NURS 4110 Does using oxygen while having COPD lead to better quality of life? Does the risk outweigh the benefits

NURS 4110 Does using oxygen while having COPD lead to better quality of life? Does the risk outweigh the benefits

NURS 4110 Does using oxygen while having COPD lead to better quality of life? Does the risk outweigh the benefits

EBP Paper

Abstract

Chronic Obstructive Pulmonary Disease (COPD) leads to considerable morbidity and mortality. In addition, its negative impacts also mean that huge amounts of money are spent annually to help in its management. Therefore, there is a need to use more effective approaches in its management. One of the approaches which have been used widely in the past and at present is home oxygen therapy. Therefore, the purpose of this paper is to explore if the use of oxygen among patients with COPD leads to a better quality of life. This purpose has been accomplished by conducting a literature review on the importance of using this therapy among patients with COPD. The evidence obtained indicates that oxygen therapy leads to improved factors which are indicators of better life quality. The nursing implication is that this approach should be adopted by nurses to help improve care outcomes among patients with COPD. Therefore, the nurses have to get adequate training regarding how the therapy is administered among these patients.

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Evidence-based practice plays a critical role in the improvement of patient outcomes since, through it, healthcare professionals, such as nurses, can use the most appropriate literature and practice-supported strategies to deliver appropriate care for patients. One of the conditions which have attracted attention is Chronic Obstructive Pulmonary Disease (COPD). COPD has been associated with a substantial cause of mortality and morbidity in the United States and other countries throughout the world (Vogelmeier et al.,2020). The negative impacts of COPD have led to research in recent years to help come up with improved treatment and management approaches. In recent years one of the management approaches which has gained attention is the use of home oxygen in patients with the condition. However, this approach has also brought some debates as to whether it leads to a better quality of life and if, indeed, the benefits outweigh the risk or vice-versa. Therefore, the purpose of this evidence-based practice paper is to explore home oxygen use in patients with COPD. As such, a critical analysis and literature search will be conducted to help answer the question.

Literature Review

As discussed earlier, COPD negatively impacts patients’ lives. Therefore, various studies have been done to identify the most appropriate strategies for dealing with the problem. One of the solutions or treatment and management approaches to COPD is home oxygen use in patients with COPD. The use of oxygen therapy for patients with COPD was shown in a landmark study in the last decade, which shows that its use has survival benefits. Since then, the use of oxygen therapy has been widely accepted and used. As such, this section explored literature supporting the use of home oxygen among patients with COPD.

In one of the recent studies, Nagata et al. (2022) conducted a study to assess whether the use of long-term use of home oxygen therapy can reduce the incidences of exacerbations among patients with COPD and help improve other physiological parameters. The researchers enrolled a total of one hundred and four patients to take part in the study. The participants were then assigned to either a long-term oxygen therapy group or a high-flow nasal cannula/long-term oxygen therapy group. The analysis of the data showed that the use of oxygen therapy led to significant rates of severe or moderate exacerbations. In addition, the approach also prolonged the durations when patients were not experiencing severe exacerbations. Therefore, this study supports the use of oxygen therapy among patients with COPD as it is beneficial.

Mesquita et al. (2018) also performed a study on the effect of adhering to oxygen therapy on the quality of life and capacity to perform exercise among patients with COPD. This was experimental research, and the researchers used the Saint George Respiratory Questionnaire to assess the quality of life. In addition, upon the use of the intervention, the investigators calculate the participant’s exercise capacity, Dyspnea, airflow obstruction, and body mass index. Upon the analysis of the data, the researchers found out that the patients who adhered to the use of oxygen therapy showed low PaCO2, higher SpO2, and better SGRQ scores as compared to those who did not adhere to oxygen therapy. This study shows that adhering to oxygen therapy among patients with COPD is beneficial as it leads to better life quality.

