Introducing the Research
Chronic obstructive pulmonary disease (COPD) is the cause of morbidity and mortality in many places. The harmful effects of COPD are psychological and functional problems, which include poor home management and isolation (Robinson et al., 2008). COPD can either manifest as a stable or acute condition. In the acute phase of the disease, the patient is hospitalized and requires collaborative care. Community health nursing plays an imperative role in the management of the patient with COPD.
Management of COPD is difficult because nurses usually blame patients (Robinson et al., 2008). For instance, a nurse can tell a patient that he/she is the cause of the disease because he refused to stop smoking, he is not following the treatment regimen and he will die. Many patients do not get an accurate diagnosis until they are in the acute phase of COPD. Nonetheless, pharmacological therapy is not the only treatment of COPD. Robinson et al. (2008) stated that patients with COPD could benefit from individualized care, which include health education, breathing techniques and self-management. Of the three interventions, self-management is fundamental. Therefore, community health nurses (CHNs) should encourage the patients to develop self-management skills.
According to Robinson et al., (2008), a high rate of patients’ turnover has increased the workload of CHNs. As a result, CHNs lack adequate time to interact with the patients. Additionally, CHNs do relate well with patients with COPD because of the assumption that the patients are responsible for their diseases and they do not take medicine. Reinforcing primary health care approach in the management of COPD may change the perception of CHNs about self-management skills.
Robinson et al. (2008) reviewed and reported the changes that CHNs should make so that they can adapt their roles as primary health care providers in the community. The research aimed to help patients with COPD develop self-management skills and increase the ability of CHNs to apply the principles of primary health care while interacting with the patients. Robinson et al. (2008) examined the impact of CHNs participation in the mentoring program on clinical practice and a shift to primary health care approach.
Methodology Used for Research
Study Design
Robinson et al. (2008) conducted a descriptive prospective research. The study area was Tasmania. They collected qualitative data from CHNs and patients with COPD. The sample population was CHNs who were working at health centers in Tasmania and patients who were admitted with acute COPD. The unit of study was community health centers, which were in or near Tasmania. The study instrument was questionnaire. The CHNs who participated in the research were known as mentors. The research took one year.
Selection of Participants
CHNs from community health centers in or near Tasmania were included in the study. Robinson et al. (2008) used probability sampling method by including the urban as well as the rural community health centers. After a meeting in the community health center, twenty one CHNs were included in the research. Patients with acute COPD were selected and included in the research during the hospitalization period. Upon discharge of the selected patient from the community health center, he was linked with a mentor who followed him for twelve months. Robinson et al. (2008) allocated a maximum of five patients with acute COPD to each participant (mentor).
Preparations
Robinson et al. (2008) prepared the participants by educating them about mentorship. The mentors were taught about interviewing techniques with emphasis on motivational and telephone interview. Besides, Robinson et al. (2008) trained them on the use of information technology in the management of patients with acute COPD. This included coaching patients with COPD through the internet and the phone.
Robinson et al. (2008) described the role of the mentors as partnership with the patients with COPD who were included in the research. This means that the mentors and the patients worked collaboratively.
In the first visit, the mentor assessed the knowledge level of the COPD patient on the disease and its management. In the second visit, the mentor discussed with the patient about his role in the management of COPD and assisted him to set realistic goals and device an action plan. Thereafter, the mentor discussed the progress of the patient through the telephone. The mentor forwarded the outcome of the research to the researchers via the internet.
Data Collection
The demographic data of the mentors were collected using a questionnaire. The mentor collected data from the patient with COPD through the telephone. Additionally, the patient with COPD used to forward diary information to the mentor via the internet. Robinson et al. (2008) had meetings with the mentors once in a month where they collected data about the progress of the patients with COPD. During the meeting, the discussed information was audio taped.
Data Analysis
Robinson et al. (2008) transcribed and subjected the audiotaped data to thematic analysis. The thematic analysis assisted in identifying the difficulties, which CHNs experienced during the partnership with patients suffering from COPD. Robinson et al. (2008) analyze the demographic data of the patients using descriptive statistics. The researchers presented the findings in notes form.
Ethical Issues
Robinson et al. (2008) obtained permission to carry out the research from Tasmania Health and Medical Human Research Ethics Committee.
The Findings
Robinson et al. (2008) analyzed the demographic data of the mentors and found out that; one male nurse was included in the study while the rest were females. Majority of the nurses were above forty five years. All the mentors had worked in a community health center for more than a year.
Robinson et al. (2008) found out that mentors experienced a transformation as they were interacting with the COPD patients. The nihilistic attitude of COPD had an impact in the mentor-patient relationship. Initially the mentors forgot their role and called the patient “non-compliant”. With time, the mentors learned the importance of appreciating the patient with COPD.
Through reflective practice, the mentors realized that culture and traditions influence the behavior of a patient with COPD. For instance, many patients with COPD smoke because according to their culture it is not wrong. As a result, the mentors spend most of their time health educating the patients with COPD about lifestyle modification.
Patients with COPD participated in self-management activities because they were involved in their care. The participation motivated the mentors to empower patients with knowledge about the disease process and the management. Although the mentors found it hard to work collaboratively with the patients, they learnt how to tolerate the patients’ behaviors. With time, they established a therapeutic relationship and were able to call the patients with COPD and discuss with them any challenges, which they were facing.
Robinson et al. (2008) found out that towards the end of the research, the mentors were providing holistic care to the patients with COPD. They were not only focusing on the medical management but also the psychological, social and emotional aspect of the patients’ life.
The conclusion
Robinson et al. (2008) concluded that it is possible for the CHNs to shift their focus from medical management to holistic care of patients with COPD. Collaborative management is imperative in the implementation of primary health care. This is because when a patient is an active participant in his care, the probability of him listening to what the CHN is saying increase. CHNs practiced primary health care because they understood factors like culture and traditions, which usually influence the behaviors of the patients with COPD. Therefore, CHNs assisted the patients with COPD to modify their behaviors by teaching them about the importance of abandoning cultures which have negative impact on health.
Personal Reflection
Although the researchers found out that the principles of primary health care are essential in managing COPD, nurses should conduct studies about it in order to improve the validity and reliability of the aforementioned research. This is because the sample size was small and 90% of the participants were females.
When a patient is involved in the management of his condition, he always trusts the health care providers. I agree with the researchers when they say that collaborative efforts of the CHN and the patient are imperative in the management of COPD. Additionally, through reflection, a nurse can change the negative attitude, which he has towards the patients. I recommend that community health nurses should develop the habit of reflecting after interacting with a client.
Reference
Robinson, A., Courney-Pratt, H., Lea, E., Cameron-Tucker, H., Turner, P., Cummings, E., et al. (2008). Transforming Clinical Practice Amongst Community Nurses: Mentoring for COPD patient Self-Management. Journal of Nursing and Health Care of Chronic Illness in Association with Journal of Clinical Nursing , 1 (17), 370-379.