Name
Capella University
NURS-FPX 4900 Capstone project for Nursing
Prof. Name
Date
A long-term inflammatory disease of the lungs, known as Chronic Obstructive Pulmonary Disease (COPD), causes constant constriction of the airways, making it a severe illness. This disease remains a significant infection to health, as it severely affects the patient’s standard of life and substantially burdens the healthcare system (Joshi, 2024). Management of COPD is complex and informed by leadership, interprofessional practice, and knowledge implementation. Specifically, this capstone project will look at mechanisms for identifying patient needs and developing leadership, communication, policy, and change management interventions for COPD. Through patient interaction, this project is expected to incorporate feasible recommendations for more effective care and disease management.
For my capstone project, the chosen health problem of COPD is a debilitating respiratory disease that is well known to bring a lot of physical, emotional, and financial misery to its sufferers. COPD is mainly affected by long-term use of irritants like cigarettes and air pollution. Conditions such as paroxysmal cough, dyspnea, and excessive production of sputum can limit activities of daily living and lead to complications and exacerbations, including recurrent respiratory infections and cardiopulmonary disease (Joshi, 2024).
I will focus on Mr. James Carter, a 65-year-old retired construction worker, and my uncle in my practicum. Mr. Carter developed COPD five years ago, and subsequently, he was diagnosed with this disease. He has smoked for 35 years and was exposed to dust and chemical substances at his workplace in construction for many years. Lately, he has developed more severe symptoms of dyspnea and reduced exercise tolerance, walking and gardening primarily. His current family includes his wife (my aunt), who has mainly become his caregiver. Mr. Carter has been admitted twice within a year due to exacerbations that could have been avoided had he adopted better self-management skills and also support. He stumbles on compliance with medical regimens such as using the inhalers correctly, avoiding products that trigger his inadequacy, and doing pulmonary rehabilitation exercises. Such demands are further exacerbated by poor health literacy and caregiver stress.
COPD is reported to be the sixth most common cause of death in the US, as well as the third leading cause of disability, touching approximately 14.2 million people in 2021. Millions more are undiagnosed and begin taking a toll on the economy through the health expenditure of billions every year. Among factors contributing to COPD, one most significant is smoking, which has been the reason for 80% of COPD-related deaths in 2021 (CDC, 2024).
COPD aligns with my scope as a baccalaureate-prepared nurse by promoting patient education, coordinating care through pulmonary rehabilitation and support services, and implementing telemonitoring and personalized plans to prevent readmissions. It is significant as it affects my uncle and ties to my field of study, allowing me to address the mental and physical toll of COPD on patients and families. By building a trusting relationship, I can actively support his care needs, enhance patient-centered interventions, and improve his life quality through effective, evidence-based nursing practices.
Studying peer-reviewed articles helps me note several nursing actions that can go along with enhancing the comprehensive care of COPD patients like my uncle. For instance, based on research focused on self-management, education such as smoking cessation, use of inhalers, and (symptom monitoring) is essential. Schrijver et al. (2022) established in their article that structured education and a greatly enhanced standard of life reduced hospitalization. Moreover, administrative and close monitoring from the patient’s home via telemonitoring and developing an individual plan of action help prevent exacerbations.
As discussed in a study by Rydberg et al. (2023), the findings suggest that telemonitoring could be an important tool in long-term COPD management, especially as it provides greater flexibility and safety for vulnerable populations during health crises like the COVID-19 pandemic. Further studies are needed to confirm its long-term benefits and scalability. Current literature emphasizes the vital role of nurses in shaping policies to improve patient outcomes, prevent illness, and reduce hospital readmissions. Nurses advocate for accessible resources, implement patient-centered care strategies, and educate families to support effective chronic disease management.
Their insights from direct patient interactions make them key contributors to health policy decisions that address real-world challenges and promote better care for individuals like my uncle with COPD (Imatz et al., 2022). These findings are based on my experience in nursing practice, where strong concerns have been made about patients’ education and adherence to their treatment regimens for chronic diseases. To assess the credibility of the information found, I used the following reference checklist known as CRAAP: Currency, Relevance, Authority, Accuracy, and Purpose. For instance, Cochrane and the International Journal of Environmental Research and Public Health and Geriatrics are current and professional authors. However, unreliable data was excluded based on references to old studies and are influenced by a conflict of interest.
