This reflective journal uses the Gibbs (1998) model, as the guideline of the reflection during a voluntary internship. The reflection is based on the experience gained whilst in working at a certain healthcare facility in the department of pulmonary rehabilitation program (PRP). The name of the client shall be assigned an alias name (Jay) for the sake of confidentiality (Nursing and Midwifery Council, 2008). Jay is currently 65 year old man, who attends the pulmonary rehabilitation program because he has a chronic obstructive pulmonary disease (COPD). He was under the short burst oxygen therapy (SBOT) prescription so as to suppress his symptoms.
According to World Healthcare Organization (2013), COPD is the interference of the airflow into the lungs as a result of chronic obstruction. COPD makes the patients to develop abnormal breathing patterns. During the internship, I closely worked with a team that dealt with PRP. The opportunity provided insight into the COPD’s theoretical knowledge, I previously learnt. The main caring session I was interested with was the breathing technique of Jay using purse lip breathing (PLB). I documented most of the exercise score programs of Jay using the Modified Borg Scale. Jay would occasionally be very anxious, de-saturated and breathless; when he attempted to walk with the assistance of fellow teammates, family or myself. Thus, I encouraged Jay to practice the purse lip breathing method during the morning walking exercise. Jay practiced the PLB technique and would often regain his breathe, relax and be calm after ten minutes of reassurance. However, Jay would occasionally be unable to apply the PLB technique without close intervention from the caregivers or family.
Close study of Jay made me calm and confident while assisting patients with COPD illness. Hence, I developed the two skills that intern assisted Jay to successfully control his breathe and anxieties. Prior to developing the sense of calmness and confidence, I could not avail physical assistance; this enervated Jay’s symptoms. However, I began gaining calmness and confidence towards assisting Jay to lower his symptoms. Therefore, I began introducing the PLB technique in addition to giving him reassurance, which greatly aided and comforted Jay by greatly debilitating his symptoms.
The morning exercise that Jay took was very instrumental for balancing his breath’s patterns. Other teammates joined suit and we built a useful combined morning exercise so as to ease Jay’s condition; this built a robust therapeutic nurse-patient relationship. Moreover, Jay perceived the PRP exercise very positively. Furthermore, he commended the exercise and deemed it very significant for his diagnosis. The conclusion made by Jay is in line with the studied of McCarthy et al. (2015), Watz et al. (2014), Rochester et al. (2015) and Bolton et al. (2013), which noted that PRP has an elevated general expectation of patients with either unstable or stable COPD.
According to National Institute for Healthcare and Clinical Excellence (2010), PRP is used to mitigate COPD, thereby reducing the admission of patients who are depressed and anxious. After attending the regular checkup on Jay, I noticed that dyspnoea is a common challenge even with other patients who lives with COPD. Thus, the timely mitigation of dyspnoea would have posed limited challenges of COPD on Jay. Dyspnoea examination should be given the first priority while offering treatment and care to the COPD patients. Anyway, PRP and Short burst oxygen therapy (SBOT), was the special program that was put in place by the management so as to offer care services to the patients, giving Jay’s family a sense of relief and hopes.
Jay’s dysponoea is a common COPD problem. Dyspnoea poses the challenge of subjective experience, which makes it very hard to measure. Notably, there are significances of quantifying dyspnoea using MBS scale. The PRP used the MBS scale to assess the rate at which dyspnoea was perceived, as well as monitoring the patient’s achievements. When Jay could hardly speak, the tool was useful since it enabled Jay to point his scores without being breathless. Thus, MBS was an appropriate tool in measuring dysponoea given that it was reliable and valid (Toren et al., 2017). Jay began experiencing moderate short breath when our team officially realized the need to participate in the exercise. Hence, it is significant that a patient is assisted at all times to minimize the risks of social isolation, muscle de-conditioning and loss of confidence (Sethie et al., 2017). Jay’s de-saturation as per the pulse oximeter recording was at 91% to 78%. This showed severe SOB, which increased Jay’s rate of anxiety. Contrary, the normal expectations of oxygen saturation of COPD patients are usually 88% and 92%. When the unusual situation arose, I would assist Jay to the chair and place him an upright sitting position to counteract the low breathe pattern.
