Discuss how an adult nurse would support an individual with a long term condition
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Discuss how an adult nurse would support an individual with a long-term condition
Nurses need an in-depth knowledge of long-term health conditions (LTCs) to provide effective nursing care. The paper provides a discussion of chronic obstructive pulmonary disease (COPD) while focusing on end-of-life care for patients with the condition. Moreover, the paper highlights two major aspects of nursing care including promotion of patient safety and legal and ethical issues. Nurses must have a profound grasp of the LTCs in order to provide effective contemporary care. Ferreira et al. (2020) affirm that knowledge helps nurses in the early detection and diagnosis of health conditions, proper symptom management, applying evidence-based practice (EBP), providing individualised care, and proper symptom management. In addition, proper medication management, patient education, and empowerment to foster self-management and behaviour change require knowledgeable and skilled nurses in LTCs (Taylor et al., 2014). The understanding of LTCs can provide proper psychosocial support, and collaborative care planning to optimise outcomes thereby enhancing the quality of life for the patients.
How Adult Nurse Support Individuals with Long-term condition
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Selected LTC: Chronic Obstructive Pulmonary Disease (COPD)
COPD is a progressive lung disorder characterised by obstinate airflow limitation (World Health Organisation [WHO], 2023). This LTC comprises a collection of lung conditions including chronic bronchitis and emphysema. According to Joe et al. (2023), LTC are chronic disease without cure, but they can be managed through self-management, behaviour change and medication. Although COPD is a second leading cause of mortality (British Lung Foundation, 2023), the National Institute of Care and Excellence (NICE, 2018) shows that multidisciplinary team (MTD) approach can foster effective care. In particularly, the MTD involves assessment to determine devices for inhaled therapy, oxygen and aids for daily living. Other care team include respiratory care nurse, physiotherapist, dietetic, occupational therapists and social services to facilitate effective care. The National COPD Policy Action Plan (2021) equally indicate that prioritising timely diagnosis, prevention and reducing disparities are necessary in the effective care of patients with this LTC.
This disease is considered a long-term condition because besides being chronic and progressive, it typically persists the entirety of an individual’s life upon being diagnosed. Primarily, the progressive nature is marked by persistent airflow limitation that degenerates over time and leads to irreversible primary lung damage (Parris et al., 2019). It is also considered LTC due to the chronic symptoms that individuals with COPD experience including coughing, breathlessness or wheezing, and fatigue, which gradually worsen with time
Another reason COPD is classified as LTC is that it is associated with the risk of symptom exacerbations where there are often periodic condition flare-ups, indicated by the acute deterioration of symptoms (Buttery et al., 2021). The flare-ups worsen the longstanding effects of COPD, both in its health- and quality of life implications; even though these symptom eruptions tend to occur occasionally and with unpredictable intensity.
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Pathophysiology and Pharmacology of COPD
The Global Initiative for Chronic Obstructive Lung Diseases (GOLD], 2023) indicates that the main pathophysiology of COPD encompasses airflow obstruction, gas trapping, abnormalities in pulmonary gas exchange, exacerbation, multimorbidity, and pulmonary hypertension.
However, the primary cause is the prolonged exposure to irritants, especially air pollutants and directly inhaled particles such as cigarette smoke, which obstruct the airways (Lange et al., 2021). In turn, the obstruction triggers the destruction of the parenchymal resulting in structural change that causes narrowing in the small airways. Specifically, these changes inhibit airways opening on expiration reducing forced expiratory volume (FEV1) and FEV1/ forced vital capacity (FVC) ratio while contributing to gas trapping and hyperinflation (GOLD, 2023).
Although there is no cure for COPD (NHS, 2023), pharmacological management is used to relieve symptoms and reduce the occurrence of exacerbations, exercise tolerance, and quality of life (GOLD, 2023). Furthermore, treatment is personalised and relies on the staging of COPD especially on airflow obstruction, the severity of exacerbations, and symptoms (GOLD, 2023). The pharmacological management of COPD involves several approaches where bronchodilators take the center stage used to change spirometry variables or increase FEV1. Through administration of medications such as salbutamol are used to act on beta2 receptors within the airway smooth muscle, which leads to bronchodilation and relief of airflow obstruction (Singh, 2021). Besides, anticholinergics, which are drugs such as ipratropium and Tiotropium administered to block muscarinic receptors (Guo et al., 2022). by reducing bronchoconstriction and mucus secretion. Inhaled corticosteroids (ICS) such as budesonide help in reducing airway irritation and control symptoms in patients with recurrent exacerbations or severe COPD (Matera et al., 2021).
