Nursing Management Strategies

This essay discusses two high priority nursing strategies in a palliative care setting: pulmonary rehabilitation and social and emotional support. It explores the benefits of pulmonary rehabilitation for managing Chronic Obstructive Pulmonary Disease (COPD) and the importance of providing emotional and social support to alleviate social isolation. The essay highlights the effectiveness of these strategies in improving the quality of life for patients.

Running Head: NURSING STRATEGIES 1
Nursing Management Strategies
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Introduction
Palliative care is an important tactic that purposes at improving the conditions linked with
life-limiting diseases. Palliative care targets to alleviate suffering from a patient with a life
threatening diseases through providing early identification, effective assessment and holistic
treatment of physical, social, psychosocial, pain, spiritual and cultural requirements of a patient
and the family at any period of a serious illness. Palliative care helps in addressing the
requirements of a patient through the use of a highly specialized multidisciplinary team that
includes psychosocial healthcare providers, nurses, spiritual supporters, and doctors. Effective
palliative care is a significant extra layer support that aid in promoting an option for pain and
symptom management and promoting the quality of life to a patient with life restraining diseases.
This essays targets to discuss two high priority nursing strategies that are effective in a palliative
care setting.
Pulmonary Rehabilitation
Pulmonary rehabilitation is an essential nursing strategy that can help in managing
Chronic Obstructive Pulmonary Disease (COPD).COPD is a pulmonary health condition that is
characterized by limitations in airflow. The social and economic burden associated with COPD is
increasing and substantial (Cruz, Marques & Figueiredo, 2017). As evident in the case scenario,
Mrs. Brown has presented symptoms of COPD like coughing with the production of sputum and
progressive and chronic dyspnea. These symptoms of COPD deserve the blame that has led to a
burden in Mrs. Brown capability to carry out her daily activities and the inability to walk around.
As presented in the case scenario and according to existing evidence people with COPD feel

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trapped in a vicious circle of inactivity which usually starts with breathlessness (Chen et al,
2018).
Pulmonary Rehabilitation (PR) is an all-inclusive intervention practice that is centered on
patient assessment followed by patient-centered therapies like behavior and education change
and exercise training. The therapies are intended in improving the psychosocial and physical
circumstances in a person with COPD and in promoting adherence that is long lasting to
behaviors that enhance the quality of life (Gardiner et al, 2010). The therapies can be conducted
across several settings like home, community, and hospital; nurses should understand the
multidisciplinary, multidimensional and multi-professional aspects of care in order to provide
efficient care (Crawford, Burgess, Young, Brooksbank & Brown, 2013). Exercise training forms
the base for PR exercise may include resistance training, water-based training, and cycling
training. Before conducting the exercise, the therapists (nurse) should follow the code of nursing
requirements like effective communication; maintain autonomy and informed consent
(McCabe&Coyle, 2014, November). Before undertaking the training, the therapist should
consider the circumstance of the patient like strength and endurance, health-related quality of life
and symptoms. The PR activities especially exercise training can be conducted 2 to 3 hours at a
rate of three times per week for a period of at least six weeks depending on the intensity of
COPD. Various exercise training methods like upper limb training, strength training, and adjunct
to the exercise training should be considered. During the training session the heart rate, blood
pressure, and oxygen saturation are measured to enhance the safety of the patient. As the training
continues, therapists have to adjust the intensity training in orders to enhance endurance (Toye et
al, 2011).

