The topic of comparing high-flow nasal cannula to BiPAP in COPD patients is both timely and relevant, considering the rising prevalence of COPD exacerbations and the need for effective interventions to improve patient comfort and outcomes

QUESTION

Please assist with providing a thought-provoking response to the following reply. Contributions are evaluated on presentation of a meaningful ‘informed opinion,’ i.e., synthesis of your preparation on the topic, interaction with peers and faculty, and ongoing learning. Useful posts may include and are not limited to: Posting your ‘take’ on the issue, this is informed by your preparation, not a ‘gut reaction.’ Asking critical thinking questions, offering alternate interpretations and additional insights, Contributing to the learning of the group.

PICO: With COPD patients, does high flow nasal cannula vs NIV provide a more comfortable return to baseline within the patient’s hospital stay?

1. Consider your PICO question: what would be your theoretical framework and/or model and the type of study you will conduct (quality improvement or evidence-based practice) related to it? Explain.

The nursing theoretical framework that will be used for this project is the theory of comfort by Katharine Kolbaca. An article written by Ali (2022) goes into detail about the comfort theory and explains that when comfort is met the patient will feel relief. The study that will be conducted for this project will be evidence-based practice. The evidence gathered in the project could be used in practice to better patient care. The evidence-based practice would prove that patient comfort is important to help patient anxiety and mental health.

1. Determine how you will collect your data and what type of research design will best meet your needs (quantitative, qualitative, or mixed methods).

The best data collection for this research would be mixed method. The quantitative data gathered would involve arterial blood gases, heart rate, and blood pressure. The arterial blood gases would be drawn upon arrival to the emergency room, and two hours after the patient is placed on either high-flow nasal cannula or BiPAP another arterial blood gas will be drawn. This would determine the oxygenation and gas exchange differences of each intervention. Heart rate and blood pressures can be measured throughout the patient’s stay at least every hour to determine if there is any difference in high-flow or BiPAP patients. A higher heart rate and blood pressure could mean the patient is anxious or not tolerating the given intervention. The qualitative side of this project would involve interviewing the patients to see how comfortable they are with their intervention, either BiPAP or high-flow nasal cannula. A questionnaire could be used for this “interviewing” portion of the study. There are many different comfort questionnaires available including open ended questions, close ended questions, structured and unstructured. Melo et al. (2017) states that the General Comfort Questionnaire (GCQ) is used to measure comfort regardless of patient health conditions. This type of questionnaire could be used for this project.

1. Discuss your project idea and the population and setting in which the capstone may/will take place.

The idea for this project would be to compare high-flow nasal cannula verus BiPAP in COPD patients. The population would be COPD exacerbation patients. The setting would be in the hospital with inpatients. Patients with COPD exacerbations have most likely been in the hospital before and have used a hospital BiPAP which can be uncomfortable for many patients. High-flow nasal cannula is an option to help make a patient more comfortable while also providing some relief from shortness of breath they may be feeling. There has not been much research done on high-flow nasal cannula for COPD patients, so this is a fairly new topic of interest among doctors and nurses.

1. What principles of ethics may be particular to your study?

According to Melnyk & Fineout-Overholt (2023) the four principles of ethics are beneficence, nonmaleficence, autonomy, and justice. Fidelity is the fifth principle (Melnyk & Fineout-Overholt, 2023). Nonmaleficence will be important for this study to be sure that no harm is done to the patient. If the patient is not handling high-flow nasal cannula well then, they will need to switch to BiPAP or intubated as to not cause them any harm. Autonomy could be another one of the principles particular to this study because if a patient decides that they do not want to participate in any part of the study then they have that right. For example, if a patient wants to change code status to do not resuscitate, then they have every right to do so per their wishes. Lastly fidelity is described as forming trust and honesty with the patients (Melnyk & Fineout-Overholt, 2023). Talking to the patient and getting to know them better and what makes them comfortable is a great way to form trust with the patient and family.

References

ASHIQ ALI, A. (2022). Comparison of Two Nursing Theories Orem’s Theory of Self-Care Deficit & Kolcaba’s Comfort Theory. Journal on Nursing, 12(2),

34-40. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.26634/jnur.12.2.18958Links to an external site.

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Melo, G. A. A., Silva, R. A., Pereira, F. G. F., & Caetano, J. Á. (2017). Cultural adaptation and reliability of the General Comfort Questionnaire for chronic

renal patients in Brazil. Revista latino-americana de enfermagem, 25(2963), 1-9. https://doi.org/10.1590/1518-8345.2280.2963

ANSWER

The topic of comparing high-flow nasal cannula to BiPAP in COPD patients is both timely and relevant, considering the rising prevalence of COPD exacerbations and the need for effective interventions to improve patient comfort and outcomes. The theoretical framework of comfort theory by Katharine Kolcaba is a suitable choice for this study, as it aligns well with the project’s focus on patient comfort and relief from respiratory distress.

In terms of data collection, the mixed-method approach is appropriate as it allows for a comprehensive understanding of both quantitative physiological measures and qualitative patient experiences. Gathering arterial blood gases, heart rate, and blood pressure will provide objective evidence on the effectiveness of each intervention in improving oxygenation and gas exchange. On the other hand, patient interviews and comfort questionnaires will give valuable insights into their perceptions of comfort, anxiety levels, and overall satisfaction with the interventions.

The proposed population of COPD exacerbation patients is well-suited for this study as they are commonly encountered in hospital settings, and their comfort and well-being are of utmost importance. Conducting the study in the hospital with inpatients will provide a controlled and standardized environment to assess the impact of the interventions accurately.

Regarding ethical principles, nonmaleficence and autonomy are particularly relevant in this study. Ensuring no harm is done to the patients is paramount, and if any patient experiences discomfort or intolerance with high-flow nasal cannula, a prompt switch to BiPAP or appropriate intervention must be implemented. Respecting patient autonomy is also vital, and patients should have the right to refuse participation in any part of the study without any consequences to their care.

The findings of this research have the potential to significantly impact clinical practice and enhance patient care. Identifying the most effective intervention for COPD exacerbation patients can improve their comfort, reduce anxiety levels, and enhance overall patient outcomes. Moreover, building trust and forming meaningful connections with patients through interviews and interactions are essential for fostering patient-centered care and promoting patient satisfaction.

In conclusion, this study focusing on the comparison of high-flow nasal cannula and BiPAP in COPD patients aligns well with the theoretical framework of comfort theory. The mixed-method approach, combining quantitative data with patient experiences, will provide a comprehensive understanding of the interventions’ impact on patient comfort and respiratory outcomes. Ethical considerations of nonmaleficence and autonomy are crucial in ensuring patient safety and respecting patient choices. The results of this study have the potential to influence evidence-based practice and improve the quality of care for COPD exacerbation patients, promoting comfort and well-being during their hospital stay.