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Change Strategy and Implementation
Learner’s Name
School of Nursing and Health Sciences, Capella University
NURS-FPX6021 Biopsychosocial Concepts for Advanced
Nursing Practice I
Instructor's Name
April, 2022
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Change Strategy and Implementation
Patients often present with respiratory issues of varying severity; these can range from
breathing difficulties to dry or wet coughs. Patients that do present with these issues are admitted
to the pulmonary ward to treat the issue at hand. Chronic obstructive pulmonary disorder
(COPD) is one of the primary issues among these. Each patient receives treatment based on the
severity of his or her condition. The treatment can include prescribing antibiotics, non-invasive
ventilation, and pulmonary rehabilitation. Pulmonary rehabilitation involves a program of
exercise and education specifically designed to help individuals with pulmonary issues such as
COPD (NHS, 2016a).
The treatment for COPD is aimed at improving the physical health of patients admitted
to the ward. However, it does not take into consideration the mental health of these individuals.
There exists a strong positive correlation between COPD and anxiety and depression (Pooler &
Beech, 2014), which means that patients who present with COPD are likely to be comorbid with
anxiety, depression, or both. Further, COPD patients who are comorbid with depression and
anxiety are statistically more likely to be hospitalized; these patients are also likely to require
longer periods of hospitalization and face a greater risk of mortality after they are discharged.
Considering these factors, it is necessary to address mental health issues simultaneously with
physical issues to ensure that these patients can manage their overall health more effectively.
Left untreated, both anxiety and depression can lead to significant implications for compliance to
medical treatment (Pooler & Beech, 2014).
Anxiety and COPD
Some of the symptoms associated with COPD overlap with those associated with anxiety.
Dyspnea or shortness of breath is particularly distressing for patients and is common to both
COPD and anxiety. A COPD patient with anxiety might interpret dyspnea in an exaggerated
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manner, often correlating this symptom with an inability to breathe or even an imminent death
(Heslop, Newton, Baker, Burns, Carrick-Sen, & De Soyza, 2013). Anxiety might not be the
cause of dyspnea in COPD patients, but it can be viewed as an indicator of acute exacerbation in
such patients (Pooler & Beech, 2014).
Depression and COPD
As mentioned above, there exists a significant correlation between COPD and depression.
The effect that depression has on COPD patients is different from the effect produced by anxiety.
Depression has been significantly linked to a perceived decrease in quality of life as well as in
physical activity. Pooler and Beech (2014) also note that depression is likely to be
underdiagnosed and undertreated for individuals with COPD.
Patients who suffer from COPD and depressive symptoms are less likely to follow
through on their recommended physical therapy. Consequently, their COPD becomes
aggravated, requiring them to receive further treatment. For most patients, particularly in cases of
acute exacerbation, further treatment would require hospitalization. However, this might cause
patients to feel that they are unable to care for themselves; they may experience inferiority or a
diminished sense of autonomy. As a result, patients are often stuck within this cycle of
deteriorating health, leading to a decline in the state of their mental health. The only effective
method to treat patients in such a situation is to address both their physical and psychological
issues (Dursunoğlu et al., 2016).
Change Strategies
Both depression and anxiety require attention from a mental health professional to
adequately and effectively help patients. Cognitive behavioral therapy (CBT) has been proven to
be an effective method of managing anxiety, depression, and a range of other mental health
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conditions. In a typical CBT session, a patient and a therapist work together to break down one
of the patient’s problems into its separate parts. Some of these parts could be how the patient
thinks about the problem, how he or she feels physically about it, and how he or she acts in
response to it. The patient and the therapist then evaluate these parts and figure out what might
be unhelpful or unrealistic as well as the effect that these parts have on each other and on the
patient (NHS, 2016b).
By identifying these parts, the therapist can figure out a plan of action for the patient to
change thoughts and behaviors that are counterproductive. The patient will then be asked to
practice these changes in his or her life and report back on whether he or she was able to enact
the changes and how effective they were. By using this method, the patient would eventually be
able to apply the skills that he or she has learned in the sessions to his or her life. This would
help the patient manage his or her issues even after the course of treatment is complete (NHS,
2016b). For example, individuals with COPD and anxiety might be able to better manage their
anxiety by not associating shortness of breath with more catastrophic outcomes.
However, CBT has certain drawbacks. It requires patients to be willing to confront their
emotions and anxieties, which can be uncomfortable. Further, CBT requires patients’
commitment to the process and their cooperation to help themselves get better. The therapy can
be guided, but ultimately the outcome of therapy is determined by the patients’ participation
(NHS, 2016b). On a practical level, it can be difficult for hospitals to accommodate an adequate
number of therapists for patients or to provide an efficient therapist-to-patient ratio.
To address this, it would be necessary for group therapy sessions to be conducted in
conjunction with one-on-one sessions. This would enable a wider range of individuals to access
the necessary treatment for their psychological condition, and it might be less intimidating for
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them if it is a group activity. Further, nurses could be trained in CBT, or those trained in CBT
could be hired to facilitate more one-on-one sessions. Patients who are provided with access to
these treatment options in addition to the treatment they receive for their COPD will have a
higher quality of life and be able to manage both their physical and mental conditions more
effectively than before (Howard & Dupont, 2014).
Pharmacological interventions can also be used to treat anxiety and depression.
Treatment doses vary based on the severity of the disorder and can have a variety of side effects.
Most antidepressants are not contraindicated; however, caution is necessary while prescribing
certain types such as tricyclic antidepressants. Benzodiazepines have the potential to cause
respiratory depression and should not be administered to COPD patients who retain CO2.
Standard antidepressants such as selective serotonin reuptake inhibitors can often have side
effects such as headaches, tremors, gastrointestinal distress, and either psychomotor activation or
sedation. These side effects occur during the initial phase of treatment and can be problematic
when coupled with the existing conditions of COPD patients. In contrast, CBT and group therapy
are nonpharmacological interventions and would not result in contraindications. It is also
difficult to implement the pharmacological treatment of depression and anxiety on the level of
policy as the medication and doses required would be based on the needs of individual patients.
Further, patients who suffer from COPD might be unwilling to take medication for depression or
anxiety along with the medication that they might already be taking. This could possibly result
from the stigma that surrounds mental illnesses or the reluctance of patients to accept their
diagnosis (Tselebis et al., 2016).
Data Table
Current Outcomes Change Strategies Expected Outcomes
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Patients who suffer from COPD do not have adequate access to mental health facilities: a) Many COPD patients
experience anxietyresulting from dyspnea.
b) Patients with COPD arelikely to experiencedepressive symptoms thathave been positivelycorrelated with theworsening of COPDsymptoms.
To ensure that patients receive the care they need, certain measures are necessary: • Therapists should be
made available to COPDpatients.
• Nurses should be trainedin CBT, or nurses who aretrained in CBT should behired.
• Group therapy sessionsshould be conductedregularly for COPDpatients who arecomorbid with anxiety,depression, or both.
Patients who suffer from COPD will have adequate access to mental health facilities and will be able to manage both their physical and mental conditions more effectively than before: a) Patients who are
comorbid with COPD andanxiety will be able todistinguish between theiranxiety and anaggravation of theirCOPD symptoms(Howard & Dupont,2014).
b) Patients who arecomorbid with COPD anddepression will be betterprepared to manage boththeir COPD and theirdepressive symptoms(Dursunoğlu et al., 2016).
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References
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
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NHS. (2016a). Chronic obstructive pulmonary disorder (COPD).
https://nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/
NHS. (2016b). Cognitive behavioral therapy (CBT).
https://nhs.uk/conditions/cognitive-behavioural-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).
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