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Nursing Care of Dyspnea:The 6th Vital Sign in Individuals ...

March 2005. Nursing Best Practice Guideline Shaping the future of Nursing Nursing Care of Dyspnea:The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD). Greetings from Doris Grinspun Executive Director Registered Nurses' Association of Ontario It is with great excitement that the Registered Nurses' Association of Ontario (RNAO). disseminates this Nursing best practice guideline to you. Evidence-based practice supports the excellence in service that nurses are committed to deliver in our day-to-day practice. We offer our endless thanks to the many institutions and Individuals that are making RNAO's vision for Nursing Best Practice Guidelines (NBPGs) a reality. The Government of Ontario recognized RNAO's ability to lead this program and is providing multi-year funding. Tazim Virani NBPG program director with her fearless determination and skills, is moving the program forward faster and stronger than ever imagined.

Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) 4 Acknowledgement Stakeholders representing diverse perspectives were solicited for their feedback and the Registered Nurses’ Association of

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1 March 2005. Nursing Best Practice Guideline Shaping the future of Nursing Nursing Care of Dyspnea:The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD). Greetings from Doris Grinspun Executive Director Registered Nurses' Association of Ontario It is with great excitement that the Registered Nurses' Association of Ontario (RNAO). disseminates this Nursing best practice guideline to you. Evidence-based practice supports the excellence in service that nurses are committed to deliver in our day-to-day practice. We offer our endless thanks to the many institutions and Individuals that are making RNAO's vision for Nursing Best Practice Guidelines (NBPGs) a reality. The Government of Ontario recognized RNAO's ability to lead this program and is providing multi-year funding. Tazim Virani NBPG program director with her fearless determination and skills, is moving the program forward faster and stronger than ever imagined.

2 The Nursing community, with its commitment and passion for excellence in Nursing care, is providing the knowledge and countless hours essential to the creation and evaluation of each guideline. Employers have responded enthusiastically to the request for proposals (RFP), and are opening their organizations to pilot test the NBPGs. Now comes the true test in this phenomenal journey: Will nurses utilize the guidelines in their day-to-day practice? Successful uptake of these NBPGs requires a concerted effort of four groups: nurses themselves, other healthcare colleagues, nurse educators in academic and practice settings, and employers. After lodging these guidelines into their minds and hearts, knowledgeable and skillful nurses and Nursing students need healthy and supportive work environments to help bring these guidelines to life. We ask that you share this NBPG, and others, with members of the interdisciplinary team.

3 There is much to learn from one another. Together, we can ensure that Ontarians receive the best possible care every time they come in contact with us. Let's make them the real winners of this important effort! RNAO will continue to work hard at developing and evaluating future guidelines. We wish you the best for a successful implementation! Doris Grinspun, RN, MSN, PhD(cand), OOnt Executive Director Registered Nurses' Association of Ontario Nursing Best Practice Guideline How to Use this Document This Nursing best practice guideline is a comprehensive document providing resources necessary for the support of evidence-based Nursing practice. The document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a cookbook fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care.

4 Nurses, other healthcare professionals and administrators who are leading and facilitating practice changes will find this document valuable for the development of policies, procedures, protocols, educational programs, assessments and documentation tools. It is recommended that the Nursing best practice guidelines be used as a resource tool. Nurses providing direct client care will benefit from reviewing the recommendations, the evidence in support of the recommendations and the process that was used to develop the guidelines. However, it is highly recommended that practice settings/. environments adapt these guidelines in formats that would be user-friendly for daily use. This guideline has some suggested formats for such local adaptation and tailoring. Organizations wishing to use the guideline may decide to do so in a number of ways: Assess current Nursing and healthcare practices using the recommendations in the guideline.

5 Identify recommendations that will address identified needs or gaps in services. Systematically develop a plan to implement the recommendations using associated tools and resources. RNAO is interested in hearing how you have implemented this guideline. Please contact us to share your story. Implementation resources will be made available through the RNAO website at to assist Individuals and organizations to implement best practice guidelines. 1. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD). Development Panel Members Pat Hill Bailey, RN, PhD Meeran Manji, RN. Team Leader COPD Educator Professor Pulmonary Rehabilitation Program Laurentian University University Health Network . School of Nursing Toronto Western Hospital Sudbury, Ontario Toronto, Ontario Ann Bartlett, RN, BScN, CAE Christina McMillan, RN, BScN, MScN(c).

6 NARTC/Diploma in COPD Graduate Teaching Assistant COPD Educator Laurentian University Nurse Clinician School of Nursing Firestone Institute for Respiratory Health Sudbury, Ontario St. Joseph's Healthcare Hamilton, Ontario Ruth Pollock, RN, MScN. Professional Practice Leader Nursing Gail Beatty, RN, BNSc, MN, ACNP Cornwall Community Hospital Clinical Nurse Specialist/Nurse Practitioner Cornwall, Ontario COPD Ambulatory Program Kingston General Hospital Josephine Santos, RN, MN. Kingston, Ontario Facilitator, Program Coordinator Nursing Best Practice Guidelines Program Janice Bissonnette, RN, MScN, ACNP, Registered Nurses' Association of Ontario CAE, CNCC(C) Toronto, Ontario Clinical Nurse Specialist/Acute Care Nurse Practitioner ICU/Medicine Queensway-Carleton Hospital Ottawa, Ontario Bozena Dabrowski, RN. Staff Nurse Day Hospital Respiratory Rehabilitation West Park Healthcare Centre Toronto, Ontario Declarations of interest and confidentiality were made by all members of the guideline development panel.

