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Moving to an Upward Spiral: VNSNY Helps Patients Cope with COPD
 The COPD self-care guide explains the disease in lay terms to help patients with COPD manage their disease.
Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States and is on the rise. The disease predominantly affects people who have smoked for many years, but it is also traced to occupational dust and chemicals, and to air pollution. COPD is also an expensive disease: Medicare costs for COPD patients are more than twice those of people with other diseases. In spring 2004, VNSNY launched a multi-pronged program to help patients with COPD better manage this debilitating disease and live more active, happier, and healthier lives.
COPD commonly presents itself as emphysema or chronic bronchitis. Sometimes coupled with asthma, it is a progressive illness characterized by lung inflammation that limits airflow causing shortness of breath, coughing, weakness, and other symptoms. Difficulty breathing can send patients on a downward spiral that leads to decreased activity, further weakness, and depression. Inactivity, in turn, leads to a worsening of symptoms.
"We have an ability to prevent the downward spiral of COPD that occurs when inactivity and non-adherence with medications allow the situation to become worse," says Eleanor Canning, VNSNY regional director for business development, who co-sponsored the project within VNSNY along with Jeanne Ryan, Rehabilitation manager. When patients first join the COPD program, many have been spending way too much time sitting around, she says. The COPD program gets them up and active, guided by therapists and nurses.
"We can get that spiral going upward and look forward to better outcomes," says Ms. Canning, adding, "With proper self-care, people can improve their breathing, become more active, and be in much better moods."
The key components of the COPD educational program are medication adherence (since patients have to juggle a formidable amount of medicines) and rehab, in which staff work with patients to increase their stamina and ability to breathe effectively, thereby increasing their activity.
VNSNY provides services to some 5,000 patients with COPD each year, including 2,000 who receive home care specifically because of trouble managing this illness. Recognizing the importance of patient education in reversing the downward spiral of COPD, the New Product Development Committee at VNSNY has developed a set of materials for staff and patients: an education program to specially train nursing and physical therapy staff, a set of protocols for front-line clinicians to help them understand how to help and instruct patients in their care, and a self-care guide for patients to help them manage the disease. The organization has also introduced a new rehab element to assist the COPD patient in controlled breathing, correct posture, and other important changes in lifestyle.
For most patients, the most important step toward preventing or slowing the progression of the disease is to quit smoking. Eighty percent of COPD patients are current or former smokers. VNSNY social workers consult with patients to implement a smoking cessation program as well as provide counseling for coping with their chronic illness and, if needed, end-of-life decision making.
The COPD program is based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The GOLD report is a concerted worldwide effort to increase awareness of COPD, review the medical research, and issue recommendations for improving the prevention and management of COPD.
"The Education Department searched the research literature to ensure that we were using evidence-based practice," says Ms. Canning, "and to ascertain that our guidelines were consistent with the Gold Report."
Many people with COPD are not diagnosed, emphasizes Lorraine Ferrara, a VNSNY education coordinator in the Clinical Education Department, who develops educational material with a multidisciplinary team for clinicians and patients. "COPD can be slowed and to some extent stopped in its tracks," she says. "If it is diagnosed and treated early, one can learn to live with COPD effectively and have a good quality of life for many years."
Communicating hope is a critical part of the COPD program, explains Sue Wittenberg, education manager in the Clinical Education Department. "That is why we focus on the upward spiral of the VNSNY COPD Program and the fact that further deterioration from COPD is preventable.
The 68-page, large-print self-care guide for patients is an optimistic look at controlling COPD. It explains the disease in lay terms and outlines the roles of visiting nurses, physical therapists, occupational therapists, speech pathologists, social workers, and home health aides in helping people cope with it. The guide also provides a chart of the various medications most often prescribed to people with COPD, how they work, when they should be used, and their side effects, in addition to an illustrated description of how inhalers should be used.
Together, the publication of the self-care guide and clinician’s protocols won high praise from the American Lung Association, which invited VNSNY to join its leadership summit on COPD. VNSNY was the only home care agency elected to do so. VNSNY has also received a Community Health Accreditation Program commendation for its COPD Program.
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(Click to enlarge) |
| Difficulty breathing can send COPD patients on a downward spiral as seen here, left. The COPD program is designed to get the spiral going upward, as shown on the right. |
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