Educational needs of chronic obstructive pul

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Educational needs of chronic obstructive pulmonary disease patients treated at the Department of Internal Medicine, Pulmonology
and Allergology of the Military Medical Institute
(Potrzeby edukacyjne chorych na przewlekłą obturacyjną chorobę płuc
leczonych w Klinice Chorób Wewnętrznych Pulmonologii i Alergologii
Wojskowego Instytutu Medycznego)
A Oskroba A,D,F, E Kądalska B,E, D Pytka C
Abstract – Introduction. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and
mortality worldwide. The main COPD risk factor is tobacco
smoking. Long-term smoking leads to respiratory disability
and, in consequence, inability to live independently. Therefore,
a suitably planned and well-conducted health education is of
great importance. The objective of this study is to attempt to
evaluate the level of patients’ knowledge about COPD and to
indicate their educational needs.
Materials and methods. The study performed in 2011 using a
questionnaire involved 60 patients treated at the Department of
Internal Medicine, Pulmonology and Allergology of the Military Medical Institute (WIM) in Warsaw.
Study results. The majority of the polled were male patients
(58.3%) above the age of 65 or aged from 56 to 65 with vocational and secondary education, living in towns or in the countryside. More than 51% of the respondents had been smoking
for 21 to 30 years, whereas 21.6% - for more than 30 years.
62% of the patients admitted to reducing their use of stimulants and following a special diet, but only 12.6% had quit
smoking. Within that group, 32% of patients claimed that they
still smoked more than one pack of cigarettes a day while
29.7% smoked less than 10 cigarettes a day. The will to stop
smoking was declared by 36% of the surveyed.
Conclusions. The study revealed that the level of knowledge
about COPD and the conviction to develop healthy habits in
the analysed group of patients were unsatisfactory. Even
though COPD risk factors were known to the study subjects,
the majority of them continued smoking tobacco. Another
issue is disease symptom control in everyday life and insufficient social support. Most of the educational needs of the respondents regard coping with dyspnoea, cough, exercise tolerance, and diet. In addition, the patients examined need infor-
mation on COPD associations and mutual aid societies for
patients. Greater psychological support in the course of the
disease would also be practical and it would help increase the
patients’ motivation to quit smoking.
Key words - chronic obstructive pulmonary disease, patient
education.
Streszczenie – Wstęp. Przewlekła Obturacyjna Choroba Płuc
jest jedną z głównych przyczyn chorobowości i zgonów na
całym świecie. Najważniejszym czynnikiem ryzyka tej choroby
jest palenie papierosów, skutkujące w ciągu wielu lat inwalidztwem oddechowym i brakiem możliwości samodzielnego życia. Ogromnego znaczenia nabiera tu właściwie zaplanowana i
prowadzona edukacja zdrowotna. Celem pracy była próba
określenia poziomu wiedzy pacjentów na temat POCHP oraz
potrzeb edukacyjnych.
Materiał i metody. Badania z wykorzystaniem kwestionariusza
ankiety przeprowadzono w 2011 roku wśród 60 pacjentów
Kliniki Chorób Wewnętrznych Pulmonologii i Alergologii
Wojskowego Instytutu Medycznego w Warszawie.
Wyniki badań: Większość ankietowanych stanowili mężczyźni
(58,3%), osoby w wieku powyżej 65 lat i od 56 lat do 65 lat, z
wykształceniem zawodowym i średnim, mieszkańcy mniejszych miast i wsi. Ponad 51% badanych paliło papierosy przez
21 – 30 lat a 21,6% dłużej niż 30lat. W związku z chorobą
62% badanych potwierdziło ograniczenie spożycia używek i
stosowanie diety ale tylko 12,6% całkowicie zaprzestało palenia. W tej grupie 32% badanych stwierdziło, ze nadal pali
więcej niż 1 paczką papierosów dziennie, a 29,7% mniej niż
10 sztuk papierosów dziennie. Wolę porzucenia palenia zadeklarowało 36% badanych.
Wnioski. Badania wykazały, iż poziom wiedzy na temat
POCHP i przekonań do podejmowania zachowań prozdrowot-
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nych wśród badanych pacjentów jest niewystarczający. Pomimo znajomości czynników ryzyka choroby większość badanych nadal pali papierosy.
