Structured COPD Discharge Education and Quality of Life: A Feasibility Evaluation

Background: Multiple internal and external factors are responsible for the development and progression of chronic obstructive pulmonary disease (COPD). Noxious stimuli such as cigarette smoking and other air borne pollutants set off the ongoing inflammatory process of COPD resulting in air flow limitation and lung tissue destruction. Objectives: Examination of inflammatory mediators of COPD and risk factors that coincide with hospital admission for AECOPD. The aim of this dissertation was to conduct a feasibility study to implement an educational intervention for hospitalized patients and evaluate their quality of life (QOL), using the RE-AIM framework to evaluate outcomes. Design: This dissertation includes three papers: a principle-based concept analysis on inflammatory mediators related to COPD, an integrative review of the psychometric instruments used to measure risk factors for hospitalization among patients with COPD, and a feasibility study using the American Lung Association’s modified COPD Action Plan to instruct patients with COPD on identifying early signs of an exacerbation and when to seek medical care. In addition, quality of life perceptions were evaluated using the World Health Organization-BREF (WHOQOL-BREF) before hospital discharge and 30 days post discharge via phone call. Conclusions: COPD is a complex chronic disease with an insidious onset by inflammatory mediator(s) or genetic origin. The episodic acute exacerbations of COPD (AECOPD) are responsible for high healthcare utilization and perceptions of low quality of life. The feasibility study results suggest implementation of the American Lung Association modified COPD Action Plan can be carried out as discharge instructions and QOL evaluated using the WHOQOL-BREF questionnaire. Positive ratings and comments on the delivery and content of the COPD Action Plan were found in a small sample of participants who responded to follow up

Staff Education on Chronic Obstructive Pulmonary Disease Self-Management Using Teach-Back

Exacerbation of chronic obstructive pulmonary disease (COPD) is the leading cause of hospital admissions and an estimated 120,000 deaths among older adults in the United States. In the community health clinic that served as the project site, more than 80% of patients with a COPD diagnosis had frequent exacerbations, with a hospital readmission rate of 23.2%, which was higher than the national benchmark of 21%. The clinic did not have a COPD discharge education plan with a teach-back tool for staff to teach patients. The purpose of the project was to develop an evidence-based COPD educational packet for staff on self-management using the teach-back method and an evidence-based COPD educational plan for patient self-management. Guided by Orem\u27s self-care theory and Rosswurm and Larrabee\u27s model of evidence-based practice, the project focused on whether the literature supported the use of the teach-back method of teaching for COPD self-management. Participants reviewed the packet and evaluated the content using a Likert-type scale with 1 =strongly disagree to 5 = strongly agree. Ninety percent of the clinic\u27s stakeholders and staff agreed/strongly agreed to all factors evaluated, and the educational packet was recommended for use on the unit. The teach-back method and educational packet for COPD might bring about positive social change by decreasing exacerbations, improving health-related quality of life, and improving stewardship of healthcare investments thus improving the human condition

Understanding intention to use telerehabilitation : applicability of the Technology Acceptance Model (TAM)

Indiana University-Purdue University Indianapolis (IUPUI)Background: Pulmonary rehabilitation (PR) has the potential to reduce the symptoms and complications of respiratory diseases through an interdisciplinary approach. Providing PR services to the increasing number of patients with chronic respiratory diseases challenges the current health care systems because of the shortages in health care practitioners and PR programs. Using telerehabilitation may improve patients’ participation and compliance with PR programs. The purpose of this study was to examine the applicability of the technology acceptance model (TAM) to explain telerehabilitation acceptance and to determine the demographic variables that can influence acceptance. Methods: A cross-sectional survey-based design was utilized in the data collection. The survey scales were based on the TAM. The first group of participants consisted of health care practitioners working in PR programs. The second group of participants included patients attending traditional PR programs. The data collection process started in January 2017 and lasted until May 2017. Results: A total of 222 health care practitioners and 134 patients completed the survey. The results showed that 79% of the health care practitioners and 61.2% of the patients reported positive intention to use telerehabilitation. Regression analyses showed that the TAM was good at predicting telerehabilitation acceptance. Perceived usefulness was a significant predictor of the positive intentions to use telerehabilitation for health care providers (OR: 17.81, p < .01) and for the patients (OR: 6.46, p = .04). The logistic regression outcomes showed that age, experience in rehabilitation, and type of PR increased the power of the TAM to predict the intention to use telerehabilitation among health care practitioners. Age, duration of the disease, and distance from the PR center increased the power of the TAM to predict the intention to use telerehabilitation among patients. Conclusion: This is the first study to develop and validate a psychometric instrument to measure telerehabilitation acceptance among health care practitioners and patients in PR programs. The outcomes of this study will help in understanding the telerehabilitation acceptance. It will help not only to predict future adoption but also to develop appropriate solutions to address the barriers of using telerehabilitation

Understanding influences on the uptake of pulmonary rehabilitation in the East of England: an Inclusive Design/mixed-methods study protocol.