Pharmacological management may also constitute administration of Phosphodiesterase-4 (PDE4) Inhibitors. These comprise drugs such as roflumilast, which act by reducing inflammation and inhibiting COPD flare-ups. The drugs target phosphodiesterase-4 enzymes, which are involved in inflammatory pathways. Other pharmacological approaches targeting COPD control and management also include combination therapy or medications, mucolytics oxygen therapy, and annual influenza and pneumococcal vaccinations to reduce the risk of respiratory infections and flare-ups (Cazzola et al., 2022). Pathophysiology of COPD is closely linked to the pharmacology of the disease because understanding its pathophysiology helps in planning the pharmacological interventions.
The primary ideas explored in this essay revolve around advocating for patient safety and addressing the legal and ethical considerations involved in delivering end-of-life nursing care to a patient with COPD.
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Ensuring patient safety is a fundamental principle ingrained in the nursing profession. Its significance becomes particularly evident when providing end-of-life care for adults with COPD, from various perspectives. Prioritizing patient comfort and dignity, promoting safety guarantees that individuals with COPD receive nursing care that upholds their dignity and enhances their quality of life as they approach the end of life (Crooms and Gelfman, 2020). This involves implementing measures such as effective pain management, symptom alleviation, and emotional support to uphold the patient’s overall well-being and respect their preferences. To promote safety, nurses undertake specific actions such as preventing falls, controlling infections, ensuring systematic medication management for medical safety, providing oxygen support, and addressing respiratory needs, while also working to mitigate potential complications (Miller et al., 2020). Additionally, O’Donnell et al. (2020) highlight the importance of fluid management as another strategy to enhance the safety of patients with COPD.
One of the main features of COPD is chronic inflammation of the airway walls and the progressive obstruction of the airways as well as the loss of lung tissue (GOLD, 2023). The air passage becomes constricted, which traps air in the lungs and renders breathing more difficult. As symptoms progress, and with continued exposure, these changes transition into an irreversible state and worse. However, effectively managed interventions require continuous support and monitoring of the patient, to attain positive outcomes result.
Legal and Ethical Considerations
There are a number of ways the nurse can act to make sure that legal and ethical considerations are taken into account in the provision of care to the terminally ill COPD patient. From the legal perspective, the nurse must first ensure strict compliance with the prevailing requirements regarding the advance directives, including the living will of the patient (NHS, 2023)
The nurse should also honor the patient’s preferred treatment preferences by complying with the patient’s power of attorney concerning the patient’s healthcare (Hall et al., 2024). Morrison et al. (2021) however argued that while legal aspects such as advanced care planning (ACP) are important for nurses to consider the preferences of patients, in emergency cases treatment is made based on written documents instead of discussing with patients or their surrogates. This limitation further limits the effectiveness of ACP and therefore a nurse may not find them to be very helpful in the provision of optimal care. Radbruch et al. (2020) add that pre-prepared palliative care wills can be very helpful for nurses to provide nursing care following the wishes of the patient, they can also contain or are based on convoluted rules, documentation, and criteria formulated by the legal counsel of the patient. This can make care provision more challenging than efficient. Morrison et al. (2021) add that the convolutions can be so intricate considerably impacting care provision.
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However, Hall et al. (2024) state that the nurse providing care to the terminally ill is better placed by adhering to laws and all regulations that govern the dispensation of palliative care and end-of-life nursing care, which includes making sure that they follow appropriate documentation and reporting. Ethical considerations that obligate the nurse during care provision include respecting the patient’s self-determination and autonomy as spelled out in the National and Midwifery Council ([NMC], 2018).
RESOURCES
When providing nursing care for terminally ill COPD adult patients, nurses require various resources to guarantee comprehensive and effective nursing care. Some of the essential resources needed include:
Medical Equipment: Terminally ill COPD patients most definitely require assisted respiration hence oxygen therapy equipment and respiratory aids are crucial (Laporte et al., 2020). The nurse also needs nebulizers and suction to help manage the patient’s symptoms and ensure respiratory comfort.
Medications: Optimal management of the patient’s symptoms will require access to a variety of medications for a variety of functions including: pain management, palliative care, management of anxiety, and symptom management (O’Donnell et al., 2020).
Informational Resources: The nurse educational materials to get information of varying nature about COPD management.