Problemem dla pacjentów jest również kontrola objawów chorobowych w codziennym życiu oraz niewystarczające wsparcie
społeczne w chorobie. Potrzeby edukacyjne respondentów
dotyczą głównie radzenia sobie z dusznością, kaszlem, tolerancją wysiłku fizycznego oraz dietą. Badani pacjenci potrzebują również informacji na temat stowarzyszeń i grup samopomocy na rzecz chorych z POCHP. Zasadne jest większe
wsparcie psychologiczne w chorobie, w celu wzmocnienia
motywacji do porzucenia palenia tytoniu.
Słowa kluczowe – przewlekle obturacyjna choroba płuc, edukacja pacjenta.
38
tive only to a limited degree. Health education of the
patient may be one effective method of supporting the ill
because a patient who knows how to behave in a healthy
manner may become an active partner in therapy [5].
The purpose of the study was to determine the level of
patients’ knowledge and to find out the educational
needs of COPD patients treated at the Department of
Internal Medicine, Pulmonology and Allergology of the
Military Medical Institute. An aspect of the patients’ life
interesting to the researchers was familiarity with the
recommended lifestyle as well as knowledge about effective action and convictions related to quitting smoking.
VII.
MATERIALS AND METHODS
Author Affiliations:
Clinical Nursing Department at the Faculty of Health Sciences
– Medical University of Warsaw
Authors’ contributions to the article:
G. The idea and the planning of the study
H. Gathering and listing data
I. The data analysis and interpretation
J. Writing the article
K. Critical review of the article
L. Final approval of the article
Correspondence to:
Ewa Kądalska, Clinical Nursing Department at the Faculty of
Health Sciences – Medical University of Warsaw Erazma
Ciołka 27 Str., PL-01-445 Warszawa, email: [email protected]
Accepted for publication: March 6, 2015.
VI.
INTRODUCTION
he chronic obstructive pulmonary disease (COPD) is
one of the leading causes of morbidity and mortality
worldwide. [1] The condition is characterised by
increasing breathing difficulty during any type of physical activity as well as respiratory disability lasting many
years and causing the inability to live independently
[2,3]. Early detection may help prevent further aggravation of the disease and reduce the negative impact of the
condition on the patient and his or her environment. The
most effective method to halt the progress of the disease
is for the COPD patient to stop smoking – the main factor for the development of the disease [4]. Late diagnosis
of the condition renders treatment expensive and effec-
T
A questionnaire was used in the study. The study was
performed in 2011 at the Department of Internal Medicine, Pulmonology and Allergology of the Military Medical Institute (WIM) in Warsaw. The study group comprised 60 patients hospitalised due to chronic obstructive
pulmonary disease. The questionnaire was composed of
four parts including 32 questions in total. The first part
concerned the patient’s knowledge about COPD and the
rules of conduct to be adopted by the ill person, the second part was devoted to coping with everyday life and to
the presented health-promoting activities, and the third
part included a set of questions concerning the educational needs and support of COPD patients. Finally, the
last part of the questionnaire consisted of demographic
questions.
VIII.
RESULTS
58% of the respondents were male (N=35), and 42%
were female (N=25). The majority of the polled (40%)
were aged over 65. More than 33% of patients were aged
between 56 and 65, 23% from 46 to 55 years old, whereas only 3% were younger than 45. Most respondents
(28%) lived in a big city with over 100,000 inhabitants.
Approximately 26% of the surveyed came from a town
of up to 50,000 inhabitants, and 25% - from the countryside. The data obtained shows that most of the respondents had obtained vocational education - 40%, over 33%
- secondary education, and 15% - higher education. Only
11.7 % of the respondents had elementary education.
At the beginning of the study, the COPD patients indicated the sources of information which they used to learn
about their disease – it was mainly the medical personnel
(34.1%) as well as television, radio and the Internet
(31.8%). Among the risk factors of chronic obstructive
pulmonary disease, 34.1% of the polled mentioned to-
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bacco smoking, 28.2% passive smoking, 18.2% inhaled
environmental pollution (mainly industrial), 15.3% occupational exposure to inhaled irritants, and 3.5% mentioned exposure to the volatile products of fuel combustion. Subsequently, 66.7% of the respondents correctly
indicated the clinical symptoms of chronic obstructive
pulmonary disease (Table 1).
Table 1. Clinical symptoms of COPD according to the
respondents
COPD symptoms
Frequency
Percentage
Exercise-induced dyspnoea, cough,
coughing up phlegm
19
31.6%
Resting dyspnoea
1
1.7%
All of the above symptoms
40
66.7%
Total
60
100.0%
Most respondents (63.3%) correctly specified the
group of medications used in COPD treatment including
not only bronchodilators but also expectorants and antibiotics.