INTRODUCTION: 1.2 million people in the UK have chronic obstructive pulmonary disease (COPD) that causes breathlessness, difficulty with daily activities, infections and hospitalisation. Pulmonary rehabilitation (PR), a programme of supervised exercise and education, is recommended for patients with COPD. However, only 1 in 10 of those who need it receive PR. Also, the UK National COPD Audit Programme concluded that the COPD treatment might not be accessible to people with disabilities. This paper applies an Inclusive Design approach to community-based PR service provisions. It aims to inform improvements to the PR service by identifying barriers to the uptake of PR in the COPD care journey in relation to patients' capabilities that can affect their access to PR. METHODS AND ANALYSIS: The protocol includes four steps. Step 1 will involve interviews with healthcare professionals and patients to gather insight into their experiences and produce a hierarchical task analysis of the COPD care journeys. Step 2 will estimate the service exclusion: the demand of every task on patients' capabilities will be rated by predefined scales, and the proportion of the population excluded from the service will be estimated by an exclusion calculator. Step 3 will identify the challenges of the PR service; a framework analysis will guide the data analysis of the interviews and care journey. Step 4 will propose recommendations to help patients manage their COPD care informed by the challenges identified in step 3 and refine recommendations through interviews and focus groups. ETHICS AND DISSEMINATION: The Cambridge Central Research Ethics Committee gave the study protocol a positive ethical opinion (17/EE/0136). Study results will be disseminated through peer-reviewed journals, conferences and the British Lung Foundation networks. They will also be fed into a Research for Patient Benefit project on increasing the referral and uptake of PR

Exploring the potential of virtual hospital care

Healthcare expenditures in the Netherlands have been rising for decades, predominantly driven by demographic and technological developments. Due to the aging population, the prevalence of chronic diseases and multimorbidity is increasing, causing the demand for healthcare to rise. In addition to the rising healthcare costs, there is also a labor market shortage in the healthcare sector, particularly a shortage of nurses. It is expected that this shortage will grow substantially, meaning that healthcare systems will have to provide care for an increasing number of patients, with less personnel. To answer these challenges, virtual care is expected to have to play an important part. This dissertation had two main aims. The first aim was to explore the extent to which virtual hospital care could lead to cost savings or increases in capacity. The second aim of this dissertation was to assess the feasibility of remote continuous monitoring of vital signs.This dissertation shows that virtual hospital care, in general, tends to reduce the number of (re)admissions and the length of hospital stay. These reductions can be expected to mainly have an impact on capacity. Expected cost savings are limited relative to the national healthcare budget, even in an optimistic scenario. This dissertation also shows that there is a need for further development of the technology, for example with regard to the reliability of data transmission, evidence that clinical deterioration can be detected with continuous monitoring of (a limited set of) vital signs, ease of use, and compatibility with existing work processes.<br/

Validación del material educativo para el alta hospitalaria de pacientes con oxigenoterapia domiciliaria prolongada

