Date of Award

2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Teresa J. Kelechi

Second Advisor

Lynne S. Nemeth

Third Advisor

Martina Mueller

Fourth Advisor

Bryan Mieckowski

Abstract

Background: Multiple internal and external factors are responsible for the development and progression of chronic obstructive pulmonary disease (COPD). Noxious stimuli such as cigarette smoking and other air borne pollutants set off the ongoing inflammatory process of COPD resulting in air flow limitation and lung tissue destruction. Objectives: Examination of inflammatory mediators of COPD and risk factors that coincide with hospital admission for AECOPD. The aim of this dissertation was to conduct a feasibility study to implement an educational intervention for hospitalized patients and evaluate their quality of life (QOL), using the RE-AIM framework to evaluate outcomes. Design: This dissertation includes three papers: a principle-based concept analysis on inflammatory mediators related to COPD, an integrative review of the psychometric instruments used to measure risk factors for hospitalization among patients with COPD, and a feasibility study using the American Lung Association’s modified COPD Action Plan to instruct patients with COPD on identifying early signs of an exacerbation and when to seek medical care. In addition, quality of life perceptions were evaluated using the World Health Organization-BREF (WHOQOL-BREF) before hospital discharge and 30 days post discharge via phone call. Conclusions: COPD is a complex chronic disease with an insidious onset by inflammatory mediator(s) or genetic origin. The episodic acute exacerbations of COPD (AECOPD) are responsible for high healthcare utilization and perceptions of low quality of life. The feasibility study results suggest implementation of the American Lung Association modified COPD Action Plan can be carried out as discharge instructions and QOL evaluated using the WHOQOL-BREF questionnaire. Positive ratings and comments on the delivery and content of the COPD Action Plan were found in a small sample of participants who responded to follow up.

Rights

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