In personal care literature, barriers to enabling evidence-based practices are also mentioned, such as limited access to resources like digital tools for telemonitoring or no support from the family for the change of pro-healthy behaviors (Schrijver et al., 2022). For this reason, theories such as Orem’s Self-Care Deficit Nursing Theory are especially appropriate when considering me a registered nurse. As per my involvement in this theory, I was able to help him where he would otherwise be helpless in helping himself comprehend the realities of living with COPD as well as the available resources. Studying such frameworks’ based on nurse-led interventions reveals that patients get more empowered, adhere to the medications, and have fewer readmissions (Imatz et al., 2022). Implementing this approach is useful as it makes empowering the uncle while catering to the special aspects of personal caregiving outside the healthcare setting much more organized.
The State Board of Nursing Practice Act (NPA) specifies how much nurses can do and serves as a guide to protecting society from the delivery of wrong care (Ernstmeyer & Christman, 2021). For instance, the NPA requires nurses to use research-informed practice, patient education, and care coordination, all essential to chronic COPD. For my uncle, these standards allow me to educate him on smoking cessation and pulmonary rehabilitation, as well as help coordinate his follow-up care and observe for early signs of exacerbations. These nursing actions by the American Nurse Association (ANA) also guide nurses to uphold ethical and professional standards while implementing evidence-based interventions (ANA, 2023). For instance, in managing Uncle James Carter’s COPD, it is essential to prioritize patient autonomy, ensuring he is fully informed about his condition and treatment options to make decisions that align with his values and preferences. Maintaining confidentiality and privacy throughout his care process is crucial to respecting his dignity and building trust in the healthcare relationship.
Like any other chronic disease, COPD can be effectively managed if proper organizations such as the American Lung Association (ALA) and CDC develop the right policies. The ALA offers ultramodern guidelines, such as pulmonary rehabilitation guidelines and educational programs for reducing exacerbations, which are patient-centered care models (ALA, 2021). Similarly, the CDC‘s National Asthma Control Program strives to improve prevention, reduce hospitalizations, and strengthen disease management by encouraging community-based interventions and self-management resources (CDC, 2024a). To my uncle, these policies enable me to use techniques such as telehealth and CDC-endorsed self-management resources to observe his conditions, increase compliance with recommended treatments, and provide timely interventions that enhance his stability to minimize hospitalization.
Federally mandated initiatives like the Affordable Care Act (ACA) encourage appropriate navigators, entitlement to care, and magnitude of chronicity. For instance, the ACA’s Hospital Readmissions Reduction Program (HRRP) incentivizes hospitals to improve care quality by reducing unnecessary readmissions, particularly for conditions like COPD. This program has reduced hospital readmissions, promoted more efficient care, and reduced healthcare costs by emphasizing preventive measures and better post-discharge management (Press & Miller, 2020). The policy makes it possible for individuals such as my uncle to access care at an affordable cost, hence allowing men and women to access such basic services as pulmonary rehabilitation. As a nurse, these frameworks enable me to advocate for my uncle’s access to these benefits, ensuring his care aligns with broader public health goals.
Patient- and family-centered communication is critical to enhancing patient care results. Again, because I am close to my uncle and aunt, there is more understanding concerning the management of COPD, and both of them participate in his caregiving process. For that transformational leadership is effective as it tends to motivate and inspire the participants in managing their disease effectively. Through discussion of his ailment, treatment preference, and desired course of action, his decisions are made from the perspective of culture, gender, and experience. It aligns with the transformational leadership principle focusing on empowering people and ensuring a customized approach (Nnate et al., 2021). As described below, making the necessary educational information available on self-managing COPD and supporting self-management activities will enable people to engage in conscious decision-making (Schrijver et al., 2022). Besides enhancing compliance, this transformational leadership enhances the bonds between the person and healthcare provider, leading to better interaction and individualized approach.
Communication skills remain critical in the provision of quality care. Due to COPD, it is crucial to provide my uncle and my aunt with effective communication while explaining all the possible details regarding the disease, further treatment, and the necessity of the symptoms’ monitoring. This may consist of daily phone check-ups or virtual visits to evaluate an evolving symptom, ensure the patient complies with a prescribed regime, or discuss issues the patient may have. I can address them because the door is open to express his concerns or even a misunderstanding about a financial issue, ensuring a culturally sensitive and personalized interaction. Furthermore, they clarify the expected outcome and discuss any emotional issues they consider at any time, though, in this intervention, they did not express any worries.
