Journal of Korean Academy of Fundamentals of Nursing (기본간호학회지)

Korean Academy of Fundamentals of Nursing (기본간호학회)
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An Explanatory Model of Dyspnea in Patients with Chronic Lung Disease

만성폐질환 환자의 호흡곤란 설명모형

  • Bang, So-Youn (Department of Nursing Science, Youngdong University)
  • Received : 2009.12.28
  • Accepted : 2010.02.08
  • Published : 2010.02.28
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Abstract

Purpose: The purpose of this study was to develop and test an explanatory model of dyspnea in patients with chronic lung disease (CLD). Methods: Participants were 181 patients with CLD, recruited from the outpatient pulmonary clinic of one university hospital in Korea. Data were collected using questionnaires, as well as measurement of 6-minute walking distance (6MWD), oxygen saturation ($SpO_2$), FEV1% predicted, and Body Mass Index (BMI). Results: The results indicated a good fit between the proposed dyspnea model and the collected data [$x^2$=91.27, p= .13, $x^2$/d.f.=1.17, Normal Fit Index= .934]. Oxygenation ($SpO_2$, = -.530), self-efficacy (= -.429), anxiety (= .253), depression (= .224), exercise endurance (6MWD, = -.211), and pulmonary function (FEV1% predicted, = -.178) had a direct effect on dyspnea (all p< .05) and these variables explained 74% of variance in dyspnea. BMI, smoking history, and social support had an indirect effect on dyspnea. Conclusion: The findings of this study suggest that comprehensive nursing interventions should focus on recovery of respiratory health and improvement of emotions, exercise ability, and nutritional status. From this perspective, pulmonary rehabilitation would be an effective strategy for managing dyspnea in patients with CLD.

