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NURS FPX 6021 Assessment 2 Change Strategy and Implementation

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    NURS FPX 6021 Assessment 2 Change Strategy and Implementation

    Student Name

    Capella University

    NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

    Prof. Name


    Change Strategy and Implementation

    Patients frequently present with varying degrees of respiratory issues, ranging from breathing difficulties to dry or wet coughs. Those presenting with such issues are typically admitted to the pulmonary ward for targeted treatment. Chronic obstructive pulmonary disorder (COPD) stands out as a predominant concern in these cases. The severity of each patient’s condition determines the treatment approach, which may involve antibiotic prescription, non-invasive ventilation, and pulmonary rehabilitation—a program addressing exercise and education designed for individuals with pulmonary issues such as COPD (NHS, 2016a).

    While the focus of COPD treatment is on enhancing physical health, mental health considerations are often overlooked. Research indicates a strong positive correlation between COPD and anxiety/depression (Pooler & Beech, 2014). Consequently, COPD patients with comorbid anxiety and depression face a higher likelihood of hospitalization, extended hospital stays, and an increased risk of mortality post-discharge. Recognizing these factors, simultaneous attention to mental health issues alongside physical concerns becomes crucial for more effective overall health management. Neglecting anxiety and depression may have significant implications for medical treatment adherence (Pooler & Beech, 2014).

    Anxiety in the Context of COPD

    Several symptoms associated with COPD coincide with those linked to anxiety, with dyspnea (shortness of breath) being particularly distressing for patients in both cases. A COPD patient with anxiety might interpret dyspnea in an exaggerated manner, associating it with an inability to breathe or even imminent death (Heslop et al., 2013). Although anxiety may not cause dyspnea in COPD patients, it can serve as an indicator of acute exacerbation in such individuals (Pooler & Beech, 2014).

    Depression and its Impact on COPD

    As highlighted earlier, a significant correlation exists between COPD and depression. Depression affects COPD patients differently than anxiety, contributing to a perceived decrease in quality of life and reduced physical activity. Notably, depression is likely to be underdiagnosed and undertreated in individuals with COPD (Pooler & Beech, 2014). COPD patients with depressive symptoms are less inclined to follow recommended physical therapy, leading to aggravated COPD symptoms and necessitating additional treatment.

    For many patients, especially during acute exacerbation, extended treatment may involve hospitalization, potentially fostering feelings of incapacity or diminished autonomy. Consequently, patients may find themselves trapped in a cycle of deteriorating health, adversely affecting their mental well-being. Addressing both physical and psychological issues simultaneously is crucial to effectively treat patients in such situations (Dursunoğlu et al., 2016).

    Revamped Approaches

    Both anxiety and depression demand attention from mental health professionals for effective patient assistance. Cognitive behavioral therapy (CBT) emerges as a proven method for managing anxiety, depression, and various mental health conditions. In a typical CBT session, a patient collaborates with a therapist to dissect problems, thoughts, feelings, and behaviors associated with the issue (NHS, 2016b).

    CBT, while effective, has challenges, including the need for patients to confront their emotions and commit to the process. To overcome these challenges, group therapy sessions could complement one-on-one sessions, expanding access to treatment. Training nurses in CBT or hiring CBT-trained individuals could further enhance accessibility. Providing these treatment options alongside COPD-specific care promises improved quality of life and better management of physical and mental conditions for patients (Howard & Dupont, 2014).

    Pharmacological interventions also exist for treating anxiety and depression. However, these come with dose-dependent side effects, making them less universally applicable. Contrastingly, nonpharmacological interventions like CBT and group therapy pose no such contraindications and can be implemented more flexibly. Overcoming the stigma associated with mental illnesses and patient reluctance to accept such diagnoses remains a challenge in implementing pharmacological treatments (Tselebis et al., 2016).

    Data Table Current Outcomes Change Strategies Expected Outcomes

    Patients with COPD lack adequate access to mental health facilities:

    a) Many COPD patients experience anxiety due to dyspnea.

    b) COPD patients are likely to experience depressive symptoms correlated with worsening COPD symptoms.

    To ensure patients receive needed care, several measures are necessary:

    1. Make therapists available to COPD patients.
    2. Train nurses in CBT or hire CBT-trained nurses.
    3. Conduct regular group therapy sessions for COPD patients with anxiety, depression, or both.
    4. Patients with COPD will have adequate access to mental health facilities and manage physical and mental conditions more effectively:

    a) Patients with COPD and anxiety can distinguish between anxiety and COPD aggravation (Howard & Dupont, 2014).

    b) Patients with COPD and depression can better manage both COPD and depressive symptoms (Dursunoğlu et al., 2016).


    Dursunoğlu, N., Köktürk, N., Baha, A., Bilge, A. K., Börekçi, Ş., Çiftçi, F., . . . Turkish Thoracic Society-COPD Comorbidity Group. (2016). Comorbidities and their impact on chronic obstructive pulmonary disease. Tüberküloz ve Toraks, 64(4), 289–298.

    Heslop, K., Newton, J., Baker, C., Burns, G., Carrick-Sen, D., & De Soyza, A. (2013). Effectiveness of cognitive behavioural therapy (CBT) interventions for anxiety in patients with chronic obstructive pulmonary disease (COPD) undertaken by respiratory nurses: The COPD CBT CARE study: (ISRCTN55206395).

    BMC Pulmonary Medicine, 13(1). Howard, C., & Dupont, S. (2014). ‘The COPD breathlessness manual’: A randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease. npj Primary Care Respiratory Medicine, 24.NHS. (2016a). Chronic obstructive pulmonary disorder (COPD). 

    NHS. (2016b). Cognitive behavioral therapy (CBT). Pooler, A., & Beech, R. (2014). Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: A systematic review. International Journal of Chronic Obstructive Pulmonary Disease, 9(1), 315–330.

    Tselebis, A., Pachi, A., Ilias, I., Kosmas, E., Bratis, D., Moussas, G., & Tzanakis, N. (2016). Strategies to improve anxiety and depression in patients with COPD: A mental health perspective. Neuropsychiatric Disease and Treatment, 12, 297–328.