D1.3 GP practice nurse/ nurse practitioner/ respiratory educator/ respiratory nurse

Nurses play an integral role in the assessment and delivery of education and management for people living with COPD. The training, expert knowledge and skills of respiratory nurses allow them to undertake multidimensional assessments and to work with patients to tailor specific therapeutic interventions and to co-ordinate the delivery of person centred care (McDonald 2018).

Specific aspects of COPD care provided by nurses may include:

  • respiratory assessment, including spirometry and pulse ;
  • assessment of comorbidity and delivery of interventions for comorbid disease, for example cognitive behavioural therapy for anxiety, and education for diabetes and heart failure;
  • evaluation of risk factors and the provision of evidence-based interventions, such as smoking cessation techniques and education to promote physical activity, good nutrition and appropriate vaccination;
  • symptom assessment and management in the context of the community, primary and tertiary care settings and pulmonary rehabilitation;
  • implementation of, or referral for interventions such as exercise training, pulmonary rehabilitation, airway clearance techniques and oxygen therapy;
  • skills training with inhalation devices;
  • assessment of adherence and implementation of interventions to improve adherence;
  • patient education and skill development regarding the importance of exacerbation avoidance, recognition and treatment;
  • education to promote better self-management;
  • organisation of multidisciplinary case conferences and participation in care-plan development;
  • assessment of the home environment;
  • end of life planning;
  • respiratory nurses also deliver specialised assessments and treatments such as, oxygen assessment and the provision of NIV.

Nurse led self management programs have led to improved outcomes for people with COPD. Patients discharged from a Hong Kong hospital after a COPD exacerbation were randomised to an intervention group (IG) or usual care group (UG). The IG received a comprehensive, individualised care plan which included education from a respiratory nurse, physiotherapist support for pulmonary rehabilitation, three-monthly telephone calls by a respiratory nurse over one year, and follow-up at a respiratory clinic with a respiratory specialist once every three months for one year. The UG was managed according to standard practice. At 12 months, the adjusted relative risk of readmission was 0.668 (95% CI 0.449 to 0.995, p=0.047) for the IG compared with the UG. At 12 months, the IG had a shorter length of stay (4.59±7.16 versus. 8.86±10.24 days, p≤0.001), greater improvement in mean Modified Medical Research Council Dyspnoea Scale (-0.1±0.6 versus. 0.2±0.6, p=0.003) and St George’s Respiratory Questionnaire (SGRQ) score (-6.9±15.3 versus. -0.1±13.8, p=0.003) compared with the UG (Ko 2017). Another nurse led RCT of an intensive self management intervention resulted in a reduction in hospitalizations (at 12 months) and in emergency department visits at 6 and 12 months. Additionally, exercise capacity improved as measured by the 6MWD, as did health related quality of life (Wang 2020). See self management section.