Friday, January 23, 2015

Providing Spiritual Care According to Disease Process: COPD

Providing Spiritual Care According to Disease Process: COPD According to the COPD Foundation ( “Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. This disease is characterized by increasing breathlessness.” Drs. Barry D. Weiss and Ellyn Lee, College of Medicine, University of Arizona, inform us that chronic lung disease is the 4th most common cause of death among older adults in the United States. Each year, more than 140,000 older Americans die from direct complications of chronic lung disease, and another 70,000 (many of whom have chronic lung diseases) die from influenza and other lower respiratory tract infections. The vast majority of these individuals with chronic lung disease have chronic obstructive pulmonary disease (COPD). There are key qualifiers for the patient to be admitted to hospice care: Life limiting illness with a prognosis of less than 6 months; dependence in 3 of 6 ADL’s; Palliative Performance Scale <50-60%; >10% weight loss over the last 4-6 months; multiple hospitalizations or ER visits; decreased tolerance to physical activity; decreased cognitive ability; other comorbid conditions. Specific to the COPD diagnosis: Dyspnea at rest or with minimal exertion; continuous oxygen therapy; >10% weight loss in 4-6 months; recurrent pulmonary infections (bronchitis or pneumonia); cor pulmonale; FEV1 <30% post broncholdilator; P02<55 or O2 sat <88% (on room air); persistent resting tachycardia; and progressive decline in the ability to perform ADL’s independently. As one can see, when a COPD patient enters hospice care he or she is suffering severe complications due to the disease process. As a result, there are significant and compelling spiritual care concerns, such as, depression, sadness, anxiety, fear, mourning over loss of ability to thrive, and strained relationships with significant others. A Chaplain’s supportive presence coupled with attentive listening (when the patient is able to converse) will set the foundation for spiritual support. Sensitivity to the patient’s breathlessness is always called for. Time spent actively listening to the caregiver/family member will lessen his or her sense of frustration, anger, or other feelings toward the disease and/or the patient. Case Example Patient: 63 year old male who was a Veteran of the Marine Corps Diagnosis: COPD Presenting Spiritual Care Concerns: Anger, Self-chosen alienation from loved ones This patient was not interested in seeing the Chaplain. I came to find out later why that was so. His wife desired spiritual, however. She was worn out by the extensive support her husband required and the constant attention he demanded. His COPD was severe to the point he could not speak more than a sentence at a time. When I arrived at his home, I would simply stick my head in to his room (after confirming with his wife that that would be alright) and say Hello to him. He rarely responded in any way. The turning point in the pastoral care relationship came when I conducted a Veterans Pinning Ceremony. I presented him with a pin, a certificate, and a teddy bear. In following visits, I noticed that the teddy bear was attached to his wheelchair and was his constant companion. He told his wife he would like to speak with me. He told me that he was not interested in a Chaplain because he thought that meant he would be told off for being a bad person. I assured him that was not my purpose, but, instead, I would be supportive and encouraging. Our visits together were short, but positive. He had questions about forgiveness and his anxiety. We worked together on those issues. He died of pulmonary complications.

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