Coordinating COPD Exacerbation Care: A Collaborative Approach

The assignment content discusses various aspects of chronic obstructive pulmonary disease (COPD) and its management, particularly the role of nurses in addressing COPD exacerbations. It highlights opportunities for interdisciplinary collaboration between healthcare professionals to develop effective care plans. The references provided offer insights from different studies and articles on topics such as self-management, care coordination, and patient empowerment.

Running Head: CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
Chronic and Complex Care Nursing for COPD Patients
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CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
Introduction
Guiding principles on management and treatment of patients with chronic and complex
conditions are all important for healthcare providers, the patients and their caretakers, to
understanding the guiding principles in the management of chronic and complex decisions.
Nursing plans in this setting must be in tandem with these guiding principles which include the
need for advocacy, health coaching, self-management and empowerment (Cramm & Nieboer,
2013). This presentation will thus entail the highlights of the main guidelines on the developing
of nursing plans in chronic and complex care setting and their different ways of improving health
outcomes of patients. The discussion also focuses of highlighting the nursing plan for a patient
presenting with COPD exacerbations and further, the situations at which the nurses can find
opportunities to collaborate with other members of the interdisciplinary team in carrying out the
nursing plan.
Nursing Plan Guiding Principles in Chronic & Complex Conditions
A. Self-management and Empowerment
The nursing plan drawn in caring for patients in chronic and complex care must include
actions that will enhance self-management and empowerment, on the part of the patient. Self-
management in this regard refers to the patient’s ability in conjunction with the healthcare
professionals, their family members and the community, to manage the signs and symptoms of
the condition, the treatment involved, necessary changes in lifestyle, and its psychosocial,
spiritual and even cultural consequences (Cramm & Nieboer, 2013). The nursing plan should
therefore include the facilitation of the patient to pursue optimal self-management where they are
can monitor their chronic and complex illness develop and engage behavioral, emotional and

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
even cognitive strategies that can help them sustain the quality of life that is satisfactory. Among
the specific actions on self-management include facilitating the patient directly or through the
family to be able to move, eat and even do grooming on their own (Sonola et al, 2013). The
interdisciplinary team should ensure that as the patient’s medical needs are managed, and that the
patient is also gaining abilities to support themselves through specialized therapies such as
occupational therapy, physiotherapy and respiratory therapy. The nursing plan should include a
modification of the patients’ hospital and home environment including empowerment approaches
so that it is healthy enough for the patient to be safe (Elder, 2017). It can also help in preventing
factors which trigger the elevated levels of a condition, a case of COPD exacerbation.
B. Health Coaching
Health coaching as guideline should be carried out with the intention of ensuring
collaborative approach in improving the health outcomes of a patient under chronic and/or
complex care. Nursing plans should thus factor in the need for health coaching of patients and
their caretakers on different aspects of their complex and chronic condition (Sciarra, 2012). The
nurse thus has to ensure that they focus on coaching patients and their caretakers using the health
promotion approach. The nurse through the interdisciplinary team members recognizes and
provides necessary informational needs for health coaching (Straughair, 2011). The sessions for
this engagement can take a formal or even an informal approach on convenience basis. The nurse
can focus on coaching the patient and their family members on personal hygiene, pain
management, exercise, treatment procedure and medication, sexuality, meal-time management
among others (Schiøtz et al, 2016). It is necessary that nurses and members of the
interdisciplinary team identify particular coaching moments where the patients seem to present
like they have some knowledge deficiency and address them adequately. The different members

