Q

critically discuss how you would support self- management of your client/patient living with this chronic illness.

Home, - Supporting self -management of patients suffering from chronic obstructive

Choose a chronic disease from the list below and critically discuss how you would support self- management
of your client/patient living with this chronic illness in the community.
Your discussion should include (but NOT be limited to) the following: Main causes and brief
pathophysiology (in simple terms - as you would explain it to your patient); impact of the disease on the
individual and family/carers; health promotion; cultural safety; empowerment.
Choose one of the following chronic diseases

b) Chronic Obstructive Pulmonary Disease (COPD)

Supporting self -management of patients suffering from chronic obstructive

Chronic Obstructive Pulmonary Disease  (COPD) is a major cause of chronic morbidity and mortality  and the fourth leading cause of death in the world (210 million people worldwide) and represents an important public health challenge (Donária et al,2013; Sigurgeirsdottir et al,2019). COPD impacts on the quality of life (QoL) of patients, careers and families  and the final goals of COPD management are to enhance  patients' COPD specific knowledge and skills for self-management to maintain or improve functional quality of life to achieve these goals (Baker, &Fatoye, 2019;Wang et al,2017)  This essay is aiming to convey a brief detail of COPD in terms of its main causes and brief pathophysiology. In addition to that, it will also highlight the impact of the disease on the individual and family/carers, health promotion, cultural safety and empowerment.

According to Lung Foundation Australia (2019), COPD is a chronic, disabling lung condition characterized by narrowing of the bronchial tubes in the lungs (bronchi or airways) and associated with an abnormal chronic inflammatory response in the lung.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD,2019)  states that COPD is characterized by progressive airflow limitation and associated with an abnormal 'inflammatory response of the lung to noxious particles or gases"(GOLD, pp1,2019). COPD includes chronic bronchitis ( frequent cough caused by excessive mucus production) and emphysema (damaged lung tissue)  or a combination of both (AIHW,2019).

By pathological point of view, COPD is a complex syndrome characterized by chronic inflammation of the airways, lung tissue and pulmonary blood vessels as a result of exposure to noxious particles or gases. To know COPD's pathophysiology, it's important to understand the structure of the lungs. When you inhale, air moves down your trachea and then through two tubes called bronchi. (Healthline,2019).The bronchi separate out into smaller tubes called bronchioles. At the ends of the bronchioles are little air sacs called alveoli. Healthline(2019) states that at the end of the alveoli are capillaries, which are small blood vessels. Oxygen moves from the lungs to the bloodstream through these capillaries and in exchange, carbon dioxide moves from the blood into the capillaries and then into the lungs before it's exhaled(Healthline,2019). According to Mahler(2016,p 16)''chronic bronchitis includes: inflammation of the inner lining ->airway wall to thicken  and mucus(produced by glands inside the airways) ''(Mahler,2014).Also, when breathing out the thickened airway wall and mucus inside the airway block, or obstruct, the flow of air(Healthline,2019)

Emphysema is a disease of the alveoli and the fibers that make up the walls of the alveoli become damaged resulting in lack of elastic recoil and reduced surface area for gas exchange (Russell et al,2013). This  making it hard to exhale carbon dioxide out of the lungs  when  the person exhale. Patients with .Chronic bronchitis(blue bloaters) inclined to be airflow obstruction, and emphysema (pink puffers) more problems with gas exchange(Russel,2013). According to Mahler(2014) airflow obstruction  can be caused by  the ''mucus inside the airway, thickening of the airway wall, and constriction, or tightening, of the muscle that wraps around our breathing tubes''(Mahler,2014,p20).

Minov (2016) states that an increase in the work of breathing can be caused by ''disturbances of ventilation, gas exchange or ventilation-perfusion relationships''(Minov,2016)

Minov(2014) remarks that the most common symptoms in COPD are ''chronic cough, sputum production and exertional dyspnea ''(Minov,2014,pp 10-11 ) In addition, another signs and symptoms include: anxiety and depression ,frequent chest infections ,wheezing ,feeling tired. As the disease progresses, and (currently) incurable disease, symptoms usually become more severe, but with the right diagnosis and treatment people can live for many years with COPD and enjoy a good quality of life (Donária et al,2013; Lung Foundation Australia,2019). The patient with severe COPD  shows a large, barrel-shaped chest owing to hyperinflation, diminished breath sounds, distant heart sounds owing to emphysema and prolonged expiration (Russel,2013)

COPD influences on the quality of life (QoL) of patients, families and carers and constitutes an ''important burden on healthcare systems globally''(Baker &Fatoye 2019).

