COPD Program - Group Session # 2 Facilitator documents. May 2013

Transcription

1 COPD Program - Group Session # 2 Facilitator documents May 2013

2 Introduction to the facilitator documents This document supports the facilitator with respect to the contents of the Group Session 2 of the COPD program When pertinent, a group education is preceded by a slide called «Facilitator notes», that can be identified by a title in yellow fonts All the supporting documents (identified in red fonts) can be downloaded from the website (password: copd) or from the RQAM website

3 Follow-up on last session

4 Session agenda 1. Management of Stress and Anxiety Stress and stressors The anxiety-breathlessness cycle Strategies 2. Aggravating factors and strategies to avoid them 3. Action plan I feel worse 4. Action plan I feel I am in danger

5 Management of Stress and Anxiety - STRESS AND STRESSORS - ANXIETY- BREATHLESSNESS CYCLE - STRATEGIES

6 Facilitator notes (Stress and stressors) 1. Explore the experiences of stress in the participants lives. Ask about the impact of COPD diagnosis on their life. Write on the board the examples of stressful situations provided by the participants. Notes to the facilitator: Try to involve all the participants in the discussion. Give personal examples to facilitate and encourage discussion. Normalize participants experiences. Underline individual differences and help the group to understand the variety of situations that may cause stress.

7 Stress and stressors Stressors are events or situations in everyday life that require change Stress refers to the physical and psychological reactions that a person experiences when faced with stressors Question: What type of situations cause you stress?

8 Stress and stressors Personal: Personal illness/handicap Change in financial status Work, daily activities and environment: Change in ability to perform activities of daily living Loss of job, disability leave, retirement Family and social network: Separation/divorce Illness or death of a relative Conflicts with family members or friends

9 Facilitator notes (Stress reactions) 1. Present to the participants the definitions of fear, anxiety and panic attack. Fear is a normal reaction to a present danger. Anxiety is a reaction that involves constantly worrying and anticipating stressful situations. Panic attack is an exaggerated, irrational and often sudden fear or anxiety reaction 2. Present the following two fictitious situations to the participants and ask questions in order to clarify the definitions of Fear and anxiety. Example of fear : A man suffering from COPD suddenly becomes seriously ill and he is unable to breathe, he calls an ambulance to get to the hospital as soon as possible. Example of anxiety : A woman suffering from COPD has had a very severe episode of shortness of breath during an outing to the park. She starts to avoid all outings.

10 Stress reactions Fear Anxiety Panic attack Question: Describe your reactions when you must face stressful situations

11 Facilitator notes (Understanding your anxiety reaction) 1. Invite the participants to talk about stressful situations that they have experienced and their impact in terms of thoughts, physical reactions and behaviours Notes: The facilitator can suggest that participants take a few moments to relax and identify the daily life situations that causes anxiety

12 Understanding your anxiety reaction What is the most important stressful situation that you are dealing with these days? Are you anxious about this situation? Do you have negative thoughts about this situation? How does your body react when you are anxious? What do you do when you are anxious (behaviours)? Can you think of other actions that would help you cope with this situation in the future?

13 Facilitator notes (The anxiety-breathlessness cycle) Use the poster of the Anxiety-Breathlessness cycle 1. Explain the anxiety-breathlessness cycle in COPD. Focus on the role of anxiety in this vicious cycle. Suggested script for the facilitator: The main symptom of COPD is shortness of breath. Shortness of breath can cause anxiety and even panic attacks. Anxiety makes you breathe faster, which increases your shortness of breath and as a result, you become more anxious. Many COPD sufferers choose to stop doing activities because of their fear of dying from breathlessness. The less you do, the less you are in shape. You will experience more fatigue, shortness of breath and anxiety. This is the Anxiety-Breathlessness cycle

14 The anxiety-breathlessness cycle

15 Facilitator notes (Strategies to break the cycle) 1. Present to the participants some strategies to break the Anxietybreathlessness cycle 2. Invite participants to discuss about the strategies they already use and explore with them other possible strategies. Write on the board Notes: Provide positive feedback to the answers given by the participants; remark those suggestions supporting the compliance with the strategies suggested in the education program

