Interview with the patient with chronic illness Analysis 2022

Interview with the patient with chronic illness
Introduction
The interview is an efficient tool aid in data collection and critical analysis of the patient
condition. It is the qualitative research interview, acts as a medium of the therapeutic
relationship with the patient. Collection of patient information is the primary step of the
nursing interview. Person-centred interview with the patient boost the rapport and reduce the
feeling of helplessness of the patient. This assessment is about the 30 minutes interview
conversation between the nurse and the patient with chronic illness. Discussion includes the
background information of the patient which includes the Pathophysiology and
pharmacological data. Impact of the chronic illness on the patient and family is analyzed.
RLT model of nursing is implemented to relate the collected information Establishment of
goal was implemented using nsqhs partnering with consumer’s standard. Nursing care
priorities goals of care and need of health education are listed as per the need of the patient.
Patient interview
Dear Clara,
He is William, participating in the interview to assess, analyze and support you for the better
outcome.
Clara is the 68 years old women, a retired school teacher suffering from multiple chronic
illnesses such as type 1 diabetes, hypertension and Chronic obstructive pulmonary disease.
She is a diabetic for the past three and a half years. She is on insulin and antidiabetic
medication for managing her blood sugar level. She has mild hypertension for which the
physician advised her for less fluid intake and low sodium diet. Clara is a chain smoker for
more than 30 years and she stopped smoking when she diagnosed with COPD as per doctors
advice in the year 2016. She is on bronchodilators for COPD management. Clara is a widow.
She suffered mild depression for a year after the death of her husband. Depression was

managed with anti-depressive medications and counseling (McGrath, Palmgren, & Liljedahl,
2019).
She is living with her only daughter, son in law and grandchildren in the outskirts of the city.
Clara loves to spend time with her grandchildren and neighbours. She loves to shop and dines
out twice a month with her family. Clara actively involves her in family and social gathering.
She suffers frequent exacerbation of the COPD nowadays due to climatic changes and has
complaints of frequent breathing difficulty episodes. Nutrition pattern of Clara is significantly
affected due to breathing difficulty. She also suffers from a recurrent respiratory infection.
She seeks medical advice for the same (Berkhof, van den Berg,Uil, & Kerstjens, 2015).
Pathophysiology
COPD is the common disease condition affects the respiratory system. It is the group of
respiratory diseases which includes Emphysema and bronchitis. Exacerbation of the disease
is triggered by allergens in the environment. Critical analysis of Clara’s signs and symptom
shows that the episodes of breathing difficulty are increased in the dusty environment and
also due to the climatic change (Anzueto, & Miravitlles, 2017). Pathophysiology of COPD
includes the inflammation of the inner lining of the respiratory system results in swelling and
increase mucus production (Mitchell, 2015). Swelling lessens the space of air entry which
results in impaired gas exchange and further complications. Increase mucus production clogs
the bronchus whereby the function of the respiratory system is affected. Clara has complaints
of recurrent respiratory infection which is due to increased mucus production (Mitchell,
2015).
Pharmacology and cultural
Bronco constriction is the most serious reaction of the system to the allergens. Clara suffers
from respiratory difficulty when exposed to allergens like dust, pollens and smoke. A
bronchodilator is the drug of choice for the treatment of COPD (Cazzola, Beeh, Price, &

Roche, 2015). Some of the common bronchodilators administered to the COPD patients are
salbutamol and terbutaline. The action of the bronchodilator is relaxing the smooth muscles
of the bronchus and the inner lining of the respiratory system. Clara manages the respiratory
difficulty using bronchodilators as it relaxes the inner muscles and eases the respiration.
Cultural cause for COPD in the case of Clara is smoking. She quit smoking four years back
but the impact of the smoking increases the complication of COPD.
Discussion
Impact of the chronic disease
Clara is the widower who had depression due to the loss of her husband. Being with her
daughter and grandchildren helped her to recover from the depression. Frequent episodes of
breathing difficulty and exacerbation of COPD affected her personal life with her family.
Multiple diseases like diabetes, hypertension and COPD together affected the physical health
of Clara. She is feeling guilty for making her daughter spend for hospitalization. She is
emotionally disturbed as she is unable to spend time with her grandchildren. As she is
financially depending on her daughter she is feeling guilty due to the financial burden of the
family. Recurrent sickness affected the social life of Clara and she is unable to meet her
friends and neighbors (Bos-Touwen et al. 2015).
RLT model of nursing is implemented to relate the collected information of Clara.
Assessment with the support of the RLT model aids in finding the need of the client. Clara is
living in a safe environment. Her communication with her family and neighbours is disturbed
due to the episodes of breathing difficulty. Clara is the known case of Chronic Obstructive
Pulmonary Disorder and her breathing is significantly affected. She is unable to meet her care
needs and incapable of implementing the Activities of Daily Life (Farooq, & De Villiers,
2017).

