COPD Quality Improvement Teaching

Improvement Areas

Chronic obstructive pulmonary disease (COPD) is the “third leading cause of death in the United States that causes serious long-term disability” (nhlbi.nhi.gov, 2012). It has also bereaved very many families worldwide and the rate of those affected is ever increasing. According to nhlbi.nhi.gov, (website) more than 12 million people are currently diagnosed with COPD and another 12 million have no knowledge of it though they may be carrying it. This is sad indeed. COPD is a chronic disease that makes it difficult to treat after it has accumulated within and without the lungs over a period. As stated, millions are unaware of their situation until they hit a stage where they are unable to breathe. It has happened for long and it is time people learned ways to treat, manage and “improve their quality of life” (Ibid). This requires teaching and training in a clinical setting.

Only a few clinics or health centers teach people how to manage their bronchioles. As it takes time to develop, not many people even consider going for a checkup. A healthcare provider or a clinician should be a call away if new or old symptoms appear that may suggest COPD. A healthcare provider ensures that a patient adheres to physical or “simple” rules such as “quit smoking, avoid exposure to air pollution and following treatment advice” (Ibid). However, it is in a clinic that a patient will get to understand the scientific complications that happen when a COPD patient disregards this rule.

The elastic air sacs within the lungs help to maintain the lung shape as they let air in (oxygen) and out (CO2).  These sacs lose their shape as they lose air then “bounce back” when air fills it. A person affected with COPD may have swollen or thick air sacs that facilitate the production of mucus that blocks these sacs. This is how breathing is affected. One may not easily comprehend these basics and a chart of the pulmonary system is more than necessary. This situation obliges the patient to seek a special place such as a clinic with a healthcare provider who will train, teach and advice accordingly. To understand the dangers of smoking or staying in polluted and unventilated rooms, a person will need to know the effects from top to bottom.

Identify the Source of Information for Needed Change

COPD patients and everyone in general needs a regular check-up in a licensed clinic or with an authentic healthcare provider. This is the first step in comprehending about the sources of information for such. From this stage (doctor’s advice), a patient would be at a better position to consult COPD patients near him or far away if traveling is possible. This is an important source of information even with the clinics at the doors. COPD support groups are offered in many hospitals (preferably local) and in community centers. A “new” patient may have to learn how to manage this condition. A doctor who lacks this infection may be a teacher and not a mentor.

In fact, a good trainer has to learn from one who has overcome COPD or is living with it. Other sources as advised by nhibi.nih.gov (website) include pulmonary rehabilitation centers or rehab. It is a program that “helps one to learn to exercise and manage COPD with physical activity and counseling.” Life has to go on thus a patient has to maintain the activity levels every time. These sources are vital before one decides to go for surgery if the extreme occurs. These sources can also be found online and it is not a requirement that a patient has to visit a doctor to acquire medication. For example, physical therapy can be done by just a click of a button from watching a recorded clinical set.  Nevertheless, a proper follow up on these sources will help one take control of his or her pulmonary condition.

3. Describe the specific group for the project, including demographics, ages, gender, cultural, ethnic, spiritual, developmental stages, knowledge deficits, and learning needs.

A health plan is needed to identify which patients will participate in this project. Eligible patients as an obvious requirement have to be diagnosed with COPD. They should also be local residents in that they should come from near the clinic. However, if a transport means is available; then a patient from far can be considered. The criteria for choosing should have a median age of 50 years and above for both sexes. This will enable the healthcare provider to ascertain whether the disease is of high or moderate complexity. The full effect of Medicare should be seen at the extremes. However, young Medicare cohort (COPD subjects or patients) can also be considered. They can be used as a control experiment. Other group specifics can also be included.

Ethnic background will not be a necessary consideration unless where culture or spirituality (religion) has a distinguished role. For example, cultures that accept tobacco smoking will be highlighted. As stated, the old preferably >50 years will be involved though there must be a young generation. This helps in defining the developmental stages required for recovery and learning needs. These two age groups have a different understanding level. This will be used to the clinic’s advantage.

4. Develop a teaching plan to meet the identified needs and include:

a. Lesson content

The study population will go through process and outcome evaluations (Hulscher et al., 2003). Recent education trials by health professionals show that evaluations are important lessons even for COPD patients. According to “Monninkhof et al (2003), knowledge has to be transferred from the health professionals to the COPD patients. Bourbeau et al (2004) state that patient outcomes have only been increased after patient education trials. Patient self-efficacy or disease management will also be introduced in the lesson (Monninkhof et al., 2003, Bourbeau et al 2004). Self-efficacy will help in ascertaining behavioral determinants (Armitage and Conner 2000; Fishbein et al., 2001). The last lesson is on systematic program development. This will look at the methods and their impacts on the health improvement of patients.

