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A Joint Effort to Affect Lives: The COPD Wellness Program
Feature Article
A Joint Effort to Affect Lives The COPD Wellness Program Katherine Monahan, RN, MSN
Abstract: Health care providers can work toward the goal of maintaining quality, dignity, and independence in the elderly when they combine resources with the community to promote wellness and help manage chronic problems. The Chronic Obstructive Pulmonary Disease (COPD) Wellness Program was undertaken for this purpose. The target participants were elderly individuals and their care partners who met the program qualifications: a diagnosis or symptoms of COPD and residency in a certain independent housing facility. The program was designed to help the participants maximize their independence through knowledge and improved management of their disease process. (Geriatr Nurs 1999;20:200-2)
V
ery old people make supportive health care promotion very challenging because of their high incidence of chronic problems, long exposure to environmental toxins, and physiological changes. The Chronic Obstructive Pulmonary Disease (COPD) Wellness Program, a joint venture of a community hospital and a rural subsidized housing facility in western Pennsylvania, was developed to meet that challenge. An apartment building for senior citizens had an increasingly rapid turnover of residents from independent living to skilled care situations. Such transfers have significant economic implications, but of even greater concern is the loss of independence. The mission of the wellness program was to help the residents with this particular chronic problem maintain their independent status through knowledge and skills aimed at improved self-management of their COPD.
BACKGROUND As a primary intervention, education can play a substantial role in directing clients to become active participants in self-care.1 Dennis et al.2 found that even minimal educational follow-up, such as providing the client with a written list of disease exacerbation warning signs and scheduling a follow-up appointment with the primary care physician, after acute episodes of chronic conditions can decrease hospital readmissions. Pulmonary rehabilitation, exercise training, and nutritional counseling provide elders with the means to effectively self-manage chronic problems, maintain
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independence, and combat the depression so often associated with COPD.
PROGRAM DESCRIPTION Participation in the wellness program was completely voluntary and provided as a free service. Invitations were extended to the residents in a particular housing facility with a documented diagnosis of COPD, those exhibiting COPD symptoms, and interested care partners. The participants were mostly women (only one man joined the group), two of whom used continuous oxygen therapy. A multidisciplinary team with members from the community hospital and the housing facility worked together to plan and implement the program. Each participant’s primary care physician was provided with information related to the program objectives (Table 1), and planned activities. The first phase of the program consisted of a six-part educational series shown in Table 2. The participants were scheduled to meet once a week for 2 hours. Each participant was provided with the 6-week course schedule at the introductory meeting. As an added incentive to participate, attendees’ names were placed in a drawing for prizes that were awarded after the final session. In the second phase of the program, the participants were offered individual assessments/counseling by an occupational therapist, registered dietitian, and pharmacist; Table 3 discusses these activities. These assessments were conducted in the participants’ own apartment, allowing for confidentiality and individualized problem-solving. Some practical outcomes of this phase included adapting shower tubing for one resident and suggesting assistive devices for other residents, such as a raised commode seat, sock aid, and reacher. The third program phase consisted of weekly informal support group meetings. The goal of these sessions was to reinforce the teaching and help participants incorporate some of the learned behaviors into their daily schedules. Each of these eight weekly meetings followed a similar format: practicing
Geriatric Nursing Volume 20, Number 4
Table 1. Program Objectives I. Apply learned principles to maintain/ improve activities of daily living
III. Use appropriate measures to maximize independent functioning
II. Increase adherence to physician recommendations
IV. Decrease COPD-related hospital admissions and exacerbations
Table 2. Course Schedule Schedule
Personnel
Content
Week 1
• Education specialist, Home Health Service, Washington Hospital • Pulmonary clinical nurse specialist, Washington Hospital
I. Introduction II. Normal anatomy and physiology
Week 2
• Education specialist, Home Health Service, Washington Hospital • Pulmonary clinical nurse specialist, Washington Hospital
I. Common lung diseases a. Asthma b. Chronic bronchitis c. Emphysema II. Lung infections a. Contributing factors b. Signs and symptoms c. Preventive measures d. When to call the physician III. Environmental triggers a. Cigarettes b. Pollution c. Weather
Week 3
Registered psychiatric nurse, Washington Hospital
I. Dealing with anxiety and depression a. Definition of anxiety vs. depression b. Contributing factors c. Signs and symptoms d. Management and treatment
Week 4
Pharmacist, Presbyterian Senior Care
I. Medication management a. Drug categories b. Purpose c. Inhaled vs. oral route d. Special guidelines II. Preventive measures a. Immunizations b. Smoking cessation
Week 5
Registered dietitian, Presbyterian Senior Care
I. Nutrition/dietary management a. Food pyramid b. Fluids c. Sodium d. Food labels
Week 6
• Pulmonary clinical nurse specialist, Washington Hospital • Respiratory therapist, Washington Hospital • Occupational therapist, Washington Hospital
I. Breathing exercises a. Pursed lip b. Diaphragmatic c. Controlled coughing d. Relaxation techniques II. Energy conservation a. Principles of work efficiency b. Benefits c. Application to daily activities
201
breathing techniques, doing range of motion (ROM) exercises, and practicing relaxation using deep breathing and imagery. Each participant was given a relaxation therapy tape to use at home. At the conclusion of 8 weeks, three of the six support group members reported participation in these activities at home 2 to 3 times weekly and generally were “feeling better.” Table 4 gives some of their comments.
