Self‐management behaviours for patients with chronic obstructive pulmonary disease: a qualitative study

Title. Self‐management behaviours for patients with chronic obstructive pulmonary disease: a qualitative study. Aim. This paper is a report of a study to explore the self‐management behaviours of patients with chronic obstructive pulmonary disease (COPD). Background. Chronic obstructive pulmonary disease is a major cause of chronic morbidity and mortality throughout the world. A patient‐centred perspective calls for the investigation of self‐management behaviours as means to develop self‐management programmes and enhance quality of life for patients with COPD. Method. The participants were a convenience sample of 18 patients with COPD of various severities. Interview data were collected in the thoracic ward, outpatient department and pulmonary rehabilitation unit of a medical centre in Taiwan from November 2006 to April 2007. Findings. Participants demonstrated the ability to choose suitable disease management behaviours to prevent symptoms and complications. Five themes of disease management behaviours were identified: symptom management, activity and exercise implementation, environmental control, emotional adaptation and maintaining a healthy lifestyle. Conclusion. Participants are experts on their lives and, as such, they adopt appropriate disease control behaviours, based on their experience and knowledge, as well as integrate the illness and its symptoms into their lives. With the worldwide increase in migration, an understanding of the cultural factors that influence patients’ perspectives on self‐management behaviours is necessary and can contribute to the development of an evidence‐based programme for disease self‐management with COPD.     

Improving self‐care efficacy and quality of life with a self‐management program among patients with chronic obstructive pulmonary disease: A quasi‐experimental study

Self‐management helps patients understand their illnesses and learn about disease‐related skills so they can better manage their situation. However, published studies on the effectiveness of self‐management for chronic obstructive pulmonary disease (COPD) are heterogeneous. Quasi‐experimental design was used to investigate the effectiveness of a self‐management program in self‐care efficacy and quality of life in patients with COPD. Sixty participants who had experienced COPD were assigned to control group (usual care) or experimental group (self‐care program) (1:1 ratio) according to a purposeful sampling at a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale, the Clinical COPD Questionnaire were used to analyze data. The Medical Research Council dyspnea scale was more significant improvement in the 2 months after discharge in the experimental group than in the control group. The COPD Self‐Efficacy Scale and Clinical COPD Questionnaire scores in the experimental group within 3 months after discharge were significantly improved compared with the control group. These findings demonstrate the application and initial effect of this self‐management program.     

Need of support in people with chronic obstructive pulmonary disease

Aim and objective

The aim of this study was to describe peoples’ experiences and expectations of support when living with chronic obstructive pulmonary disease.

Method

We conducted and analysed face‐to‐face or telephone interviews with 17 individuals (aged 44–77 years) diagnosed with chronic obstructive pulmonary disease. The interviewer asked open‐ended questions aimed at encouraging further narration, and we analysed the participants’ narratives using a phenomenological hermeneutical approach. This report adheres to the COREQ guidelines.

Results

The overall theme suggests that people with chronic obstructive pulmonary disease describe support as shared knowledge and experiences, based on the following subthemes; similar experiences, the need of genuine professional knowledge, self‐reliance versus self‐blame, and the Internet – feeling safe but uncertain.

Conclusions

People with chronic obstructive pulmonary disease find their strength through shared knowledge and dialogical support with others who have similar experiences and with professionals. A person‐centred eHealth approach may be suitable for this group as it offers both collaboration and support.

Relevance to clinical practice

There is a demand for access to genuine professional knowledge as additional support to patients’ own capabilities and needs. Patient associations were assessed as reliable sources of information and to some extent also support, but the importance of access to professional sources was also stressed.     

Living with chronic obstructive pulmonary disease: developing conscious body management in a shrinking life‐world

Title. Living with chronic obstructive pulmonary disease: developing conscious body management in a shrinking life‐world. Aim. This paper is a report of a study to explore the changes experienced by the person living in a body with chronic obstructive pulmonary disease. Background. Chronic obstructive pulmonary disease is the world’s fourth leading cause of death, and the World Health Organisation predicts further increases in prevalence and mortality. Despite a growing body of associated knowledge, there remains much to learn about patient and family‐driven goals for medical and surgical treatment to guide nursing practice, to support self–management strategies, and to provide a context for therapeutic outcomes. Methods. Merleau‐Ponty’s philosophy of the body provided a framework for this Heideggerian phenomenological inquiry with 15 people with emphysema and 14 of their family members. The participants were drawn from three Australian teaching hospitals. Hermeneutic analysis was used to interpret 58 in‐depth interviews conducted between 2003 and 2005. Findings. People with severe emphysema experience a shrinking life‐world shaped by breathlessness. This diminishes the predictability and automatic nature of their bodies and their perceived effectiveness as a person. They develop a number of strategies of conscious body management to facilitate breathing, mobility and task completion. Conclusion. Understanding of the person’s changed body and the resulting expertise that those living with chronic illness bring into care and assessing and facilitating this expertise are central to planning sensitive and appropriate care and evaluating outcomes for medical or surgical therapies that are perceived as meaningful to the person.     

