Management And Prevention Of Exacerbations Of COPD

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Management And Prevention Of Exacerbations Of COPD

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Discuss About The Management And Prevention Of Exacerbations Of COPD.

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Introduction
The current assignment focuses upon the aspect of implementing evidence based practices in nursing care. The evidence based practices are well researched healthcare protocols which have been effective in producing desired health effects within the patient. The evidence based approaches helps in improving the quality of care by focussing upon practical methods rather than theoretical approaches. The implementation of the evidence based practices requires effective collaboration between clinicians, researchers. The evidence based practices helps in the implementation of sufficient autonomy and right to informed decision making.
In the current study, chronic obstructive pulmonary disease has been taken into consideration. Therefore, the study will highlight the different evidence based approaches which could be undertaken for the treatment and cure of COPD within the patients. As mentioned by Doyle, Dunt, Ames, Fearn, You & Bhar (2016), COPD affects 14 to 20 million Americans and could lead to increased levels of disability. The article which had been chosen over here takes into consideration cognitive behavioural therapy for management of anxiety and depression within the COPD patients. Reports have suggested that almost one fourth of the people suffering from COPD   are also affected with subclinical depression (Doyle et al., 2017). COPD is often associated with long term physical disability and restricted life patterns. The ones suffering from COPD often experience lower body mass index, associated co-morbidities and sleep dyspnoea. Some of these make the quality of life miserable making the person suffering from COPD gloomier.
The assignment employs a randomised control trial where focus group was sleeted from among patients suffering from COPD with borderline anxiety or depression. In this respect, patients who depicted a ratio of forced expiratory value in one second (FEV)1/ forced vital capacity (FVC) less than 70% were referred   to be suffering from breathing difficulties (Kunik ET AL., 2008).
The methodology adopted for the current assignment was quantitative in nature where survey was conducted using chronic respiratory questionnaire. The responses obtained were used for arriving at statistically significant results.

Overview of the article
The article here focuses upon the treatment and management of chronic pulmonary obstructive disorder. The intervention methods which were used for the focus group over here was six minute walking distance and use of health services. Both of these methods had been seen to deliver positive health outcomes. The article focuses upon COPD as a major health debacle and also takes into consideration other associated health con-morbidities such as anxiety and depression. As mentioned by Geiger-Brown  et al. (2015), acute anxiety has been seen to make the situation of COPD worse.   Anxiety triggers the synthesis of adrenaline which could righty develop a feeling of breathlessness within the patient (Heslop-Marshall et al., 2015). The paper mainly discusses two broad intervention methods for the treatment of CBT, which are CBT group treatment intervention and COPD Education intervention. These two therapies have been rightly referred to over here as the behaviour therapy helps in changing the reactions or the responses of the patients to particular behaviour therapy.
The focus groups were provided with one hour sessions of CBT, which integrated interventions for both anxiety and depression. There were total eight sessions designed for the participant group which comprised of – awareness training focused in anxiety, depression   and other psychological symptoms; relaxation training; increasing the number of pleasurable activities; cognitive therapy; problem solving skills; sleep management skills and future planning for maintenance of gains.
As mentioned by Hynninen & Nordhus (2017), practising relaxation techniques such as deep breathing can also help in reducing the stress levels of the patient along with increasing the forced vital capacity. In the current study the treatment was administered to a group of 10 patients and here each group was led by a counsellor with significant experience in CBT for the management of anxiety and depression.   The session would begin with group discussion and review of symptoms. The exercise was designed with the view of encouraging group interactions while emphasizing upon individual skill building. Therefore, the article successfully discusses the impact of holistic care approaches for the management of anxiety and depression in the patient. As suggested by Cully  et al. (2017), some of these methods could make the patient more self sufficient and restore autonomy within the patient. The holistic care approaches were delivered with a motive of making the patient more self aware regarding their present health status and have a more positive outlook towards the chronic condition management for COPD (Farver-Vestergaard, 2018). It was found that most of the patients had given positive feedback regarding the long term benefits of cognitive behavioural therapy in the management of anxiety and depression.
The second method which had been selected over here was education intervention for COPD. It included eight sessions of COPD education. Some of the topics included breathing strategies, airway management, pathophysiology of lung disease, medications, use of oxygen, being aware of exercises and reducing the exposure to environmental pollutants. It was found that the educational sessions were useful in reducing the doubts in the participants regrading the efficacy of the therapy methods. The educational sessions were taped in order to view the competent of the therapists in delivering the health objectives. Therefore, some of the educational strategies incorporated over here such as using anti-pollution masks and practicing deep breathing exercises have been found to be beneficial over here (Barrera, Grubbs, Kunik & Teng, 2014). From the discussion of paper, it was inferred that the cognitive behavioural therapies produced much better results compared to educational awareness for COPD within the patients. Additionally, the survey questionnaire used over here helped in arriving at statistically significant results. These results were further represented in the form of graphs and charts which made the analysis easier. Additionally the results obtained from the different intervention methods were compared for arriving at a conclusive theory. Majority of the responses were obtained in the favour of the cognitive behavioural therapy. It was seen during the course of the educational programs that the responses of the candidates varied to different degrees. Additionally, some of the factors such as language differences were not taken into consideration. During the delivery of the educational programs it was found that difficulty in understand a unified common language by the participants made it difficult for the course modulators to get their message clearly across the focus groups (Kapella et al., 2016).