The patients were asked about the duration of their
addiction to tobacco smoking – 51.3% of COPD patients
indicated that they had been smoking for 20 to 30 years,
21.6% admitted to smoking longer than 30 years, 24.3%
found that it had been 11 to 20 years, and 2.7% pointed
to a period of up to 10 years (Figure 1).
0-10 years 11-20 years 21-30 years
longer
Figure 1. Period of smoking cigarettes in the study group
From the advantages of quitting smoking, 44% of the
respondents mentioned a reduced risk of lung cancer
39
and heart disease while 38% mentioned saving money
(Table 2).
Table 2. Advantages of stopping smoking
Answers
Advantages
N
Percentage
Saving money
32
38.1%
Reduced risk of cancer
37
44.0%
Better physical fitness
11
13.1%
Other including saving time
4
4.8%
*the answers do not add up to 60 because the question could
be answered in more than one way.
At the same time, 36% of patients emphasized that in
order to stop smoking tobacco “you must want it” and
“have the willpower”. In the study group, 23.3% of respondents stated that nicotine-replacement therapy may
be helpful: patches, pills and chewing gum, whereas
20.9% of the surveyed pointed to reducing the number of
cigarettes smoked every day.
The respondents were also asked how they coped with
the disease on a daily basis. As many as 40% of the respondents admitted to contacting a pulmonary specialist
only in case of acute shortness of breath, 23.3% visited a
doctor occasionally and 25% less frequently than once a
month (Table 3).
Table 3. Frequency of appointments with a pulmonologist
Frequency of appointments
N
Percentage
Once a week
1
1.7
Once a month
6
10.0
Less than once a month
15
25.0
Occasionally
14
23.3
In case of acute dyspnoea
24
40.0
Total
60
100.0
Also, in the event of a sudden aggravation of
disease symptoms, the patients usually took a fast-acting
inhalation medicine and they called an ambulance if that
did not help.
Table 3 below illustrates the change of patients’
health-related behaviour resulting from treatment for
COPD. In total, 62 % of the respondents stated that they
had partially changed their health habits. The largest
group of respondents comprising 31% reduced alcohol
consumption and only 12.6% declared that they had
completely stopped smoking. As many as 37.9% of the
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respondents stated that they had not changed their health
habits at all.
stairs. The type and frequency of physical exercise practised by the respondents is shown in Table 5.
Table 3. Change of health behaviour resulting from illness
Table 5. Physical exercise practised by the respondents
Type of exercise
Answers
Change of behaviour
N
Percentage
Yes, I have changed my eating habits
16
18.4%
I have completely quit smoking
11
12.6%
I have reduced alcohol consumption
27
31.0%
I have not changed anything
33
37.9%
Total
87
100.0
In the study group, 40% of respondents admitted that
they continued smoking whereas 21.6% stated that they
smoked sometimes and 38% replied that they did not
smoke (Interestingly, a change of health habits in the
form of quitting smoking altogether was indicated only
by 12.6% of the respondents - Table 3)
Among the respondents, as many as 32.4% smoked
more than one pack of cigarettes a day while 29.7%
stated that they smoked less than 10 cigarettes a day.
Over 61.6% of the polled indicated that they stayed in
rooms where others smoked. As many as 28.3% of respondents found that they often stayed in rooms where
others smoked. Only 10% of the polled declared that
they stayed in smoke-free rooms (Figure 8).
46.6% of the respondents emphasized that they had
tried to quit smoking several times while 10% had never
tried to cease tobacco smoking (Table 4).
Table 4. Attempts to quit smoking
Frequency Percentage
Walking
14
23.3%
Climbing the stairs
5
8.3%
Swimming
3
5.0%
Riding the bike
2
3.3%
All of the above
34
56.7%
Physical exercise is not recommended
2
3.3%
Total
60
100.0%
When asked about the duration of physical exercise,
50% of respondents selected the answer “at least 15
minutes a day”, 45% - “at least 30 minutes a day”, and
5% - “at least 1 hour a day” (figure 2).