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
of the interdisciplinary team have specific areas of professionalism and therefore they should be
facilitated to coach the patient and their caretakers on each informational need in regard to the
management of their health condition.
C. Advocacy In The Collaborative Management of The Patient and Her Family
It is necessary that nursing plans incorporate advocacy for patients and their caretaker’s
rights. According to Sonola et al (2013) advocating for patient safety and health in chronic and
complex care is a crucial requirement in nursing practice. The multidisciplinary team including
family members has the responsibility to advocate for the rights of the patient and each other in
their quest to provide a collaborated care. Under advocacy, providing culturally appropriate care
that considers equity and/or social justice is important (Schiøtz et al, 2016). Advocacy also
requires that the collaborating team members in patient care should in their nursing plan identify
and also explain different policies and practices which can infringe patient and family’s rights.
They should further provide information on policies, plans, particular guidelines on what the
patients can do where these rights have been compromised (Sciarra, 2012). There is need to
ensure that ethical considerations are fully complied with in the provision of patient care in
complex and chronic management settings. Access to appropriate healthcare for patients with
chronic and complex conditions is paramount. The multidisciplinary team including the social
workers in the community, the family and home-nurses should ensure that the patient accesses
medication when necessary (Sonola et al, 2013). The nurse should facilitate the continuity of
care making sure that there is both connected and/or coherent care for the patient by the
interdisciplinary team. The continuity of care helps in ensuring that at each stage of disease
management, every member of the interdisciplinary team is able to advocate for the rights of the
patient and those of their families.

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
.
The Role of a Registered Nurse, Nursing Planning & Nursing Interventions for Patients
with COPD Exacerbation
A. Managing Imbalanced Nutrition
COPD patients may present with imbalanced nutrition while under care. At this point, the
patient’s body has insufficient nutrients that can meet metabolic needs. Managing imbalanced
nutrition in complex and chronic care units is in line with the guideline that emphasizes the need
for healthcare and support (Parikh et al, 2016). Among COPD patients, imbalanced nutrition can
be caused by dyspnea and the production of sputum. It is also caused by nausea, side effects of
medications, anorexia, recurrent vomiting and fatigue. To address imbalanced nutrition, it is
important for the dietician within the interdisciplinary team to determine the patient’s and/or
caretaker’s understanding of nutritional needs (Lau et al, 2017). The approach will enable the
dietician to determine their informational needs so as to effectively teach and coach them
regarding the same. An evaluation of patient’s dietary habits including the recent food intake is
necessary to confirm the extent of eating difficulty the patient has been experiencing.
Determination of the patient’s weight and their size to inform on the BMI can inform nutritional
options for the patient. The nurse should auscultate the patient’s bowel to check any decrease in
gastric motility as this indicates low fluid intake, poor food choice and hypoxemia. The
expectorated secretions by the patient should be immediately removed as they bring about
noxious smells and negative altering their appetite while at the same time bringing about nausea
and increased difficulty in breathing (Jan, 2013). Sufficient rest time should be allowed before
mealtime to minimize any fatigue while eating. Lastly, the respiratory therapist should avail

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
supplemental oxygen during mealtime to lower dyspnea and that might reduce the patients
energy needed for eating.
B. Ineffective Airway Clearance Intervention
COPD presents with difficulties in breathing and therefore a nursing plan must involve the
management of ineffective airway clearance. The patent should be encouraged to rid respiratory
tract secretions and unblock the airway (Kuharic et al, 2015). The nurse with the assistance with
the respiratory therapist will auscultate the patient’s breath sounds in order to determine any
crackles, wheezes and rhonchi (Parikh et al, 2016). Usually, the presence if moist crackles
indicate that the patient should be treated for bronchitis. Expiratory wheezes on the other hand
indicate the need for treatment for emphysema. There is need for the patient to be assisted to
maintain a comfortable position and their head elevated so as to enhance respiration. The nurse
can let the patient have her arms and/or legs supported using pillows to reduce fatigue while
enabling chest expansion (Fromer, 2011). Any air pollutants should be removed to avoid re-
triggering of the acute level of COPD in the critical care setting and at home after discharge.
A respiratory therapist should advice the patent to practice pursed-lip exercises and/or
abdominal breath exercises (Ides et al, 2011). These will help Angela to cope with dyspnea while
minimizing the chances of air-trapping as is the characteristic of COPD. They should confirm
whether the patient’s cough is characteristically hacking, moist, or persistent, in order to assist
her improve the effort for effectiveness (Kuharic et al, 2015). The approach is important
especially understanding that while the cough might be persistent it could be ineffective. Chest
percussion is important in ensuring effective clearance of the airway (Lau et al, 2017). Hydration
is important also as it will boost expectoration by reducing the viscosity of secretions. In this

