Nursing Commons^™

Reducing Copd Readmissions Through The Implementation Of A Guideline-Based Clinical Pathway: An Evidence-Based Practice Improvement Project, Hannah F. Hall, Allyson Neal, Samantha Bauer

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is characterized by airway inflammation and damage that inhibits appropriate airflow. Exacerbations of COPD (ECOPD) hasten disease progression and have profound impacts on the patients.

Local Problem: East Tennesseans experience higher rates of COPD than the rest of the state. Community members at the project site identified that the inpatient management of ECOPD is inconsistent and discordant with the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The purpose of this project was to reduce readmissions and increase guideline concordance by developing an algorithm …

Decrease Copd Readmissions With Aprn Interventions Using Agile Implementation, Andrea D. Conley Msn, Rn, Agcns-Bc, Mscrn

Nursing Publications

Abstract presented at the 2023 Nursing Research Symposium.

Objectives/Aim/Purpose

In September 2022 a team was established and tasked with decreasing COPD readmissions.

Hyperoxemia Education To Nurses To Increase The Adherence To Oxygen Weaning Goals In Inpatient Copd Patients., Katherine Ellingson

Doctor of Nursing Practice Projects

Hyperoxemia in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are at risk for increased hospital stay, mechanical ventilation, and increased risk of death. Literature supports that establishing increased education to nursing staff on the risks of hypoxemia to increase adherence to oxygen weaning protocols has the potential to improve future practice. Oxygen weaning protocols are often not followed for concern of patient care. Nurses may believe to be helping patients when increasing oxygen, when they could actually be potentially harming them. Increased education on hypoxemia in COPD patients for the nursing staff will assist them to feeling …

Identification Of Molecular Markers Associated With Copd In Non-Smokers And Smokers: A Bioinformatics Analysis, Agede O. Ayodele, Isa M. Wasagu, Ademola E. Fawibe, Alakija K. Salami

The University of Louisville Journal of Respiratory Infections

Background

Even though the proportional burden of COPD among never-smokers is significant in both developing and developed nations, accounting for around 30% of all COPD in the community, there is little awareness of the prevalence of COPD in this population. Understanding the molecular processes that underlie COPD in nonsmokers is essential.

Methods

Dataset (GSE146560) was acquired from the Gene Expression Omnibus (GEO). The limma and clusterProfiler software tools were used to identify differentially expressed genes (DEGs) and conduct a functional enrichment analysis respectively.

Results

In all, 10,583 DEGs were found, of which 1,065 were up-regulated and 9,518 were down-regulated. The …

Inhaler Education To Prevent Chronic Obstructive Pulmonary Disease And Asthma Exacerbations, Stephanie Lamar

Poster Presentations

The purpose of this study was to develop an educational program that will inform patients and healthcare providers about the importance of proper inhaler use and the impact of education on COPD and asthmatic patients' ability to recognize risk-triggering exacerbations resulting in deteriorating lung function (Klijnet al., 2017).

Lived Experiences Of Copd Patients With Exertional Hypoxemia Prescribed Supplemental Oxygen, Sarah Ann Evans

Walden Dissertations and Doctoral Studies

Patients with exertional hypoxemia are often prescribed supplemental oxygen therapy to alleviate their symptoms and maintain adequate arterial oxygen saturation; however, little is known about how chronic obstructive pulmonary disease (COPD) patients with exertional hypoxemia experience the addition of supplemental oxygen on their lives. The purpose of this descriptive phenomenological study guided by Roger’s science of unitary human beings was to explore the lived experiences of COPD patients with exertional hypoxemia and who require supplemental oxygen. Purposive sampling was used to recruit participants using a query from the electronic medical records to identify patients prescribed supplemental oxygen for exertional, not …

Lived Experiences Of Copd Patients With Exertional Hypoxemia Prescribed Supplemental Oxygen, Sarah Ann Evans