EVALUATION AND FOLLOW-UP Most of the participants (70%) found the information helpful in managing their lung disease and activities of daily living. The program also was instrumental in helping some elders resume previously enjoyed social activities. For example, after the program, one participant felt more confident in venturing out because of increased endurance and a feeling of greater stability when walking. At the 2-month follow-up point, some significant lifestyle changes were reported by the group: four of the six individuals continued the breathing exercises, ROM exercises, and relaxation techniques at least once or twice per week. One individual reported no participation in any of the activities, one was unavailable for the follow-up survey, and one was hospitalized twice—once related to COPD exacerbation and once because of a fall injury.
Table 3. Individual Activities Personnel
Activity
Occupational therapist, Washington Hospital
I. Assessment of activities of daily living II. Home management III. Adaptive equipment needs
Registered dietitian, Presbyterian Senior Care
I. Nutrition assessment II. Diet history III. Appropriate nutritional care plan
Pharmacist, Presbyterian Senior Care
I. Assessment of current medication regimen II. Recommend medical follow-up as appropriate
Table 4. Comments from Participants Satisfaction with the program/outcomes “I never thought this would work, but I’m glad I stayed with it, it really works.” “I love this. I feel so much safer now, especially when I get out of bed at night.” “I can walk to my car with no problem now.” “My arms feel better; they’re easier to use.” “I only need two breathing treatments now; I did need four.”
CONCLUSION In planning and implementing the COPD program, the importance of having participant input was reinforced dramatically. The program initially was scheduled for the summer. After the first 2 weeks, attendance dropped to a point necessitating cancellation because these independent elders maintained a very active schedule. The team interviewed participants regarding a better time frame for the program, and they said early in the afternoon on Tuesdays during the fall would better suit them. The program was very well received when rescheduled according to the participants’ input. Chronic, debilitating diseases, such as COPD, affect every aspect of an individual’s mental, physical, and social well-being. Because no cure has been found, the focus of care needs to be disease management through lifestyle modifications. Wellness promotion specifically designed to increase knowledge of COPD management strategies can help emphasize abilities, lessen limitations, promote continued activity rather than dysfunction or activity intolerance, and maintain independence rather than allow a slow progression toward dependency. The continuity afforded by the COPD wellness program was vital. Following the individuals over time by reinforcing, reminding, and cueing toward health promotion yielded a positive result that education alone could not accomplish.
202
Camaraderie/sharing of ideas “Here’s how I season my chicken.” “Try the (relaxation) tape, it really works.”
Lifestyle changes “I do the (ROM) exercises 2 to 3 times every week.” “The relaxation tape helps me rest better.”
REFERENCES 1. Chapman KR. Therapeutic approaches to chronic obstructive pulmonary disease: an emerging consensus. Am J Med 1996;100:5S-10S. 2. Dennis LI, Blue CL, Stahl SM, Benge ME, Shaw CJ. The relationship between hospital readmissions of Medicare beneficiaries with chronic illnesses and home care nursing interventions. Home Healthcare Nurse 1996;14:303-9.
