Framework
Utilizing Neuman’s Systems Model as the framework, a random assignment, comparative experimental research design is proposed. Implementation of PR for COPD patients to optimize their health in a disease state would represent a tertiary level of practice intervention per Neuman’s Systems Model. The concepts being explored include, the comparison effect of a nurse led home-based PR program verses a nurse-led primary care office based PR program verse no PR program for patients who have had an acute hospital discharge within the past 15 days. The variables to be measured include hospital readmission for a period of one year after completion of the PR program or 10 weeks post enrollment, lung function defined by the measurement of
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Several studies, including two systematic reviews noted in Table 1, provide evidence that PR has an impact on reducing hospital admissions, as well as improving patient lung capacity and quality of life (QOL). While these studies have all shown some type of positive outcome, referral patterns from primary care providers remains low (Johnston & Grimmer-Somers, 2010). Holland and Hill (2011), also identify that program access and availability are also issues that hinder patient participation. Four of the studies noted in Table 1 include evaluation of nurse-led programs which provide positive outcomes The nurse-led program example were performed in both home-based and hospital-based programs, but no literature was found on nurse led PR programs that were based in primary care offices. As stated above, the focus of this research will be the comparison of two nurse-led PR programs which contain the same structure and education, one program in the patient home setting, the other conducted in the primary care office that will receive services within 15 days of a hospital discharge for a COPD exacerbation. A control group will consist of COPD patients with the same criteria, but the will not receive PR post discharge. The hypothesis of this study is, the implementation of structured nurse-led PR programs initiated within 15 days of a hospital discharge for COPD patients, will decrease hospital readmissions for a minimum of a year, as well as increasing lung function and QOL, while filling a service gap in the Northeastern and Central Pennsylvania
This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Principles of spiritual care are also naturally situated in
In the community lead pulmonary rehabilitation, (Linda Nici et al., 2006) says, nurses have shown their effectiveness across many settings around the country. (Griffiths et al. 2001) has produced a study that showed a saving in treatment of £152 for every patient treated by the pulmonary rehabilitation programme. Therefore, if a patient could be treated effectively as an outpatient in the home environment, this could enable the ambulance service to contribute to the referral proses, rather than taking the patient to the hospital for assessment by a Doctor. This would allow critically ill patients accesses to the intensive care
As the number of smokers are rapidly increasing recently, the number of patients with COPD (Chronic Obstructive Pulmonary Disease) is also gradually increasing. It is one of the most common chronic diseases and is considered to be one of the five leading diseases following heart disease, pneumonia, HIV and AIDS worldwide (GOLD, 2004). Smoking is the main cause of COPD. However, long term exposure to chemical fumes and air pollution could also cause COPD. This essay is all about how COPD affects individual, family and society as a whole across their lifespan. Also, it discusses the role of a nurse in caring patients with COPD.
The role of nurse practitioner is valuable when discussing collaborative care. There are so many levels of care, so many health entities, and so many insurer criteria involved that it is instrumental to have a role that can work towards help bring all aspects together. In addition to diagnosing, treating, and managing care, the role of the nurse practitioner is to manage simple and episodic acute health issues along with chronic disease (Sangster-Gormley, Martin-Misener, & Burge, 2013). It is important to note that although this is a function of this role, nurse practitioners also practice from a holistic point of view which allows them to help manage patient conditions or wellness in a more complete fashion. This includes helping patients have access to care beyond primary and secondary care settings. This encourages nurse practitioners to work alongside other health care and allied health professions, and families to create an individualized plan for every patient (van
The problem in this scenario is the challenges faced with trying to implement a new clinical pathway. This particular clinical pathway trying to be implemented is concerning ventilator-dependent patients who are discharged to home with home health care needs. These patients tend to have multiple health care needs beyond the ventilator and the new clinical pathway will establish a smooth transition from hospital to home, allowing for all the patient’s needs to be met. The challenges arise when trying to get all areas of the health care team to get involved. This especially includes the physicians that seem reluctant to follow a nurse’s guidelines. Not only are the physicians reluctant, the home health care representative will not be available to attend team meetings for a while. The new clinical pathway is due to be started in one month, so there is little time to get all parties on board.
The success of NPs depends on practicing evidence-based care with competency in assessment, diagnosing, managing patients, and maintaining a caring practice. The nursing component of the NP role continues to be challenged from within nursing, as well as by large national physician organizations. NPs are extensions of nursing practice who are guided by nursing theory. The transformation from nurse to the advanced practice role of NP involves development of advanced knowledge and skills for listening, knowing, being with patients, connecting patients to their communities, promoting health,
Hopkinson et al (2011) conducted a study where a COPD discharge care bundle was initiated on 94 patients. The hospital saw a large decrease in their 30-day readmission rate. It fell from 16.4% to 10.8% (Hopkinson et al., 2011).