Another research was carried out by Nagata et al.,(2018) that focused on evaluating the effectiveness and safety of using high-flow oxygen therapy among patients with COPD. This was a multicenter randomized crossover trial. The participants were randomized into two groups, either high-flow nasal cannula oxygen therapy or long-term oxygen therapy. The St George’s Respiratory Questionaire for Chronic Obstructive Pulmonary disease was used in assessing the quality of life. The analysis of the data showed the importance of oxygen therapy in both groups. Upon the use of the intervention, it was found that patients had improved SGRQ scores. The researchers also observed improved arterial partial carbon dioxide pressure among the patients. Therefore, this is another study that supports the use of oxygen therapy for improved life quality among patients with COPD.

Model or Framework For Research Utilization to Guide the EBP Guideline

Nursing EBP models or frameworks play a key role in the implementation of evidence-based projects. Therefore, it is important to choose a relevant and more appropriate model. As such, the chosen model that will be used in this EBP is the John Hopkins model (Dang et al.,2021). This model employs a problem-solving approach to clinical decision-making. The model focuses on meeting the needs of nurses by using three main steps or processes. The three steps include practice questions, evidence, and translation. Among the major goals of the John Hopkins Model include ensuring that the best practices and latest research findings are appropriately integrated into patient care.

This model will be applied in this project by following the three phases. As discussed earlier, the first phase is the practice question which involves asking a clinically investigable question to act as the lead question. This phase has been accomplished and the practice question is: Does using oxygen while having COPD lead to a better quality of life? Does the risk outweigh the benefits? This question is to be used in all the phases of the project. The evidence phase entails searching for high-quality evidence that supports the use of oxygen therapy among patients with COPD. This phase is one of the most important phases since critical appraisal of evidence is needed to ensure that the best evidence is revealed (Dang et al.,2021). It is important to pick the level one and two evidence, such as randomized controlled trials and systematic reviews, and meta-analysis of articles with the evidence on the use of oxygen therapy among patients with COPD.

The final phase, as documented in the model, is the translation phase. Translation entails using the evidence obtained from the critical analysis of the literature and implementing such evidence in clinical practice. Evidence that is translated into practice should meet specific guidelines, and therefore, it should be high-quality evidence. In addition, the studies to be translated should have statistically significant and clinically significant results to meet the threshold (Dang et al.,2021). In relation to this project, this phase will entail using the evidence obtained in the second phase of the model to help in the management of patients with COPD. The focus is to ensure that the patients have better health outcomes and better quality of life.

Synthesis of Evidence

From the early discussion, it was evident that COPD negatively impacts patient outcomes hence the need for better solutions. The evidence-based solution to this problem is the use of oxygen therapy. There is substantial evidence that the use of oxygen therapy among patients with COPD increases the patient’s survival rates, especially among those with severe hypoxemia. The use of home oxygen may be varied depending on the symptoms displayed by COPD patients. Recent evidence shows that long-term oxygen therapy should be used among patients with COPD who are displaying chronic resting room air hypoxemia (Jacobs et al.,2021). However, such oxygen therapy is not recommended for individuals with COPD but what moderate chronic resting room air hypoxemia. On the other hand, ambulatory oxygen is recommended for patients with COPD who display severe exertional room air hypoxemia.

Various sources can be used in finding the differences and similarities in approaches taken towards COPD. One of the sources is the Cochrane database or library. This is a database that contains nursing articles with varied quality evidence. This source has relevant systematic reviews and meta-analyses as well as randomized controlled trials. Such articles can be key in finding the similarities and differences between the approaches used. The other sources include PubMed, CINHAL, and google scholar article databases.

Evaluation of Evidence

Over the years, various strategies have been used in the management of COPD. For example, pharmacological strategies have been used. For example, in pulmonary rehabilitation, long-acting muscarinic antagonists/long-acting beta-agonists are used for stable patients with COPD. Nutritional support, handheld fan, self-management, and low-dose opioids have also been shown to lead to benefits for these patients (Fu et al.,2022). For patients with COPD exacerbations, exacerbation action plans, non-invasive ventilation, and systematic corticosteroids are recommended and have been used. In addition, antibiotics and short-acting inhaled beta-agonists are also used during hospitalizations, however, pulmonary rehabilitation should not be used during such times. Oxygen therapy which is the center of this research has been recommended for individuals experiencing severe chronic hypoxemia.