Historical and social factors of dyspnoe mitigation show that a patient should have a pulse oximeter of 88% to 92%. However, during any contradiction, then the patient should be placed in an upright sitting posture. Throughout the implementation of the exercise, it was evident that other than upright sitting postures of reducing dysponoea, patients can as well sit down and lean forward as the elbows rests on a table. Additionally, I have learnt that for the exercises to be beneficial then it must be practiced continuously for at least twelve weeks. Moreover, I have learnt that anxiety and depression are robustly associated with COPD patients (Watz et al., 2014). Additionally, I learnt that SBOT is just a mitigation of the dysponoea and not a curative; these findings changed my original opinion of COPD diagnosis and care of patients.
Conclusion:
In summary, a critical evaluation of the reflection shows that COPD is a weakening illness that leads to social, physical, emotional and psychological distress among the patients. Dyspnoea is also the major factor linked to the proposed distresses. As COPD is a longstanding challenge for most patients including Jay, the patients becomes expert in mitigating their condition and even comprehend the techniques, which are beneficial to them. However, PRP program is very significant to Jay since physical and education event may hamper muscle de-conditioning and social isolation, which are the main factors that degenerates his condition. Notably, assessing depression and anxiety in COPD patient is significant in gaining insight of the patients’ needs; this is important lead for future patient centered care programs. My belief before interacting with short burst oxygen therapy was that it was evidence based approach of treatment, which aimed at alleviating patient’s symptoms. After the experience, I deduced that the belief was an inaccurate assumption. Therefore, SBOT and PRP are mitigates of COPD and not a complete treatment.
If a patient persistently lives with a certain chronic illness for a couple of years then he or she becomes an expert in mitigating the general symptoms. An effective communication and listening will be crucial in building a therapeutic relationship between patients and me. Since the COPD and other related chronic illness patients will be already distressed, it is therefore essential to keep calm and be confident while offering treatment, care and reassurance of the condition; since it’s a legal and ethical nursing consideration during diagnosis. I am also aiming at applying the new ideas collected from my voluntary internship to create awareness of the COPD and its contributors.
References:
Bolton, C. E., Bevan-Smith, E. F., Blakey, J. D., Crowe, P., Elkin, S. L., Garrod, R., … & Morgan, M. D. (2013). British Thoracic Society guideline on pulmonary rehabilitation in adults: Accredited by NICE. Thorax, 68(2), 1-30.
Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.
McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (2).
National Institute for Health and Clinical Excellence (NICE) (2010) Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care. *Online*. Re Retrieved on 21st October 2018 from: https://www.nice.org.uk/nicemedia/live/13029/49425/49425.pdf
Nursing and Midwifery Council (2017) The Code: Standards of conduct, performance and ethics for Nurses and Midwives. *Online*. Re Retrieved on 21st October 2018 from: https://www.nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/
Rochester, C. L., Vogiatzis, I., Holland, A. E., Lareau, S. C., Marciniuk, D. D., Puhan, M. A., … & Crouch, R. (2015). An official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. American journal of respiratory and critical care medicine, 192(11), 1373-1386.
Sethi, S., Martinez, F. J., Rabe, K. F., Pizzichini, E., McIvor, A., Anzueto, A., … & Rennard, S. I. (2017). Effect Of Roflumilast On Cough And Sputum In Patients With Severe Or Very Severe Chronic Obstructive Pulmonary Disease (COPD) Receiving Inhaled Combination Therapy: Evaluation Of The Exacerbation Of Chronic Pulmonary Disease Tool-Patient Reported Outcomes (exact-Pro) Subdomain Scores. Clinical Studies in Obstructive Lung Disease (33), P.335-1335.
Toren, K., Murgia, N., Olin, A. C., Hedner, J., Brandberg, J., Rosengren, A., & Bergstrom, G. (2017). Validity Of Physician-Diagnosed Chronic Obstructive Pulmonary Disease (COPD) In Relation to Spirometric definitions of COPD in a General Population (scapispilot). Epidemiology Of Airways and Chronic Lung Diseases 1(59), p. 2037-2037.
Watz, H., Pitta, F., Rochester, C. L., Garcia-Aymerich, J., ZuWallack, R., Troosters, T., … & Vogiatzis, I. (2014). An official European Respiratory Society statement on physical activity in COPD.
World Health Organisation (WHO) (2016) Chronic respiratory disease; COPD: Definition. *Online*. Re Retrieved on 21st October 2018 from: https://www.who.int/respiratory/copd/definition/en/index.html
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