Communication In Chronic Obstructive Pulmonary Disease Palliative Care Nursing Essay

communion In Chronic Obstructive Pulmonary Disease alleviative C are Nursing EssayThe following is an evaluation of enhanced communication techniques in mitigatory charge for patients with chronic obstructive pulmonary disease (COPD) with propagation to a case study.COPD is a debilitating terminal condition that is distinguished by a growthive airflow obstruction, primarily caused by smoking. It is usually non fully irreversible (NICE, 2010).For an airflow obstruction to qualify, post bronchiodilation FEV1/FVC is less than 0.7 ( FEV forced expiratory volume in one second, FVC forced vital capacity). The course of COPD is highlighted as being an illness characterised by a long inexplor competent disease, punctuated with protracted periods of disabling breathlessness, reducing exercise tolerance, causing recurrent hospital admissions and premature death (Buckley, 2008). diagnosing of COPD is not entirely dependent on severity of breathlessness but in any case account, physic al examination and as well as spirometry confirmation of airway obstruction (Buckley, 2008 NICE, 2010). Because of the hassle with the prognosis of COPD, it presents a challenge for physicians and health guardianship practitioners to provide adequate superintend to patients (Curtis, 2006 NICE, 2010).Due to the nature of symptoms associated COPD (such as dyspnoea), patients more often die with COPD or relate than from it (NICE, 2010) with mortality rate for men steadily reduced from 1970 while womens has seen a small but steady rise, although COPD mortality is on the general rise. Buckley (2008) reported that on that point was a relatively higher proportion, (72%) of COPD who die in hospital care, compared with 12% at habitation and none in hospices.Palliative CarePalliative care has several definitions but has similar concepts according to Campbell (2009). NICE (2010) guidelines define palliative care as active holistic care of patients with advanced progressive illness. Curti s (2006) defines palliative care as the goal being to prevent and relieve suffering and support the best possible loyalty of life for patients and their families and their families, regardless of the state of disease or the need for other therapies.The general aim of palliative care is to improve the quality of care through alleviation of symptoms and promoting comfort over discussion as some treatment involve mechanical aids which patients might find taxing (Curtis, 2006). This has brought about the suggestion for the need of specialised centres (Curtis, 2006) considering how little prudence palliative care quality has received. Curtis (2006) then went on to report that there was a very low number of patients who talked about end of life care with their physicians, which can be made even more difficult with loss of emotional control or fear of having little training (Wittenberg-Lyles et al., 2008). There is also a need for patients to show more confidence in their carers (Curtis, 2006).The Gold Standards Framework GSF (2006) Prognostic Indicator Guidance (PIG) lists the criteria that would assist in making a prognosis for requirement of palliative care asSeverity of disease, such as FEV1 being less than 30% predictedRecurrent hospital admissionsLong term oxygen therapyShortness of breath with 4/5 grade on the Medical Research Council (MRC) Dyspnoea scaleSigns and symptoms of right heart failure early(a) factor such as non invasive ventilation (NIV)The GSF (2006) PIG summarises which three steps are key to determine which patient needs palliative care. They areIdentifying patient based on criteriaAssessing needsPlanning administrationThe above steps are dependent on patients satisfying chronic condition criteria listed earlier.CommunicationCommunication is the process of enhancing thoughts or information between individuals through different media spoken or written and through body language gestures (Payne et al., 2004).Buckley (2008) states that good commun ication is the key to the delivery of effective supportive palliative care services as it has an interpersonal perspective that is about health professionals and patients engaging emotionally (Wittenberg-Lyles et al., 2008).Delivering magnanimous bare-asseds is not an easy or comfort open feat. The United States EPEC (Education for Physicians on End of life) is a training program based on SPIKES model (Setting, Perception, Invitation, Knowledge, Empathy, and dodging/Summary), that has listed steps to follow that in the delivery of bad news, summarised belowPreparing to meet i.e. location settingAssess what patient knows about conditionDetermine sum of information to give patientDelivery of newsRespond to any questions from patient and/ or familyMake follow up planCase depicted object Patient profileThe vitrine used in the case study was an eighty year old man in a nursing home who presented as generally quiet, with long standing chronic obstructive pulmonary disease (COPD). Co nsent was obtained from him to participate in the study with the potential benefits explained to him. The subject had memorial of chain smoking and was diagnosed with heart murmurs in 1986. Long term smoking causes the damage to the lung tissues and repeated authority infections (NICE, 2010) and is a major contributor to COPD. The subject was inflict bronchodilator salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vial, administered by mask one or two ampoules four times a day. It was used as and when it was required although he did not usually exceed three doses daily.The subject had shortness of breath with basic living tasks and dependent on staff. The subject had several GP visits for COPD associated chest infections in the last twelve months and had to be supported by pillows in an almost upright position to sleep to reduce the discomfort caused by the dyspnoea. The subject was chosen as he satisfied most of the criteria from the GSF (2006) in terms of shortness of breath, r eliance on the bronchiodilator, several GP visits for chest infections and long history of smoking. The do not resuscitate (DNR) forms were filled in passed on to the multidisciplinary team that include the Ambulance service with the family aware.Communication in Palliative care with COPDDifferent communication techniques were employed when it came to dealing with the subject to reassure him and the family skills i.e. maintaining appropriate eye contact, low tone of voice is the key to the delivery of effective supportive palliative care service (Buckley, 2008). A SPIKES model approach was employed with the current case study.DiscussionIt is essential for nurses to establish a therapeutic relationship with patients as they act more with the patient, employing strategies such as empathy, spending more time listening and being more initiative (Edwards, et al 2006). Communication sometimes can also been limited by workplace policies or insufficient training (Edwards, et al 2006), whic h raises the need for proper training to better these relationships (Davidson et al., 2002). The current case study was able to overcome the difficulties of communicating with the patient and family as they had been there already offering support, and hence during the meeting to discuss the end of life they stated that they were satisfied with the progress as part of the continued care.The subject did not seem to be happy with the nebulisation therapy at first and he expressed fear and anxieties because it was a new therapy, which was not unusual (Stevens et al., 2009). Curtis (2006) study argues that health care for patients with COPD was often initiated proactively based on a previously developed plan for managing their disease. The subject was given a choice if he wanted a member of his family to be present and if the time was appropriate to which he had no objection, being emotionally functional and able to make his decisions (Lemmens et al. 2008). It was also noted that the sub ject became more relaxed when the nebulisation therapy was explained to him that it would reduce the dyspnoea, rattly chest, symptoms that he acknowledged made his breathing difficult and other symptoms such as reedy and sleep disturbance.It is authoritative to have a suitable location where there would be few disturbances when breaking bad news (Stevens et al, 2009 Wittenberg- Lyle, 2006). In the case study, the subjects family was contacted in order to arrange a meeting to discuss his diagnosis, the way forward regarding his treatment and control of his symptoms and also make them aware of any changes that would need to be made in terms of his care. This afforded the subject and family to be to be reassured that the patient would be made as comfortable as possible to palliate the symptoms of his condition through to end of life and bereavement.ConclusionPalliative care for COPD has not received much attention until recently. Communication is a very important aspect for high stand ards of care particularly in end of life care. Nurse to patient relationships are even more important as they wager a major role liaising with the family and multidisciplinary team to make the end of life as comfortable as possible. There is still much to be make in terms of communication training for nurses and also getting more physicians involved. The role of a multidisciplinary team is highly valued as it helps streamline the provision and administration of palliative care. The current case study found that the patient was happy with the way that the way that his care was planned.