Many people with lung conditions experience loss of time from school or work, inability to stay in a job, difficulty participating in social activities, anxious and depressive symptoms and disorders, and impaired quality of life (Cruz et al,2017; Lung Foundation Australia,2018)

According to Lung Foundation,(2018) the circle represent the cycle of inactivity for people with COPD   and shows how people living with COPD may find it difficult to continue their normal exercise routine, and how this can result in other social impacts(Lung Foundation Australia,2018 ;Cooper, 2009). In addition, for carers with little or no employment income the consequences of the disease (e.g. need for expensive medication, loss of patient's income) led to financial strain (Gabriel et al. 2014; Strang et al ,2019). Positive aspects of care-giving were related to carers' personal  satisfaction and growth in being able to do something useful for their relatives (Cruz et al,2017).

 World Health Organization (2019) states that health promotion is the process of empowering individuals ''to increase control over, and to improve their health''(WHO,2019)

According to Nursing and Midwifery Board of Australia (NMBA,2018) Code of Professional Conduct Nurses and Midwiferies must protect and ''promote the principles of public health such as health promotion activities,'' vaccination and wellbeing for patients in their care and their families (NMBA,2018, p.1; Howcroft et al,2016).

The health promotion involves action on inform people to improve health and quality of life by addressing and preventing causes of illness(VicHealth,2019) .

Health promotion activities encourage a healthy lifestyle, reduce health risk factors and are an important element in preventing chronic conditions and helping people to improve quality of life and live longer(VicHealth,2019)

According to Department of Health (2019) the National Strategic Action Plan for Lung Condition (the Action Plan) reflects the 'Framework's guiding principles and enablers for successful action  and  has a focus on COPD prevention, management and priority populations' (Department of Health ,2018).

 The priority area of the Action plan is focused on: prevention and risk reduction, diagnosis, management and care, reduce stigma, discrimination and social isolation, partners in health support people, equitable access, research and monitoring (Lung foundation in Australia ,2018).

 According to Australian Health Minister s' Advisory Council (2017) the National Strategic Framework for Chronic Conditions areas known contain: '' promote health and reduce risk ,timely and appropriate detection and intervention ,continuity of care ,partnerships for health''(Australian Health Minister s' Advisory Council,2017,p3).

The Australian Commission on Safety and Quality in Healthcare(ACSQH)(2017) reported that the lack of commitment to best practice in primary care contributes to discrepancy in hospitalization and health care costs. The ACSQH(2017)recommends that earlier diagnosis through use of spirometry in primary care and improved access to pulmonary rehabilitation might greatly improve outcomes for people with COPD in Australia(ACSQH,2017).

 The Lung Foundation has Information and Support Centre team operates a toll-free number 1800 654 301 or email who can assist  people to obtain ,information ,support and link to support services or to speak with a Lung Care Nurse but this service does not offer medical or treatment advice (Lung Foundation Australia,2019 ;Harper,2013)

Lung Foundation Australia website provide many information for patients with COPD such as: signs and symptoms, diagnosis, Self-management treatment options, pharmacological (or medicine-based) (medicines(relieve, maintenance, flare-up) and inhalers (puffer) (Lung Foundation Australia,2019).

In addition, oxygen therapy  is necessary in severe cases of COPD and home oxygen may be prescribed by the doctor also, the doctor will make an  COPD Action Plan to help and recognize COPD flare-up when  the symptoms change and what action to take it to reduce the symptoms (Lung Foundation Australia,2019;Lee,2017)

Lung Foundation Australia currently has an application for a Medical Benefits Scheme (MBS) item number for the delivery of pulmonary rehabilitation in the community. According to Lung Foundation Australia(2019) pulmonary rehabilitation program is recommended to improve exercise capacity and quality of life, and reduce hospitalizations is a full 8-week exercise and education program provided by specially trained health professionals(Lung Foundation Australia,2019)

The health professional  teaches people  the skills that they need to know to stay well and out of hospital such as :how to manage breathlessness , how to clear lung secretions to reduce infections  and other education: medications, social services, diet, intimacy (Lung Foundation Australia,2019)