A community model of group therapy for the older patients with chronic obstructive pulmonary disease: a pilot study

OBJECTIVE: A community-based programme for chronic obstructive pulmonary disease (COPD) patients in group sessions is designed, and the feasibility, acceptability and physical and psychosocial outcomes evaluated. METHODS: Patients with COPD discharged from hospital, or those attending specialist outpatient clinic, with a history of hospital admission owing to COPD in the preceding 12 months were recruited. Those who had malignancy or were housebound were excluded. Group sessions were arranged once a week in a Community Centre, and consisted of two hourly sessions. The components of each session consist of education regarding the disease, breathing techniques, use of oxygen and other medication, smoking cessation, nutrition, dyspnoea management skills, relaxation and energy conservation techniques, introduction of social and community support, and strengthening as well as aerobic exercises. Assessments before and after intervention include lung function, 6 minutes walk test (6MWT), general Health Questionnaire (GHQ), the St. George's Respiratory Questionnaire (SGRQ), and a COPD knowledge Questionnaire. A programme evaluation was carried out using questionnaire and group discussions. RESULTS: Forty-four subjects were recruited, with 75% completing the programme, and 20% with drawing for unavoidable reasons. Statistically significant improvement was noted in all domains of the GHQ, SGRQ, and knowledge test, while the mean 6MWT improved, although statistical significance was not reached. Subjects were enthusiastic about the provision of this service in helping them cope with the disease through empowerment and mutual support. CONCLUSION: A group community intervention programme for COPD patients is feasible and acceptable, with positive psychosocial outcomes. Such a model could be further developed and cost-effectiveness evaluated as a model of chronic disease management in the community.     

老年慢性阻塞性肺疾病合并肺性脑病的护理

目的探讨护理干预对老年慢性阻塞性肺疾病(COPD)合并肺性脑病的影响。方法对5例COPD合并肺性脑病患者进行心理护理、合理氧疗护理、血气分析监测护理、病情观察、饮食护理、出院指导。结果 5例患者均好转出院,护理满意率为100%。结论护理干预能提高治疗依从性,有利于患者康复。     

慢性阻塞性肺疾病患者自我管理能力及影响因素研究

目的调查慢性阻塞性肺疾病患者自我管理能力及影响因素。方法采用自我管理问卷对湖南省413例慢性阻塞性肺疾病患者进行自我管理能力及影响因素调查。结果慢性阻塞性肺疾病患者自我管理水平得分为73～219(152.52±28.71)分。自我管理水平中等及以上者133例,占32.20%;自我管理水平低者280例,占67.80%;初中及以下文化程度、家庭人均月收入≤500元、全部自费、病程≤5年与低自我管理水平有关;高中或中专文化程度、家庭人均月收入501～1 500元、医疗费用部分报销、病程≥16年与中等及以上自我管理水平有关;男性对两者皆有影响。结论慢性阻塞性肺疾病患者自我管理水平不高,影响慢性阻塞性肺疾病患者自我管理水平的因素有性别、文化程度、家庭人均月收入、付费方式及病程。     

延续护理对COPD合并呼吸衰竭患者的自我管理能力影响效果研究

目的评价延续护理对COPD合并呼吸衰竭患者自我管理能力影响效果。方法成立COPD延续护理小组,制订康复方案并按康复方案实施延续护理。结果观察组患者出院后3个月的自我效能、健康知识水平、自我护理技能、日常生活能力、自我管理能力总分均高于对照组(P0.01);观察组患者在出院后3个月的12项一般健康问卷,圣乔治呼吸问卷得分高于对照组(P0.01或P0.05)。结论 COPD合并呼吸衰竭患者实施延续护理,能提高患者的自我管理能力,改善患者心理状态和生存质量。     