Clara’s eating and drinking pattern are changed due to the disease condition. She is able to
meet the elimination needs without any support. Clara is meeting her cleansing and dressing
needs herself. She is maintaining her body temperature and she is active in the absence of
exacerbation of COPD. Moderate mobilization is done without any support and she seeks
support for mobilization to hospital, church and shopping. Her sleeping pattern is moderate
and significantly affected during respiratory infection and breathing difficulty.
Care priorities and Goal setting
Establishment of goal
Establishment of a goal was implemented using nsqhs partnering with consumers standard
(Milic et al. 2015). As this is the interview conversation through telephone, the nurse has to
establish goals in such a way to support Clara indirectly. Nursing care and support can be
provided in the form of health education to improve the individuals’ quality of life. The
primary goal for nursing care of Clara is the maintenance of a normal breathing pattern after
applying the nursing intervention for 72 hours. The secondary goal includes intake of
appropriate nutrition after implementing the health education into practice for a week to 10
days.
Nursing care
Patent airway and breathing
The primary problem of Clara is breathing difficulty and related complications. Nursing care
needs to execute considering the causative factors for a better outcome. Primarily, advise
Clara to stay away from allergens and ensure the pollution-free environment. Deep breathing
and coughing exercise is an efficient intervention that helps to strengthen the respiratory
muscles and ensure easier breathing (Chien, Chung, Yeh, & Lee, 2015). Clara needs to be
educated about deep breathing and coughing exercise. The nurse has to encourage Clara to
take prescribed medications and regular follow up (Rooddehghan, 2018). Advise Clara to

always sleep in the semi-fowlers position and explain the benefit of sleeping in semi-fowlers
position. The nurse has to encourage Clara to do her care needs slowly and advise to take
small breaks between her works. Counsel her to get help from the family members. Advise
Clara to use bronchodilators whenever she gets breathing difficulty (Suissa, Dell'Aniello, &
Ernst, 2017).
Intake of nutritious food
Conversation with Clara shows that intake of highly nutritious food would help her to
overcome the problems. The respiratory difficulty is the primary cause of a decrease in
nutritional intake. Advise her to take high protein and fibre diet and encourage her to include
more fruits and vegetables in the diet. The nurse has to counsel her to reduce caffeinated and
alcoholic drink as it may worsen the condition. Clara has complaints of frequent respiratory
infection; eating nutritious food can reduce the level and frequency of infection (Rawal, &
Yadav, 2015). Taking a small amount of food in small intervals helps in balancing the
nutritional needs of Clara. Potassium-rich can be advised to Clara as it improves the function
of the respiratory system. Encourage her to take less sodium diet as increased sodium intake
may attract increased fluid intake which can lead to fluid overload and breathing difficulty.
Spiritual and psychological support was provided as she has a history of depression
(Brugnoli, 2016).
Conclusion
Research nursing interview through telephone was done for Clara. She stays in outskirts,
away from the city and not able to access health services frequently. The interview was
conducted after getting consent from Clara after explaining the related factors. List of
questions was prepared before conducting the telephonic with the patient. Confidentially of
the patient information and conversation was ensured to the patient before the
commencement of the interview. Cultural and spirituality safety was maintained during the

interview. Personal history, past and present medical history were collected as part of data
collection. Critical analysis of the impact of the disease condition was analysed. Goals were
established focusing on the high priority need of Clara. Nursing care priorities and health
education were provided as per the need of the person. This research interview improved the
understanding and knowledge of the telephonic interview with the patient. It is also
encouraging multiple modes of nursing care and support.

