Collaborative Self-Management and Chronic Obstructive Pulmonary Disease: Integrating Patient Needs into an Educational Program for Nurses

Background: Chronic obstructive pulmonary disease (COPD) affects over 2.5 million individuals Canada wide and is the leading cause of hospitalization in Canada among chronic diseases with an 18% hospital readmission rate. The high cost of emergency room visits, hospitalizations, and readmissions for COPD tells a story of need; the need for education of patients. Collaborative self-management (CSM) is a process whereby the individual patient and nurse work together to improve health. The integration of CSM in COPD care has shown evidence for reduced exacerbations, hospitalizations and readmissions. Little is known about the level of knowledge and self-efficacy of hospital-based nurses to promote and facilitate CSM during hospitalization of COPD patients. Purpose: The aim of this study was to determine the effect of an educational program for nurses on their knowledge and self-efficacy for preparing patients for discharge, patients knowledge of COPD and readiness for discharge and the COPD 30-day rate of readmission to hospital. The program integrated Bandura’s social cognitive theory and the CSM approach to COPD care. Method: A three-phase, two group, pretest-post-test, quasi-experimental, research study was conducted. In Phase I, hospital-based nurse participants working on two Medicine units were assigned to either the intervention group who attended an education program or the control group who viewed a videotape of COPD patient experiences. In Phase II, patients admitted to hospital were invited to participate by completing study questionnaires. In Phase III, the rate of 30-day readmission to hospital was obtained from decision support in the study site. Results: Results of this study showed that nurses who attended the education intervention reported higher COPD knowledge scores and higher self-efficacy scores than control group nurses. Patients admitted to the intervention unit had higher knowledge of COPD and readiness for discharge home when compared to patients admitted to the control unit; however, no reduction in the COPD 30-day readmission rate was observed. Conclusions: Findings suggest that providing the hospital-based nurse with education related to COPD and framed by the social cognitive theory increases nurse knowledge and self-efficacy for providing discharge care to patients with COPD. Based on the concept of CSM the nurse may be the influencing factor for changing behaviour of COPD patients and provide nurses, hospital administration and policy makers with evidence to support ongoing development of CSM programs within this setting