An EBP Model Guides Exploration of a COPD Self-Management Strategy Lynda S. Facchiano, DNP, MA, FNP-BC Mayo Clinic Arizona Problem: COPD was the sixth leading cause of death worldwide in 1990 and is expected to become the third leading cause of death by 2020. The magnitude of COPD, associated symptoms and complications of the disease, lead to an exploration of alternative management strategies that can augment or complement existing clinical management available to individuals with COPD. Evidence: An exhaustive literature search among multiple databases identified several breathing retraining techniques, such as, pursed lip breathing (PLB), to be associated with improving dyspnea in individuals with lung disease. Evidence supports PLB as the best intervention for addressing perception of dyspnea in COPD. Strategy: Breathing retraining as a self-management strategy incorporating Wagner’s chronic care model, self-efficacy and behavioral learning theories, depicts a model within Rosswurm and Larrabee’s evidence-based practice model. Using an evidence-based practice (EBP) model, a chronic disease self-management strategy - PLB, was explored in individuals with COPD. Practice Change: Incorporating PLB into ones daily regimen will lead to improved perception of dyspnea, functional performance, and self –efficacy while fostering self-empowerment. Evaluation: Over a 4 month period, 26 COPD clients were offered the opportunity to voluntarily participate with only 10 being willing to learn and practice PLB. Three pre- and post testing scales were used to measure dyspnea, functional performance and self-efficacy. Participants were taught PLB, asked to practice PLB daily for 5 minutes for the first week, and then increase the daily practice time by 1 to 5 minutes each week thereafter. Results: When COPD clients practiced PLB on a regular basis their perception of dyspnea and self–efficacy were improved. Recommendations: Pursed lip breathing can easily be taught at routine COPD office visits of both primary care and specialty practices, and supports the use of chronic disease self-management strategies to augment the existing provider-client relationship. Lessons Learned: Clients need time to absorb the magnitude of any project before participating. Some clients are more motivated then others. Bibliography: Bandura, A. (1982). The assessment and predictive generality of self-percepts of efficacy. Journal of behavioral Theory Experimental Psychiatry, 13(3), 195-9. Bodenheimer, T, Lorig, K, Holman, H & Grumbach, K. (2002). Patient self management of chronic disease in primary care. JAMA, 288(19), 2469-2475. Bourbeau, J. & Nault, D. (2007). Self-management strategies in chronic obstructive pulmonary disease. Clinics in Chest Medicine, 28, 617-628. Bourbeau, J. & Barlett, S. J. (2008). Patient adherence in COPD. Thorax, 63(1), 831-838.

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