Walden Dissertations and Doctoral Studies

Patients with exertional hypoxemia are often prescribed supplemental oxygen therapy to alleviate their symptoms and maintain adequate arterial oxygen saturation; however, little is known about how chronic obstructive pulmonary disease (COPD) patients with exertional hypoxemia experience the addition of supplemental oxygen on their lives. The purpose of this descriptive phenomenological study guided by Roger’s science of unitary human beings was to explore the lived experiences of COPD patients with exertional hypoxemia and who require supplemental oxygen. Purposive sampling was used to recruit participants using a query from the electronic medical records to identify patients prescribed supplemental oxygen for exertional, not …

Chronic Obstructive Pulmonary Disease Pathophysiology, Alex Thompson

Nursing Student Class Projects (Formerly MSN)

This poster presentation overviews the pathophysiologic process and accompanying disease characteristics associated with Chronic Obstructive Pulmonary Disease (COPD). COPD is a leading cause of mortality worldwide. Studies suggest that its incidence will only increase in the future. COPD risk factors include smoking tobacco, environmental chemical/pollution irritants, and genetic predisposition. Smoking is the most common cause of COPD, and cessation can improve patient outcomes drastically. This chronic obstructive pulmonary disease overview discusses the importance of knowledge of COPD, signs, symptoms, pathophysiology, peri-operative management, treatments, and prevention.

Discharge Care Bundle To Reduce Copd 30-Day Readmission Rates In A Hospital Acute Care Unit, Dao Vang

Student Scholarly Projects

Practice Problem: Chronic obstructive pulmonary disease (COPD) readmissions severely impact patients’ health, mortality, and quality of life and increase unnecessary healthcare use and spending. Utilization of a protocol and discharge care bundle to reduce the readmission rate for COPD patients is critical to combat the problem.

PICOT: The PICOT question that guided this project was in adult patients 65 years or older admitted to a hospital acute care unit for acute exacerbation of COPD (P), does a protocol and discharge care bundle (I) compared to no protocol and no discharge care bundle (C) reduce the 30-day hospital COPD readmission rate …

A Chronic Obstructive Pulmonary Disease Pilot Using Risk Stratification To Improve Resource Allocation And Reduce Readmissions, Linda Gould

Doctor of Nursing Practice Projects

Background: Chronic Obstructive Pulmonary Disease (COPD) impacts 250 million people, is associated with high hospital readmission rates, and costs over $50 billion annually. Purpose: Apply risk stratification identifying higher risk patients to prioritize complex, time-consuming interventions and resources. Methods: Patients hospitalized with COPD were risk stratified using PEARL. Moderate-high risk patients were referred to specialty nurse practitioners, who used real-time interventions and motivational interviewing during intense weekly visits over 30 days targeting self-management, patient-specific risks, and resources. Results: No patients were readmitted or died during the pilot using risk stratification with patient-specific tertiary preventive care to …

A Provider Needs Assessment For A Pulmonary Rehabilitation Program At A Rural Community Hospital, Shelbie Cosby

Doctor of Nursing Practice Scholarly Project

Pulmonary rehabilitation is a comprehensive rehabilitation program that utilizes exercises and education in order to assist with the management of chronic obstructive pulmonary disease (COPD) by decreasing COPD exacerbations and increasing patient quality of life. A critical component to proposing a pulmonary rehabilitation program at a rural community hospital involves the support for a program by the potential referring providers. It is theorized that positive thoughts and attitudes towards pulmonary rehabilitation by providers correlates with support and ongoing success of a pulmonary rehabilitation program. A survey of providers associated with Labette Health was conducted to assess such attitudes and thoughts …

Chronic Obstructive Pulmonary Disease (Copd), Whitney R. Stant

Nursing Student Class Projects (Formerly MSN)

To make a safe anesthetic plan, a nurse anesthetist must evaluate a patient's medical history. Anesthesia providers will encounter patients with COPD requiring anesthesia. It is necessary that nurse anesthesia understands the pathophysiology and peri-operative considerations to provide safe care to COPD patients. The poster provided can be a tool to review the pathophysiology and nursing implementations of COPD. It provides information for the nurse anesthetist to apply to the perioperative setting to improve patients’ surgery outcomes. An anesthetist is always striving to provide quality anesthesia care to their patients. COPD patients require extra preparation to prevent complications from arising …

Developing An Evaluation Process For Telehealth In A Copd Clinic, Jodi H. Biller

Graduate Theses, Dissertations, and Problem Reports

Background: Telehealth was broadly implemented as a care modality in response to a worldwide pandemic in 2020. Before the COVID-19 pandemic, while telehealth was not new, it was not widely utilized at the project site location, and a uniform method of evaluating its effectiveness was needed. This quality assurance project developed and piloted a uniform process to evaluate telehealth in a Chronic Obstructive Pulmonary Disease (COPD) clinic, then evaluated stakeholder perceptions about the process used in developing the evaluation tool.

