by Miguel Padilha | Oporto, Portugal
Goal: Develop, implement and evaluate the impact of a nursing program intervention in clinical practice.
COPD is a major cause of morbidity and mortality worldwide, the WHO (2008) predicts that by 2030 is the third leading cause of death. Despite the mortality achieve impressive values, it is however, the morbidity that has greater impact, because, although the main pathophysiological characteristic of COPD is the reduction of air flow rates, it is responsible for a systemic disease process that primarily affects muscle strength the lower limbs. COPD imposes severe limitations on power that patients have available to make their self-care activities, featuring up by activity intolerance that patients have and that has great impact on the professional, social, family, and self-care. COPD develops between phases of exacerbation that often require hospitalization. Hospitalized patients are those with more advanced stages of disease (GOLD, III/IV) and consequently have a higher impact of the disease in its ability for self-care. The management of this disease involves the management and adherence to a complex treatment regimen, consisting on a pharmacological regimen and a non-pharmacological regimen of treatment. The best available evidence indicates that adherence to treatment regimens is lower among these patients compared with other chronically ill patients. This is associated with the pharmacological characteristics of the treatment regimen, the intrinsic characteristics of patients and non-pharmacological specificity of the treatment regimen. The patients with COPD, faces daily challenges to integrate the power limitations in self-care activities, and in the integration of the treatment regimen. COPD is a chronic and progressive disease and in the early stages can develop without the patient has the perception of symptoms, but with the progression of the disease poses serious limitations in daily activities. Due to its slow and progressive evolution, and its pathophysiological characteristics, patients will increasingly leaving to perform the activities for which they no longer have available energy, which in the long-term results in high dependence of the patient and dramatic consequences on the patient, in which the prevalence of depression is two and a half times higher than patients with other chronic diseases. Costs professional, social and family and health systems also have great impact. The GOLD (2011) recommends that treatment of COPD among others, involves the training of the patient to self-management of the disease, which may be developed through therapeutic education. Nurses can be a key in the process of therapeutic education of patients, either because of their proximity, either by its social mandate. The success of therapeutic education is multifactorial and multidimensional, being addressed in multidisciplinary and multiprofessional. The evidence links the development of self-management of this disease to the development of: knowledge in specific areas (risk factors; nature of the disease; use of inhalers; strategies to minimize dyspnea; recognize and treat exacerbations; complications of the disease; oxygen therapy; care in end of life); adoption of appropriate behaviors (smoking cessation; avoidance of indoor and outdoor pollution; adherence to therapy; exercise; self-monitoring; clinical follow-up); and the perception increase of self-efficacy (in the management of therapeutic regimen and in self-care activities). The therapeutic education emerges as a strategy to promote self-control of health condition. However, little systematic intervention and evaluation by health professionals, have contributed to their integration into clinical practice, and continues to have low rates of accession. The therapeutic education should "... be tailored to the needs and individual environment of the patient, interactive, directed at improving the quality of life, simple to follow, practical and appropriate to the intellectual and social skills of patients and caregivers" (GOLD, 2010). The failure of therapeutic education is multifactorial, influenced by intrinsic factors to the patient (literacy; health literacy; technological literacy; accessibility to information resources; attitude towards self-care; family support; perception of benefits; perception of the "costs"), or by factors intrinsic to organizations (physical space; budget availability; ratios of professionals; the availability of educational resources) and factors associated with health professionals (training; awareness; overload of clinical requests; absence of clinical guidelines for the implementation and evaluation; interdisciplinary communication). Currently there are general guidelines on the content of therapeutic education (GOLD, 2010), but without specifying the content and implementation strategies and evaluation. Given the above, emerges the need to specify the contents and strategies to the implementation and evaluation of these guidelines, in order to maximize their effectiveness, efficiency and efficacy. In this context, nurses as part of its social mandate can be an effective contribution, through the development and implementation of nursing intervention programs, integrated in multidisciplinary and multiprofessional intervention programs, focus on the patient. A systematic review of the literature in this field has enabled us to recognize the absence of guidelines that support the creation of a nursing intervention program (EFFING T. et al., 2009) and definition of evaluation strategies based on evidence (PADILHA, 2010). Nurses who carry out their activity in a hospital are faced with the challenges that patients face. These challenges become greater with progression to more severe stages of the disease. During the hospitalization the health condition of patients, length of stay and the overload of requests affect the success of the therapeutic action of Nurses, but emerges the opportunity to help the patient become aware of the need for changes in everyday life and know the resources that health services are available to help. Beyond awareness, the hospitalization can establish itself as an opportunity to help the patient to develop hope and engage in managing their health condition. After this phase and also during hospitalization or outpatient treatment, the conditions are there, to help the patient to develop basic and advanced skills to manage the health condition. At this stage it's crucial to help the patient to live with the power limitations, that disease imposes on him, helping him to develop adaptive strategies for attainment of self-care activities. Based on the foregoing, in the absence of evidence to set guidelines and specifications for contents in this area, we intend to develop a nursing intervention program and a monitoring strategy that is effective in contributing to a better quality of life of these patients