Reference guide for individual patient education Integrating Long-Term Home Oxygen Therapy into the COPD patients life Topics: 1. Long-Term home oxygen therapy and oxygen equipment To have a better understanding of the usefulness of long-term oxygen therapy To make better use of oxygen equipment (optimally and safely) Living well with oxygen on a day-to-day basis 2. Learning contract Authors 2 nd edition of the Living Well with COPD program, February 2011: Maria SEDENO and France PAQUET, Montreal Chest Institute, McGill University Health Centre Diane NAULT and Sylvie GAGNÉ, Regional home care services for chronic respiratory patients of the Maisonneuve-Rosemont Hospital.
INTEGRATING LONG TERM HOME OXYGEN THERAPY INTO THE COPD PATIENTS LIFE BASIC INFORMATION FOR HEALTHCARE PROFESSIONALS Phases of the education session Session length Introduction: Introduction of healthcare professional. 60-90 minutes Educational intervention: Follow the sections in this guide using the educational methods, the questions and the necessary teaching and learning materials (Module Integrating Long Term Oxygen Therapy into your life and other material). Conclusion: Take note of the learning contracts. Assess what the patient has learned and, if necessary, refer the patient to the appropriate available professionals (doctor, pharmacist, etc.) depending on the biopsychosocial needs detected. Necessary documents Other teaching/learning materials Module Integrating Long Term Oxygen Therapy into your life Patients oxygen equipment Educational methods used in this guide (each method is referred to in the text by its number) [1] Learning needs assessment: Assess prior knowledge/skills to identify the patients needs. [2] Interactive method: Ask the patient questions, ask for his opinion, give him an opportunity to ask questions. [3] Creation of ambivalence (motivational interview technique): A rephrasing technique consisting of restating the patients comments using different words, creating doubt in the patients mind about the obstacles to change and proposing ways of overcoming these obstacles. Use open questions, change your strategy if you encounter patient resistance, express your confidence in the patients ability to cope with change, use the positive experiences already encountered by the patient and other people in similar situations (peer-modelling) to stimulate the patients desire for new positive learning experiences. [4] Demonstration and practice: Allow enough time to practise the techniques that need to be learned and mastered (use the patients equipment). This is necessary to develop the patients skills and self-confidence. [5] Learning contract: Plan for learning contracts involving patients and their families in the achievement of concrete objectives that are realistic in the short and long terms. [6] Self-efficacy evaluation: On a scale of 1 to 10, ask patients to identify their self-efficacy with respect to the behaviour that is to be adopted or modified, 1 = not at all confident and 10 = very confident. [7] Constructive feedback and reinforcement: Explain the effects of the patients behaviour on their own health to encourage the acquisition of selfmanagement strategies. Identify examples in the patients life when they have used self-management strategies and experienced positive results, and evaluate what could be improved if the results were negative. Re-evaluate how these experiences affected their self-efficacy and adherence to new behaviours. [8] Information summary: Ask patients to summarise the information they have been given to check comprehension. [9] Referral to other healthcare professionals: Prepare an assessment and refer the patients to other professionals or documentation if necessary. [10] Written information: Use printed learning materials to help patients remember what they have been taught. [11] Case history: Use simulations or scenarios to come up with solutions or stimulate the decision-making process. Suggested questions These are questions designed to assess patients needs, their comprehension of the given information and the expected outcomes. This evaluation should be conducted regularly throughout the learning process to verify that the predetermined goals and objectives have been achieved. Methods such as direct questions, problem solving, simulations and reiteration of key instructions can be used to complete the communication of information, constructively correct misunderstandings and errors and reinforce the newly acquired knowledge and skills. If any goals or objectives are not achieved, the education plan will eventually need to be reviewed and the process repeated using other methods. Notes: 1. For convenience, the pronoun he in this reference guide includes the female gender. 2. Adapt this guide as required according to the specific needs of the patient (i.e., types of medication he takes or equipment he uses) and the opportunities/limitations identified in the education session. Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 2 of 10