7 Further details are available from the Registered Nurses' Association of Ontario. 2. Nursing Best Practice Guideline Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD). Program Team: Tazim Virani, RN, MScN, PhD(candidate). Program Director Josephine Santos, RN, MN. Program Coordinator Heather McConnell, RN, BScN, MA(Ed). Program Manager Stephanie Lappan-Gracon, RN, MN. Program Coordinator Best Practice Champions Network Jane M. Schouten, RN, BScN, MBA. ProgramCoordinator Bonnie Russell, BJ. Program Assistant Carrie Scott Administrative Assistant Julie Burris Administrative Assistant Keith Powell, BA, AIT. Web Editor Registered Nurses' Association of Ontario Nursing Best Practice Guidelines Program 111 Richmond Street West, Suite 1100. Toronto, Ontario M5H 2G4. Website: 3. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD).

8 Acknowledgement Stakeholders representing diverse perspectives were solicited for their feedback and the Registered Nurses' Association of Ontario wishes to acknowledge the following for their contribution in reviewing this Nursing Best Practice Guideline. Qasim Alikhan, MD, FRCP(C) Respirologist, Sleep Medicine, Intensive Care, Queensway-Carleton Hospital, Ottawa, Ontario William Laurence Beeton Consumer Reviewer, Toronto, Ontario Ren e Berquist, RN, BScN Nurse Manager, Queensway-Carleton Hospital, Ottawa, Ontario Barbara Cassel, RN, BScN, MN, GNC(C) Advanced Practice Nurse, West Park Healthcare Centre, Toronto, Ontario Julie Duff Cloutier, RN, BScN, MSc, CAE Assistant Professor, Laurentian University, School of Nursing , Sudbury, Ontario Wendy Earle, RN, MScN(c), CCN(C) Clinical Nurse Specialist, Roadmap Project Queen's University, Kingston General Hospital, Hotel Dieu Hospital, Kingston, Ontario Catherine Evers, RN Staff Nurse, Medicine, Queensway-Carleton Hospital, Ottawa, Ontario Ginette Ferguson, BScN, RN(EC)

9 Cornwall Community Hospital, Cornwall, Ontario Janet Fraser, BSc, RRT/RRCP Staff Respiratory Therapist, Respiratory Rehabilitation and Home Ventilator Training Programs, West Park Healthcare Centre, Toronto, Ontario Cynthia Giff, RN Nursing Director Medical/Surgical Units, Brockville General Hospital, Brockville, Ontario Dianne Husbands, BA, RN, BScN, MN(c) Educator, Chest Program, St. Joseph's Healthcare, Hamilton, Ontario Khiroon Kay Khan, RN, CAE, Clinical Nurse Educator, Asthma and Airway Centre, University Health NARTC Diploma & Instructor in Network Toronto Western Hospital, Toronto, Ontario Asthma and COPD. Colleen Kenney, RN, BScN, CRRN Respiratory Nurse Clinician, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario Mary Layton, BA Consumer Reviewer, Toronto, Ontario Carole LeBlanc, RRT COPD Educator, Professional Practice Leader, The Rehabilitation Centre, Ottawa, Ontario Ljubica Lesage, RN Staff Nurse, Respiratory Rehabilitation, West Park Healthcare Centre, Toronto, Ontario Lisa Lynch, RN Team Leader, Surgery, Queensway-Carleton Hospital, Ottawa, Ontario Tanya MacDonald, RPT, BScPT Physiotherapist, St.

10 Joseph's Healthcare, Hamilton, Ontario Duncan McMillan, MD, CM Family Practitioner, Private Practice, Sudbury, Ontario 4. Nursing Best Practice Guideline Marilyn Morris, RCPT(P) Registered Pulmonary Technologist, Clinical Trial Coordinator, Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario Mika Laura Nonoyama, RRT/RRCP, PhD(c) Registered Respiratory Therapist, Research Coordinator, West Park Healthcare Centre, Toronto, Ontario Carolyn Ross, MN, PhD Associate Professor, Faculty of Nursing , University of Alberta, Edmonton, Alberta Martin Rowland, BPharm, MSc, BCPS Pharmacist, Queensway-Carleton Hospital, Ottawa, Ontario Lorelei Samis, BScPT Physiotherapist, PCCC St. Mary's of the Lake Hospital Site, Kingston, Ontario Pat Steele, RN, BN, RCPT(P), CAE Chest Clinic Nurse Technologist, Cape Breton Healthcare Complex, Sydney, Nova Scotia Donna Tucker, RN, MScN Project Director, Healthy Workplace Environment Best Practice Guideline Project, Registered Nurses' Association of Ontario, Toronto, Ontario 5.


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