慢性阻塞性肺疾病病人症状体验与自我效能感的相关性研究

目的:调查慢性阻塞性肺疾病病人的症状体验情况和自我效能感水平,分析两者间的相关性。方法:纳入2018年10月—2019年6月就诊于医院的147例慢性阻塞性肺疾病病人作为研究对象。病人填写一般资料调查表、记忆症状评估量表和慢性阻塞性肺疾病自我效能感量表。结果:病人最常见的5个症状分别为气促/呼吸困难、缺乏活力、咳嗽、焦虑不安和睡眠不足。自我效能感量表总分为(78.13±17.57)分,得分指标为50.4%。病人的症状体验得分与自我效能感量表得分呈负相关(P<0.05)。结论:慢性阻塞性肺疾病病人的症状体验较差,自我效能感为中等水平,两者之间呈负相关。临床医护人员要注意同时加强病人的症状管理和提高其自我效能感。     

慢性阻塞性肺疾病患者社区支持性干预及健康管理研究进展

文章归纳了慢性阻塞性肺疾病患者社区干预研究中的支持性药物干预、长期氧疗、戒烟干预、肺康复干预、支持性心理行为干预及健康管理的内容、形式和方法,在此基础上对慢性阻塞性肺疾病社区支持性干预及健康管理研究进行了展望。     

Fatigue in patients with chronic obstructive pulmonary disease

BACKGROUND: Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease (COPD). Despite this, relatively few studies have objectively assessed patients' perceptions of fatigue and the impact of perceived fatigue on their everyday lives. OBJECTIVE: The purpose of this study was to describe the prevalence, duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive, physical and psychosocial functioning in comparison with controls. METHOD: The Fatigue Impact Scale, including physical, psychosocial and cognitive dimension and structured questions about the frequency, duration, and severity of fatigue was mailed to 44 outpatients with COPD and 88 randomly selected age- and sex-matched controls. In total 36 patients and 37 controls completed the questionnaire. RESULTS: Almost half of the patients (47.2%), reported fatigue every day during the preceding month compared with 13.5% of the control group (P < 0.001). The duration of fatigue was more than 6 hours in 52.7% of the patients and 44.4% reported that fatigue was either the worst or one of the worst symptoms they had, compared with 18.9% (P < 0.001) and 10.8% (P < 0.01) in the control group. The patients reported a significantly greater impact of fatigue on cognitive, physical and psychosocial functioning compared with the control group (P < 0.001). CONCLUSION: These findings indicate that fatigue is a highly prevalent symptom, which impacts on patients' functional condition and needs to be professionally assessed and managed.     

慢性阻塞性肺疾病急性加重患者的护理体会

目的探讨慢性阻塞性肺疾病急性加重期患者的护理方法和体会。方法 54例住院的慢性阻塞性肺疾病急性加重期患者予以控制感染、对症治疗和呼吸功能锻炼,同时采取相关的护理干预措施,包括一般护理、饮食护理、心理护理、劝告戒烟、用药护理和呼吸专科护理。结果本组54例患者治愈50例,好转4例。结论慢性阻塞性肺疾病急性加重期患者在急性发作期实施相应的护理措施,能有效地改善肺功能,稳定或逆转肺部疾病所引起的病理生理改变和心理障碍,杜绝和减少护理失误,提高护理质量,促进患者早日康复。     

社区慢性阻塞性肺疾病缓解期患者遵医行为的调查分析

目的 了解社区慢性阻塞性肺疾病缓解期患者的遵医行为.方法 对32例患者进行问卷调查,计数资料以百分比统计.结果 慢性阻塞性肺疾病缓解期患者对纠正不良生活习惯、药物治疗、康复训练的重要性认识不足,不能按医嘱正确实施,疾病出现反复时多数患者没有立即就医.结论 慢性阻塞性肺疾病缓解期患者对疾病遵医行为和正确认知态度不仅有个体和时间段坚持性的差异,同时受亲情等因素的影响,社区卫生服务中应提供更客观、符合个体需求的有效服务措施.     

小组工作对社区老年慢性阻塞性肺疾病病人自我管理的影响

[目的]探讨小组工作对社区老年慢性阻塞性肺疾病病人自我管理的影响。[方法]应用社区小组工作法干预社区老年慢性阻塞性肺疾病病人,将研究对象随机分为对照组(n=44)和试验组(n=40),对照组采用常规社区健康教育法,试验组在常规社区健康教育基础上进行小组工作干预。分别于出院时、出院后3个月应用慢性阻塞性肺疾病病人自我管理量表调查并进行比较分析。[结果]试验组病人自我管理水平提高较对照组明显,两组比较差异有统计学意义(P0.05)。[讨论]小组工作能提高社区老年慢性阻塞性肺疾病病人自我管理水平,是一个社区健康教育的可行途径。