60,0%
50,0%
40,0%
30,0%
50,0%
20,0%
45,0%
10,0%
5,0%
0,0%
co najmniej 15 minutco najmniej 30 minut co najmniej 1
dziennie
at least 15dziennie
minutes a day/ at least
30 minutesgodzinę
a day/ dziennie
at least 1 hour a
day
Attempts to quit smoking
Frequency
Percentage
Yes, once
2
3.3%
Yes, several times
26
43.3%
No
6
10.0%
I don’t remember
6
10.0%
Total
40
66.7%
When asked about physical exercise, the respondents
usually replied that it was recommended in the case of
their disease (56.7%) and it should take the form of
walking, swimming, riding the bicycle and climbing the
Figure 2. Duration of physical exercise according to
COPD patients
When asked about their own educational needs related
to life with the disease, the patients usually pointed to
advice on preventing aggravation of the disease and how
to “live normally with COPD” – 45.2%. Within this
group, 4.8% of respondents would expect advice on how
to cease smoking effectively, whereas 21% of the polled
would like to learn about organisations and associations
acting for the benefit of COPD patients (Table 6).
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Table 6. The most important educational needs of the
respondents
Educational needs
Answers
N
Percentage
How to quit smoking effectively
3
4.8%
Contact with organizations/societies
providing support to the ill
13
21.0%
Lack of educational needs
18
29.0%
How to avoid disease aggravation and
live normally
28
45.2%
How to receive psychological support
3
4,8%
Titles of magazines for COPD patients
5
8,3%
Where to buy literature on the subject
3
4,8%
*the answers do not add up to 60 because the question could
be answered in more than one way
It must be added that 80% of respondents asked about
their familiarity with organizations and societies acting
for the benefit of COPD patients indicated that they did
not know any such organisation. When asked about the
most frequently read magazines on the illness, 48.6% of
respondents answered that they did not read magazines
on the subject, 25.7% provided the title of Polish magazine “Świat Zdrowia” [The World of Health], 10% indicated “Alergia Astma Immunologia” [Allergy Asthma
Immunology], and 7.1% - “Postępy nauk medycznych”
[The Progress of Medical Sciences].
IX. DISCUSSION
COPD is the most frequent chronic disease of the
lungs which still remains the reason for a considerable
amount of sick leaves and premature disability. In Poland, approx. 15,000 people die every year as a result of
COPD and its complications. In the etiopathogenesis of
COPD, the main factor is active and passive smoking as
well as the impact of harmful environmental factors –
dust and gas emissions [6].
Quitting smoking is the basis of primary and secondary prophylaxis of the condition with proved effectiveness [6,7,8]. In the treatment of COPD patients, bronchodilators are used – in combination therapy – including aerosol therapy, and depending on the severity of the
disease: corticosteroids, oxygen therapy and antibiotic
therapy are incorporated [5,7].
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The purpose of polytherapy is to alleviate disease
symptoms, improve the quality of patients’ life as well as
to enhance their everyday activity. Therefore, it is essential for the patient to cooperate with the doctor, nurse
and physiotherapist in a conscious manner which may be
achieved by educating the patient and his environment
about the disease [5]. Education of COPD patients is one
of the crucial factors determining therapeutic success.
Apart from the patient’s active participation in therapy, it
is important for them to adapt to the new situation and to
alter some of their everyday habits as well as to improve
their physical performance, counter depression and social isolation of the ill [6].
The study presents the results of the analysis of
knowledge about the disease and of educational needs
among 60 chronic obstructive pulmonary disease patients treated at the Department of Internal Medicine,
Pulmonology and Allergology of the Military Medical
Institute in Warsaw. A questionnaire was used in the
study.
Male patients comprised the majority of the polled
(58.3%) and they were predominantly aged over 65 or
between 56 and 65 with vocational (40%) or secondary
(33.3%) education.
Most of them had been smoking for multiple years.
Over 51% of the respondents had been smoking cigarettes for 21 to 30 years, 24.3% for a period of 11-20
years and 21.6% for longer than 30 years.
In the study group, 28.3% came from a city of over
100,000 inhabitants, 26.7% from a town of up to 50,000
inhabitants and 25% from the countryside. The majority
of the polled –34% – obtained knowledge about their
disease from the medical personnel and 31.8% watched
television programmes, listened to the radio or searched
the Internet.
The respondents had a basic knowledge and understanding of the disease itself, its symptoms, treatment
methods and rehabilitation; they also knew the main
COPD risk factor being tobacco smoking – both active
and passive. Patients visited the doctor rather systematically. When asked about the change of their health habits
due to illness, the answers demonstrate that 62% of patients had changed their habits, e.g. eating habits or they
had restricted their use of stimulants. Only 12.6% of the
group had stopped smoking altogether. Nearly 38% of
the polled had not changed their health behaviour in any
fashion. Over 60% of the respondents found that they
stayed in smoke-filled rooms, thus becoming passive
smokers.
