiness and health. The study showed this approach rewards practices for compliance. However, it might also inhibit holistic COPD care. Most of the practitioners did not have strong courage while delivering nutritional care for people living with COPD. As such, the mentality was that integration of care providers could enhance pulmonary rehabilitation. Such an approach would link the patient with the dietician, the GP, nurse, GP, and rehabilitation services in providing complete COPD care. Such a model would integrate nutritional program as part of a patient’s complete treatment action. Other associated functions include goal-oriented therapy and sexual expression.
The Relationship between Better Nursing Practice and Effective Prevention, Management, and Treatment of COPD
The third goal of this study was “To assess the relationship between better nursing practice and effective prevention, management, and treatment of COPD in the UK.” In responding to this objective, results on the relationship between nursing practice and effective prevention, management, and treatment of COPD are presented in three components of quality of life, self-efficacy, and depression, and anxiety management.
Quality of Life. Seven sources comprising (Bucknall et al., 2012; Bischoff et al., 2013; Freund et al., 2016); Steurer-Stey et al., 2018; Ko et al., 2017; Aboumatar et al., 2019; and Ng et al., 2017) examined the health-related quality of life. Five studies (Bischoff et al., 2013; Bucknall et al., 2012; Steurer-Stey et al., 2018; Ko et al., 2017; and Ng et al., 2017) showed a significant increase in the quality of life in the intervention groups versus those not receiving an intervention. Out of these studies, Ko et al. (2017) and Ng et al. (2017) focused on educational training intervention accompanied by several months of phone interviews. Quality of life-based on Freund et al. (2016) study differences improved significantly at 24 months. This was indicated via “(differences 1.16 [CI, 0.24 to 2.08] on SF-12 physical component and 1.68 [CI, 0.60 to 2.77] on SF-12 mental component) and general health (difference on EQ-5D, 0.03 [CI, 0.00 to 0.05]).”
The Bischoff et al. (2013) study was conducted in the Netherlands employing a modified version of Canadian “Living Well with COPD” and CRQ techniques. The intervention was delivered by AP, BT, DK, E, Ex, HL, and SA.
Two others (Bucknall et al. (2012) and Steurer-Stey et al., 2018) focused on COPD self-management plan. Bucknall et al.’s (2012) intervention involve nurses in the promotion of self-management. The intervention comprised four 40-min homed-based individual training. This was done for more than two months. It was integrated with more home visits once in six weeks. Steurer-Stey et al. (2018) study used the Chronic Care Model. Also called “Living well with COPD.” Intervention approaches comprised a six group module program dealing with (1) defining COPD; (2) pharmacological management and proper inhalation process. Most of the interventions were delivered by multidisciplinary health teams as opposed to the use of only nurses. The time of delivery ranged from six months to twenty-four months. Different instruments were used to evaluate the quality of life, including self-efficacy tool, Short Form Chronic Respiratory Disease Questioner (CRQ-SF), HRQOL, St.-George’s Respiratory Questionnaire (SGRQ-C), and Bristol Knowledge questionnaire.
Patient Self-Efficacy. Four studies assessed the effects of self-efficacy of nursing interventions (Steurer-Stey et al., 2018; Ng et al., 2017; Poureslami et al., 2016; Bucknall et al., 2012). All of these studies demonstrated significant improvement in self-efficacy. Those delivering the interventions were health experts comprised of primary care providers, physiotherapists, and nurses.
Anxiety and Depression. The effects of depression and anxiety were assessed by two studies (Hernandez et al., 2015; and Bucknall et al., 2012). Only one study (Hernandez et al., 2015) found a significant decline in depression following the nursing intervention. The remaining study (Bucknall et al., 2012) did not record any progress in self-efficacy, depression, and anxiety. The delivery of these interventions was through primary care teams and trained tutors. The emphasis of these studies was to empower patients and provide psychosocial advice.
Education and Improvement in Disease Knowledge. Four studies reported disease knowledge as an outcome (Ng et al., 2017; Hernandez et al. 2015; Poureslami et al., 2016, and Aboumatar et al., 2019). Two of these articles used self-efficacy tool (Ng et al., 2017; Poureslami et al., 2016). On the other hand, Hernandez et al. (2015) and Aboumatar et al. (2019) used HRQOL and depression and anxiety tool. Some of the interventions for improving knowledge and disease include one hour COPD education, as reported by Ko et al. (2017). Poureslami et al. (2016) reported a culturally specific educational treatment that integrated two videos for the two practitioners. A pamphlet was also used. In the Aboumatar et al. (2019) study, COPD nurses delivered the intervention. It comprised individualised COPD self-management support assisting them in taking medications properly. According to the Ferrone et al. (2019) research, GPs delivered the intervention with an educator and physician. It comprised skills and education sessions, including self-management education. Another was case management. Similarly, the authors reported the use of self-management education workshops, patient handbook, and two-hour educational session integrated with the provision of patient-specific support resources.
Effective management of COPD calls upon nurses to tailor each treatment approach based on the individual needs of the patient. They must also integrate care with the three crucial elements of patient, medication, and device. Nursing roles must complement each other across these three elements. In delivering medication to each COPD patient, nurses also should ensure that the patient can competently utilise the medication, procedures, or device provided and that he or she finds satisfaction in adopting such a method. Adopting the right medication for the patient should cater for the needs such as “age, manual dexterity, cognitive impairment, personal preference, ease of use, inspiratory flow rate, licensing options, and the medication required” (Scullion, 2018). Nurses should equally consider individual patient characteristics including inspiratory ability and any comorbidities that can influence the delivery of drugs.