According to Australian Health Ministers' Advisory Council(2017, )the Action plan  provide effective prevention and equitable access to management of lung conditions  for all Australians  and Aboriginal and Torres Strait Islander people .Moreover, include: provides to entitled Aboriginal and Torres Strait Islander people access to PBS medicines at reduced cost, and in most cases, free of charge, empowering people to take active role in their Aboriginal and Torres Strait Islander specific immunization programs (Lung foundation in Australia ,2018).Health promotion is key to prevention and progression of diseases and prevent complication. Enhancing patients' COPD-specific knowledge and skills for self-management of their physical and psychological distress enables them to achieve these goals (Wang et al,2017)

To improve the lives of all Australians through effective prevention and equitable access to management of lung conditions. the Action plan includes: the PBS Closing the Gap co-payment provides eligible Aboriginal and Torres Strait Islander people access to PBS medicines at reduced cost, and in most cases, free of charge,(Health.gov,2017).

Also,empowering people to take active role in their Aboriginal and Torres Strait Islander specific immunization programs (Health.gov,2017).

The Coach Program (www.thecoachprogram.com) is coaching support  and will support patients to take more control of their disease and manage their symptoms, and staying out of hospital (Lung Foundation Australia,2019).

Health literacy is critical to empowerment and affects a person's capacity to make good decisions about their health and health care and take appropriate action (ACSQHC,2019) . Low health literacy and a lack of culturally safe services for Aboriginal and Torres Strait Islander Australians, and people from other culturally and linguistically diverse (CALD) backgrounds may be a barrier to accessing health care effectively. (ACSQHC,2014,p54). As a result of poor health literacy, many people with COPD are not able to understand written information or complex verbal information well enough to make appropriate health decisions. This can reduce their ability to take medicines correctly, maintain good healthcare habits and respond to acute exacerbations of COPD promptly (ACSQHC,2014)

In addition ,this may contribute to poorer medication management and lower influenza vaccination  rates, with resulting higher hospitalization rates. In addition, compared with other Australians, Aboriginal and Torres Strait Islander Australians experience disadvantage across a range of socioeconomic indicators, including education, employment and income. (ACSQHC,2014,p54)

Stellefson et al (2018) confirmed that health and eHealth literacy levels is very important when we provide patient education and can influence patients' health outcomes and reduce the overall cost burden of the disease(Ture et al,2018).Enhancing patients' COPD-specific knowledge and skills for self-management of their physical and psychological distress enables them to improve quality of life, a reduction in hospital admissions.

Jordan et al (2015) stated that self-management including disease education, medication management, smoking cessation advice, action planning, breathing management, bronchial hygiene techniques, respiratory muscle training, exercise, correct inhaler technique, advice about nutrition, stress management, relaxation and attendance at patient support groups (Jordan et al,2015; GOLD,2019).

The Community Health Program principles of care are the foundation for person-centred practice and apply to all aspects of service delivery and support across the program including chronic care management (HealthVic,2019)

Community Health Services need to align with these principles of person-centred (Chronic Care Model) and is culturally responsive, encourages health literacy is health promoting, facilitates self-management focuses on early intervention, uses evidence-based practice and takes a team approach (HealthVic,2019,pp 9-10).In addition, The Community Health Program supports the strategic directions of the plan by ''providing primary and preventative health services, including earlier support that is personalized to the health and wellbeing needs of local communities''(HealthVic,2019,p10).

 The image shows the Principles of Care as outlined in the Community Health Integrated Program guidelines (HealthVic,2019)

Empowerment will enable elderly patients with COPD by communicating with the medical team to participate in their own treatment and plan, access vital information, and make decisions on their life. This demonstrates that empowerment programs are central to reducing the severity or frequency of exacerbations, preventing hospitalization, and improving health-related quality of life (Zwerink et al,2014: Fotoukian et al,2017)

The concept of health for Aboriginal and Torres Strait Islander people is holistic, with culture, land and spirituality playing a key role (Australian Health Ministers' Advisory Council (2017).To improve health outcomes for Aboriginal and Torres Strait Islander people with, or at risk of chronic conditions, health care services must be culturally safe and appropriate. Culturally safe and appropriate services for Aboriginal and Torres Strait Islander people are provided by a culturally competent workforce, who communicate respectfully and are able to establish good relationships (Australian Health Ministers' Advisory Council ,2017).

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