References
Anzueto, A., & Miravitlles, M. (2017). Pathophysiology of dyspnea in COPD. Postgraduate
medicine, 129(3), 366-374 Retrieved from
https://www.tandfonline.com/doi/abs/10.1080/00325481.2017.1301190
Berkhof, F. F., van den Berg, J. W., Uil, S. M., & Kerstjens, H. A. (2015). Telemedicine, the
effect of nurse‐initiated telephone follow up, on health status and health‐care
utilization in COPD patients: A randomized trial. Respirology, 20(2), 279-285
Retrieved from
https://onlinelibrary.wiley.com/doi/abs/10.1111/resp.12437
Bos-Touwen, I., Schuurmans, M., Monninkhof, E. M., Korpershoek, Y., Spruit-Bentvelzen,
L., Ertugrul-van der Graaf, I., ... & Trappenburg, J. (2015). Patient and disease
characteristics associated with activation for self-management in patients with
diabetes, chronic obstructive pulmonary disease, chronic heart failure and chronic
renal disease: a cross-sectional survey study. PloS one, 10(5)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423990/
Brugnoli, M. P. (2016). Clinical hypnosis for palliative care in severe chronic diseases: a
review and the procedures for relieving physical, psychological and spiritual
symptoms. Ann Palliat Med, 5(4), 280-297 Retrieved from
https://www.researchgate.net/profile/Maria_Brugnoli2/publication/
309360203_Clinical_hypnosis_for_palliative_care_in_severe_chronic_diseases_A_re
view_and_the_procedures_for_relieving_physical_psychological_and_spiritual_symp
toms/links/5818d0b208ae1f34d24aa9bf.pdf

Cazzola, M., Beeh, K. M., Price, D., & Roche, N. (2015). Assessing the clinical value of fast
onset and sustained duration of action of long-acting bronchodilators for
COPD. Pulmonary pharmacology & therapeutics, 31, 68-78 Retrieved from
https://www.sciencedirect.com/science/article/pii/S1094553915000267
Chien, H. C., Chung, Y. C., Yeh, M. L., & Lee, J. F. (2015). Breathing exercise combined
with cognitive behavioural intervention improves sleep quality and heart rate
variability in major depression. Journal of Clinical Nursing, 24(21-22), 3206-3214
Retrieved from
https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.12972
Farooq, M. B., & De Villiers, C. (2017). Telephonic qualitative research interviews: When to
consider them and how to do them. Meditari Accountancy Research Retrieved from
https://www.emerald.com/insight/content/doi/10.1108/MEDAR-10-2016-0083/full/html
McGrath, C., Palmgren, P. J., & Liljedahl, M. (2019). Twelve tips for conducting qualitative
research interviews. Medical teacher, 41(9), 1002-1006. Retrieved from
https://www.tandfonline.com/doi/full/10.1080/0142159X.2018.1497149
Mitchell, J. (2015). Pathophysiology of COPD: Part 2. Practice Nursing, 26(9), 444-449.
Retrieved from
https://www.magonlinelibrary.com/doi/abs/10.12968/pnur.2015.26.9.444
Mitchell, J. (2015). Pathophysiology of COPD: Part 1. Practice Nursing, 26(4), 172-178.
https://www.magonlinelibrary.com/doi/abs/10.12968/pnur.2015.26.4.172
Milic, M. M., Puntillo, K., Turner, K., Joseph, D., Peters, N., Ryan, R., ... & Anderson, W. G.
(2015). Communicating with patients’ families and physicians about prognosis and
goals of care. American Journal of Critical Care, 24(4), e56-e64
https://aacnjournals.org/ajcconline/article/24/4/e56/4019/Communicating-with-
Patients-Families-and

Peters, K., & Halcomb, E. (2015). Interviews in qualitative research. Nurse Researcher
(2014+), 22(4), 6 Retrieved from
https://search.proquest.com/openview/ba3075a18bb3bb5131d28a13da33cd0e/1?pq-
origsite=gscholar&cbl=2042229
Rawal, G., & Yadav, S. (2015). Nutrition in chronic obstructive pulmonary disease: A
review. Journal of translational internal medicine, 3(4), 151-154 Retrieved from
https://content.sciendo.com/view/journals/jtim/3/4/article-p151.xml
Rooddehghan, Z. (2018). Nursing Care in COPD. Iranian Journal of Allergy, Asthma &
Immunology, 17 https://web.b.ebscohost.com/abstract?
direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=17351502&AN=131
097851&h=1pLjmqmAzrEQ2rIpNQ1lB8fVRjyNzDtiu0HlYDc0Upfeja1qRzUfrfm6K
ksAFsMq5ZwZu5g%2fsliI9syXAvNsFA%3d
%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=log
in.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype
%3dcrawler%26jrnl%3d17351502%26AN%3d131097851
Suissa, S., Dell'Aniello, S., & Ernst, P. (2017). Concurrent use of long-acting bronchodilators
in COPD and the risk of adverse cardiovascular events. European Respiratory
Journal, 49(5) Retrieved from
https://erj.ersjournals.com/content/49/5/1602245.short