As shown in the results, most of the nursing interventions yield a positive quality of life indicators. For instance, Taylor et al. (2012) findings indicate that the intervention may increase both the quality of “(mean EQ-5D change 0.12 (95% confidence interval [CI] = -0.02 to 0.26) higher, intervention versus control) and exercise levels.” Mitchell et al. (2014) study utilised a 6-week “Self-Management Programme of Activity, Coping and Education (SPACE) FOR COPD” to inspect the role of nurses using this approach in the management of COPD. Results demonstrated substantial improvements across the quality of life.
Provision of telephone service. Another way of improving the psychological wellness of patients is through telephone interviews. Three studies substantiated this approach towards enhancing the condition of COPD patients. Ng et al. (2017) reported the relevance of a monthly telephone follow-up while Ko et al. (2017) indicated 3 monthly phone calls to the patients that boosted their morale. Accordingly, Billington (2015) employed the relevance of telephone intervention to enhance the condition of patients with COPD. Telephone services as an alternative to the primary face-to-face interaction for patients is an emerging form of nurse clinics. The objective is to promote self-management practices. Nurses can incorporate this approach with an information pack and quick treatment options in case of communication with patients. Studies using telephone interviews demonstrated enhancements in clinical indicators, especially for self-efficacy and self-management knowledge up to four months following an intervention.
Health Happiness and Pulmonary Rehabilitation. The effects of fatigue and breathlessness affect an individual’s psychological and emotional wellbeing. As established in the reviews, the rehabilitative approach enables patients to participate in supervised and progressive exercise plans. The focus of these activities as observed include smoking cessation, social support, a nutritional evaluation, exercise reconditioning, and breathing exercises. Wilson (2019) study revealed this approach rewards practices for compliance. The role of nurses for such a condition is to conduct and involve patients in periodic exercise plans. They can achieve this using the “Chronic Respiratory Disease Questionnaire,” a self-reported tool that measures the rate of pulmonary rehabilitation and health condition. The tool analyses the effect of respiratory condition on patients overall wellness. Additionally, nurses can use the Hospital Anxiety and Depression Scale to measure the rate of anxiety and depression experienced by patients. Other measures of happiness are the coping skills and emotional functioning of patients. Nurses can use these measures also determine the pulmonary rehabilitation rate of patients. By recognising the influence of mood, mastery, and self-efficacy on pulmonary rehabilitation, nursing professionals can use their knowledge, skills, and empathy to assist patients to gain coping techniques. Such will motivate them to change their behaviour and improve wellbeing. The study also encourages the integration of different care providers that would link the patient with the dietician, the GP, nurse, GP, and rehabilitation services in providing complete COPD care. Such a model would integrate nutritional program as part of a patient’s complete treatment action
Reinforcing physical health. One of the objectives of nurses is to enhance the capacity of patients towards the endurance of exercises. Nurses diagnose patients and develop physical activity plans considering the effects of two walking experiments that evaluate their exercise capability and endurance. However, most COPD patients fear to participate in these processes due to a probability of breathless and exacerbation of their state. As such, nurses can participant by evaluating, planning, and creating appropriate exercise plans and engage patients to voice their fears and anxieties regarding such plans.
Self-management. Talen (2013) defines self-management as “any formalised patient education programme aimed at teaching skills needed to carry out medical regiments specific to the disease, guide health behaviour change and provide emotional support for patients to control their disease and live functional lives.” Most of the conducted studies supported the role of nurses in promoting self-management for COPD patients. Such management programs can incorporate written and verbal patient education. The essence of this measurement is for facilitating control of nutrition and body weight, energy preservation, collaboration, infection management, recognition of symptom and worsening conditions, participation in exercise, and engagement with healthcare experts.
Activities of daily living and home care. Nurses have primary responsibilities of examining the activities of daily living and helping patients to satisfy their needs. There is a need to evaluate the level of coping that patients have regarding. Nurses can perform multiple functions for COPD patients in their daily adjustment including giving of dietary advice, assisting in diet modification, and guiding them on sleep patterns. Three specific studies (Steurer-Stey et al., 2018; Aboumatar et al., 2019; Howard & Dupont, 2014) focused on home-based respiratory service and other activities for daily living emphasising mild to critically ill patients. The primary content of these services was the assessment of health, exacerbation management, adoption of a healthy lifestyle such as stopping smoking habits, teaching patients about the infection, identification of COPD symptoms, management of infections, and breathing practises and medications. Other services focused on the provision of telephone interviews and information on service referrals. Steurer-Stey et al. (2018) study focused on COPD self-management plan using the Chronic Care Model. Also called “Living well with COPD.”
Appropriate management of COPD in the UK will require nurses to establish positive relationships with patients and deliver patient education aimed at patient self-management. The availability of treatments options indicates that this burden is avoidable, but successful management requires such a collaboration. The regular nurse-patient associations across the various stages of infection management put nurses in a point of advantage to address patients with COPD appropriately. As shown in this results, nurse-patient relationships also serve to deliver patient education, an important required to equip patients in self-management techniques. Using the interventions outlined above, nurses have the responsibility and capacity to identify patients with poor suitability to the existing medications. Besides, nurse-led training and empowerment programs can positively motivate patients to adopt these self-management strategies individually. Most of the studies demonstrated that these measures are associated with improved quality of life, self-efficacy, reduction of depression and anxiety, as well as confidence in management and compliance. The United Kingdom should encourage hospital adoption because it can reduce COPD morbidity and promote clinical outcomes.
Recommendation for Future Studies. Future studies should also focus on the role of nurses in promoting the sexual expression of COPD patients. Sexuality can also affect the psychology of patients, have a detrimental effect on their quality of life, and thus limit their recovery if not well addressed. For instance, lung conditions can inhibit the ability of patients to engage in sexual activities. As such, nurses should advise on the use of a variety of positions. Alternatively, they can recommend an increase in the physical support of partners.
