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)Recommendation 8.2:Nursing research related to interventions for individuals with COPD must be supported.(Level of Evidence = IV)Recommendation 8.3:All Nursing programs should include dyspnea associated with COPD as one context for learningcore curricula concepts. (Level of Evidence = IV)Discussion of Evidence:Nurses play a vital role in the care of patients with dyspnea associated with COPD. They are in a pivotalposition to facilitate evidence-based, team approach to treatment. If nurses are to fulfill these roles, nursesmust be better equipped to assess individuals and intervene for all levels of dyspnea. The skill sets requiredto meet the needs of dyspneic patients with COPD must be taught in nursing programs.Nursing research related to interventions for individuals with COPD must also be supported in order tohave better understanding of effective approaches to care for individuals with dyspnea.Recommendation 8.4:Funding regulations for oxygen therapy must be revisited to include those individuals with severedyspnea, reduced ventilatory capacity and reduced exercise tolerance who do not qualify under thecurrent criteria. (Level of Evidence = IV)Discussion of Evidence:According to the Canadian Thoracic Society guidelines (O’Donnell et al., 2003), the longer the patients areexposed to supplemental oxygen, the larger the benefits in terms of survival. However, the current fundingcriteria in Ontario for oxygen therapy excludes those individuals with severe dyspnea, reduced ventilatorycapacity and reduced exercise tolerance. The RNAO guideline development panel advocates that changesbe made to funding regulations to include those individuals who do not qualify under the current criteria.Dyspnea is the most disabiling symptom of COPD. The disabilities associated with COPD are not alwaysovertly recognizable and may reduce one’s social status, economic situation and sense of self. Traditionally,disability has been defined as a visible functional limitation recognizable by physical limitations thatrequire the use of a cane, walker or wheelchair. Funding agencies do not always award for shortness ofbreath or physical deterioration experienced in COPD. Some individuals living with COPD may have anoxygen tank with them when they are at home and out in public. This may be viewed as a visible sign ofdisability, however, funding regulations do not address it as such and therefore individuals are deniedfunding and services that those with visible functional limitations receive. The RNAO guidelinedevelopment panel advocates that changes be made to funding for assistive transportation (e.g., HandiTransit, Wheel Trans) so that COPD is recognized as a disability.50