Palliative care is a type of nursing healthcare whose main focus is to reduce pain and severity of the disease symptoms. Palliative care is a very important aspect of nursing and requires that nurses are equipped with the required knowledge and skills to handle any patient situation. For patients suffering from Chronic Obstructive Pulmonary Disease, palliative care involves both the physical and psychological aspects (Bal Özkaptan & Kapucu, 2016).
Palliative nursing care is hereby critical for patients with COPD because it ensures patient pain and suffering is controlled, and the nursing care acts as a support system when it comes to physical and psychological therapy.
The following report focusses two palliative care nursing strategies namely; psychological support and management of psychological problems and relieving and management of shortness of breath during care.
- Psychological support and management of psychological problems
High priority nursing strategy is Psychological support and management of psychological problems. Anxiety and depression is often a common health issue for patients suffering from COPD and if not well managed is bound to have very significant impact on the patient, her family and the development of the condition (Bal Özkaptan & Kapucu, 2016). Anxiety and depression is among the major causes of increased mortality, lengthy stays in palliative care, exacerbation rats and the decrease in the quality of life.
Among the interventions include the provision of psychological support and management of her psychological problems which could be related to the condition. During nursing care, it is essential for the nurse to recognize some of the symptoms to come up with a better strategy in assisting the patient in coping with the situation. Also during the nursing care, the nurse will help the patient to practice relaxation through cognitive behavioural therapy (CBT), the nurse can also assist the patient in doing some things for herself like walking to the toilet, taking medication and simple tasks like taking meals and medicine at the required time (Maters, Pool, Sanderman, Wempe, & Fleer, 2017). When the nurse can administer the proper COPD care for a patient with anxiety and depression, it can have a significant impact on the whole palliative care process for the patient. Other studies have affirmed the importance of psychological intervention among COPD patient in palliative care.
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Another important intervention is to conduct interpersonal therapy sessions with the patient which will help them to improve their mood through interpersonal relationships. The nurse can show the patient that he can count on their care and support . The main focus here would be to change the patient's thoughts, feelings, and fear about their condition though increase social support and increasing interpersonal function. The nurse needs always to review the patterns of relationship associated with the patient within the nursing care and family; the nurse will then weight the capacity for intimacy in the current relationship (Maters, Pool, Sanderman, Wempe, & Fleer, 2017). It is also important that during this interpersonal relationship, the nurse discusses patient’s treatment plan, what works for them and what does not and what can be done by the nurse to makes the patient is comfortable. When psychological and management of psychological issues is done properly, the patient will be able to deal with events that trigger anxiety and depression, effectively communicate his or her condition and learn to solve problems that are specific to her condition.
The above intervention were chose for Mrs. Brown since it is indicated that she had suffered incidences of anxiety which could also mean there were underlying psychological issues related to the condition. Her situation was also complicated due to several risk factors associated with biochemical alterations and symptomatology. In any case, as a nurse, there will be no possible consensus on the right approach to psychological screening as to affirm that the patient is suffering from anxiety and depression associated with COPD.
In conclusion, overall focus will be to ensure the patient gains independence while under care and is free to negotiate the support plans and how the patient family can participate in the continued care process.
- relieving and Management of shortness of breathe
High Priority nursing strategy here is relieving and management of shortness of breath. Patients with COPD usually have damage to their lungs that makes it difficult for them to breathe. The shortness of breath will occur since they are using a lot of effort in breathing the air and releasing it out of the lungs. They will require more effort to breath, experience hunger for air, gasp for air and experience heaviness in the chest (Braço Forte & Sousa, 2017).
Among the intervention when the patient experiences shortness of breath is to first of all ensure that she is placed at an airy place, this entails making sure that the environment to which he bed is located is not filled with junk and dust, and that there is easy circulation of air. Since communication is very important in care, the second intervention is to ensure that she can communicate with the nurse through other techniques such as using closed questions when attending to her. Here the nurse can instruct the patient to answer with a shake of the head or a nod as this will allow her to communicate. During this time it is essential that the nurse exercises a lot of patience as this is very important to ensure the nurse does not make assumptions on behalf of the patient (Hussain, Neoh, & Hurlow, 2014). If the patient is strong enough, the nurse can allow the patient to write on the paper or use a flash card as a way to ensure communication about medication, a reminder to go the toilet, change of beddings and progress of treatment and care takes place. Oxygen therapy may also be needed with respect to the severity of the patient as this is also a barrier to communication (Hussain, Neoh, & Hurlow, 2014).
Also ensure the patient seats or lays in the right position all the time; since a patient with COPD experiencing shortness of breath needs to maximize all the respiratory function with minimal physical effort, meaning the nurse needs to ensure the patient is well supported and stays comfortable (Braço Forte & Sousa, 2017). The nurse should put the patient's pillow on the back to promote his or her posture; they should not be too many as they will restrict chest movement.
In addition to keeping the right posture, the nurse should provide a number of breathing exercises; these are very beneficial to the patient with COPD. Examples of breathing exercise for an elderly patients would include, pursed lip breathing and muscle exercise as this makes the lungs strong. The nurse can teach the patient other controlled techniques for breathing; however this should only be explained to the patient at the moment that they have regained their breath, the nurse should also ensure that they practice this regularly (Braço Forte & Sousa, 2017). In the event that they are breathless then they will be required to use such a technique in controlling their breathing rate and reduce the discomfort associated with it. The above interventions were chosen for Mrs. Brown, is it was observed that she was suffering intervals of shortness of breath which is a common condition for COPD patients.
Shortness of breath is a common phenomenon for COPD patients, however physical therapy as the ones discussed above ensure that the patient can manage her condition, whenever moments of shortness of breath occur during palliative care.
Patients suffering from COPD need nursing palliative care since the condition is unpredictable due to physical and psychological symptoms. Nurses should continuously implement the two high priority strategies. However, the most critical aspect of the two care strategies is negotiating with the patient and finding out from them what can work and what cannot work. Patient family support is also significant during this time, especially in terms of reducing patient anxiety and depression, and management of shortness of breath ensures the patient drifts his thought from the chronic condition and puts more effort towards care. The above strategies need to be done with a lot of care to ensure that the interventions do not cause harm to the patient.
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