LOOKING AT LONG-TERM CONDITIONS
COPD in the community: working beyond boundaries In the second monthly column examining long-term conditions, Aysha Mendes discusses the impact of COPD and argues that, wherever it is delivered, treatment must be carried out holistically in order to remain effective
Smoking cessation Smoking is the most important risk factor for COPD and nurses working in the community can play a vital role in supporting patients to stop. However, there are also examples of acute services, the effects of which have rippled out into the community—demonstrating the power of working beyond the typical boundaries of a nursing role. NICE (2010)
Aysha Mendes
Freelance journalist specialising in health, psychology and nursing Email: [email protected]
514
points out that competencies are more important than professional boundaries when it comes to interdisciplinary or multidisciplinary management of COPD. Wendy Harrison, a trainee advanced practitioner in the emergency department of Royal Blackburn Hospital, recently won a community nursing award despite not being a community nurse. Wendy implemented a smoking cessation intervention for patients admitted into the emergency department with COPD exacerbations. Whether a patient’s condition has been caused by factors within or beyond their control, they need information about what they can do to prolong their lives and live better.
Shared responsibility There is a continual push to manage long-term conditions in the community where possible, promoting patient autonomy, awareness, responsibility and self-care, while freeing up hospital beds and resources. However, home care is not suitable for all patients with COPD and there are several factors to consider when deciding whether a patient should be treated in hospital or at home (NICE, 2010). One thing that remains constant across the boundaries of nursing, health care and COPD is that all patients must be treated as a whole person (holistically) despite the inevitability of fragmented services. They should be regularly assessed and treated both physically and psychologically, and any comorbidities should be taken into account (NICE, 2010). Governments, too, share a responsibility in commissioning appropriate training for COPD, as well as equipment that will enable community nurses to carry out blood gases and oxygen assessment, for instance. The Government, along with everyone within and beyond health care—particularly patients themselves—should be working to reduce environmental fumes and promote healthy, smoke-free and physically active living. Nonetheless, there is no substitute for supportive patient-centred nursing care and the effects of this on patients living with COPD cannot be underestimated. BJCN Department of Health (2011) An outcomes strategy for chronic obstructive pulmonary disease (COPD) and asthma in England. NHS Companion Document. http://tinyurl.com/o9bqkms (accessed 17 September 2014) National Institute for Health and Care Excellence (2010) Chronic obstructive pulmonary disease. NICE clinical guideline 101. http://tinyurl.com/o6elxst (accessed 22 September 2014) NHS Choices (2012) Chronic obstructive pulmonary disease. http://tinyurl.com/ c45ohye (accessed 17 September 2014) NHS Right Care (2014) Introducing the Atlas of Variation in Healthcare for People with Respiratory Disease. http://tinyurl.com/b9ve8nv (accessed 17 September 2014) World Health Organization (2014) COPD management. http://tinyurl.com/ kgy3e5v (accessed 17 September 2014)
© 2014 MA Healthcare Ltd
A
fter cancer and circulatory disease, respiratory disease is the third leading cause of death in England (NHS Right Care, 2014). Chronic obstructive pulmonary disease (COPD), in particular, kills more than 25 000 people a year in England and Wales (Department of Health (DH), 2011). COPD is a lung disease characterised by airflow obstruction and progressive lung damage and it covers chronic bronchitis, emphysema and chronic obstructive airways disease (DH, 2011). It affects an estimated 3 million people throughout the UK, although only 900 000 of these have been formally diagnosed (National Institute for Health and Care Excellence (NICE), 2010). The most common symptoms of COPD are breathlessness on exertion, a chronic cough with regular sputum (phlegm), frequent winter bronchitis, and wheezing. These symptoms can be easy to dismiss, whether as a smoker’s cough or a normal reaction to cold weather.The World Health Organization (WHO) (2014) emphasises the importance of educating both patients and health professionals that coughing, sputum production and especially breathlessness are not trivial symptoms. While it is not curable, it is largely preventable (NHS Choices, 2012) and community nurses play a crucial role in health promotion. The earlier COPD is diagnosed, the more that can be done to slow its progression and improve the quality of life of patients suffering from it.Although there is no single diagnostic test for COPD, diagnoses are made using clinical judgements based on the patient’s history, physical examination and quality-assured spirometry to confirm airflow obstruction (NICE, 2010). Treatment for COPD is usually a combination of pharmacological therapies to control symptoms and nonpharmacological interventions in the form of psychological support or assistance with lifestyle changes.
