Carolyn Ross

Cognitive-Behavioral Treatment Combined With Asthma Education for Adults With Asthma and Coexisting Panic Disorder

This study tested the efficacy of a nurse-administered 8-week group treatment program for adults with asthma suffering from coexisting panic disorder. The program consisted of cognitive behavioral treatment (CBT) for panic disorder combined with asthma education (AE). Forty-eight women with a confirmed diagnosis of asthma and panic disorder were randomly allocated to a treatment condition (n=25) and a wait-list control condition (n=23). Twenty-five participants—15 in the treatment group and 10 in the wait-list control group— completed treatment. Repeated measures ANOVA procedures were used to compare the groups on panic and asthma outcomes at posttreatment and 6-month follow-up. The results demonstrate that the CBT-AE program is capable of producing substantial and durable antipanic and antianxiety treatment effects and led to substantial but nonsustained improvement in morning peak-flow expiratory rate and asthma-related quality of life. Implications of these findings for this clinical population are addressed.

Screening and Assessing Adolescent Asthmatics for Anxiety Disorders

The purpose of this study was to evaluate a strategy designed to permit early detection of anxiety disorders in adolescent asthmatics. Adolescents with asthma (N = 53) were screened for anxiety disorders using the Trait subscale of the State-Trait Anxiety Inventory for Children [STAI-C (Trait)] and the Multidimensional Anxiety Scale for Children (MASC). Adolescents and their parents were individually evaluated by a nurse trained in the administration of the Anxiety Disorders Interview Schedule-IV: Parent and Child Versions (ADIS-IV: P&C). Of the participants, 21 (40%) met the diagnostic criteria for one or more anxiety disorders. The STAI-C (Trait) was more effective than the MASC in screening adolescents for risk of coexisting anxiety disorders. Nurses trained to administer the ADIS-IV: P&C diagnosed anxiety disorders with a high degree of accuracy. These results have important implications for resolving the problem of unrecognized and untreated anxiety disorders in the adolescent asthmatic population.

Instructor comfort level in high-fidelity simulation.

BACKGROUND The literature in the use of simulation in nursing education has expanded significantly over the past 5-10 years. What it is like as an instructor who facilitates this experience is largely unexplored. This paper is part of a larger ethnographic study, and represents findings related to the comfort level of instructors facilitating in high-fidelity simulation (HFS). OBJECTIVES The question of what is it like to engage in simulated clinical experiences as an instructor is presented in this paper. DESIGN AND PARTICIPANTS Twenty instructors participated in two separate focus groups and two instructors participated in individual interviews. The average years of nursing experience for this group was over 20 years, whereas the number of years of experience as a clinical instructor was less than five years. METHODS Ethical approval was obtained from two academic institutions. A focused ethnography was conducted and included two terms of participant observations, recorded field notes, individual interviews and focus groups. Data was coded and then sorted for themes related to the instructor experience. RESULTS The primary results focus on the comfort level of instructors in HFS, and what instructors believe this meant to student learning in HFS. CONCLUSIONS What the instructor does during HFS and how they feel about their ability to facilitate HFS has a perceived effect on student learning.

Perceptions About Self-Management Among People with Severe Asthma

Aim. The purpose of this study was to explore the perceptions about self-management among people who were being followed up in a severe asthma clinic by asthma specialists for confirmed, overall severe asthma. Such insight informs how best to tailor programs for this difficult to treat patient population. Method. In-depth tape-recorded interviews of eight adults with severe asthma were transcribed and analyzed for salient themes using content analysis. Results. To self-manage their illness, over time participants sought asthma information from a variety of sources that they often viewed as inadequate due to lack of scope and or plain language. The most valued sources of asthma information were encountered after referral to an asthma specialist and were health professionals and a pulmonary rehabilitation program. Conclusion. There is a need to examine the content of asthma information sources for their relevance to and influence on the behavior of patients with severe asthma.

A Case Study of Comorbidities Vocal Cord Dysfunction, Asthma, and Panic Disorder

The purpose of this case study was to describe the nature of the symptom episodes experienced by a 24-year-old woman diagnosed with VCD, asthma, and panic disorder.A multiple card sort procedure was used to identify the type, order of presentation, and severity of symptoms experienced by the participant during her typical symptom episodes. Seven types of symptom episodes were investigated including VCD, asthma, and panic episodes; and co-occurring or combined episodes of VCD and asthma; VCD and panic; asthma and panic; and VCD, asthma, and panic. The variability and complexity of the participant’s symptom episodes, which are described, led to the development of a new VCD/asthma/panic comorbidities symptom classification system.