Methods: The telehealth evaluation tool was developed using the National Quality Forum (NQF) framework and Global Obstructive Lung Disease (GOLD) …

Copd Discharge Care Bundles: An Integrative Review, Leigh Goodwin Wingo

Doctoral Dissertations and Projects

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the United States. It is the reason for millions of emergency room and hospitalizations, increasing healthcare costs, morbidity, and mortality. Many studies have evaluated the effects of COPD patient care bundles to help reduce the risk of 30-60-90-day readmissions post discharge from the hospital for COPD exacerbation. A comprehensive search was conducted on articles dated between February 2015 to January 2020 in the MEDLINE, EMBASE, and CINAHL, OVID, internet search, and Liberty University online library. This review included articles based on the effectiveness of COPD discharge …

Chronic Obstructive Pulmonary Disease, Aaron Mcneilan

Nursing Student Class Projects (Formerly MSN)

The following poster presentation provides a brief overview of the disease process of Chronic Obstructive Pulmonary Disease (COPD). COPD is one of the leading causes of disability and death worldwide, and its incidence does not appear to be declining. The most common factor causing COPD is cigarette smoking, which is modifiable. Other contributors are environmental air pollutants which some people may encounter depending on where they live or their occupation. This presentation is a culmination of information from different scholarly sources which discuss the symptoms, pathophysiology, causes, management, and prevention of COPD.

Food Insecure Copd Patients And Healthcare Utilization: A Retrospective Study, Kristine Mendoza

Dissertations

Abstract

Purposes/Aims: Despite advances in the recognition and treatment of high-cost users of health care, the incidence of healthcare utilization remains high. Rates of hospital admissions and emergency room visits among chronic disease like COPD have become a targeted group for health management. COPD patients have multiple and complex health and social needs, but the impact of their unmet food needs is not well understood and warrants further investigation. The purpose of this study is to explore the relationships between COPD food insecure patients and healthcare utilization in San Diego County.

Background/Rationale: Government programs targeting patients with high healthcare costs …

Reduction Of Hospital Readmissions In Patients With A Diagnosis Of Copd: An Integrative Review, Guerline Norbrun

Doctoral Dissertations and Projects

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease with potential to interfere with breathing ability. It is the third leading cause of 30-day readmission and death in the US, and the leading cause of mortality and morbidity worldwide. It constitutes a society burden and poor disease management leads to major health consequences such as acute COPD exacerbation resulting in frequent costly readmissions, add to its massive direct healthcare costs. Over $50 billion are spent annually in direct care alone in addition to $15 billion in hospital readmissions; with 12 million adults are being affected in the United States …

Differences In Smoking Behaviors And Readiness To Change For Patients With Copd And Differing Categories Of Depression, Jessica M. Floyd

Graduate Theses, Dissertations, and Problem Reports

Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world. Depression is a common comorbidity of COPD and affects patient outcomes and smoking cessation. The purpose of this study was to explore and describe factors influencing smoking behaviors and readiness to change in patients with comorbid COPD and depression.