British Journal of Community Nursing October 2014 Vol 19, No 10
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 15, 2015. For personal use only. No other uses without permission. . All rights re
COPD in the community: working beyond boundaries In the second monthly column examining long-term conditions, Aysha Mendes discusses the impact of COPD and argues that, wherever it is delivered, treatment must be carried out holistically in order to remain effective
Smoking cessation Smoking is the most important risk factor for COPD and nurses working in the community can play a vital role in supporting patients to stop. However, there are also examples of acute services, the effects of which have rippled out into the community—demonstrating the power of working beyond the typical boundaries of a nursing role. NICE (2010)
Aysha Mendes
Freelance journalist specialising in health, psychology and nursing Email: [email protected]
514
points out that competencies are more important than professional boundaries when it comes to interdisciplinary or multidisciplinary management of COPD. Wendy Harrison, a trainee advanced practitioner in the emergency department of Royal Blackburn Hospital, recently won a community nursing award despite not being a community nurse. Wendy implemented a smoking cessation intervention for patients admitted into the emergency department with COPD exacerbations. Whether a patient’s condition has been caused by factors within or beyond their control, they need information about what they can do to prolong their lives and live better.
Shared responsibility There is a continual push to manage long-term conditions in the community where possible, promoting patient autonomy, awareness, responsibility and self-care, while freeing up hospital beds and resources. However, home care is not suitable for all patients with COPD and there are several factors to consider when deciding whether a patient should be treated in hospital or at home (NICE, 2010). One thing that remains constant across the boundaries of nursing, health care and COPD is that all patients must be treated as a whole person (holistically) despite the inevitability of fragmented services. They should be regularly assessed and treated both physically and psychologically, and any comorbidities should be taken into account (NICE, 2010). Governments, too, share a responsibility in commissioning appropriate training for COPD, as well as equipment that will enable community nurses to carry out blood gases and oxygen assessment, for instance. The Government, along with everyone within and beyond health care—particularly patients themselves—should be working to reduce environmental fumes and promote healthy, smoke-free and physically active living. Nonetheless, there is no substitute for supportive patient-centred nursing care and the effects of this on patients living with COPD cannot be underestimated. BJCN Department of Health (2011) An outcomes strategy for chronic obstructive pulmonary disease (COPD) and asthma in England. NHS Companion Document. http://tinyurl.com/o9bqkms (accessed 17 September 2014) National Institute for Health and Care Excellence (2010) Chronic obstructive pulmonary disease. NICE clinical guideline 101. http://tinyurl.com/o6elxst (accessed 22 September 2014) NHS Choices (2012) Chronic obstructive pulmonary disease. http://tinyurl.com/ c45ohye (accessed 17 September 2014) NHS Right Care (2014) Introducing the Atlas of Variation in Healthcare for People with Respiratory Disease. http://tinyurl.com/b9ve8nv (accessed 17 September 2014) World Health Organization (2014) COPD management. http://tinyurl.com/ kgy3e5v (accessed 17 September 2014)
© 2014 MA Healthcare Ltd
A
fter cancer and circulatory disease, respiratory disease is the third leading cause of death in England (NHS Right Care, 2014). Chronic obstructive pulmonary disease (COPD), in particular, kills more than 25 000 people a year in England and Wales (Department of Health (DH), 2011). COPD is a lung disease characterised by airflow obstruction and progressive lung damage and it covers chronic bronchitis, emphysema and chronic obstructive airways disease (DH, 2011). It affects an estimated 3 million people throughout the UK, although only 900 000 of these have been formally diagnosed (National Institute for Health and Care Excellence (NICE), 2010). The most common symptoms of COPD are breathlessness on exertion, a chronic cough with regular sputum (phlegm), frequent winter bronchitis, and wheezing. These symptoms can be easy to dismiss, whether as a smoker’s cough or a normal reaction to cold weather.The World Health Organization (WHO) (2014) emphasises the importance of educating both patients and health professionals that coughing, sputum production and especially breathlessness are not trivial symptoms. While it is not curable, it is largely preventable (NHS Choices, 2012) and community nurses play a crucial role in health promotion. The earlier COPD is diagnosed, the more that can be done to slow its progression and improve the quality of life of patients suffering from it.Although there is no single diagnostic test for COPD, diagnoses are made using clinical judgements based on the patient’s history, physical examination and quality-assured spirometry to confirm airflow obstruction (NICE, 2010). Treatment for COPD is usually a combination of pharmacological therapies to control symptoms and nonpharmacological interventions in the form of psychological support or assistance with lifestyle changes.
British Journal of Community Nursing October 2014 Vol 19, No 10
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 15, 2015. For personal use only. No other uses without permission. . All rights re