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PR programs are useful since they help in strengthening muscle, decrease exacerbations
in patients with COPD, improve physical activity, reduce breathlessness and in enhancing
exercise tolerance (Ekren et al, 2018). As in the case scenario, conducting PR to Mrs. Brown will
help in reducing some of her life-limiting conditions like reduce exacerbations of her COPD,
enhance her ability to walk around and also help in reducing her condition of acute
breathlessness.
Also, research indicates that PR helps in reducing the cost of health care and decreasing
mortality. It helps in reducing the cost of health care by decreasing the number of hospital visits
and admissions. As in the case scenario, Mrs. Brown has been visiting the hospital frequently,
and hence PR can help in reducing the visits. Also, Mrs. Brown condition was deteriorating and
hence initiating PR can help in improving her condition hence prolong her life. Consequently,
PR embodies a safe and significant therapeutic selection that targets in reversing the systemic
exhibitions of COPD (Levack, 2018). COPD along with pharmacological therapy can be useful
in obtaining optimized patient management, which leads to positive changes in the daily life of
the patient.
Social and Emotional Support
Providing emotional and social support is a high priority nursing care strategy that can be
applied to alleviate the social isolation condition. The social isolation condition arises when
people become disconnected and withdrawn from friends, community, and family (Boekhout,
Berendsen, Peels, Bolman & Lechner, 2019). Mrs. Brown had presented situations that can lead
to social isolation like the incapability to carry out activities of daily life and even if she had
contact with the family members her condition of not able to carry out the activities of daily

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living can be connected to social isolation. Her inability to even walk around has led to
depression and feelings of loss. She feels like she is a burden to her family. To ensure adequate
care provision in the palliative care unit for social isolation an effective emotional and social
support should be incorporated (Domènech-Abella, Mundó, Haro & Rubio-Valera, 2019).
Nurses can incorporate various interventions aimed at providing good emotional and social
support. The interventions are psychosocial therapies, social and care provision, befriending
interventions, social facilitation intervention, skill/leisure intervention and animal interventions
(Gardiner, Geldenhuys & Gott, 2018).
The interventions are conducted through activities like friendship enrichment
programmes, connections to facilitated group based activities and one on one discussions. These
interventions strategies mainly focus on providing skills on social training like approaches to
develop effective social behaviors, providing emotional and social support through supporting
groups after bereavement and volunteer programmes that are aimed at befriending and increasing
opportunities that enable social interaction (Lindsay, Young, Brown, Smyth & Creswell,
2019).Common features that are associated with the effectiveness of the above interventions
include individual participation in the implementation and designing, interventions that consist of
productive engagement and adaptability of the intervention.
Research indicates that emotional and social supports intervention is useful in alleviating
social isolation because for instance social facilitation interventions help in the provision of
contact between the affected person and the family. It is because they help in providing a
supportive situation, keeping the patient occupied and helping in instilling a sense of belonging
(Newall & Menec, 2019). Emotional and social support will help Mrs. Brown instilling a sense

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of belonging and hence despite her inability to conduct daily activities like walking she will be
able to interact with others freely, and she won't feel like a burden to her family.
Also, the provision of emotional and social support is a useful initiative for ensuring
emotional adjustments required for alleviating depression. This is because social and emotional
support helps in creating awareness and understanding of negative thoughts and assumptions that
may be affecting them. After creating awareness and understanding, then the patient is able to
challenge the negative assumptions and thoughts and replace them with positive ones
(Perissinotto, Holt‐Lunstad, Periyakoi l& Covinsky, 2019). Good emotional and social support
will help Mrs. Brown in alleviating her underlying assumption that she seems like a burden to
her family members. Emotional and social support can be conducted in various settings like
home, community, and hospital; it should be encouraged as it provides a long lasting solution.
Conclusion
It is evident from the essay that effective strategies are the determinants of quality of care
of the patient in palliative care. As discussed effective strategies help in alleviating negative
health issues since they provide a holistic and multi-disciplinary approach to patient’s needs.
Appropriate palliative strategies are vital because they help in addressing specific physical,
emotional, spiritual and psychosocial requirements of a patient in a palliative care setting.
However, as highlighted non-pharmacological strategies like pulmonary rehabilitation should be
supplemented with pharmacological treatments in some circumstances especially when the
conditions being addressed are intense.

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http://hdl.handle.net/20.500.11937/5951