16 Strategies to break the cycle Recognize and understand your anxiety Maintain a positive attitude Plan your actions in advance Try to solve one problem at a time Let yourself make mistakes

17 Strategies to break the cycle Do things you enjoy Use humour Learn to relax If you feel uneasy, ask questions and find answers

18 Facilitator notes (Relaxation) 1. Present the benefits of relaxation 2. Demonstrate the diaphragmatic breathing technique 3. Let the participants practice Notes: Depending on the time allowed for this education session, you could use other relaxation techniques (hot bath, reading, music, etc.)

19 Relaxation Goal: Relax your body and quiet your mind. Benefits: Allows you to be in better control of your emotions Slows your breathing and reduces muscular tension

20 Deep breathing (diaphragmatic breathing) Invite the participants to experiment the deep breathing technique Ask them to close their eyes and think about a quiet place or the word calm, in order to feel more relax. Explain that if they start feeling dizzy during the process, they should take a few normal breaths before starting again.

21 Deep breathing (diaphragmatic breathing) 1. Put one hand on your abdomen. 2. Breathe in deeply. 3. Feel your abdomen inflate. Push your abdomen out as much as possible when you are inhaling. This will help your lungs fill up with air. 4. Exhale through your mouth while keeping your lips pursed (as if you were about to whistle). 5. Feel your abdomen returning to its normal position. 6. Wait after each exhalation until you are ready to take another deep breath. 7. After a few times, you will find your own rhythm. For example: one deep breath for 5 normal breaths.

22 Aggravating factors - STRATEGIES TO AVOID THEM

23 Facilitator notes (Factors that can make COPD symptoms worse) 1. Invite each patient to name a risk factor to the development of a respiratory infection. Write on the board the factors mentioned, complete and correct as needed SUGGESTED QUESTION: What can put you at risk to develop a respiratory infection? Answers expected from the participants: Being in contact with a person that suffers from a respiratory infection: bronchitis, flu, cold Not taking good care of his own person bad habits: lack of sleep, do not eat good food, etc. Not washing hands Cigarette smoke (it paralyses the action of the cilia) Stress Lack of proper ventilation Using a humidifier without giving it the proper maintenance

24 Factors that can make COPD symptoms worse Most common factors:

25 Factors that can make COPD symptoms worse Most common factors:

26 Facilitator notes (Suggestions to reduce or avoid exposure to those factors) 1. Invite patients to discuss the strategies to avoid or reduce the exposure to aggravating factors: inside the house, outside the house, temperature related. 2. Using a board, write each one of the strategies mentioned. Complete as needed. 3. Discuss with the participants about the integration of these strategies into their daily lives Suggested question: What can you do to avoid or reduce your exposure to aggravating factors? What methods have you used to implement these strategies into your daily life?

27 Suggestions to reduce or avoid exposure to those factors Indoor and Outdoor Pollutants Quit smoking and avoid second-hand smoke. Avoid strong odours. Avoid smog. Avoid exhaust and gas fumes. Emotions If you are stressed and anxious, talk to your friends and family about your feelings. Practice breathing and relaxation techniques.

28 Suggestions to reduce or avoid exposure to those factors Changes in Temperature: A) When it is cold, dress warmly and cover your nose with a scarf B) When it is hot: Stay in an air-conditioned environment Drink plenty of water (if there are no medical restrictions) Avoid strenuous activities Wear light clothing, preferably in light colours, and a hat

29 Suggestions to reduce or avoid exposure to those factors Respiratory Infections Avoid people who have a respiratory infection such as a cold or the flu. Wash your hands if you are in contact with them. You and the people you are living with should get a flu shot every fall. Ask your resource person or doctor about a pneumonia vaccine.

30 The action plan - SIGNS AND SYMPTOMS OF A RESPIRATORY INFECTION - I FEEL WORSE - I FEEL I AM IN DANGER

31 Facilitator notes (Signs and symptoms) 1. Invite each participant to describe the symptoms of a respiratory infection 2. Write on the board all the symptoms described; differentiate the symptoms specific to a respiratory infection from the other symptoms related 3. Make sure that they recognize the difference between their baseline symptoms and symptoms of an exacerbation due to a respiratory infection Suggested Question: What are the symptoms of a respiratory infection?