The efficacy of home oxygen use in patients with COPD has been shown to be effective in improving patient outcomes. One of the past research offered moderate-quality evidence of the positive impact of oxygen therapy among patients with COPD experiencing chronic, severe resting room air hypoxemia. There was a 55% reduction in mortality risk within a two-year study; another evidence also revealed a 59% reduction in mortality risk upon the use of oxygen therapy. These sources offered moderate quality evidence since they did not blind the participants even though they were randomized controlled trials (Jacobs et al.,2021). Other evidence also showed that the use of oxygen therapy also leads to improved survival rates, lower arterial pH, lower mean pulmonary arterial pressure, and reduced mean pulmonary vascular resistance. On the basis of the evaluated evidence, it is important to note that the use of oxygen therapy can be associated with improved quality of life and care outcomes (Jacobs et al.,2021). The fact that these studies showed clinically significant results upon the use of oxygen therapy, evidence is significant and the confidence is substantial that using home oxygen therapy among patients with COPD will lead to better health outcomes and improved quality of life.

Change Design

Change is inevitable in any organization and offering better patient care services will in most cases require that the organizations adopt a particular change approach as appropriate (Hussain et al.,2018). Therefore, the synthesized evidence can be applied to create a change in practice. The first step would be to present the data or findings to the organization’s leadership and convince them that oxygen therapy can benefit patients with COPD. Various change frameworks, such as Kurt Lewin’s model, can be followed to help create awareness of the need to make a change and implement the change to help improve care outcomes among patients with COPD (Hussain et al.,2018). I also plan to involve the nursing staff as they are always at the center stage of patient care and make them part of the whole process, including the best ways of administering oxygen. The implementation of the intervention will have to be monitored to ensure that the nurses follow the protocols. It will also be important to make this change in practice part of the organization’s normal practice, hence support will be offered by change champions to ensure that the practice is sustainable and goes for as long as possible.

Conclusion

COPD impacts patients’ health negatively hence a need for better management. The use of home oxygen therapy has widely been adopted as a strategy for the management of patients with this condition. However, it is important to explore its benefits in terms of improved patient outcomes and quality of life. This paper has explored evidence supporting the use of oxygen therapy among patients with COPD.

References

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. Sigma Theta Tau.

Fu, Y., Chapman, E. J., Boland, A. C., & Bennett, M. I. (2022). Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review. Palliative Medicine, 36(5), 770–782. https://doi.org/10.1177%2F02692163221079697

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Jacobs, S. S., Krishnan, J. A., Lederer, D. J., Ghazipura, M., Hossain, T., Tan, A. Y. M., … & Holland, A. E. (2020). Home oxygen therapy for adults with chronic lung disease. An official American Thoracic Society clinical practice guideline. American Journal of Respiratory And Critical Care Medicine, 202(10), e121-e141. https://doi.org/10.1164/rccm.202009-3608ST

Mesquita, C. B., Knaut, C., Caram, L. M. D. O., Ferrari, R., Bazan, S. G. Z., Godoy, I., & Tanni, S. E. (2018). Impact of adherence to long-term oxygen therapy on patients with COPD and exertional hypoxemia followed for one year. Jornal Brasileiro de Pneumologia, 44, 390-397. https://doi.org/10.1590/S1806-37562017000000019

Nagata, K., Horie, T., Chohnabayashi, N., Jinta, T., Tsugitomi, R., Shiraki, A., … & Tomii, K. (2022). Home High-Flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD: A Randomized Clinical Trial. American Journal of Respiratory and Critical Care Medicine, 206(11), 1326-1335. https://doi.org/10.1164/rccm.202201-0199OC