Perspectives of aging among persons living with chronic obstructive pulmonary disease.

Among pulmonary rehabilitation attendees, we explored their tendency to downplay versus acknowledge physical and psychosocial health limitations, and the subsequent impact either strategy had on how they perceive their own aging process. Participants (N = 87) were 44 to 82 years of age, and diagnosed with chronic obstructive pulmonary disease (COPD). The St. George’s Respiratory Questionnaire measured their health limitations. The Attitudes to Aging Questionnaire captured their perspectives of aging. Participants downplayed their symptoms and psychosocial impact, and remained most positive about psychosocial loss and carefully reserved about psychological growth. Acknowledged activity impairment had negative consequences, however, for their perspectives of physical change. These findings signify a balanced identity and perspective of aging that supports the Identity Process Theory. We encourage nurses and other practitioners, and researchers in pulmonary rehabilitation setting, to use this theory to better understand how people with COPD adapt to aging.

Anticipating the outcomes and care choices for people living with COPD.

241 PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org In this issue of the PCRJ are reports of two qualitative studies from the UK investigating aspects of organisation of care for COPD. Cleland et al. in Aberdeen, Scotland investigated stakeholder views of a community-based anticipatory care service (CBACS) for COPD, and Seamark et al. in East Devon investigated the opportunity for advance care planning (ACP) in COPD. While ACP for people with advanced COPD is widely understood both in the UK and in other developed countries as addressing patients’ holistic needs including psychological, social and financial needs, an anticipatory care service in COPD is less well defined. Cleland et al. describe the role of a CBACS as not only responding to symptoms but also addressing health promotion to prevent exacerbations. The aim of such a service is therefore to deliver better outcomes for people living with COPD and to reduce hospital admissions, emergency department attendance, and urgent general practitioner (GP) visits. Seamark et al. address the narrower (often neglected) aspect of ACP, which requires patient understanding about prognosis and options for end-of-life care. Qualitative research methods are ideally suited for exploring people’s perceptions and attitudes using strategies such as focus groups and/or in-depth interviews – as was the case in these two studies. In the Seamark study, the qualitative approach is used to understand patient views about when and who should introduce the topic of advance care planning, and in the Cleland study it is used to examine the attitudes of a range of stakeholders – patients, carers and healthcare providers currently delivering COPD care – to a potential new service. The results of qualitative research, although limited in generalisability, can be a powerful tool for sensitising policymakers and practitioners to the perceptions of health service users and healthcare professionals. In turn, this disclosure can be the impetus for changes in healthcare delivery and health professional education which are needed to provide more cost effective care for chronic diseases such as COPD. Although a CBACS for COPD with the potential to reduce hospitalisation was broadly acceptable to stakeholders, key benefits identified were patient education, patient-centred care and patient empowerment. This fits with a shift in focus by policy makers in the community healthcare sector to implement models of care that are ‘person-centred’, ‘goal-oriented’ and enabling. A ‘person-centred’ approach to care encourages working with clients and/or their carers to achieve greater independence and wellbeing and the maintenance of independence for as long as possible, provided management can be done in a safe and effective way. Cleland et al. did not directly address the fact that these objectives are also those of existing health care providers who care for COPD patients in general practice and in outreach services for COPD such as assisted-discharge service and hospital in the home. The findings did suggest that a CBACS could engage directly with existing services, but necessary linkages were not clearly defined. There was no consensus on the professional groups that would contribute to any new service, and resources for such a new service were recognised as limited. Stakeholders working in primary care and community nursing made it clear that they had no capacity to assume additional clinical, managerial or organisational responsibilities, although there were concerns for GPs if other healthcare professionals assumed leadership in a CBACS. Increasingly it is recognised that improved competencies for inter-professional collaboration can increase the consistency, continuity, and cost effectiveness of care. In Canada, the UK, New Zealand and the USA, policy makers are calling for changes in health professional education to improve collaborative practice. Findings from the study by Seamark et al. confirm both the need for, and the well-documented difficulty implementing, ACP for patients with COPD. No patients could recall discussion in hospital about issues of resuscitation, the possibility of being ventilated, or planning for future exacerbations. The lack of follow-up instructions at the point of hospital discharge is a critical gap in transition of care recently reported in an 11-country survey. The logistic barriers to ACP inherent in the chaotic nature of hospital admission are understandable and probably not amenable to change. Patients’ preference for their GP as someone they knew and with whom they could engage in ACP discussions in a non-hospital setting is supported by other studies. However, this may be problematic, since GPs are already seen as being poorly placed with respect to both time and resources in order to deliver asthma or COPD education. Anticipating the outcomes and care choices for people living with COPD