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
regard, patient needs to be given about 3000mL each day according to her cardiac tolerance as
determined by the respiratory therapist.
C. Managing Knowledge Deficiency
Management of a patient’s and/or the caretaker’s knowledge deficiency is important in
chronic and complex care for COPD according to the guiding principle on teaching and
coaching. The nurse will identify a patient’s knowledge deficiency from going through their
request forms, the misconceptions the patients present with, and a poor way of following
instructions (Jan, 2013). Particularly on COPD, it is important for the nurse to explain the whole
disease process to the patient and make repeated messages to emphasize the different messages
on the disease and self-care (Cramm & Nieboer, 2013). The patient should take part in the
discussion actively where possible as well as the family members. This can be through question
and answer sessions that are free of anxiety.
Particular concern should be focused on breathing exercises, their importance, effective
coughing, and prevention of factors that bring about COPD exacerbations (Chin, 2017).
Breathing exercises can enable the patient to have improved respiration muscle strength and also
prevent small-airway-collapse. As a result, the patient will have minimal or no dyspnea. Dental
care and/or oral care are imperative in caring for patients with COPD as it helps in preventing
bacterial growth and multiplication that can bring about pulmonary infections. The
interdisciplinary team under the nurse should be able to outline and explain the different factors
that trigger exacerbations of COPD so that the patient and the family are able to avoid them.
Some of them include fine pollen grains, extreme temperatures, cigarette smoke, dry air, aerosol
sprays among others. It is thus important that the patient be taught and coached on the effects of

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
smoking and encouraged to cease the behavior as it aggravates COPD. The teachings should be
directed also at the need to adhere to medication and participation in follow-up care. Angela who
is the patient in the case study should be encouraged to go for regular sputum culture analysis
and chest x-rays (Jan, 2013). These tests are very important considering that therapeutic regimen
can be altered depending on their results. A respiratory therapist can feed the patient with
information on side effects of different medications used including any adverse reactions so that
they understand when to request for a change of the medication regimen.
Collaboration Opportunities with Inter-disciplinary Team & Care Coordination
One collaboration opportunity is at the point of managing the COPD patient’s ineffective
airway clearance. A respiratory therapist will be needed to ensure that the patient’s respiration is
managed professionally and dyspnea is minimized. They will provide and control mechanical
ventilation means for the patient, incentive spirometry, and also recommend and administer
respiratory medication (Kuharic et al, 2015). The therapist will intubate the patient and even
facilitate bronchoscopy procedures. The respiratory therapist will also offer pulmonary hygiene
and also do necessary chest physiotherapy to minimize the chances of cardiac arrests.
Secondly, it will be important for the nurse to collaborate with a specialized occupational
therapist in the management of COPD patients. The therapist’s task will be to support, coach and
educate the patient in regard to movement. The occupational therapist can assess the COPD
patient, organize and implement interventions that will enable the patient achieve independence
in doing routine activities like walking, eating, and grooming (Jan, 2013). The nurse should
collaborate with the occupational therapist especially in assessing and recommending
modifications to be done both within the critical care clinic and at Angela’s own home.

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
A further opportunity will be where there will be need for managing imbalanced
nutrition. The dietician in this case will be the most appropriate for collaboration to help the
patient with meal-time management (Fromer, 2011). The dietician thus will assess the patient,
organize interventions, implement them and then evaluate them to ensure that the patient gets
sufficient dietary needs. On the other hand, the dietician should teach the patient and her
caretaker on the necessary dietary requirements within the hospital and when discharged (Chin,
2017). A dietician must thus be fully incorporated in patient teaching, coaching, assessment and
advice on balanced nutrition.
Conclusion
In conclusion, it is important for healthcare providers, the patients and their caretaker to
understanding the guiding principles in the management of chronic and complex decisions. The
discussion above highlights the main guidelines on the developing of nursing plans in chronic
and complex care setting and their different ways of improving health outcomes of patients.
Among the guidelines include advocacy, health coaching, self-management and empowerment.
The discussion also focuses of highlighting the nursing plan for a patient presenting with COPD
exacerbations and further, the situations at which the nurses can find opportunities to collaborate
with other members of the interdisciplinary team in carrying out the nursing plan.