Critical appraisal of the article
The article provided two main intervention methods for the treatment and management of COPD. These are Cognitive behavioural therapies (CBT) and COPD awareness educational programs. These were mainly focused at providing long term care strategies for the management of COPD within the patients. The CBT methods over here focus upon relaxation techniques and procedures. Some of these were increasing the time of activities, which could produce pleasure as well as calm down the anxieties within the participants. For example, training the participants upon performing light to heavy exercises everyday could help in restoring the normal movement and agility within the patients. As argued by van Straten  et al. (2017), COPD has often been associated with obesity within the patients. For example, an obese person may find it difficult to move at the same time suffer from breathing difficulties on slight exhaustion. However, as supported by Pollok et al. (2016), there are a number of limitations in this regard as the presence of COPD often makes performing light top heavy exercises difficult within people. Additionally, the ones who are suffering from other co-morbid health conditions such as obesity and heart disorder can often find it tiresome to perform the relaxing activities for long. The paper here fails to discuss some of these contradictions. The article also discusses the importance of cognitive behavioural therapy for the management of COPD in the patients.   It has been seen that 30-40% patients suffering from COPD undergo through sub-clinical depression (Wu, Appleman, Salazar & Ong, 2015). Some of these are also expressed in the form of anxiety or panic disorders within the patient. As reported by Pateraki & Morris (2018), the ones suffering from COPD are ten times more prone to panic attacks which may vary in intensity. Sometimes the panic or the anxieties are expressed in different patterns or to different levels within the patient. Therefore, care management plans need to be designed which could meet the individual needs of the patients (Wiles, Cafarella & Williams, 2015). However, the paper fails to discuss any particular risk management method. For example, some of the methods which had been developed in this regard are the Lung Management Treatment Program. It is based on the principles of CBT and self management. The intervention is implemented by respiratory nurses to reduce anxiety, depression within the patients as well as improve the quality of life (Blackstock, ZuWallack, Nici & Lareau, 2016). The reduction in the anxiety levels can enhance the recovery rate within the patients by reducing their number of hospital visits.   In the lack of a structured program the quality of the management of COPD is affected. The paper also fails to address the different psychosocial dilemmas, which could affect the pattern of recovery of the COPD patients. For example, the anxiety and depression within the patients could be attributed to some of the root or underlying causes such as presence of bipolar disorder, schizophrenia or other psychological issues which could make the matter worse. Therefore, some of these factors were not taken into consideration over her. Additionally, more focus should have been given to the living standards of the people. Sometimes the living conditions worsen the situation of COPD within the patients. For example, living in a low socio economic and damp conditions can further worsen the present health condition of the patient triggering lung infections, which could make the situation of COPD worse within the patients (Ouellette & Lavoie, 2017).
The article also emphasises upon educational programs for generating awareness in the patient population regarding COPD. However as argued by Usmani  et al. (2017), languages offers sufficient hindrances in the implementation and execution of educational programs. In this respect, the article fails to take into consideration the various gaps in imparting education with respect to language, faith and culture. As mentioned by Kunik  et al. (2008), within a healthcare setup the participants come from different cultural backgrounds. Therefore, it often becomes difficult to deliver healthcare programs as per the cultural faith and vernacular abilities of the participants.Additionally, the socio-economic issues and cultural paradoxes often prevent some of the participants from actively taking part in the educational campaigns. Therefore, the research paper fails to take into consideration some of these factors. Additionally, the success of the educational programs also depends upon the cognitive abilities of the person. Therefore, the paper fails to provide a comprehensive outlook at the matter. As mentioned by Travers  et al. (2007), individual cognitive behavioural therapies have been more beneficial in addressing the COPD issues within the patient. This is because the past life experiences and psychosocial dimensions of each patient varies. For example, the ones living within a culturally backward and repressive environment are comparatively less open to different treatment methods and approaches whereas the ones coming from a supportive social background are more open to discussion and understanding with the support carers (Trappenburg et al., 2009). However, the article emphasises upon group cognitive behavioural therapies rather than care approaches which are tailor made for individuals (Ben-Aharon, Gafter-Gvili, Paul, Leibovici & Stemmer, 2008). The article places little importance upon pharmacological treatment methods, which leaves a considerable amount of gap in the research. COPD is a chronic disorder and often requires long term dependence upon medicines. Some of the bronchodilators with long term effects which could be used over here are- acilidinium, arformoterol, formeterol etc. As mentioned by Kruis  et al. (2014), COPD is a chronic disorder and non-pharmacological treatment alone is not sufficient to provide complete relief to the patient. The paper also fails to take discuss into details some of the non-pharmacological methods of treatment such as pulmonary rehabilitation. As mentioned by Aaron (2014), the pulmonary rehabilitation have been seen to produce positive results in the patient by effective airway management and controlling secretion.

