¶ … family copes with COPD COPD Nursing Intervention: Patient and Family Coping

The objective of this work in writing is to analyze current literature and apply various nursing approaches to a family experiencing a complex health challenge related to their current clinical practice experience.

Chronic Obstructive Pulmonary Disease (COPD) is a "progressive illness characterized by airflow obstruction and dyspnoea that afflicts over 12 million people and represents a leading cause of death in the United States. Not surprisingly, COPD is often associated with emotional distress and reduced psychosocial adjustment, which can negatively affect physical functioning and impair quality of life. However, the psychosocial consequences of COPD remain largely untreated." (Blumenthal, et al., 2009)

Coping with COPD and Impact on Patient's Family

The Journal of Family Practice article written by Fisher and Weihs (2000) reports that the National Working Group on Family-Based Interventions in Chronic Disease:

"…identified potential mechanisms by which the relational context of the family affects disease management and how characteristics of family relationships serve as risk or protective factors. The data suggest that approaches to the management of chronic disease should be expanded to include the broader relational context in which disease management takes place. A family-focused approach to the management of chronic disease stands in sharp contrast to traditional patient-focused approaches. It emphasizes: (1) defining and assessing the relational context in which disease management takes place; (2) including the family environment and other family members as potential targets for intervention; (3) addressing the educational, relational, and personal needs of the patient and other members of the family; (4) viewing the disease not as a series of acute episodes, but as an ongoing process that requires continuity of care between the health care team and the family; and (5) including the patient and other family members as part of a comprehensive program of outcomes assessment." (Fisher and Weihs, 2000, p.1)

Anne H. Boyle, RN, Ph.D., CNE writes in the work entitled "An Integrated Review of the Impact of COPD on Families" published July 2009, reports a review of nineteen articles on the research on the impact of chronic obstructive pulmonary disease (COPD) on the families of patients and states that the information in this area of research is limited when compared to other chronic disease impact research. Researchers have discovered that COPD patients are "significantly less satisfied with life, less socially active, and more disabled than persons with coronary artery disease, and have a lower mental health status than persons with peripheral vascular disease." (Boyle, 2009 p. 1) Other evidence is reported to indicate that "adjustment and morale of wives with disabled or chronically ill husbands is similar to their spouses -- with poor health linked to having an ill spouse." (Boyle, 2009, p. 1) COPD is reported to be & #8230;characterized by irreversible airway obstruction and typically occurring after years of cigarette smoking, COPD produces symptoms later in life." (Boyle, 2009, p. 1) The challenges faced by the individual with COPD include such as "…dyspnea, fatigue, cough and mucus production, disturbed sleep, and altered appetite, all of which can negatively impact life quality."(Boyle, 2009, p. 1) Shortness of breath affects the mobility of the individual and restricts the ability of the patient in performing common activities. In addition, the individual with COPD experiences such as "…psychological distress, have high rates of anxiety and depression, and impaired cognitive functioning. Families who live with and care for COPD patients must also deal with these challenges as, increasingly, society expects care and support of chronically ill elders to be provided by the family." (Boyle, 2009, p. 1)

The work of Kelly and Lymes (2008) entitled "Psychological Effects of Chronic Lung Disease" states that the "identification and management of the physical signs and symptoms of chronic lung diseases has improved but the psychosocial burden is often unrecognized and neglected." (p.1) Dysponoea is associated with COPD. Dysponoea is described as "a very complex phenomenon, with patients experiencing a mix of physiological, psychological, social, environmental and behavioral responses. Therefore, it follows that successful treatment of dysponoea should not be restricted to bronchodilators or other physiological interventions" (Kelly and Lymes, 2008, p.1) The physical symptoms and the persistent nature of the symptoms as well as the "degenerative trajectory of disease all contribute to psychological responses that impact on patients' quality of life." (Kelly and Lymes, 2008, p.1) The experience of living with COPD is...

(Kelly and Lymes, 2008, p. 1) It is reported as well that research in the area of psychological effects of patients living with COPD "demonstrates that patients with respiratory disease often fare worse than patients with cancer." (Blumenthal, et al., 2009, p. 1) The work of Arne et al. (2007) used grounded theory in interviewing patients with COPD for the purpose of exploring the patient's views at the time they were diagnosed. It is reported "shame proved to be main theme and was related to the notion that their disease was self-inflicted and this was an obstacle when seeking advice. This idea of psychological impact early in the disease trajectory may suggest that the psychological morbidity could be equal to or even greater than the effect of early physical symptoms themselves." (Blumenthal, et al., 2009, p. 1)
It is related that patients with COPD often view themselves as being a burden and this is due to guilt often because the patient has a history of smoking. Even in patients who have not ever smoked there is a stigma in that the disease involves coughing and production of phlegm, which tends to affect negative attitudes from the public and from professionals as well. It is related that the caregivers of those with COPD "may experience psychological problems similar to those of the patient due to "stress in relation to feeling restricted, anxious and profoundly helpless in the face of dysponoea, accompanied by a sense of preoccupation with their relative and a debilitating hypervigilance." (Blumenthal, et al., 2009, p. 1) It is reported that the life expectancy of those with COPD has increased "considerably in recent years" resulting in such as quality of life and psychological well-being increasingly recognized as primary factors in coping for the patient and their family. It is reported that while there is a high incidence of psychological effects for those with COPD as well as for their family, 82% of individuals with COPD do not receive treatment for depression. (Kelly and Lymes, 2008, p. 1) There are several tools available for assessing psychological morbidity however, these are generic in nature. Kelly and Lymes (2008) report that disease-specific tools are such that focus on "aspects of chronic lung disease that affect health-related quality of life" and include: (1) the Chronic Respiratory Disease Questionnaire; or (2) the St. George's Respiratory Questionnaire. (2009, p. 1) Potential drawbacks exist for use of these tools in clinical practice and specifically questionnaires "take time to complete and this can lead to healthcare professionals selecting self-administered versions." (Kelly and Lymes, 2008, p. 1) Self-administered tools may result in erroneous information due to questions being misunderstood. (Kelly and Lymes, 2008, p. 1)

The work of MacNaughton (2009) entitled "COPD Caregiver Perspectives -- Dealing with Depression" states that there are several stages which those with COPD and their caregivers progress and one of these stages is the grieving process and specifically for the caregivers as they slowly watch the person they love fade away. Signs that the depression stage has been entered include: (1) isolation of self from others; (2) difficulty concentrating when away and difficulty sleeping at bedtime; (3) spending less time sleeping or other solitary activities and avoiding social contact; (5) feeling apathetic or numb and lacking the capacity for joy; (6) emotions are on a hair trigger, laughing too loud and crying too easily; and (7) experiencing low energy. (MacNaughton, 2009)

Blumenthal et al. (2009) report that coping skills training (CST) is based on the idea that "cognitive factors such as perceptions, attitudes, beliefs and expectations can have a significant impact on physical symptoms and disability." (p. 1) CST uses such as: (1) training in relaxation; (2) imagery; (3) calming self-statement; (4) activity pacing; (5) symptom monitoring; and (6) communication, for the purpose of symptom reduction as well as reduction of anxiety and depression and to improve physical functioning. (Blumenthal, et al., 2009, p. 1) Stress among caregivers of patients with COPD includes the daily challenges and the experience of 'disruptions in their own emotional well-being and their physical health." (Kelly and Lymes, 2008, p.1) In addition distress among spouses of patients with COPD "has been shown to be associated with low levels of physical functioning of patients." (Blumenthal, et al., 2009, p. 1) It is stated that there is "relatively little known about the psychosocial functioning of caregivers for patients with…