KATHERINE MONAHAN, RN, MSN, is a geriatric clinical nurse specialist for the Washington Hospital Home Health Service in Washington, Pa. Copyright © 1999 by Mosby, Inc. 0197-4572/99/$8.00 + 0
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Geriatric Nursing Volume 20, Number 4
A Joint Effort to Affect Lives The COPD Wellness Program Katherine Monahan, RN, MSN
Abstract: Health care providers can work toward the goal of maintaining quality, dignity, and independence in the elderly when they combine resources with the community to promote wellness and help manage chronic problems. The Chronic Obstructive Pulmonary Disease (COPD) Wellness Program was undertaken for this purpose. The target participants were elderly individuals and their care partners who met the program qualifications: a diagnosis or symptoms of COPD and residency in a certain independent housing facility. The program was designed to help the participants maximize their independence through knowledge and improved management of their disease process. (Geriatr Nurs 1999;20:200-2)
V
ery old people make supportive health care promotion very challenging because of their high incidence of chronic problems, long exposure to environmental toxins, and physiological changes. The Chronic Obstructive Pulmonary Disease (COPD) Wellness Program, a joint venture of a community hospital and a rural subsidized housing facility in western Pennsylvania, was developed to meet that challenge. An apartment building for senior citizens had an increasingly rapid turnover of residents from independent living to skilled care situations. Such transfers have significant economic implications, but of even greater concern is the loss of independence. The mission of the wellness program was to help the residents with this particular chronic problem maintain their independent status through knowledge and skills aimed at improved self-management of their COPD.
BACKGROUND As a primary intervention, education can play a substantial role in directing clients to become active participants in self-care.1 Dennis et al.2 found that even minimal educational follow-up, such as providing the client with a written list of disease exacerbation warning signs and scheduling a follow-up appointment with the primary care physician, after acute episodes of chronic conditions can decrease hospital readmissions. Pulmonary rehabilitation, exercise training, and nutritional counseling provide elders with the means to effectively self-manage chronic problems, maintain
200
Geriatric Nursing Volume 20, Number 4
independence, and combat the depression so often associated with COPD.
PROGRAM DESCRIPTION Participation in the wellness program was completely voluntary and provided as a free service. Invitations were extended to the residents in a particular housing facility with a documented diagnosis of COPD, those exhibiting COPD symptoms, and interested care partners. The participants were mostly women (only one man joined the group), two of whom used continuous oxygen therapy. A multidisciplinary team with members from the community hospital and the housing facility worked together to plan and implement the program. Each participant’s primary care physician was provided with information related to the program objectives (Table 1), and planned activities. The first phase of the program consisted of a six-part educational series shown in Table 2. The participants were scheduled to meet once a week for 2 hours. Each participant was provided with the 6-week course schedule at the introductory meeting. As an added incentive to participate, attendees’ names were placed in a drawing for prizes that were awarded after the final session. In the second phase of the program, the participants were offered individual assessments/counseling by an occupational therapist, registered dietitian, and pharmacist; Table 3 discusses these activities. These assessments were conducted in the participants’ own apartment, allowing for confidentiality and individualized problem-solving. Some practical outcomes of this phase included adapting shower tubing for one resident and suggesting assistive devices for other residents, such as a raised commode seat, sock aid, and reacher. The third program phase consisted of weekly informal support group meetings. The goal of these sessions was to reinforce the teaching and help participants incorporate some of the learned behaviors into their daily schedules. Each of these eight weekly meetings followed a similar format: practicing
Geriatric Nursing Volume 20, Number 4
Table 1. Program Objectives I. Apply learned principles to maintain/ improve activities of daily living
III. Use appropriate measures to maximize independent functioning
II. Increase adherence to physician recommendations
IV. Decrease COPD-related hospital admissions and exacerbations
Table 2. Course Schedule Schedule
Personnel
Content
Week 1
• Education specialist, Home Health Service, Washington Hospital • Pulmonary clinical nurse specialist, Washington Hospital
I. Introduction II. Normal anatomy and physiology
Week 2
• Education specialist, Home Health Service, Washington Hospital • Pulmonary clinical nurse specialist, Washington Hospital
I. Common lung diseases a. Asthma b. Chronic bronchitis c. Emphysema II. Lung infections a. Contributing factors b. Signs and symptoms c. Preventive measures d. When to call the physician III. Environmental triggers a. Cigarettes b. Pollution c. Weather
Week 3
Registered psychiatric nurse, Washington Hospital
I. Dealing with anxiety and depression a. Definition of anxiety vs. depression b. Contributing factors c. Signs and symptoms d. Management and treatment
Week 4
Pharmacist, Presbyterian Senior Care
I. Medication management a. Drug categories b. Purpose c. Inhaled vs. oral route d. Special guidelines II. Preventive measures a. Immunizations b. Smoking cessation
Week 5
Registered dietitian, Presbyterian Senior Care
I. Nutrition/dietary management a. Food pyramid b. Fluids c. Sodium d. Food labels
Week 6
• Pulmonary clinical nurse specialist, Washington Hospital • Respiratory therapist, Washington Hospital • Occupational therapist, Washington Hospital
I. Breathing exercises a. Pursed lip b. Diaphragmatic c. Controlled coughing d. Relaxation techniques II. Energy conservation a. Principles of work efficiency b. Benefits c. Application to daily activities
201
breathing techniques, doing range of motion (ROM) exercises, and practicing relaxation using deep breathing and imagery. Each participant was given a relaxation therapy tape to use at home. At the conclusion of 8 weeks, three of the six support group members reported participation in these activities at home 2 to 3 times weekly and generally were “feeling better.” Table 4 gives some of their comments.