Through the convenience sampling, 90 clients were recruited as research participants were in the waiting room of the respiratory clinic. 60 subjects agreed to attend a support group for socialization with each other. 30 of 60 clients were assigned to participate in the presentation and therapeutic exercises by the instructor. The instructor group divided into halves: 15 clients received instructions with family caregiver and the other clients without a caregiver. The second 30 clients received written materials and allowed to access the website for video presentation and exercises. Half of website group assigned to the family caregiver and the other half without a caregiver. The last 30 subjects were assigned as a control group, and half of these clients received usual care with family caregiver and other 15 clients without a family caregiver. The data was collected by the pulmonary functional status survey, 30 items, five points, Likert-type scale.
The aim of this essay is to explore evidence based nursing intervention in the care and management of chronic obstructive pulmonary disease (COPD) in an acutely ill patient. The acutely ill patient involved in this essay was admitted to hospital due to cerebrovascular accident and had a past medical history of myocardial Infarction, left Ventricular failure, peripheral vascular disease and duodenal ulcer as well as chronic obstructive pulmonary disease. This essay will provide a rationale for the chosen aspect of care (COPD) and reason will be given why it is a priority. In particular the essay will examine the significance of the underlying pathophysiology of the disease relating to the acutely ill patient other
As defined by Association of American Colleges & Universities, a “Liberal Education is an approach to learning that empowers individuals and prepares them to deal with complexity, diversity, and change. It provides students with broad knowledge of the wider world.” (M, 2015) A liberal arts education, also known as humanities, is designed to give a student a well-rounded approach to learning and the skills needed to implement their education through out every aspect. “Incorporation of the humanities can be beneficial in providing a more extensive body of knowledge to draw upon, including social awareness, critical thinking, and communication skills” (M, Wilby, 2011) Components of an exemplary nurse include demonstrating application of the nursing process while using the Neumans Systems model, implementing critical thinking skills, using effective communication, the use of evidence based practice, and discovering world changing nurses within the context of Christian ethics.
There are five major components of a disease-specific program (Health Policy Institute, 2004): As the initial step, disease-specific programs need to identify a population to target patients with a specific disease. The utilization of health care and expenditures based on the patient’s demographic information is analyzed to classify patients who will benefit from a disease specific management program. The second component is utilization of a collaborative team of medical providers, including physicians, nurses, pharmacists, psychologists, dieticians and respiratory therapists to educate and assist the patients manage their chronic conditions. Physicians are provided
The role that nurse practitioner (NP) plays within the increasing complex health care system is a constant changing role with the Consensus Model and the introduction of the Affordable Care Act in 2010. The scope of the nurse practitioner (NP) includes the care of the young, the old, the sick and the well. The educational needs of a nurse practitioner vary greatly from that of a Registered Nurse (RN), in the amount of education as well as the focus of the education. NPs provide coordinated primary care with the use of comprehensive health histories and physical examinations, diagnosing and treating acute and chronic illnesses, the management of medications and therapies, ordering and interpreting tests results, and educating and
Nursing theories serve as thinking guides for nurses to follow in order to reach optimal outcomes for patients. Theories are applied in conjunction with experience one has gained and critical thinking in everyday nursing practice, research, and education. The Neuman Systems Model, which was created by Betty Neuman, is one example of a theory that has been in practice for decades and continues to be modified to reflect new research. When applying the NSM, the nurse focuses on identifying and preventing stressors which are factors that lead to fluctuations in the body that affect daily living.
This article introduces that pulmonary rehabilitation is useful for patient with chronic diseases such as COPD patients (chronic obstructive disease). Patients with chronic illness have to go under a rehabilitative exercise program in order to improve their health and life quality. According to the article, there are 200 million COPD patients worldwide and COPD will become the fourth cause of death worldwide. However, patients who have undergone pulmonary exercise, adhere to the program while they are at the rehabilitation center and this decline when they are at home. Furthermore, the article demonstrates how technology can be used to monitor patient at home and help them to improve their lifestyles. It talks about using
The impact of nursing theories continues to provide a framework for guidance for patient centered care. Nurses continue to use these theories to provide beneficial knowledge in advancing their profession. Kearney-Nunnery (2012) describes the function of the conceptual model as a reference point and has been used to supply information to nursing scholars. One of these scholars that uses this model is Betty Neuman with the development of Neuman’s Systems Model. Neuman’s Systems Model refers to the individual, family, group and community as the client system and how they react when confronted with stress (Kearney-Nunnery, 2012). The purpose of this paper is to provide an understanding into to Neuman’s Systems Model, how it can improve patient care, and how it is used in nursing practices.