Aims: The research question that guided this study was, “What are the relationships among smoking, COPD, and depression?” The following aims stemmed from the research question: to describe the characteristics of a convenience sample of people living with COPD and differing categories of depression who …

Increasing The Completion Of Advance Directives In Patients With Chronic Obstructive Pulmonary Disease In The Primary Care Setting, Cynthia Davis

Doctor of Nursing Practice Projects

When considering patients with COPD, current evidence indicates that discussions related to prognosis, illness trajectory, and goals of care between the provider and patient do not happen as they should. Consequently, without any advanced directives, the default in crisis is “do everything”. This gap in practice supported the need to implement an evidence-based assessment protocol regarding advance care planning needs in patients with COPD. The purpose of this project was to increase the number of COPD patients having advanced directives in a mid-western primary care clinic. The protocol included a chart review to assess for completed advanced directives among patients …

Implementing Feno Testing Protocol In A Pulmonary Clinic: A Dnp Project, Herbert "Allen" Nolan

Doctor of Nursing Practice Projects

Airway inflammation is a common condition seen in the pulmonary clinic and can be present in patients with chronic obstructive pulmonary disease, asthma, chronic cough and asthma chronic obstructive overlap syndrome. Utilization of fractional exhaled nitric oxide testing is a quick means of identifying airway inflammation in patients who visit the pulmonary clinic with the diagnoses listed above. Fractional Exhaled Nitric Oxide testing along with Asthma Control Testing were used in the pulmonary clinic to aid in the identification of airway inflammation along with traditional spirometry testing. The results reflected an increase in the identification of patients with airway inflammation …

An Educational Intervention To Improve Healthcare Provider Confidence And Utilization Of The Teach-Back Method When Providing Patient Education On Inhaler Technique, Caitlin Crowley

Doctor of Nursing Practice (DNP) Projects

Background: Patients with asthma and COPD often do not use prescribed inhalers correctly. This impacts the safety and effectiveness of the medication and potentially leads to increased symptoms, exacerbations, and hospitalizations. Inhaler technique should be assessed regularly; however, many patients do not receive initial education on devices or follow up evaluation to ensure correct use. Many healthcare providers (HCPs) are not properly educated on how to use inhalers, and a correlation exists between poor patient inhaler technique and improper training by HCPs. Purpose: The purpose of this quality improvement project is to increase HCPs ability and confidence to …

Benson’S Relaxation Response: Psychological And Physiological Responses Among Patients With Copd, Crista Reaves

UNLV Theses, Dissertations, Professional Papers, and Capstones

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. In patients with COPD, distress is significantly prevalent and can have adverse psychological and physiological effects. Considering the increased rate of COPD, a mind-body intervention focusing on the reduction of both psychological and physiological responses such as anxiety, elevated blood pressure (BP), heart rate (HR), dyspnea, and respiratory rate must be integrated into the patient’s plan of care. The relaxation response (RR) is a term coined by Dr. Herbert Benson in the 1970s describing the body’s ability to counter the fight-or-flight response to decrease …

Education-Based Interventions Effects On 30-Day Readmission Rates For Patients With Copd, Gina Hand-Eoloff

Dissertations

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing education-based program for Chronic Obstructive Pulmonary Disease (COPD) and its effect on 30-day readmission rates in one hospital in rural Missouri.

Method: A retrospective chart review was completed on 493 patients with an inclusive diagnosis of COPD from June 1, 2018, to March 31, 2019, using a cohort study design and a two-sample t-test analysis. Additional variables were analyzed to determine if there were predictive factors of an elevated risk of readmission.

Results: The two-sample t-test reveals there is no statistically significant difference between the rates of readmission …

Collaborative Self-Management And Chronic Obstructive Pulmonary Disease: Integrating Patient Needs Into An Educational Program For Nurses, Loretta G. Mccormick Rn (Ec)

Electronic Thesis and Dissertation Repository

Background: Chronic obstructive pulmonary disease (COPD) affects over 2.5 million individuals Canada wide and is the leading cause of hospitalization in Canada among chronic diseases with an 18% hospital readmission rate. The high cost of emergency room visits, hospitalizations, and readmissions for COPD tells a story of need; the need for education of patients. Collaborative self-management (CSM) is a process whereby the individual patient and nurse work together to improve health. The integration of CSM in COPD care has shown evidence for reduced exacerbations, hospitalizations and readmissions. Little is known about the level of knowledge and self-efficacy of hospital-based nurses …

The Lived Experience Of Discharged And Readmitted African Americans With Chronic Obstructive Pulmonary Disease To A Safety-Net Hospital, Kiiyonna Jones

