Nursing Palliative Care: Strategies for COPD Patients

This article discusses nursing palliative care strategies for COPD patients, focusing on addressing breathlessness and social isolation. The case study of Mrs. Brown is used to illustrate the application of these strategies. Non-pharmacological approaches, such as pursed-lip breathing and psychological counseling, are explored.

Soumya prakash Biswal
[COMPANY NAME] [Company address]
NURSING PALLIATIVE CARE

NURSING PALLIATIVE CARE 1
Contents
INTRODUCTION.....................................................................................................................................2
NURSING PALLIATIVE STRATEGY 1 – BREATHLESSNESS ( PHYSICAL).....................................................2
PALLIATIVE STRATEGY 2........................................................................................................................4
CONCLUSION.........................................................................................................................................5
REFERENCES..........................................................................................................................................5

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INTRODUCTION
The health of an individual is not limited to physical health but extends beyond the
physical aspect. To be healthy, a person must be mentally, physically and socially fit.
However, maintaining a balance in these three at an advance age is difficult. Therefore, very
often healthcare services are channelized towards palliative care where patient’s issues are
addressed in a positive environment by reducing their physical pain but improving their
quality of life. The social factors that play an important role in person’s life is also considered
in the care process (Kelley & Morrison, 2015).
Thus, it can be inferred palliation is to make the journey of the individual meaningful,
respectful and with dignity from a multi-disciplinary approach towards improving her quality
of life.
In the present context, Mrs. Brown’s case has been taken for consideration. She is a
62-year-old lady who lives with her family. But, currently, her condition has worsened due to
shortness of breath and morning cough. She was admitted to the emergency department for
care. She has been diagnosed with the chronic obstructive pulmonary disease. On assessment,
she was found to be depressed, low in weight and malnourished. Although her family
supports her, she wants to be independent. Therefore she has opted for a palliative approach.
In the present case study, two palliative nursing care strategy will be identified and discussed
in brief the rationale for such a strategy and why it must be applied in the case of Mrs.
Brown.
NURSING PALLIATIVE STRATEGY 1 –
BREATHLESSNESS (PHYSICAL)

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Breathlessness or shortness of breath is a chronic condition in COPD. This demands
continuous pharmacotherapy and in severe condition, supplemental oxygenation. The simple
mechanism that leads to COPD includes the inability of the lungs to respire with full
capacity. As a result, some amount of carbon-dioxide is always left in the lungs causing the
discomfort. This symptom, excluding the physical effect impacts on day to day life activities
or activities of daily living. Due to shortness of breath patient feels exhausted with less
activity also, increase in activity intolerance, difficulty in eating that can lead to poor health
and malnutrition and poor personal hygiene as mobility increases the symptom (Diaz, Smyth
& Curtis, 2015). Coughing put extra pressure on the lungs and causes physical pain on the
ribs and chest area. Therefore, from palliative care point of view, the target should be
addressing the reversible cause of issue via a collaborative approach and shifting the focus
towards comforting her through non-pharmacological approach. Pharmacological options can
involve either low dose morphine or prescribed benzodiazepines and supplemental oxygen
therapy (Chin & Booth, 2016). However, this must not be considered as ultimate or a set
framework, it depends on the patient too due to variation in their needs. A patient-centered
approach to medication will make Mrs. Brown feel empowered and improve her self-esteem
since, she has been hospitalized thrice for COPD. Therefore assessment of Mrs. Brown by
simply asking about symptoms and observing her speech, short or long sentence speaking,
and vital sign measurement can indicate about her current lungs status. Once, the underlying
cause such as airway inflammation, bronchoconstriction or airway modulation has been
addressed, the next step is to move towards non-pharmacological palliative care (Mulkerns,
O'Toole, Gregan, & McDonnell, 2017).
Comforting Mrs. Brown so that she doesn’t feel fatigued during her hospital stay is
the main target. Therefore, from a patient-centered approach pursed-lip breathing technique
must be taught in a positive and empathetic environment. This will improve her vital capacity