EVALUATION AND FOLLOW-UP Most of the participants (70%) found the information helpful in managing their lung disease and activities of daily living. The program also was instrumental in helping some elders resume previously enjoyed social activities. For example, after the program, one participant felt more confident in venturing out because of increased endurance and a feeling of greater stability when walking. At the 2-month follow-up point, some significant lifestyle changes were reported by the group: four of the six individuals continued the breathing exercises, ROM exercises, and relaxation techniques at least once or twice per week. One individual reported no participation in any of the activities, one was unavailable for the follow-up survey, and one was hospitalized twice—once related to COPD exacerbation and once because of a fall injury.
Table 3. Individual Activities Personnel
Activity
Occupational therapist, Washington Hospital
I. Assessment of activities of daily living II. Home management III. Adaptive equipment needs
Registered dietitian, Presbyterian Senior Care
I. Nutrition assessment II. Diet history III. Appropriate nutritional care plan
Pharmacist, Presbyterian Senior Care
I. Assessment of current medication regimen II. Recommend medical follow-up as appropriate
Table 4. Comments from Participants Satisfaction with the program/outcomes “I never thought this would work, but I’m glad I stayed with it, it really works.” “I love this. I feel so much safer now, especially when I get out of bed at night.” “I can walk to my car with no problem now.” “My arms feel better; they’re easier to use.” “I only need two breathing treatments now; I did need four.”
CONCLUSION In planning and implementing the COPD program, the importance of having participant input was reinforced dramatically. The program initially was scheduled for the summer. After the first 2 weeks, attendance dropped to a point necessitating cancellation because these independent elders maintained a very active schedule. The team interviewed participants regarding a better time frame for the program, and they said early in the afternoon on Tuesdays during the fall would better suit them. The program was very well received when rescheduled according to the participants’ input. Chronic, debilitating diseases, such as COPD, affect every aspect of an individual’s mental, physical, and social well-being. Because no cure has been found, the focus of care needs to be disease management through lifestyle modifications. Wellness promotion specifically designed to increase knowledge of COPD management strategies can help emphasize abilities, lessen limitations, promote continued activity rather than dysfunction or activity intolerance, and maintain independence rather than allow a slow progression toward dependency. The continuity afforded by the COPD wellness program was vital. Following the individuals over time by reinforcing, reminding, and cueing toward health promotion yielded a positive result that education alone could not accomplish.
202
Camaraderie/sharing of ideas “Here’s how I season my chicken.” “Try the (relaxation) tape, it really works.”
Lifestyle changes “I do the (ROM) exercises 2 to 3 times every week.” “The relaxation tape helps me rest better.”
REFERENCES 1. Chapman KR. Therapeutic approaches to chronic obstructive pulmonary disease: an emerging consensus. Am J Med 1996;100:5S-10S. 2. Dennis LI, Blue CL, Stahl SM, Benge ME, Shaw CJ. The relationship between hospital readmissions of Medicare beneficiaries with chronic illnesses and home care nursing interventions. Home Healthcare Nurse 1996;14:303-9.
KATHERINE MONAHAN, RN, MSN, is a geriatric clinical nurse specialist for the Washington Hospital Home Health Service in Washington, Pa. Copyright © 1999 by Mosby, Inc. 0197-4572/99/$8.00 + 0
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Geriatric Nursing Volume 20, Number 4