LONG TERM HOME OXYGEN THERAPY AND OXYGEN EQUIPMENT General objective The goal of this section is to help patients have a better understanding of the need for long term oxygen therapy and the importance of using their equipment optimally and safely. Patient/family specific objectives 1. To have a better understanding of the usefulness of long term oxygen therapy. Understanding oxygen s role in the body and the problems associated with chronic blood oxygen deficiency How to assess chronic blood oxygen deficiency Being familiar with the objective, benefits and side effects of long term oxygen therapy, and the prescription 2. To make better use of oxygen equipment (optimally and safely) Being familiar with the operation and maintenance of the different kinds of oxygen equipment Being familiar with and applying well the safety rules 3. Living well with oxygen on a day-to-day basis Learning how to stay active, get a good sleep, travel and manage a worsening of COPD symptoms while using oxygen Learning how to overcome fears and concerns about oxygen and the limitations associated with its use Related teaching/learning materials Necessary documents Module Integrating Long Term Oxygen Therapy into your life p. 4-31 Other teaching/learning materials Patients oxygen equipment 1. Discuss the patient s/family s perception about oxygen Expresses his perceptions, beliefs therapy. [1,2,3] and fears about oxygen use. Oxygen s role in the body and a chronic lack of oxygen in the blood p. 4-7 2. Explain to the patient/family oxygen s role in the body and the problems associated with a chronic lack of oxygen in the blood. [2,8] Explains oxygen s role in the body in his own words. Explains the chronic lack of oxygen in the blood in his own words. Do you know why your doctor has prescribed oxygen therapy? What worries you most about the idea of using oxygen? Do you know someone on oxygen therapy? Have you talked to that person? If so, how did it help? How are oxygen and carbon dioxide exchanged in the lungs of a healthy person?. a person with COPD? How can COPD develop into a chronic lack of oxygen in the blood? Describes the problems that could be caused by chronic blood oxygen deficiency. What problems/symptoms could be caused by a chronic lack of oxygen in the blood? Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 3 of 10
How to assess a chronic lack of oxygen in the blood p. 8 p. 9-10 LONG TERM HOME OXYGEN THERAPY AND OXYGEN EQUIPMENT 1. Explain to the patient/family the tests for measuring the amount of oxygen in the blood. [2] Oxygen therapy at home: Objectives, benefits and points to remember Prescription 2. Explain to the patient/family how these tests are performed. [2] 1. a. Assess what the patient already knows about the benefits of oxygen therapy. [1] b. Discuss with the patient/family the objectives, benefits and points to remember about oxygen therapy. [2,3,8] If the patient is a smoker: a. Discuss with the patient/family about the impact of smoking on the efficacy of oxygen treatment. [2,3,8] b. Discuss with patient/family about the risks and dangers related to smoking in presence of oxygen. [2,3,8] Lists the tests for assessing a chronic lack of oxygen in the blood. Describes in his own words how the tests used to evaluate a chronic lack of oxygen in the blood are performed. Says what he already knows about the benefits of oxygen therapy. Describes in his own words the objectives, benefits and points to remember about oxygen therapy. If the patient is a smoker: Describes in his own words the effects of smoking on the efficacy of oxygen treatment. Describes the risks and dangers related to smoking in presence of oxygen. What tests are used to measure the amount of oxygen in your blood? How is the oxygen saturation in the blood measured? How are arterial blood gas measured? Do you know about the benefits of oxygen therapy? Can you explain to me the objective and benefits of oxygen therapy? Why should you take your oxygen treatment as prescribed? If the patient is a smoker: How do you think smoking affects the efficacy of your oxygen therapy? What risks are you taking if you smoke and use oxygen? 2. a. Explain to the patient that oxygen is a medication and discuss the importance of adhering to his prescription. [2,3] Describes his oxygen prescription using the correct terms. Expresses the importance of following his prescription. What oxygen flow rate has your doctor prescribed? Has your doctor prescribed a single flow rate or different flow rates? What is your flow rate (single, at rest, on exertion, while sleeping)? How many hours a day do you need to use your oxygen? b. Do a contract with the patient for the use of oxygen as prescribed and, at the end of the period covered by the agreement, assess his therapeutic compliance and his perception of its efficacy. [3, 5] Agrees to commit to using oxygen as prescribed on a short term basis. Demonstrates therapeutic compliance with his oxygen therapy at least 15 hours a day. Why do you have to adhere to the flow rate and duration of administration prescribed? How would you feel about trying to use your oxygen at least 15 hours/day? Have you been able to use your oxygen for 15 hours/day? How do you feel since you have been using your oxygen? Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 4 of 10