b. Teaching strategies

Conversation is one major strategy. Here, the teacher helps the patient to manage her medication and treatment therapy.  According to Scullion (2010), people with COPD can only succeed in treatment when they change their lifestyle and adhere to treatment. This requires communication on both parties. A participatory approach is another strategy. The teacher here takes part in all the training and practical exercises directed to patients. Lastly, trainers should follow up on their patients to ensure adherence to advice.

c. Time/Site/Community resources

Physical exercises will be scheduled for 3 hours every day. It will commence at 7 am. The following period will be divided into conversations, process/outcome evaluations and follow up on medication. The patients will use the community center near the office for physical activity.

d. Plan for collaboration with other health care professionals

The clinic will plan to engage the services of other health care professionals. They include nurses who have handled OCPD exacerbation patients, doctors, healthcare providers, Medicare centers and physical therapists. These will be able to give guidelines as well as help in the treatment exercise. Their services can also be engaged online where the clinic will have to register. An example can be {http://www.nhlbi.nih.gov/studies/index.htm}. The healthcare professionals will be required to guide patient recruitment and conduction of clinical trials.

e. Explain how services will be coordinated

Hospital services that are beyond the clinic will be handled by the hospitals. The clinic will not keep a patient in unclear conditions of health. Coordination will be reserved for patient care services. This will ensure collaboration of the faculty, clinical attendants and the patients. Communication between the COPD patients and the support groups will closely be coordinated to ensure the patients adopt a positive strategy.

f. Evaluation plan for participants to evaluate program or post-test

Subjective and objective data will be used to evaluate the goal of this program (Diana, 2011). Pre and posttests will be carried out to examine the patient’s comfort level. It will require a verbal exchange and measurement of pain. For example, if pain when breathing went from 6/10 to 4/10 after an exercise then the necessary adjustment will have to be made (Diana, 2011). On an objective approach, the several aspects will have to be checked from the participants. They are “oxygen saturation level, rate and depth of breathing and activity tolerance” (Ibid). There can be improvement if the oxygen level rises from 89% to 95%. Advice is given on how to balance the rate and depth of breathing. The patient is also “motivated to ambulate for a short distance with assistance and increase fluid intake by 16 ounces” (Ibid).

5. Implement the plan following approval of faculty and other appropriate professionals and/or officials.

The clinic would begin its operations after instilling a health education program. The healthcare team will develop a plan where they inform the patients about chronic illnesses. The nurse should ensure the patients understand the health plan as a major goal towards their education at the clinic. Other aspects that will be made clear include “learning readiness, learning environment, teaching techniques and the population” (Diana, 2011). As stated earlier, the clinic will enroll more old patients (>50 years) and less (<50 years). After this, the plan will move to understanding the medical history of patients.

This will be critical in analyzing the outcomes and helping instill self-efficacy. A 50-year-old female patient with COPD exacerbation has a medical history of “myotonic muscular dystrophy, hypertension and obesity” (Ibid). These chronic illnesses may cause fatigue, break jobs and make destroy their health, as they may not even have the strength to cook. The other two patients are 62 years and 38 years old OCPD patients. The younger patient was a male while the elder were female. The older patients (62 years and 50 years) were asked about their management techniques, they said that they do not use inhalers as they feel a hoarse after effect on the throats. Religion plays a huge role in handling their situations as this may mean she goes to church (she is a Christian) or have her local pastor visit her regularly. Their spouse and close family members offer emotional support and therapists’ visit sum it up. The older patients may also have suffered from “impaired gas exchange, failed therapy management, knowledge deficiency and acute pain” (Diana, 2011).  The nurse will develop a teaching plan from this assessment to ensure an effective therapy regimen. The next step is to assess the learning needs of the patients.

Conversation is at play here. The patients will be asked how much they know about COPD and why the older patients feel their inhalers was causing hoarse throat after effect as they had stated. The nurse will then teach the patients “effective breathing skills, how to use inhalers, the importance of adequate dietary and fluid intake and how to pace physical activities” (Ibid). Patient background knowledge will help the nurse understand the side effects of “patient medication, the anatomy and physiology of the respiratory system and how it differs in COPD patients.” In addition to that, the nurse will assess the readiness of the patients to learn. Here is where one takes in the aspects of culture or religion that may inhibit the patient’s learning process. It also makes clear what is good or what causes anxiety in the learning process.

Since the patients have their families, then it is important that the nurse schedules visiting hours for the afternoon after they have had her morning exercises and medication. However, no restrictions will be given if a pressing matter arises. Hard medical jargons should be avoided if the patients feel they are complicated and would cause distraction. Rest periods are necessary in between the sessions to ensure fatigue does not give in. The nurse will communicate the importance of buildup exercises and the goal of physical fitness. However, they must start small as their tolerance level gradually picks. This will be an indication of successful hard and consecutive breathing.