Lewin’s Change Management Model will be used to manage changes to transform COPD care for my uncle. Lewin’s model consists of three stages: Unfreeze, Change, and Refreeze. In the Unfreeze stage, my uncle and aunt will be educated on the impending change and processes like adopting new tools such as telemonitoring and personalized care plans (Imatz et al., 2022). This is the optimum time regarding change for addressing any issue and developing readiness for change. The Change stage involves making the new practices happen, practicing the symptom check function, and adjusting their routine (Bustos, 2022).
In this phase, I would be given continuous assistance and resources and monitor progress while maintaining communication with an open door. Last, the Refreeze stage focuses on locking in the changes to guarantee that my uncle and aunt are comfortable with the altered new routines. I will revisit the care plan often, ensure changes are staggered into their lifestyles, and assess outputs. Lewin’s change management model makes this transition smooth and sustainable for my uncle and me, and it has achieved health improvement.
During the two practicum hours, we discussed my uncle’s COPD management plan, focusing on symptom tracking and the importance of medication adherence. I provided educational resources about COPD, emphasizing lifestyle changes, and connected him and my aunt with support groups and smoking cessation services. We also explored options for integrating telemonitoring into his daily routine to manage his symptoms effectively. I addressed their concerns throughout the session and worked with them to set achievable health goals.
Therefore, managing COPD calls for a multidisciplinary and holistic approach to patient-centered patient-centered education, communication, and implementation of research-based practices. With the help of leadership methods, including Lewin’s Change Model, and following agencies’ policies like the CDC and ALA, the situation with COPD patient care can be enhanced. This is true as demonstrated by my work with my uncle, where we developed a better way of care planning and monitoring to ensure that he was adhering to his treatment and would not be getting readmitted to the hospital.
ALA. (2021, March 5). Diagnosing and treating COPD. American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/treating
ANA. (2023, June 1). What is evidence-based practice in nursing? American Nurse Association. https://www.nursingworld.org/content-hub/resources/workplace/evidence-based-practice-in-nursing/
Bustos, K. C. (2022). Decreasing chronic obstructive pulmonary disease exacerbations by the implementation of the COPD assessment tool (Publication No. 29398508.) [Requirements for the Degree Doctor of Nursing Practice, Grand Canyon University]. Proquest. https://www.proquest.com/openview/120b5316e0da61a9ea5c930bdf65005d/1?pq-origsite=gscholar&cbl=18750&diss=y
CDC. (2024a, May 20). About CDC’s national asthma control program. Centers for Disease Control and Prevention. https://www.cdc.gov/national-asthma-control-program/php/about/index.html
CDC. (2024b, June 12). Chronic Obstructive Pulmonary Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html
Ernstmeyer, K., & Christman, E. (2021). Scope of practice. National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK591808/
Imatz, A. A., Carrasco, J. de la C. L., Luque, A. M., Pastor, J. M. J., León, M. del R. V., Cortés, F. J. R., Buitrago, P. A., Soto, P. J. L., & Cané, I. M. (2022). Nurse-led interventions in chronic obstructive pulmonary disease patients: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(15), 9101. https://doi.org/10.3390/ijerph19159101
Joshi, P. R. (2024). Pulmonary diseases in older patients: Understanding and addressing the challenges. Geriatrics, 9(2), 34. https://doi.org/10.3390/geriatrics9020034
Nnate, D. A., Barber, D., & Abaraogu, U. O. (2021). Discharge plan to promote patient safety and shared decision making by a multidisciplinary team of healthcare professionals in a respiratory unit. Nursing Reports, 11(3), 590–599. https://doi.org/10.3390/nursrep11030056
Press, V. G., & Miller, B. J. (2020). The hospital readmissions reduction program and COPD: More answers, more questions. Journal of Hospital Medicine, 15(04), 252–253. https://doi.org/10.12788/jhm.3362
Rydberg, M., Burkett, P., Johnson, E., & Drummond, M. B. (2023). Home telemonitoring program in individuals with COPD during the coronavirus disease 2019 pandemic: A pilot study. Chronic Obstructive Pulmonary Diseases Journal of the COPD Foundation, 10(4), 437–443. https://doi.org/10.15326/jcopdf.2023.0431
Schrijver, J., Lenferink, A., Keizer, M. B., Zwerink, M., Valk, P. D. van der , Palen, J. van der, & Effing, T. W. (2022). Self-management interventions for people with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2022(1). https://doi.org/10.1002/14651858.cd002990.pub4