Objective: The aim of this study was to validate the content and understandability of the instrument of written communication, complementary educational material to hospital discharge for patients with prolonged home oxygen prescription. Methods: This is a descriptive study, in which a quantitative approach was used. In this study we developed an educational material in the form of folder regarding the use of oxygen, which was analyzed by five nurses, who suggested modifications. After completion of the folder changes, it was given to patients receiving Prolonged Home Oxygentherapy (PHO). Results: The assessment that patients had regarding the educational material was positive, as 100% of respondents rated themselves between good and excellent (or scores between 7 and 10). Conclusion: The role and function of nurses as health educators is confirmed since they need to use verbal and written communication to the healthcare process.Objetivo: Validar el contenido y la comprensibilidad del instrumento de comunicación escrita, material educativo complementario al alta hospitalaria de pacientes con prescripción de oxígeno domiciliario prolongado. Métodos: Estudio descriptivo con enfoque cuantitativo, que resultó un material educativo sobre el uso de oxígeno en forma de carpeta. Esto fue analizado por cinco enfermeras, quienes sugirieron modificaciones. Después de efectuarse los cambios de la carpeta, la entregaron a los pacientes que recibieron prescripción de oxígeno domiciliario prolongada (ODP). Resultados: La evaluación de los pacientes cuanto al material educativo fue positiva, ya que el 100% de las respuestas se calificaron entre excelente y bueno (notas entre 7 y 10). Conclusión: Se confirma el papel y la función de la enfermera como educadora de salud, que necesita la comunicación verbal y escrita para el proceso de atención en salud.O objetivo deste estudo foi validar o conteúdo e a compreensibilidade do instrumento de comunicação escrita, material educativo complementar à alta hospitalar para pacientes com prescrição de oxigenoterapia domiciliar prolongada.Métodos: Estudo descritivo, com abordagem quantitativa, no qual se elaborou um material educativo sobre uso de oxigenoterapia, em forma de folder. Este foi analisado por cinco enfermeiros, que sugeriram modificações. Após a realização das alterações no folder, este foi entregue aos pacientes que receberam a prescrição de Oxigenoterapia Domiciliar Prolongada (ODP). Resultados: A avaliação que os pacientes tiveram quanto ao material educativo foi positiva, pois 100% das respostas se classificaram entre excelente e bom (ou notas entre 7 e 10). Conclusão: Confirma-se o papel e a função do enfermeiro como educador em saúde, que necessita utilizar a comunicação verbal e escrita para o processo de cuidar em saúde.Universidade Federal de PernambucoUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Examining Determinants Of Patient Activation In Chronic Obstructive Pulmonary Disease: A Cross-Sectional Survey Study

Introduction: Self-management plays a central role in the treatment chronic obstructive pulmonary disease (COPD). However, the patient characteristics necessary for effective self-management are not understood. The skills, confidence, and knowledge to engage in chronic disease self-care, known as patient activation, may play a key role in the capacity of people to self-manage COPD. How the complex, systemic nature of COPD influences patient activation has not been explored. Therefore, the purpose of this study was to examine the relationships among patient characteristics and health outcomes as determinants of patient activation among community-dwelling adults in the U.S. with COPD. The Revised Wilson Cleary Model (Ferrans, Zerwic, Wilbur & Larson, 2005) was adapted to examine a continuum of integrated variables integral to the experience of COPD for this descriptive correlational survey study. Methods: A random sample of 64 community-dwelling adults with COPD completed a self-report postal survey. The questionnaire was comprised of demographic questions and the Positive Affect Negative Affect Schedule, to measure individual and environmental patient characteristics, and the Quality of Life Index Pulmonary Version III, Pulmonary Functional Status and Dyspnea Questionnaire-Modified, a single question to assess general perception of health, and the Patient Activation Measure-13 (PAM) to assess health outcomes. Additionally, spirometry data was abstracted from participantsâ medical records. Descriptive and univariate statistics were utilized to describe and examine the unadjusted associations between patient characteristics, health outcomes and patient activation scores. Variables significantly (p \u3c .25) associated with patient activation were entered into stepwise multivariate regression models to identify independent predictors of patient activation in the sample. Results: The participants in the study were mostly men and women in their 70s with moderate to severe COPD, having lived with the disease for over four years. The patient activation scores were high among the sample (M = 66, SD = 16), with over 70% of the sample activated at PAM Level 3 and 4 (n = 47, 73%). Univariate analyses revealed significant relationships between several patient characteristics (gender, positive affect, lower Body Mass Index, education level, time since diagnosis of COPD, smoking pack years, urban residence) and patient activation. Health outcome domains, such as low fatigue, good or very good general perception of health, and better perceived overall quality of life) were directly related to patient activation in the sample. The resulting statistically significant regression model (R2 = .488, Adj.R2 = .454, p \u3c .001) contained four independent predictors explaining 45% of the variation in patient activation in the sample. Positive affect β = .457 contributed most to the model, followed by smoking pack years β = .345, overall quality of life β = .264, and female gender β = -.192. Conclusions: Several patient characteristics and complex health outcomes underlie self-management capacity in COPD. This study revealed novel determinants of patient activation that have implications for COPD self-management science and nursing practice. Nurses are in a pivotal position to apply knowledge of patient activation to the individualized assessment and care interventions of people living with COPD. Further research is needed to explicate the unique psychosocial factors that contribute to capacity to self-manage for targeted intervention design in this population

Nosocomial Pneumonia and Oral Health

This article will critically review the evidence linking pneumonia to the aspiration of microbe-laden oropharyngeal secretions and tie that to the predisposition for these processes to affect dependent, medically compromised individuals. The goal of this review is to alert the reader to the role that oral disease and oral health play in fostering and preventing, respectively, widespread and potentially fatal pulmonary disease among high-risk individuals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73840/1/j.1754-4505.2005.tb01647.x.pd