Occupational Therapy for Chronic Obstructive Pulmonary Disease (COPD) in an Acute Setting

Kelly Stasiulewicz, OTDS

Huntington University Doctor of Occupational Therapy Program

KEY REFERENCESAndersen, I. C., Thomsen, T. G., Bruun, P., Bødtger, U., & Hounsgaard, L. (2017). The experience of being a participant in one’s own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary

disease: A longitudinal study. International Journal of Qualitative Studies on Health and Well-Being, 12, 1372994. http://doi.org/10.1080/17482631.2017.1371994

Barrecheguren, M., & Bourbeau, J. (2018). Self-management strategies in chronic obstructive pulmonary disease: A first step toward personalized medicine. Curr Opin Pulm Med, 24, 191-198.

Chan, S. C. C. (2004). Chronic obstructive pulmonary disease and engagement in occupation. American Journal of Occupational Therapy, 58, 408-415.

Nakken, N., Janssen, D. J. A., van den Bogaart, E. H. A., van Vliet, M., de Vries, G. J., Bootsma, G. P., Gronenschild, M. H. M., Delbressine, J. M. L., Muris, J. W. M., Wouters, E. F. M., & Spruit, M. A. (2017). Patient versus proxy-reported

problematic activities of daily life in patients with COPD. Respirology, 22, 307-314. http://doi.org/10.1111/resp.12915

Walker, B. A., & Breckner, H. (2016). An open-access review to determine best evidence-based practice for COPD. The Open Journal of Occupational Therapy, 4(2), 1-22. http://doi.org/10.15453/2168-6408.1199

Project Description & SitesThe purpose of this capstone project was to address the lived experience of occupational therapy

intervention for COPD patients at Riverside Methodist Hospital (RMH) in Columbus, Ohio. In acute care

settings, patients tend to have short stays, at which time occupational therapy primarily focuses on

discharge planning and interventions that address basic activities of daily living. Therefore, it is important

to address the needs of the patient to ensure patients outcomes and reduce risk of readmission following

discharge. This capstone experience consisted of direct patient care to individuals with COPD,

examination of documentation and the interprofessional approach to care and discharge, and

examination of evidence-based practice. The project was completed with the aim of improving the COPD

patient experience of occupational therapy to improve patient outcomes and compile recommendations

for care of COPD patients in an acute setting. The findings were compiled utilizing current evidence-

based practice, patient interviews, direct patient care, interprofessional observations, and medical

records to assist in improving acute care occupational therapy provision and reduce readmission rates

for those with COPD.

Area of Focus: Clinical Practice & Program and Policy Development

Sites: Riverside Methodist Hospital & Grant Medical Center

vOutcome Measure #1: Student will gain advanced knowledge in the patient’s experience of

occupational therapy in acute care.

Ø Learning Objective #1: Student will gain advanced knowledge in the COPD population through

observation/treatment of a minimum of 20 patients with COPD throughout their stay at RMH.

vOutcome Measure #2: Student will gain advanced knowledge in COPD treatment techniques and

interventions.

Ø Learning Objective #2: Student will gain advanced knowledge in evidence-based practice for COPD patients

throughout their continuum of care.

Ø Learning Objective #3: Student will examine patient IADL participation in tasks associated with risk of

readmission.

vOutcome Measure #3: Student will identify potential areas of need and risks of readmission within

patients with COPD.

Ø Learning Objective #4: Student will gather patient barriers to daily occupations during clinical practice to

determine COPD patient indicators and patterns to assist in streamlining provided services.

Ø Learning Objective #5: Student will complete a minimum of 40 hours examining the multidisciplinary team

approach to patient care.

Individuals diagnosed with chronic obstructive pulmonary disease (COPD) have been found to be at an

increased risk for hospital readmission(s) and may have particular factors contributing to readmission

and negative outcomes. The high prevalence of readmissions and the severity of the disease itself

indicates a need for healthcare professionals to improve patient care to ensure the best outcomes for

individuals diagnosed with COPD. Walker & Breckner (2016) stated “COPD is an incurable disease but

can be managed through lifestyle adaptations and modifications” (pg.1). The characteristics of COPD

including exacerbations and increased dyspnea with activity tends to lead individuals with COPD to

experience fear, loss of confidence in their ability to perform ADLs, and feelings of loneliness as a result

of the limited mobility that comes along with the disease progression (Chan, 2004; Nakken et al., 2017).

It has been found that enabling self-management is an important aspect of treatment for individuals with

chronic diseases, including COPD. According to Barrecheguren & Bourbeau (2018), “self-management

is in which patients acquire the necessary skills to manage and cope on a day-to-day basis with their

disease, assume greater responsibility for healthcare decision, adopt and maintain behaviors that

improve their wellbeing” (pg. 191).

Project Mission Statement:To identify patient needs and experiences of COPD patient intervention in the acute care setting.

Project Vision Statement:To provide patients at Riverside Methodist Hospital an enriched and effective occupational therapy

experience with the aims of improving occupational engagement and participation following discharge.

Mission & Vision Statements

Literature Review

Project Completion and Outcomes

DeliverablesvDocumentation and personal reflection of patient occupational

therapy sessions observed or completed by student at Riverside

Methodist Hospital to assist in determining patient patterns and/or

indicators for readmissions amongst the COPD population.

vCompilation of evidence-based practice of COPD patients to be

utilized by hospital occupational therapy staff and provide a quick

resource to assist in implementation of current best practice.

vReport of findings and recommendations of occupational therapy

practice in acute settings for COPD patients, including potential

COPD patient indicators for readmission.

Future Implications for OTvIncreasing self-management skills for patients with COPD as a way of placing responsibility back on

the patient to be an active participant in their own day to day healthcare.

vUse of the Canadian Occupational Performance Measure (COPM) to gain patient perspective on

occupational engagement and satisfaction.

vWriting and viewing therapeutic goals through an adaptation/modification lens as a way to guide

occupational therapy treatment in line with the progressive, chronic nature of COPD.

vEnsuring carryover of self-management strategies following discharge through appropriate

discharge recommendations and potential occupational therapy involvement in pulmonary rehab.