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

Nursing Best Practice GuidelineRecommendation 2.1:Nurses must remain with patients during episodes of acute respiratory distress. (Level of Evidence =IV)Discussion of Evidence:The severity of disability relates to respiratory insufficiency and this can cause fear and anxiety for thepatient (Narsavage, 1997). Devito (1990) conducted a qualitative phenomenological study to determine thepatients’ experiences with dyspneic episodes during hospitalizations for an acute phase of COPD. Themesof fear, helplessness, loss of vitality, preoccupation and legitimacy surfaced from the patients’ recollectionsof their lived experiences (Devito, 1990). In 2003, the qualitative study by Heinzer and colleagues used the fivethemes in Devito’s model to focus on the emotional aspects of acute experience of dyspnea in patientsdiagnosed with COPD and explored nursing activities that eased the intensity of the symptoms. Heinzer etal. (2003) found that patients reiterated the importance of having someone with them to anticipate theirneeds and assist them with activities. Responses included “attending to needs right away”, “nurse breathedwith me”, “sitting up”, “felt better when someone was in the room”, “nurse took time to find out what I need”,“nurse kept me relaxed”, “making me feel comfortable and safe”, and “having someone to hold on to”.Presence is one of the themes that were discovered in this study.A sense of control could help patients with COPD cope with fear, anxiety and dyspnea. Nurses’ presenceduring episodes of acute respiratory distress may assist patients in achieving that sense of control.Recommendation 2.2:Smoking cessation strategies should be instituted for patients who smoke:■■Refer to RNAO (2003a) guideline, Integrating Smoking Cessation into Daily Nursing Practice.Use of nicotine replacement and other smoking cessation modalities during hospitalization foracute exacerbation. (Level of Evidence =IV)Discussion of Evidence:According to the Canadian Thoracic Society recommendations for management of COPD (O’Donnell et al.,2003), cigarette smoking is the single most important cause of COPD, and the greater the exposure, thegreater the risk of developing airway obstruction. The most important preventive measure is encouragingpatients to stop smoking (Clinical Epidemiology and Health Service Evaluation Unit, 1999; GOLD Scientific Committee, 2003; 2004).The RNAO (2003a) guideline, Integrating Smoking Cessation into Daily Nursing Practice (available atwww.rnao.org/bestpractices), provides recommendations to assist nurses and other healthcare professionalsin promoting smoking cessation through minimal and intensive smoking cessation interventions.In a systematic review, Rigotti, Munafo, Murphy and Stead (2004) found that high intensity behaviouralinterventions that include at least one month follow-up contact are effective in promoting smokingcessation in hospitalized patients. They suggest that their findings were compatible with research in othersettings. They also contend that that the use of a nicotine replacement patch be used during hospitalizationfor acute exacerbation of COPD.35