LONG TERM HOME OXYGEN THERAPY AND OXYGEN EQUIPMENT 1. Find out what the patient knows about oxygen supply equipments. [1] Oxygen equipment: Concentrator Oxygen cylinders Liquid oxygen tanks Accessories Explains what he knows about the types of oxygen equipment, especially his own. What do you know about the ways of administering oxygen? What type of equipment has been prescribed for you? p. 11-15 2. a. Give the patient/family an overview of the types of equipment available. Focus on the equipment prescribed for him: definition/operation, autonomy and other information. [2] Describes the operation (start-up, alarms) and autonomy of the oxygen equipment he needs. How does your work? What kinds of alarms does your equipment have? What is the autonomy of your? Is there anything else you need to remember? b. Explain and demonstrate to the patient/family the checks to do when an alarm is triggered (equipment malfunctions or power failure). Ask the patient to notify his oxygen provider if the alarm continues. [4, 5] Does the necessary checks when an alarm is triggered. Notifies his oxygen provider of any equipment malfunction or power failure. What will you do if an alarm is triggered on your oxygen equipment (malfunction or power failure)? What will you do if your oxygen equipment s alarm does not stop in spite of the checks that have been done? 3. Explain and demonstrate to the patient/family the general rules for maintaining the oxygen equipment and its accessories. [2,4] Describes and demonstrates correctly the general rules for maintaining the oxygen equipment and accessories. How are you going to look after your oxygen equipment (concentrator, portable device, etc.)? and your accessories (nasal cannula, tubing, connectors, etc.)? Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 5 of 10
LONG TERM HOME OXYGEN THERAPY AND OXYGEN EQUIPMENT Safety rules 1. Discuss with the patient/family the dangers and risks associated with using oxygen and assess their perception of the dangers and risks. [1,2,3] Describes the dangers and risks associated with using oxygen Recognises that the dangers and risks are real. What do you know about the dangers and risks associated with using oxygen? Do you think these dangers and risks are real? If not, why not? p. 16 2. a. Assess the potential for dangerousness of the patient/family environment with respect to the dangers and risks associated with oxygen use (tobacco, drugs, alcohol, meal preparation, cognitive limitations, etc.). [1] The patient/family cooperate in assessing the potential for dangerousness. Do you make your own meals? If so: Show me how you cook. Do you smoke? If yes, see section below. Do you live with people who smoke? Do you often have many guests who smoke? Do you drink alcohol? If so, what kind? How much a day? Do you take any drugs? If so, which ones? b. If the patient is a smoker: Assess the patient s motivation to quit smoking. If he is motivated to quit, provide him with help and support; if he is not, ask him to commit to smoking safely (removing nasal cannula, turning off the concentrator, smoking in another room). [ 5,6] If the patient is a smoker: Expresses whether or not he is motivated to quit smoking. Agrees to commit to quitting or to smoke respecting the safety rules. If the patient is a smoker: How many cigarettes/day do you smoke? Show me how you smoke. On a scale of 1 to 10, do you think it is important not to smoke when using oxygen? On a scale of 1 to 10, do you think you can quit smoking? Will you agree to try to quit smoking? If you smoke, will you agree to respect the safety rules? How can I help you to quit smoking? 3. Introduce and demonstrate to the patient/family the safety rules for oxygen use; ask them to commit to following the safety rules. [2, 4, 5, 8] Commits to following the safety rules for oxygen use and demonstrates them correctly. How much do you know about the safety rules for using oxygen? What rules will you follow to use your oxygen equipment safely? Do you think you can ask those around you not to smoke when you are there? If not, why not? Why is it so important to follow these safety rules? Do you agree to commit to following the safety rules you have learned at all times? If not, why not? Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 6 of 10