Supportive Services: Availability of social workers and counsellors alongside support groups are crucial in providing emotional support for patient and families hence supplement the work of the nurse (Laporte et al., 2020).
Legal Documents/Advance Directives: Assistance in completing advance directives, living wills, and other legal documents (NHS, 2023) makes a nurse’ decision-making process easier.
Interdisciplinary Team Collaboration: Partnership with physicians, respiratory therapists, pharmacists, and other healthcare specialists is fundamental for comprehensive care planning (Chan et al., 2020).
Technology: Ready availability of technology, for instance, electronic health records (EHRs) and telehealth platforms can make the nurse’s care provision more efficient and effective by improving communication and coordination (Chan et al., 2020).
FACILITATORS AND BARRIERS
There are various facilitators to the nurse’s provision of optimal quality of care to the terminally ill COPD patient during the end-of-life care provision. For example, effective communication skills to rapport with patients and families, initiate discussions about end-of-life care preferences and address worries or fears, which is associated with better outcomes (Ryan et al., 2022).
Moreover, a properly instituted and working interdisciplinary collaboration. with physicians, social workers, and palliative care specialists, helps ensure care is coordinated and holistic. Effective patient- and family-centred end-of-life care should address patients’ and family members’ physical, psychological, emotional, and spiritual needs. Then, education and training are vital for nurses providing end-of-life care (Chan et al., 2020). Nurses with education and training in end-of-life care principles, symptom management, and communication techniques are better prepared to provide high-quality end-of-life care to patients and their families. Another facilitator is cultural competence (Laporte et al., 2020). Nurses with cultural competence and sensitivity can accommodate various cultural beliefs, values, and preferences and create an inviting, inclusive care environment. Waller et al. (2020) noted that a supportive work environment plays a major role as a facilitator of effective dispensation of nursing care. Accordingly, leaders who promote a work environment that values teamwork, empathy, and self-care promote nurse well-being. This, in turn, improves nurses’ ability to provide compassionate and patient-centered care to patients at the end of life.
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Nonetheless, communication challenges, which include language barriers and cultural differences may be detrimental to the creation of a professional relationship with patients, and these barriers can also impede discussions about end-of-life care preferences. Another barrier is limited resources such lack of specialist palliative care services, and insufficient training options, which can significantly reduce the quality of the final life care provided to patients and their families (Rhee et al., 2021).
Ethical dilemmas can also act as barriers to proper dispensation of care (Lee et al., 2023). Various ethical dilemmas emerge within the domain of the end-of-life care decision-making sphere. The dilemma between a patient’s autonomy and the wishes of his or her family or uncertainty about the suitability of treatment interventions can make nurses emotionally distressed and thereby reduce the delivery of patient-centred COPD care. Miller (2020) argues that the provision of care goes beyond the administration of medications to ensure that patients are kept clean and nurses must invest emotionally and ethically to dispense care with a touch of humanity to avoid being robotic in their decision-making.
Cultural and religious differences can also affect the delivery of end-of-life COPD care leading to conflicts or misunderstandings. As a result, a nurse must have a certain level of cultural sensitivity and respectful practice. In end-of-life care, nurses may lose a connection or not feel they are providing what is needed. This drain of energy from patients can result in burnout, compassion fatigue, or moral distress (Silverman et al., 2021). Inadequate support systems and a lack of opportunities to debrief or implement proper coping mechanisms can prevent nurses from offering compassionate care.
Legislation and regulations could create barriers, like what is allowed and what is not when end-of-life planning or nursing scope of practice is concerned, which could limit a nurse’s ability to provide full and excellent end-of-life care.
Conclusion
The report has looked at the intricate nature of LTCs with a convergent focus on the provision of end-of-life nursing care to a terminally ill COPD patient. Analysis of pathophysiology and pharmacology has revealed pathophysiology and pharmacology of COPD are closely linked because understanding the pathophysiology informs planning for interventions. The promotion of safety and the legal and ethical issues are the main principles of care provision. The discussion demonstrated that nurses act in ways that promote the patient’s safety through managing pain, and symptom control, and offering emotional support to help maintain the patient’s overall well-being. Respecting patient autonomy by involving patient and family in decision-making, properly documenting care decisions, and adhering to living wills are necessary ethical and legal considerations in end-of-life care. Nonetheless, cultural cum religious differences, emotional and moral issues, and legal and regulatory constraints can prevent delivery of end-of-life care. However, the report shows effective communication mechanisms and interdisciplinary collaboration, facilitate the provision of care to the terminally ill COPD patient.
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