32 Facilitator notes (Signs and symptoms) 1. Invite patients to describe the strategies that they use to prevent a respiratory infection. Write the mentioned strategies on the board, complete and correct as needed 2. Emphasize on the importance of prevention by avoiding as much as possible or reducing the exposure to the risk factors for a respiratory infection Notes: Exacerbations should be prevented in order to avoid related complications (e.g. hospitalisations), consequent deterioration of symptoms (e.g. not coming back to baseline after exacerbation is treated) and disease progression

33 Signs and symptoms of a respiratory infection

34 Facilitator notes (I feel worse) 1. Introduce the section I Feel Worse of the written action plan 2. Present the sub-section My symptoms 3. Review with the participants the specific respiratory symptoms that can be aggravated by a respiratory infection Suggested script for the facilitator: When you are feeling worse, your action plan helps you identify an aggravation of symptoms and take the necessary actions to manage it

35 I feel worse

36 Facilitator notes (I feel worse) Identify with participants the strategies that they already use to manage a respiratory infection 1. Review with participants the actions to be taken once they have recognized the presence of an aggravation of symptoms (exacerbation) due to a respiratory infection 2. Complete the list of actions mentioned by the participants Discuss with them the expected effects of these actions Suggested questions: What are the actions that you usually take to manage a respiratory infection? Do you take additional medication to treat a respiratory infection?

37 I feel worse

38 I feel worse

39 Facilitator notes (I feel worse) 1. Introduce the sub-section My additional treatment of the written action plan 2. Explain to the participants the decision process to initiate the additional treatment (Customized Prescription) based on symptoms presentation Suggested script for the facilitator: You have to look at the changes in your symptoms in order to decide if you need to start the additional treatment included in your action plan: Observe the changes in your sputum colour, volume and consistency (not only in the morning). If the colour becomes yellow or green you probably have a bacterial infection and you need to start the ANTIBIOTIC prescribed by your doctor. Do not wait more than 48 hours to start your antibiotic. It is possible that the usual colour of your sputum be slightly yellowish or greenish. You must then evaluate the change of the colour tone (e.g. colour that changes from slightly yellowish to dark yellow). For any other changes in your sputum (volume, consistency) discuss with your physician the need for antibiotics.

40 I feel worse

41 Facilitator notes (I feel worse) 1. Introduce the sub-section My additional treatment of the written action plan 2. Explain to the participants the decision process to initiate the additional treatment (Customized Prescription) based on symptoms presentation Suggested script for the facilitator: Look at your shortness of breath If you have more shortness of breath than usual, you should first try to increase your RELIEVER (BRONCHODILATOR) as prescribed by your doctor If after increasing your reliever (bronchodilator) your shortness of breath does not improve and you have difficulty performing your usual activities, you need to start the PREDNISONE treatment prescribed by your doctor. Do not wait more than 48 hours to start your prednisone.

42 I feel worse

43 Facilitator notes (I feel much worse) 1. Introduce the section I Feel Much Worse of the written action plan 2. Identify with the participants the strategies that they already use when their symptoms get worse or do not improve despite taking the additional treatment. 3. Review with participants the actions to be taken once they have recognized that their symptoms further deteriorate or do not improve despite taking the additional treatment. 4. Complete the list of actions mentioned by the participants. 5. Discuss with them the expected effects of these actions. Suggested question: What do you do when your symptoms get worse or do not improve even after taking the additional actions?

44 I feel much worse

45 Facilitator notes (I feel I am in danger) Identify with the participants the symptoms that indicate that their life is in danger. Complete the list of symptoms mentioned by the participants. Review the actions to be taken in an emergency situation. Discuss with the participants the expected effects of these actions. Suggested question: What are the symptoms that can indicate that your life is in danger and that you need to get help immediately?