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and respiratory rate (Wangsom & Matchim, 2017). During the treatment facilitation for
breathlessness, any non-pharmacological treatments such as music therapy or acupuncture
can be facilitated to address her psychological states (Nyatanga, Cook, Goddard, 2018).
Encouraging Mrs. Brown for a small level of activity with encouraging words will have the
satisfaction and empowering effect on her psychological state. The environment maintenance
must be as per patient, and any type of triggering agents must be avoided. Communicate
behavior; compassionate care must be facilitated to improve her physical and psychological
condition (Gardener, Ewing, Kuhn, & Farquhar, 2018). Thus, in palliative care approach
while addressing her shortness of breath issue, the psychological, and spiritual care can be
taken to ensure the patient’s choices are prioritized and she feels empowered during her stay.
PALLIATIVE STRATEGY 2
The second palliative strategy for the present client should be addressing her social
isolation issue. Although, the physical effects of COPD on a patient’s life has been
extensively studied and reported, how it affects the personal and social space of the patient
has not been explored as its physical factors. Analysis shows, advanced age patients with
COPD feel very low as they feel they are under the mercy of disease and have less control
over their life. This is evident in the case of Mrs. Brown too who feels she is becoming a
burden to the family. Thus, in an extended form, the feeling of vague due to poor knowledge
on the disease, slow progress and debilitating symptoms can force for social isolation and
depression. Though the patient tries to carry out their daily activities and takes medication
regularly, lack of social support and fatigue kills their inner motivation (Schunk, Schulz &
Bausewein, 2018). As a result, depression arises. This might be the factor behind Mrs. Brown
depression. Therefore, from palliative care point of view integration of psychological
counselor for making Mrs. Brown understand the disease process and how it can be

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controlled through modifications in lifestyle (Brown, Jecker & Curtis, 2016). Referral self-
help groups can be contacted as the realistic approach towards better living in COPD can
come from a self-help group. This will address her social isolation risk and depression. For
the time being a referral to residential aged care service for assisting in her day to life as well
as a movement will be preferred (Chan, Graham, Roots, Hodson, & Sunak,, 2017). This will
help her in gaining confidence while carrying out her daily activities. The fatigue will be less,
and she can learn self-management of the disease. The chances of low felling increases, as
the progression is slow; however, the same slow progression status implicates the health
adaptation behavior can be set for longer years, and a better life can be lead. The spiritual
aspects of Mrs. Brown need to be assessed. Many times, patients feel relieved when their
spiritual needs are met (Vermylen, Szmuilowicz, & Kalhan, 2015). Therefore, from a holistic
point of view, Mrs. Brown’s care plan needs to be designed.
CONCLUSION
Thus, the current palliative care case study implicates, the physical and social effects
of the disease. The case of Mrs. Brown is a perfect example where physical symptoms
impacts on the mental health of an individual. Thus, healthcare professionals and nursing
professionals can include palliative care in early approach in their care regimen. However,
palliative focused care must not disregard the importance of physical symptoms since this can
severely affect life too. The evaluation must be carried out simultaneously to know the
effectiveness of palliative care.

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REFERENCES
Brown, C. E., Jecker, N. S., & Curtis, J. R. (2016). Inadequate palliative care in chronic lung
disease. An issue of health care inequality. Annals of the American Thoracic
Society, 13(3), 311-316.
Chan, C. S. J., Graham, L., Roots, D., Hodson, M., & Sunak, S. (2017). M4 Meeting the
psychological needs of copd patients and enhancing self-efficacy: integrating clinical
psychology in a community respiratory service.
Chin, C., & Booth, S. (2016). Managing breathlessness: a palliative care
approach. Postgraduate medical journal, 92(1089), 393-400.
Diaz-Lobato, S., Smyth, D., & Curtis, J. R. (2015). Improving palliative care for patients with
COPD.
Gardener, A. C., Ewing, G., Kuhn, I., & Farquhar, M. (2018). Support needs of patients with
COPD: a systematic literature search and narrative review. International journal of
chronic obstructive pulmonary disease, 13, 1021.
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England
Journal of Medicine, 373(8), 747-755.
Mulkerns, A., O'Toole, P., Gregan, P., & McDonnell, T. (2017). Does Combined Respiratory
and Palliative Care Management Improve Care for COPD Patients. International
Journal of Integrated Care, 17(5).

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Nyatanga, B., Cook, D., & Goddard, A. (2018). A prospective research study to investigate
the impact of complementary therapies on patient well-being in palliative
care. Complementary therapies in clinical practice, 31, 118-125.
Schunk, M., Schulze, F., & Bausewein, C. (2018). What Constitutes Good Health Care for
Patients with Breathlessness? Perspectives of Patients, Caregivers, and Health Care
Professionals. Journal of palliative medicine.
Vermylen, J. H., Szmuilowicz, E., & Kalhan, R. (2015). Palliative care in COPD: an unmet
area for quality improvement. International journal of chronic obstructive pulmonary
disease, 10, 1543.
Wangsom, A., & Matchim, Y. (2017). Dyspnea Management in Patients with COPD: Non-
Pharmacological Strategies. Songklanagarind Journal of Nursing, 37(4), 108-117.