Nevertheless, the patients will be on a given amount of oxygen dose such as 2L. This will keep the “saturation levels above 90%” (Diana, 2011). Of major importance is that they begin to breathe on their own. Inhalers have to be used with a spacer in order for it to be effective. This will prevent the hoarse voice or throat. The two old patients had been diagnosed with a case of myotonic muscular dystrophy that contributed to their fatigue. This nurse will liaise with neurologists; put them on high fiber (vegetable) diet and use supportive if necessary. However, physical fitness will be vital to the treatment campaign. Lastly, the nurse will have to connect the patients with COPD support groups and “rehab” centers to ensure they learn the coping techniques. Follow up will be regularly made to ensure progress is made even at home.

6. List and describe the following:

a. Implementation date/responsible party

The date of implementation will commence two weeks after validation by the approval of faculty and other appropriate professionals and/or officials. This time is important as it gives the patients a period of adjustment and equipping the clinic with relevant medication implements. Three healthcare providers (nurses) have also been selected to help in the care. The first phase of this project is two months.

b. Participation data (Summary of demographics of participants).

Three participants have been selected to begin the medication strategy. Two are old women of 50 years and 62 years while the younger one is a male of 38 years. The young man is not only a participant but a control experiment as well. His reaction to treatment will not be expected to concur with the two old women unless he develops health complications ahead. All of them have spouses and children (not toddlers) who are relevant in facilitating treatment. They come from near the clinic so it is easy for the therapists (nurses) to visit them at home

c. Teaching/learning outcomes based on evaluation or posttest

The assessment was on a weekly basis. All patients had their pain levels reduce after the first week of training. This was a tremendous improvement as it reflected on the rate and depth of breathing. Fluid intake was also increased. It was also identified that all patients were victims of smoking and frequently found themselves in polluted areas.

d. What are the projected results of this quality improvement project?

Pain decreased from 6/10 to 4/10 in all patients. The two elder patients had their oxygen level shoot up from 89% to 95% while that of the young man (38 years) shot from 93% to 96%. After the first month, the two elder patients had managed to recover a faster pace of breathing and could move longer distances (1 km) without using their supportive elements such as canes, ankle and wrist braces. This was a huge step towards treating myotonic muscular dystrophy.

Conclusion

To recapitulate, OCPD has been identified as a killer respiratory disease. This is despite the fact that numerous treatment agencies have been established in hospitals. This quality improvement-teaching project seeks to establish a clinic that specifically handles COPD patients giving relevant remedial assistance. Various sources of information have been identified to help the clinic’s operation. COPD support groups have been identified as most vital as they give a real treatment experience, which patients can associate with. Patients’ demographics were considered. The project had to record the age, religious affiliation and culture of patients before commencing the projects. The project was slated to begin two weeks after approval by the authority. Three patients were picked and their all made a positive response to treatment. Learning needs were identified and the proper mechanisms installed. This project is indeed a success and it bridges the gap between COPD and self-efficacy treatment 

References

Armitage C. J, Conner M. (2000). Social cognition models and health behavior: a structured review. Psychol Health.; 15:173–89

Bourbeau J, Julien M, Maltais F, et al. (2003). Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention.Arch Intern Med.; 163:585–91. [PubMed]

Diana, B. (2011). Patient teaching Plan: COPD. Retrieved from http://dianab90.wordpress.com/2011/07/13/patient-teaching-plan/. Updated on July 13, 2011. Accessed on August 30, 2013 at 09: 34 am

Dunn, N. (2001). Keeping COPD patients out of the ED; chronic obstructive pulmonary (Web resource. Retrieved from {http://www.modernmedicine.com/modern.../keeping-copd-patients-out-ed. Updated on February 2001. Accessed on August 29, 2013 at 10:00 pm

Monninkhof E.M, van der Valk P.D, van der Palen J, et al. (2003). Self-management education for chronic obstructive pulmonary disease. Cochrane Database of Syst Rev. 2003:CD002990. [PubMed]

National Heart, Lung, and Blood Institute. (2012). Breathing better with COPD diagnosis. (Web resource. Retrieved from {http://www.nhlbi.nih.gov/health/public/lung/copd/campaign-materials/html/copd-patient.htm}. updated on January, 2012. Accessed on February 29, 2013 at 10:50 pm 

Scullion, J. (2010). Helping patients with chronic obstructive pulmonary disease adhere to regimens. Retrieved from http://dianab90.wordpress.com/2011/07/13/patient-teaching-plan. Accessed on August 30, 2013 at 11:10 am

World Health Organization (2008). COPD predicted to be third leading cause of death in 2030.[http:/ / www.who.int/ respiratory/ copd/ World_Health_Statistics_2008/ en/ print.html] website. Updated on January 13, 2008. Accessed on August 30, 2013 at 11:00 am.