District Nursing Intervention to support breathless patients with lung

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District Nursing Intervention to support breathless patients with lung Powered By Docstoc
					  District nursing intervention
  to support breathless patients with lung cancer
  Jan Dobie
  District Nurse, NHS Lothian , Primary & Community Division

                                                                                                                                                                          Aims and objectives
Breathlessness is one of the top ten most frequently occurring                                                                                                                To raise awareness within District Nursing (DN) teams of the non-
symptoms in people requiring palliative care and nurse led                                                                                                                    pharmacological methods of breathlessness management
breathlessness clinics are known to improve the quality of life of lung
cancer patients (Corner et al 1995, Hately et al 2003, Syrett and Taylor
                                                                                                                                                                              To facilitate DN support of patients in their care through the provision of
2003).                                                                                                                                                                        recommended information and resources
Current    pharmacological        interventions   and strategies for
breathlessness management can be ineffective and sometimes                                                                                                                     To implement change in practice, by improving quality of life for
inappropriate for patients living in their own homes.                                                                                                                         housebound patients with lung cancer induced breathlessness

                 Strategies to implement change
                 30 DN staff completed a short questionnaire, which asked if a locally accessible resource on breathlessness would be useful resource.
                 Patient information literature, CD-ROMs and videos have been obtained from sources recommended by the lung cancer Clinical Nurse Specialist (CNS). This is
                 to ensure continuity of information provision between the hospital and community and also gives DNs and families an opportunity to reinforce information given
                 in the clinic setting.
                 Other items to be included: -
                 •Additional information requested by DN staff
                 •Useful references / websites
                 •Laminated copy of the Lothian Palliative Guideline on breathlessness
                 •Useful contact numbers
                 •How to obtain further copies of materials used
                 Information will be placed in box files and located in 4 DN bases in NW Edinburgh LHCC. The author in her role as Palliative Link Nurse (PLN) will distribute the
                 resource personally and show staff how to use the contents. A further questionnaire is planned at 3 months after introduction, to ascertain if the resource has
                 been used and hopefully demonstrate that improvements in patient care have occurred.

Literature critique                                                                                                                                                          Conclusion
Seminal work done by Corner et al in 1995, demonstrated that nurses could improve                                                                                            District Nursing Teams, if provided with information on
the care of lung cancer patients with breathlessness, through the use on non-                                                                                                breathlessness, can improve the quality of life for patients with
pharmacological intervention techniques.                                                                                                                                     lung cancer in their care.
The literature has shown that the proactive introduction of self-help measures, when
supported by advice from healthcare professionals and carers, can lead to improved                                                                                            Recommendations
coping skills and quality of life for patients (Gallo-Silver and Pollack 2000, Hately et al
2003, Andrewes 2002)                                                                                                                                                            Resource files to be maintained by DN teams

SIGN 80 (2005) recommends that breathlessness clinics led by nurses or                                                                                                          Support and advice for staff and carers to be provided by PLN
physiotherapists should be made available to all lung cancer patients. Clinical Nurse
Specialists provide support for patients who are able to attend hospital or health                                                                                              Future requirements to be monitored by PLN
centres however; further reading has supported the evidence that some housebound
patients are not gaining access to these services (Bredin et al 1999, Johnson and                                                                                               DN team members need to be aware of own limitations, and refer on
Moore 2003).                                                                                                                                                                    to other healthcare professionals

The emotional and psychological impact of breathlessness may be lessened by the
                                                                                                                                                                                Resource file to be costed, and potentially rolled out to other areas if
instruction of simple coping methods and giving patients time to discuss their                                                                                                  successful
concerns (Bredin et al 1999, Krishnasamy et al 2001). Patients may not always be
able to absorb or recall information given in clinic and nursing staff involved in caring
for the patient at home, may consequently be unable to reinforce this (Cox 2002).
These are interventions, which District Nurses may be best placed to provide in the                                                                                           Acknowledgements
home setting along with the support of other members of the Primary Healthcare                                                                                                Diana Borthwick,
Team. Multi-professional involvement can lead to a more holistic and person-centred
outcome (Hoyal et al 2002, Syrrett and Taylor 2003).                                                                                                                          Roy Castle Lung Cancer Specialist Nurse


             Andrewes, T. (2002) The management of breathlessness in palliative care Nursing Standard 17(5): 43-53
             Bredin, M., Corner, J., Krishnasamy, M., Plant, H., Bailey, C. and A’Hern, R. (1999) Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer British Medical Journal 318(7188): 901-904
             Corner, J., Plant, H. and Warner, L. (1995) Developing a nursing approach to managing dyspnoea in lung cancer International Journal of Palliative Nursing 1(1): 5-11
             Cox, C. (2002) Non-pharmacological treatment of breathlessness Nursing Standard 16(24): 33-36
             Gallo-Silver, L. and Pollack, B. (2000) Behavioural interventions for lung cancer-related breathlessness Cancer Practice 8(6): 268-273
             Hately, J., Laurence, V., Scott, A., Baker, R. and Thomas, P. (2003) Breathlessness clinics within specialist palliative care settings can improve the quality of life and functional capacity of patients with lung cancer Palliative Medicine 17: 410-417
             Hoyal, C., Grant, J., Chamberlain, F., Cox, R. and Campbell, T. (2002) Improving the management of breathlessness using a clinical effectiveness programme International Journal of Palliative Nursing 8(2): 78-87
             Johnson, M. and Moore, S. (2003) Research into practice: the reality of implementing a non-pharmacological breathlessness intervention into clinical practice European Journal of Oncology Nursing 7(1): 33-38
             Krishnasamy, M., Corner, J., Bredin, M., Plant, H. and Bailey, C. (2001) Cancer nursing practice development: understanding breathlessness Journal of Clinical Nursing 10(1): 103-108
             Scottish Intercollegiate Guidelines Network (2005) Management of patients with lung cancer: A national clinical guideline. SIGN publication number 80 SIGN, Edinburgh
             Syrett, E. and Taylor, J. (2003) Non-pharmacological management of breathlessness: a collaborative nurse-physiotherapist approach International Journal of Palliative Nursing 9 (4): 150-156

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