Article review using CASP tool
The article could be further reviewed over here using the CASP checklist for randomised control experiments. Here, CASP refers to Critical Appraisal Skills Programme. It consists of a series of questions which could be used to evaluate the correctness of the research paper. Some of the questions based upon which the article could be evaluated are – identification of the results, validity and trustworthiness of the results and usefulness of the results. In order to evaluate the article completely or accurately we need to find out the relevant results. In the current study two different intervention methods had been chosen which cognitive behavioural therapy and COPD awareness programs are –. From the various analysis it was found that CBT produced better results on the participants compared to COPD educational programs. The results were found to be valid as it complied with the   results of the some of the data obtained from clinical tests and results.   The results were used to design effective clinical practice where the responses of the candidates form the test results were used to develop CBT processes further. The CASP tests could be conducted by designing a number of questions. Some of which have been detailed below and justified with proper comments.

1. Did the trial address a clearly focussed issue?

A: Yes, the trial addressed a clearly addressed issues aimed at COPD education and CBT for treatment of clinical depression.
In this respect, 238 patient undergoing treatments for COPD who recorded low in the FEV/FEC were taken into consideration. A randomised control trial was undertaken over here where the participants were made to undergo either CBT or COPD, which acted as a comparator.

Was the assignment of patients to treatment randomised?

A: yes, the assignment of patients to treatment was randomised as the allocation sequence was concealed from researchers and patients.

Were all of the patient’s account who entered the trial taken into consideration?

A: no, as all of the patients who entered the trial didnot continue till the end of the experiment, their accounts were not taken into consideration.

Were patients, health workers and study personnel’s blind to treatment?

A: no. Due to lack of knowledge the patient’s were sceptical of the some of the treatment methods and approaches. The same could be stated for the study personnel.
On the other hand, due to implementation of randomised control trials the researchers were often subjected to confound biases.

Were demographics taken into consideration at the beginning of the trial?

A: yes, some of the demographics were taken into consideration over here such as gender, ethnicity, age, years of education, history of psychiatric anomalies within the patient. Some of these demographics helped to rule out the confounding biases presented to the researcher.

Apart, from the experimental interventions what equal treatments were provided to the group?

A: can’t tell

How large was the effect of the treatment?

A: The treatment aimed at providing long term holistic care to the patients.The primary outcomes were disease specific and general quality of life.

How precise was the estimate of the treatment methods?

A; The differential ways of delivering the treatment and the differential responses produced served as a research limitation

Could the results be applied to local population?

A: yes, the results could be applied to local population based upon the results received regarding the success of different intervention methods

Were, all clinically important outcomes considered?

A: Can’t tell as the research paper throws little light upon pharmacological methods of control and treatment of the disease.

Are the benefits worth the costs?

A: yes, the cognitive behavioural therapies have been seen to produce sufficient amount of positive results within the patient. Hence, they are worth the expenditure.
Limitations
There are a number of limitations of the research study conducted over here. Some of these have been discussed in details. For the current study low recruitment was a problem as out of the 256 participants selected for the study design only 238 participated. From which the number of participants kept on reducing gradually as the various levels of the study was interpassed. As suggested by Kunik (2008), retention in research studies is often a problem which affects the quality of the end results. Additionally, the way the interventions have been delivered might have resulted in dropouts. For example, the sessions set at the same time each week might have resulted in a lot of difficulties in people attending the program. The limited time could have hindered exposure to all subjects of interest in the questionnaire affecting the end quality of the result. Additionally, the patients with psychotropic disorders may react differentially to treatments. Hence, some of these factors were not taken into consideration.

Conclusion
The current assignment focuses upon the aspect of COPD education and cognitive behavioural therapy for social groups. In this assignment a randomised control trial had been taken into consideration where participants with chronic or long history of COPD were employed. In this respect, two different intervention methods were designed for the patients such as cognitive behavioural therapy and COPD education programs. Through the methods employed in the study design it was found that the patients responded more positively to CBT. However, there are a number of limitations within the research study design such as the small size of the participants which further affected the end quality of results. Additionally, the different intervention methods applied over here failed to take into consioderation individual s deep seated psychological characteristics of the participants. For example, the participants with long history of depression were also taken into consideration while finding out the results of the study. This could have led to confounding biases affecting the quality of the results.

References
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Ben-Aharon, I., Gafter-Gvili, A., Paul, M., Leibovici, L., & Stemmer, S. M. (2008). Interventions for alleviating cancer-related dyspnea: a systematic review. Journal of Clinical Oncology, 26(14), 2396-2404. https://ascopubs.org/doi/abs/10.1200/JCO.2007.15.5796
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