NURSE COACHED PRACTICE FOR RELIEF OF DYSPNEA

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The overall objective of this study is to design and implement a nursing intervention strategy which will decrease the distress of the symptom of dyspnea and increase patients' capability for coping with this frightening and disabling sensation. This purpose will be accomplished by studying how repeated practice with the experience of dyspnea with nurse coaching in a controlled situation affects the intensity of dyspnea and the distress of the symptom for the patient, related anxiety, dyspnea with selected activities, perceived self efficacy for completing activities and distance walked. A secondary aim will be to determine if there is a pattern of change over time in anxiety, dyspnea intensity and dyspnea distress during the actual practice of exercising with dyspnea with nurse coaching. Theories of coping, control, desensitization, and self efficacy provide the framework. The design is an experimental longitudinal design over 3 months, with random assignment to a control group which receives the usual information about pulmonary disease and an experimental group which receives information plus repeated practice with the experience of dyspnea with nurse coaching. A 3 day a week for 3 weeks intensive graduated exercise with coaching through dyspnea will be followed by at home exercise with dyspnea. One home visit will be made at 2 months for reinforcement of the experimental intervention. The sample will be 62 chronic lung disease patients who are limited by dyspnea. Pre and post treatment measures of dyspnea intensity, anxiety, dyspnea with activities, perceived self-efficacy and distance walked between the 2 groups will be compared followed by a secondary analysis of the trends in anxiety, dyspnea intensity and dyspnea distress during actual graduated levels of dyspnea with nurse coaching. This study will systematically examine a "desensitization" treatment of dyspnea proposed by several authors. The study findings will add to knowledge related to the treatment of dyspnea, a common human response to illness, and contribute to the development of nursing science in the care of pulmonary patients.