p. 17-26 LONG TERM HOME OXYGEN THERAPY AND OXYGEN EQUIPMENT 1. Help the patient /family to come up with strategies for adjusting to the use of oxygen on a daily basis (during activities that require exertion, while sleeping, while travelling and during symptoms worsening). [3, 5, 7, 8] Living well with oxygen on a day-to-day basis Activities and sleep Describes his activities that require oxygen use. Agrees to use oxygen as prescribed during his activities. Travel Summarises the key points in planning a trip. Which of your activities do you think require the use of oxygen? Do you agree to use your oxygen during your various activities? What do you think of the need to use your oxygen while you are sleeping? Do you agree to use your oxygen while you are sleeping? If not, which are your reasons? What do you think are the key points in planning a trip? Aggravation of symptoms Describes the symptoms of a worsening of his COPD. Gives the reasons for using his oxygen at all times during a worsening (exacerbation) of his COPD. Agrees to use his oxygen at all times during an exacerbation. What changes in your symptoms indicate a worsening of your COPD (exacerbation)? Why do you need to stay on oxygen at all times during a worsening (exacerbation) of your COPD? Do you agree to use your oxygen at all times during a worsening (exacerbation) of your COPD? If not, for which reasons? 2. Explore with the patient his concerns about his long term oxygen therapy (emotional, family-related and social consequences and equipment-related constraints). [1] Expresses his concerns about the use of long term oxygen therapy. Refer to the table on page 23 of the module Are you ready to use the oxygen your doctor has prescribed? Do you have any concerns about your oxygen therapy? If so, are they mostly about your emotions and feelings? (awareness of disease worsening, dependency, loss of self esteem ) the social constraints for you or your family and friends? (loss of job, limited recreational activities and mobility, isolation ) equipment-related constraints (noise, tubing, deliveries ) 3. Work with the patient to develop a strategic plan for reducing the impact of long term oxygen therapy on his day-to-day life, emotions and feelings. [2,3,7] Works with his resource person to develop strategies for reducing the impact of oxygen therapy on his day-to-day life, emotions and feelings. What could you do to feel better about using oxygen? Do you need help to manage certain situations more effectively? If so, which ones? How can we help? Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 7 of 10
p. 32-34 LONG TERM HOME OXYGEN THERAPY AND OXYGEN EQUIPMENT Self-efficacy evaluation 1. Assess the patient s self-efficacy at following his oxygen prescription and using his equipment optimally and safely. [6] Says he can follow his oxygen prescription correctly. Says he can use and maintain his oxygen equipment correctly. Says he is confident about the benefits of oxygen therapy. Refer to the questions on pages 27-28 of the module Do you think you can take your oxygen therapy as prescribed, hours a day? Do you think you can use and maintain your properly? Check for each oxygen supply used. Do you think long term oxygen therapy will help you to prevent an aggravation of your health condition? Do you think oxygen therapy at home will help you to do more activities in your day-to-day life? For each question, if not, for which reasons? Summary of the session p. 36 1. Ask the patient to summarise the information he has received about long term oxygen therapy. [8] 2. Provide constructive feedback and reinforcement on therapeutic compliance with the oxygen prescription. [7] Summarises the key elements in his use of long term oxygen therapy. Accepts comments positively and says he is ready to make the necessary changes. Could you summarise in a few words the most important thing you have learned about your long term oxygen therapy? Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 8 of 10
LEARNING CONTRACT Learning contract 1. Give the patient the Integrating Long Term Oxygen Agrees to read the document. Therapy into your life module. [10] 2. a. Together with the patient, fill in page 31 of the module, based on his oxygen prescription. b. Suggest to the patient that he tear out pages 31-32 and always keep them readily at hand (for example, post them up at home). [5] 3. Ask the patient to take his oxygen as per his prescription (flow rate and duration) while following the safety rules and maintenance instructions. [5] Agrees to keep this information readily at hand. Uses his oxygen as prescribed. Correctly maintains his equipment and uses it safely. Have you used your oxygen therapy? If so, how many hours/day and at which flow rate? If not, why not? Have you had difficulty maintaining your oxygen equipment? If so, why? Have you used your oxygen equipment safely? If not, why not? Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 9 of 10
LEARNING CONTRACT 1. Refer the patient to his doctor, his resource person or Agrees to be referred to his doctor his pharmacist for any problem to do with taking the or pharmacist for any problems to medication. [9] do with taking his medication. Referral to other healthcare or technical service professionals Do you agree to see your doctor about taking your medication? your pharmacist? 2. Refer the patient to the appropriate resources available (doctor, nurse, respiratory therapist, social worker, pharmacist, etc.) depending on the biopsychosocial needs identified. [9] Agrees to get help from the healthcare professional(s) recommended. Do you agree to see a? Integrating Long Term Home Oxygen Therapy into the COPD patients life. 2 nd edition February 2011. Page 10 of 10