Keywords

References

  1. Alvisi, V., Mirkovic, T., Nesme, P., Guerin, C., & Milic-Emili, J. (2003). Acute effects of hyperoxia on dyspnea in hypoxemia patients with chronic airway obstruction at rest. Chest, 123(4), 1038-1046. https://doi.org/10.1378/chest.123.4.1038
  2. American Thoracic Society. (2002). ATS statement: guidelines for the six-minute walk test. American Journal of Respiratory & Critical Care Medicine, 166(1), 111-117. https://doi.org/10.1164/ajrccm.166.1.at1102
  3. Bang, S. Y. (2002). Aggravating factors and management strategies of dyspnea in chronic lung disease patients. Unpublished master's thesis, Yonsei University, Seoul.
  4. Belza, B., Steele, B. G., Hunziker, J., Lakshminaryan, S., Holt, L., & Buchner, D. M. (2001). Correlates of physical activity in chronic obstructive pulmonary disease. Nursing Research, 50(4), 195-202. https://doi.org/10.1097/00006199-200107000-00003
  5. Carrieri, V. K., Janson-Bjerklie, S., & Jacobs, S. (1984). The sensation of dyspnea: A review. Heart & Lung, 13(4), 436-447.
  6. Choi, H. J. (1985). Effects of Benson's tension relaxation therapy and biofeedback relaxation therapy on psychological stress of nursing college students. Unpublished master's thesis, Korea University, Seoul.
  7. Choi, J. K., & Back, D. M. (2003). Development of predicting formula of Korean pulmonary function. Seoul: Occupational Safety & Health Research Institute.
  8. Ding, L., Velicer, W. F., & Harlow, L. L. (1995). Effects of estimation methods, number of indicators per factor and improper solutions on structural equation modeling fit indices. Structure Equation Modeling, 2(2), 119-143. https://doi.org/10.1080/10705519509540000
  9. Gift, A. G. (1990). Dyspnea. Nursing Clinics of North America, 25(4), 955-965.
  10. Gift, A. G., Plaut, S. M., & Jocox, A. (1986). Psychologic and physiologic factors related to dyspnea in subjects with chronic obstructive pulmonary disease. Heart & Lung, 15(6), 595-601.
  11. Han, S. J. (2003). The effects of a pulmonary rehabilitation program for chronic obstructive pulmonary disease patients. Journal of Korean Academy of Nursing, 33(7), 1008-1017. https://doi.org/10.4040/jkan.2003.33.7.1008
  12. Kim, D. S., Kim, Y. S., Jung, K. S., Chang, J. H., Lim, C. M., Lee, J. H., et al. (2005). Prevalence of chronic obstructive pulmonary disease in Korea: a population-based spirometry survey. American Journal of Respiratory & Critical Care Medicine, 172(7), 842-847. https://doi.org/10.1164/rccm.200502-259OC
  13. Kim, S. J. (2002). Relationship of dynamic hyperinflation during exercise and resting lung volume status in the patients with chronic airflow limitation. Unpublished master's thesis, Ulsan University, Ulsan.
  14. Mahler, D. A., Weinberg, D. H., Wells, C. K., & Feinstein, A. R. (1984). The measurement of dyspnea: contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Chest, 85(6), 751-758. https://doi.org/10.1378/chest.85.6.751
  15. Martinez-Moragon, E., Perpina, M., Belloch, A., de Diego, A., & Martinez-Frances, M. (2003). Determinants of dyspnea in patients with different grades of stable asthma. Journal of Asthma, 40(4), 375-382. https://doi.org/10.1081/JAS-120018637
  16. McCarley, C. (1999). A model of chronic dyspnea. Image: Journal of Nursing Scholarship, 31(3), 231-236. https://doi.org/10.1111/j.1547-5069.1999.tb00486.x
  17. McCathie, H. C., Spence, S. H., & Tate, R. L. (2002). Adjustment to chronic obstructive pulmonary disease: the importance of psychological factors. European Respiratory Journal, 19(1), 47-53. https://doi.org/10.1183/09031936.02.00240702
  18. McCord, M., & Cronin-Stubbs, D. (1992). Operationalizing dyspnea: focus on measurement. Heart & Lung, 21(2), 167-179.
  19. McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). Manual for the profile of mood states. San Diego, CA: Educational and Industrial Testing Services.
  20. National Heart, Lung, and Blood institute. (1998, 2008). Global Initiative for Chronic Obstructive Lung Disease. US Department of Health and Human Services, Public Health Services, National Institutes of Health. Retrieved December 19, 2009, from http://www.goldcopd.com/GuidelinesResources. asp
  21. Nield, M. (2000). Dyspnea self-management in African Americans with chronic lung disease. Heart & Lung, 29(1), 50-55. https://doi.org/10.1016/S0147-9563(00)90037-2
  22. Oh, E. G., Kim, C. J., Lee, W. H., Kim, S. S., Kwon, B. E., Chang, Y. S., et al. (2002). Factors influencing functional status in people with chronic lung disease. Journal of Korean Academy of Nursing, 32(5), 643-653. https://doi.org/10.4040/jkan.2002.32.5.643
  23. Oh, H. S. (1993). Health promoting behaviors and quality of life of Korean women with arthritis. Journal of Korean Academy of Nursing, 23(4), 617-630.
  24. Oh, Y. M. (2005). Basic pulmonary function test. In Y. M. Oh, T. H. Kim, Y. S. Kim, T. B. Kim, H. L. Yoon, & S. H. Kim (Ed.), Symposium of standardization and quality management of chronic respiratory disease clinical research (pp. 1-5). Seoul: Chronic Respiratory Disease Clinical Research Center.
  25. Park, J. W. (1985). A study to development a scale of social support. Unpublished doctoral dissertation, Yonsei University, Seoul.
  26. Piecoro, L. T., Potoski, M., Talbert, J. C., & Doherty, D. E. (2001). Asthma prevalence, cost, and adherence with expert guidelines on the utilization of health care services and costs in state Medicaid population. Health Service Research, 36(2), 357-371.
  27. Salmon, G. F., Mosier, M. C., Beasley, B. W., & Calkins, D. R. (2003). Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials. Journal of General Internal Medicine, 18(3), 213-221. https://doi.org/10.1046/j.1525-1497.2003.20221.x
  28. Sherer, M., Maddux, J. E., Mercadante, B., Prentice-Dunn, S., Jacobs, B., & Rogers, R. W. (1982). The self-efficacy scale: construction and validation. Psychological Reports, 51, 663-671. https://doi.org/10.2466/pr0.1982.51.2.663
  29. Siela, D. (2003). Use of self-efficacy and dyspnea perceptions to predict functional performance in people with COPD. Rehabilitation Nursing, 28(6), 197-204. https://doi.org/10.1002/j.2048-7940.2003.tb02060.x
  30. Steele, B., & Shaver, J. (1992). The dyspnea experience: nociceptive properties and a model for research and practice. Advances in Nursing Science, 15(1), 64-76. https://doi.org/10.1097/00012272-199209000-00009
  31. Sunyer, J., Basagana, X., Roca, J., Urrutia, I., Jean, A., Anto, J. M., et al.; ECRHS study. (2004). Relations between respiratory symptoms and spirometric values in young adults: the European community respiratory health study. Respiratory Medicine, 98(10), 1025-1033. https://doi.org/10.1016/j.rmed.2004.01.013