Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...

Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)Responsibility for Guideline DevelopmentThe Registered Nurses’ Association of Ontario (RNAO), with funding from the Governmentof Ontario, has embarked on a multi-year program of nursing best practice guideline development, pilotimplementation, evaluation and dissemination. In this fifth cycle of the program, one of the areas ofemphasis is on the care of patients with dyspnea associated with chronic obstructive pulmonary disease(COPD). This guideline was developed by a panel of nurses convened by the RNAO, conducting its workindependent of any bias or influence from the Government of Ontario.Purpose & ScopeBest practice guidelines (BPG) are systematically developed statements to assist practitioners andpatients in decision making about appropriate healthcare (Field & Lohr, 1990). This guideline, Nursing Care ofDyspnea: The 6th Vital Sign in Individuals with COPD, will address the nursing assessment andmanagement of stable, unstable and acute dyspnea associated with COPD.The guideline focuses its recommendations on four areas: (1) Practice Recommendations directed at thenurse; (2) Educational Recommendations directed at the competencies required for practice; (3)Organization and Policy Recommendations directed at practice settings and the environment in order tofacilitate nurses’ practice and (4) Evaluation and monitoring indicators.It is acknowledged that individual competencies of nurses vary between nurses and across categories ofnursing professionals (RNs and RPNs) and are based on knowledge, skills, attitudes and judgementenhanced over time by experience and education. It is expected that individual nurses will perform onlythose aspects of care for which they have received appropriate education and experience. Both RNs andRPNs should seek consultation in instances where the patient’s care needs surpass the individual nurse’sability to act independently.Although this guideline contains recommendations for Registered Nurses (RNs) and Registered PracticalNurses (RPNs), caring for individuals with chronic obstructive pulmonary disease is an interdisciplinaryendeavour. It is acknowledged that effective care depends on a coordinated interdisciplinary approachincorporating ongoing communication between health professionals and patients. Personal preferencesand unique needs as well as the personal and environmental resources of each individual patient mustalways be kept in mind.14