Personal Impact Paper

Personal Impact: A Patient Living with COPD
Pamela D. Eliowitz
NURS/427
May 28, 2012
Trecia Jones

Personal Impact: A Patient Living with COPD Chronic Obstructive Pulmonary Disease, is a Chronic and progressive illness that affects a person’s ability to breath. The affects to breathing occur due to obstructive airways caused by production of mucous from continuous inflammation and by constrictive airways caused by the narrowing of the bronchial tubes from spasms, scar tissue, reactive airways, infections of the lung, and the continuous response to irritating substances within the environment. Pollution, smoking, and other irritating substances cause the negative and damaging cascade of events that follow.
The disease affects a large majority of people. It is the 5th leading cause of mortality currently. The World Health Organization predicts that COPD will rise to the 3rd leading cause of death by 2030 (WHO, 2007, p. 27). In the BMC Public Health Journal, they estimate that this disease affects 210 million people now. The following discusses the Impact the disease has on a person on a social, financial, and personal level. The information obtained by use of several videos, of people who shared their stories about living with and affected by COPD. COPD and the Social Implications Each person from the impact videos verbalized changes in their activity level. Betty mentioned that she used to love to dance and now she is barely able to move her feet. Norma loves to garden and clean her home; since her diagnosis she no longer can clean her home or garden; she finds it more challenging to go grocery shopping as the disease progresses. Therefore, she resorts to enlisting the services from a vast support network of people. This includes her friends, family, neighbors, and professionals. This disease has played a large ubiquitous role in her life. Lack of interest in usual activities appears to be a common theme each shared, in large part due to fatigue and difficulty breathing. Financial Impact Simpson and Rocker (2008) address the financial aspects of this disease by stating, “Severe exacerbations of COPD that lead to unscheduled visits/admissions to hospital result in the significant economic burden associated with the disease—about $10 billion in the US in 2003.” The cost of the disease has affected all of these individuals, and Norma mentions that she had an exacerbation of her disease twice in the past year that put her in the hospital.
She takes many medications and says, “It is a daily chore that she hates,” but because she cares about her health, she does it. The World Health Organization mentions the toll that this disease will have on a National Level alone. Fletcher (2010) states, “Nearly 1 in 5 of 45-68 year olds are forced to retire prematurely due to the condition, thereby incurring increased health costs and reducing personal contribution from taxation”(p. 1). In addition, the individual facing limitations on medical insurance have out-of-pocket-costs for drugs, supplies, oxygen, and assistance from various sources. Medical costs for re-hospitalizations, multiple medical appointments, and their related co-pays increase these expenses. The lack of employment because of the disability this disease creates, all play a pivotal role in the patient’s financial resources, or lack
thereof. Personal Impact Simpson & Rocker (2008) discuss the social impact of this disease, “Social Isolation due to disease progression poses a problem for these patients, as it limits their mobility, increasing their homebound status and a common desire to avoid breathlessness” (p. 1). “As COPD progresses to advanced stages, it tends to impose a growing social isolation as individuals become virtually housebound due to increasing immobility and a common desire to avoid dyspnea induced by this activity” (Simpson & Rocker, 2008, p. 1). Depression plays a large role in caring for and living with this disease. MRISER says, “Men have learned as young children, not to show emotion.” This disease causes many emotions, and one that challenges these men. As nurses, we will need to teach men to re-think showing emotion and learning how to share their concerns about COPD. COPD prevents activity that MRISER, Norma, and Betty, once enjoyed. This leads to depression and anxiety. MRISER says that he has constant sadness, difficulty with sleeping, depression, weariness, feeling inferior or blameworthy for no reason, notable weight alterations, challenged sleeping and coping patterns, along with many other difficulties encountered since his diagnosis. Learning Process MRISER stated, “You start by taking control of your life by starting with putting together your healthcare team.” If a person, suffering from this disease takes an active role in their own management and self-care; by working with a Pulmonologist, a Dietician, and Physical Therapist, whom instruct and guide patients in proper exercises and learning more about their disease they tend to do better. By creating their own health care team, they have played an active role and created the process by which to begin, a first step in self-care efficacy. Nurses can instruct, manage, and educate you on your medications, and plan of care. Redman (2007) states in his conclusion that, “Patient education is practiced by using a process of diagnosis and intervention. Motivation and learning theory provide the foundation to begin the planning process, and to be successful in teaching these patients” (p. 1). In motivating a person, we need to learn how to structure positive and negative responses to remove behaviors, which are not helpful; additionally, cognitive changes require reorganizing the way a patient is thinking about things. By, engaging the patient and learning the level at which they can learn; we can map the desired outcome, matched with the prescribed interventions that will elicit the changes needed. In the Critical Care Nurse Journal article, they show strategies that nurses and patients can use to improve education and involvement; such as, “Use of multiple educational materials, that can reduce hospital readmission rates and costs” (Paul, 2008, p. 77). Many educational tools and materials that can be used to structure and improve self-efficacy are at the nurse’s discretion. In implementing these various tools, we need to know the client’s level of learning in which to formulate and structure them, and knowing what the patient prefers is their best form of learning, be it visual, written, oral, or all three. Motivators a. Exercise, gradually building up endurance makes daily living more bearable, and helps with easing depression, and breathing. b. Modeling behaviors of those that share the same disease- has proven helpful and supportive. c. Returning to independence- is an ongoing motivation for all of them. d. Going shopping- using automated carts in the shopping malls has made a difference in their endurance, and in preventing exertional dyspnea. e. Values- These people have new value systems that are created in response to the disease and their newfound limitations. Family was valued above most. f. Identity- These individuals have worked on redefining who they are now. g. Control over plan of care: Arranging your health care team: MRISER mentions how important this is. h. Support Groups are superior resources, being around others living with the disease, coming together and sharing information, struggles, and concerns. Conclusion COPD has made a significant impact on individuals and society. The World Health Organization states, it is estimated that over 125 million people are affected with this devastating illness, and the cost to society, individually, and nationally is at all time highs and is projected to become far worse, with many more implications. Flowers (2004) discussed, “A common pitfall to avoid in becoming culturally competent is unintentionally stereotyping a patient in this or any cultural characteristics” (p. 2). Therefore, as nurses we need to know that patients with COPD are individuals within a new culture created by their disease. Nurses need to be aware always to respect and define each patient based on the patient’s values and motivations; we need to empower people with this disease, not take away their power, by even the slightest bias. Simpson & Rocker (2008) stated, “Severe exacerbations of COPD that led to unscheduled visits/admissions to hospital result is the significant economic burden associated with the disease—about $10 billion in the US in 2003” (p.1). Each of these individuals mentions that smoking was the main causation of their disease. MRISER stated, “Quit smoking, try a variety of smoking cessation tools like the patches, medication, hypnosis, but try something, and if one thing does not work try something else. Of all things, quit smoking!

Reference
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