Nagata, K., Kikuchi, T., Horie, T., Shiraki, A., Kitajima, T., Kadowaki, T., … & Tomii, K. (2018). Domiciliary high-flow nasal cannula oxygen therapy for patients with stable hypercapnic chronic obstructive pulmonary disease. A multicenter randomized crossover trial. Annals of the American Thoracic Society, 15(4), 432-439. https://doi.org/10.1513/AnnalsATS.201706-425OC

Vogelmeier, C. F., Román-Rodríguez, M., Singh, D., Han, M. K., Rodríguez-Roisin, R., & Ferguson, G. T. (2020). Goals of COPD treatment: focus on symptoms and exacerbations. Respiratory Medicine, 166, 105938. https://doi.org/10.1016/j.rmed.2020.105938

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Home Oxygen Use in Patients with COPD

Does using oxygen while having COPD lead to better quality of life? Does the risk outweigh the benefits

Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline | American Journal of Respiratory and Critical Care Medicine (atsjournals.org)

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NURS 4110: Evidence Based Paper Rubric

Guidelines: All key elements of the assignment must be covered in 4 to 8 pages of substantive content in APA format. Exclude title, abstract, table of content and reference pages.

Content / Development	Points XX/110	Comments:
I.      Abstract (13.75) a.  Background b.  Purpose c.  Solution or Intervention d.  Nursing implications
II.   Introduction (13.75) a.      Background b.     Describe your clinical nursing practice problem and specifics of problem c.       Purpose d.
III.    Review Literature (13.75) a.      Literature review performed on solution(s) to the identified problem. b.     Perform web search to find scholarly nursing journal articles c.      Include at least three research articles from scholarly nursing journals. d.     Can include your critique article as one of your articles.
IV.   Choose a Model or Framework for research utilization to guide your EBP guideline (13.75) a.      Describe how it will be used (explain what you will do in each step/phase). b.
V.   Synthesize the Evidence (13.75) a.      Discuss evidence-based solution(s) to the identified problem. b.     Compare and contrast the available sources to find similarities and differences in the various approaches taken. c.      Major points are stated clearly, supported by the evidence, specific details, and/or analysis, and are organized logically. d.

Content / Development continue	Points XX/110	Comments:
VI.   Evaluate the Evidence (13.75) a.      Evaluate the effectiveness of your solution(s)/intervention based on the evidence found including the significance of the evidence found and your confidence in the evidence found. b.     Major points are stated clearly, are supported by the evidence, specific details, and/or analysis, and are organized logically.
VII.    Design the Change (13.75) a.      Describe how you would apply the synthesized evidence to create a change in practice that reflects the new understanding.
VIII. Conclusion (13.75) Conclusions are stated clearly and are supported by specific details, examples, and/or analysis, and are organized logically.
Readability and Style 20 Points	Points Earned XX/20
Paragraph transitions are present and logical and maintain the flow throughout the paper.
The tone is appropriate to the content and assignment.
Sentences are complete, clear, and concise.
Sentences are well-constructed, with consistently strong, varied sentences.
Sentence transitions are present and maintain the flow of thought.
Mechanics 20 Points	Points Earned XX/20
The paper, including the title page, abstract, table of content and reference pages following APA (latest edition) format.
Citations of original works within the body of the paper follow APA format.
The paper is laid out with effective use of headings, font styles, and white space.
Rules of grammar, usage, and punctuation are followed.
Spelling is correct.
Late Penalty (cannot exceed four days)		– 2 points/day
Total 150 Points	Points Earned XX/150

Tips for EBP paper

 Review Chapter 17, “Using Research Findings in Practice Settings”, and select a research utilization model or framework to guide your EBP guideline development. Follow the grading rubric above in that order. Use APA formatted headings to make your paper readable. Use APA format in general and produce an APA formatted reference page at the end.

Ensure your findings include at least three nursing research studies related to your chosen clinical issue/problem. The EBP guidelines must be based on solid evidence, and not just other organization’s EBP guidelines. In your research, you can use other organization’s EBP guidelines to gain ideas and possibly find studies they cite as evidence. You would then find the study(ies) they cite as evidence in your paper and not their EBP guidelines as a reference.