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
References
Chin, E. (2017). The COPD exacerbation experience: A qualitative descriptive study. Applied
Nursing Research, 38, 38-44. http://dx.doi.org/10.1016/j.apnr.2017.09.005
Cramm, J., & Nieboer. (2013). The relationship between self-management abilities, quality of
chronic care delivery, and wellbeing among patients with chronic obstructive pulmonary
disease in The Netherlands. International Journal Of Chronic Obstructive Pulmonary
Disease, 209. http://dx.doi.org/10.2147/copd.s42667
Elder, C. (2017). Health Care Systems Support to Enhance Patient-Centered Care: Lessons from
a Primary Care-Based Chronic Pain Management Initiative. The Permanente Journal.
http://dx.doi.org/10.7812/tpp/16-101
Fromer, L. (2011). Implementing chronic care for COPD: planned visits, care coordination, and
patient empowerment for improved outcomes. International Journal Of Chronic
Obstructive Pulmonary Disease, 605. http://dx.doi.org/10.2147/copd.s24692
Hodson, M. (2016). The nurse role in addressing malnutrition in COPD patients. Practice
Nursing, 27(10), 502-504. http://dx.doi.org/10.12968/pnur.2016.27.10.502
Howard, L., & Ceci, C. (2012). Problematizing health coaching for chronic illness self-
management. Nursing Inquiry, 20(3), 223-231. http://dx.doi.org/10.1111/nin.12004
Ides, K., Vissers, D., De Backer, L., Leemans, G., & De Backer, W. (2011). Airway Clearance in
COPD: Need for a Breath of Fresh Air? A Systematic Review. COPD: Journal Of
Chronic Obstructive Pulmonary Disease, 8(3), 196-205.
http://dx.doi.org/10.3109/15412555.2011.560582

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
Jan, R. (2013). Pulmonary Embolism as a Cause of Acute Exacerbation of COPD in Patients
With Exacerbation of Unknown Etiology. Chest, 144(4), 680A.
http://dx.doi.org/10.1378/chest.1704030
Kuharic, J., Sustic, A., Marcun, R., & Lainscak, M. (2015). NT-PROBNP PREDICTS THE
NEED FOR VENTILATORY SUPPORT IN THE PATIENTS WITH ACUTE
EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY
DISEASE. Intensive Care Medicine Experimental, 3(Suppl 1), A390.
http://dx.doi.org/10.1186/2197-425x-3-s1-a390
Lau, C., Siracuse, B., & Chamberlain, R. (2017). Readmission After COPD Exacerbation Scale:
determining 30-day readmission risk for COPD patients. International Journal Of
Chronic Obstructive Pulmonary Disease, Volume 12, 1891-1902.
http://dx.doi.org/10.2147/copd.s136768
Parikh, R., Shah, T., & Tandon, R. (2016). COPD exacerbation care bundle improves standard of
care, length of stay, and readmission rates. International Journal Of Chronic Obstructive
Pulmonary Disease, 577. http://dx.doi.org/10.2147/copd.s100401
Rezapour Nasrabad, R. (2017). Introducing a new nursing care model for patients with chronic
conditions. Electronic Physician, 9(2), 3794-3796. http://dx.doi.org/10.19082/3794
Schiøtz, M., Høst, D., & Frølich, A. (2016). Involving patients with multimorbidity in service
planning: perspectives on continuity and care coordination. Journal Of
Comorbidity, 6(2), 95-102. http://dx.doi.org/10.15256/joc.2016.6.81
Sciarra, E. (2012). The Importance of Practice Guidelines in Clinical Care. Dimensions Of
Critical Care Nursing, 31(2), 84-85. http://dx.doi.org/10.1097/dcc.0b013e3182445f62

CHRONIC AND COMPLEX CARE NURSING FOR COPD PATIENTS
Sonola, L., Thiel, V., & Goodwin, N. (2013). Care co-ordination and continuity of care for
patients with complex needs: emerging lessons from five models in the UK. International
Journal Of Integrated Care, 13(5). http://dx.doi.org/10.5334/ijic.1253
Straughair, C. (2011). Safeguarding vulnerable adults: the role of the registered nurse. Nursing
Standard, 25(45), 49-56. http://dx.doi.org/10.7748/ns2011.07.25.45.49.c8627