46 I feel I am in danger

47 Facilitator notes (Aggravation of respiratory symptoms following exposure to environmental factors) 1. Guide the participants to recognize an aggravation of symptoms (exacerbation) caused by the exposure to environmental factors 2. Identify with participants the strategies that they already use to manage this type of aggravation 3. Review with participants the actions to be taken once they have recognized the presence of an aggravation of symptoms due to environmental factors. Complete the list of actions mentioned by the participants. 4. Discuss with them the expected effects of these actions

48 Aggravation of respiratory symptoms caused by environmental factors Your Plan of Action in this situation 1. Immediately take your reliever (bronchodilator) as prescribed by your doctor 2. Prevent or reduce exposure to factors that worsen your symptoms 3. Use your breathing, relaxation and body positioning techniques If your symptoms worsen or do not improve, call your resource person or go to the hospital emergency department If you believe that your life is in danger, don t take a chance, call 911

49 Facilitator notes (Aggravation caused by stress) 1. Guide the participants to recognize an aggravation of symptoms (exacerbation) caused by stress/emotions 2. Identify with participants the strategies that they already use to manage an aggravation of symptoms caused by stress/emotions 3. Review with participants the actions to be taken once they have recognized the presence of an aggravation of symptoms (exacerbation) due to stress/emotions. Complete the list of actions mentioned by the participants. 4. Discuss with them the expected effects of these actions.

50 Aggravation of respiratory symptoms caused by stress or emotions Your Plan of Action in this situation 1. Use your breathing, relaxation, and body position techniques 2. If necessary, take your reliever (bronchodilator) as prescribed by your doctor If your symptoms worsen or do not improve, call your resource person or go to the hospital emergency department If you feel that your life is in danger, don t take a chance, call 911

51 Facilitator notes (Use of the Action Plan) 1. Stimulate the discussion by choosing questions that will allow to verify participants comprehension on the use of the Action Plan. Foster participants interaction 2. Discuss each action proposed by the participants and question them about the expected effects 3. Provide positive feedback to the answers given by the participants 4. Remark those suggestions supporting the compliance with the instructions given in the Action Plan

52 Use of the Action plan Which symptoms of a respiratory infection tell you that it should be treated? How? When? How do you know that your shortness of breath has worsened? Give some examples. When should you increase your reliever (bronchodilator)? When should you start your Prednisone? How do you know that your additional treatment did not work? What should you do if you do not see any improvement or if your symptoms get worse?

53 Facilitator notes (Learning contract) 1. In an interactive way, summarize the important points about the action plan 2. Reinforce the importance of using the written Action Plan of the program «Living Well with COPD»

54 Integration of an Action Plan on your life Identify your resources Identify your usual symptoms, your regular treatment and the life habits to keep healthy Prevent and manage exposure to environmental factors and stressful situations Learn to recognize and manage an aggravation of symptoms (exacerbation) - caused by a respiratory infection - in other situations

55 Facilitator notes (Conclusion) 1. Answer the questions of the participants. 2. In an interactive way, summarize the points to remember 3. Learning Contract: Ask the participants to review and practice at home each one of the different techniques (at least one technique each day). Ask participants to review their Action Plan and personalize it with their resource person 4. Evaluate the satisfaction of the participants

56 Questions?

57 Acknowledgements Mrs. Maria Sedeno, Living Well with COPD Mr. Michel Lebel, Living Well with COPD and Network Case Manager, Centre-West region Mrs. Esther César, Network Case Manager, North region Mrs. Kathy Noël, Network Case Manager, East region Mrs. Lorraine Isabelle, Network Case Manager, West region Mrs. Nathalie Poupart, Network Case Manager, South-East region Mrs. Lyse Millette, Network Case Manager, Centre-East region Mrs. Cathy Dresdell, planning, programmation and research agent, Agence de la santé et des services sociaux de Montréal Mrs. Édith Lemay, planning, programmation and research agent, Agence de la santé et des services sociaux de Montréal Mrs. Lucie Des Groseillers, administrative technician, Agence de la santé et des services sociaux de Montréal Mrs. Élodie Cornier, administrative agent, Agence de la santé et des services sociaux de Montréal