The study has shown that over 32% of the respondents
still smoked more than one pack of cigarettes a day, and
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29.7% less than 10 cigarettes a day. In total, approximately 61% of the polled still smoked and 38% declared
that they did not smoke, yet the subsequent questions
verified this answer and the non-smoking group shrank
to 12.6% (as shown above).
As many as 46.6% of the respondents had tried to quit
smoking, most of them many times, but to no avail.
Within the group, 36% of the respondents still evinced a
will to quit smoking, they used nicotine-replacement
therapy and attempted to reduce the amount of cigarettes
smoked.
As the main advantage of ceasing smoking, 44% of
patients mentioned a reduced risk of developing lung
cancer and heart disease. For 38.1% of the respondents,
an additional advantage would be saving money. However, as the study has revealed, neither knowledge about
the disease risk factors nor the awareness of advantages
related to quitting smoking did have a major influence
on the change of health habits among the patients surveyed.
The educational needs of patients mainly concern
knowledge about “how to avoid disease aggravation”
and “how to live normally with COPD”. Few need advice on how to stop smoking effectively or how to obtain
the aid of a psychologist. The patients did not know any
organisations or societies acting for the benefit of COPD
patients (some patients requested contact data to organisations/societies providing support to the ill and they
also wanted to know the titles of books and magazines
on the illness). It must be noted that the majority of respondents came from small towns and villages where
access to this type of information may be limited. It is an
unsettling fact that 29% of the polled did not evince any
educational needs.
In the study by L. Boratyn-Dubiel, B. Gugała and B.
Dudek entitled “Zapotrzebowanie na edukację w
zakresie zmiany stylu życia pacjentów z POCHP” [Educational needs in the scope of lifestyle change among
COPD patients”] based on the examination in 2010 of
100 patients at the Specialised Tuberculosis and Lung
Disease Health Centre in Rzeszów, it has been emphasised that 62% of the patients did not comply with all of
the doctor’s recommendations, and the worst problems
were related to quitting the addiction to smoking (74%
of respondents). At the same time, 17% of the surveyed
declared that they made systematic appointments with a
specialist. Educational needs were indicated by 54% of
the affected. In the conclusion, the authors stressed the
need
to
introduce
a professionally-conducted education for patients on an
everyday basis. [9]
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K. M. Kieczka in the work entitled “Jakość życia chorych na astmę i przewlekłą obturacyjną chorobę płuc
mieszkających w województwie mazowieckim i lubelskim” [The quality of life among asthma and COPD patients in the Mazowieckie and Lubelskie Provinces] published in 2010 in magazine “Pielęgniarstwo XXI wieku”
[20th-Centruy Nursing] finds that the patients cannot be
left without specialist help. In the periods when the quality of their life deteriorates and the disease becomes
more severe, the ill must be provided with the support of
a psychologist and with rehabilitation. The quality of life
becomes worse when disease symptoms are not controlled accordingly. [10]
Summing up, based on this study we may state that the
respondents know the risk factors, disease symptoms and
treatment methods; they know what lifestyle to maintain
and they are aware that everyday physical activity such
as walking, climbing the stairs, and swimming is recommended except in the periods of insufficient control of
disease symptoms. The medical personnel remain a good
source of information for patients. Nevertheless, the patients do not demonstrate enough motivation to modify
their health habits and quit smoking. Few patients reported the need for psychological support, contact with
organisations and societies acting for the benefit of
COPD patients or the wish to know the titles of magazines on the disease.
X.
CONCLUSIONS
The following conclusions have been formulated based
on the research:
1. The level of knowledge about chronic obstructive pulmonary disease is varied among the patients at the Department of Internal Medicine,
Pulmonology and Allergology of the Military
Medical Institute in Warsaw. The patients usually know the disease risk factors, symptoms
and treatment methods.
2. The greatest problem for the patients is the proper control of disease symptoms in everyday life.
They also require help in the scope of lifestyle
change and information on social support in illness which constitutes an incentive to subject
the patients to a special educational programme.
3. The patients have formulated their own educational needs related to coping with disease
symptoms including shortness of breath, cough,
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improved tolerance of physical effort, implementing its recommended forms as well as an
optimal diet. The patients surveyed also need
information on societies and self-help groups
acting for the benefit of COPD patients as well
as access to literature on the subject.
4. The ill know what steps to take in order to quit
smoking but their motivation to do so is not
strong enough. It is therefore reasonable to increase the psychological support offered to patients.
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