Dissertations

Background:Chronic Obstructive Pulmonary Disease (COPD) is a debilitating respiratory disease that negatively affects the quality of life of those affected and has been a major contributor to the continuous rise in healthcare cost in the Unites States (Guarascio, Ray, Finch, & Self, 2013; National Heart Lung and Blood Institute, 2009; Shavelle, Paculdo, Kush, Mannino, & Straus, 2009; Scott, Smith, Sullivan, & Mahajan, 2001). In 2014, Centers for Medicare & Medicaid Services (CMS) identified COPD as an applicable condition to the Hospital Readmissions Reduction Program, which penalizes healthcare organizations having readmissions higher than the national average. COPD is the second …

Federal Weatherization And Health Education Team Up: Process Evaluation Of A New Strategy To Improve Health Equity For People With Asthma And Chronic Obstructive Pulmonary Disease, Rachael De Souza, Robin Evans-Agnew, Christine Espina

Nursing & Healthcare Leadership Publications

Unhealthy housing is a major cause of respiratory health inequity. In-home health education improves health equity for low-income and minority populations with asthma and chronic obstructive pulmonary disease. Yet, outcomes of educational interventions are limited by poor housing conditions. Federal weatherization programs represent a promising source of funding for home repairs. Innovative legislation in Washington State integrates the 2 interventions as "Weatherization Plus Health," offering environmental health education in partnership with the Weatherization Assistance Program for low-income families with respiratory disease. This practice brief describes process evaluation results of a Weatherization Plus Health program in Pierce County, Washington. Evaluation data …

Impact Of An Ehr-Based Tool On Copd Management In Primary Care, Nancy Ann C. Kelly Rn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: GOLD (2017) guidelines provide evidence based recommendations for treating COPD, although their employment in clinical practice is inconsistent. Lack of a standardized method to view COPD specific information within the EHR during patient encounters complicates visits and development of GOLD-guided treatment plans. Our goal is to determine the impact of an EHR-based tool on relevant COPD disease measurements (spirometry rates, pneumococcal vaccination rates and COPD Action plans)

Methods: An EHR-based tool (SmartPhrase) was developed and released to providers to facilitate GOLD(2017) guideline reference during patient encounters. Computer based instructional videos of GOLD (2017) guidelines and EHR-based tool …

The Effect Of Provider Education On Copd Screening Rates In The Primary Care Setting, Kelli Craig

DNP Projects

BACKGROUND: Chronic Obstructive Pulmonary Disease is one of the leading causes of morbidity and mortality in the United States. With early detection, COPD is a treatable disease, highlighting the need for an effective screening measure. The COPD Population Screener Questionnaire (COPD-PS) is a valid, accurate questionnaire that can identify individuals likely to have COPD.

PURPOSE: The purpose of this study was to evaluate the impact of a provider-based educational intervention on the knowledge, attitudes, self-efficacy and screening rates of COPD using the COPD-PS screening tool among primary care providers.

METHODS: This study was a single-center, pre/post implementation study to evaluate …

Chronic Bronchitis, Conrad Boyer

Nursing Student Class Projects (Formerly MSN)

Chronic Bronchitis is an aspect of the broad disease known as Chronic Obstructive Pulmonary Disease (COPD). It is a widely prevalent disease in the world today and effects 15 million people and is the third leading cause of death. The signs and symptoms of Chronic Bronchitis is very specific, however diagnoses and treatment is different for each patient and can be quite challenging. The pathophysiology underlying Chronic Bronchitis is quite complex with metaplasia changes within the lung parenchyma, increase in mucous from goblet cell hyperplasia and chronic inflammation leading to permanent scarring. The bodies adaptive processes because of Chronic Bronchitis …

Chronic Obstructive Pulmonary Disease: Emphysema, Sherri Cardellino

Nursing Student Class Projects (Formerly MSN)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. The purpose of this poster is to investigate and transfer knowledge of the pathophysiological concept of emphysema along with the significance of pathophysiology, and implications of nursing. The research also includes the signs and symptoms and treatment options available. Sources used were published between 2013- 2018 in the United States. The poster provides valuable information for providers to be competent when caring for this patient population.