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These two curricular concepts will help me take a leadership role as I transition to professional practice. Leaders must have effective communication skills to successfully collaborate their ideas and thoughts to other healthcare professionals. Evidence-based practice will allow me to be confident in myself knowing that my practice is best practice for the patients I will take care of.

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COPD patients are seen in Emergency Departments throughout the United States in respiratory distress. These patients are at risk for oxygen-induced hypercapnia from receiving too much oxygen by the health care professionals trying to help them. This occurs because some health care providers lack the knowledge about appropriate use of oxygen therapy in this patient population.

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Health care professionals are putting COPD patients at a greater risk for developing type two respiratory failure with the misguided use of oxygen therapy (Brill & Wedzicha, 2014). Type two respiratory failure is when the patient is presenting with an increased PaCO2 with or without hypoxia (Brill & Wedzicha, 2014). There are beneficial effects of oxygen therapy in COPD patients, but the amount of oxygen given is crucial to the patients outcomes. According to Cousins, Wark, and McDonald (2016), research shows that “mortality rates decrease by 58% when titrating oxygen therapy to achieve 88-92% compared to using a non-rebreather mask at 8-10L/min.”

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The nurse's current roles and participation

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The nurse's current roles and participation

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Whether COPD patients come in through the front doors of the emergency department or the ambulance bay, there is a lack of action regarding the appropriate oxygen use. Some EMS bring these patients in on non-rebreathers delivering high oxygen concentrations and nurses leave these patients on the oxygen therapy. When these patients walk in the front door with shortness of breath and decreased O2 saturations, some nurses apply too much oxygen and call a respiratory therapist to come see the patient.

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The importance of the nurse's involvement

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The importance of the nurse's involvement

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The nurse would be able to help decrease the risk of oxygen-induced hypercapnia in this patient population by educating themselves on this issue. By educating themselves on this issue; the nurses would be able to become a patient advocate. The nurse’s involvement will help improve this problem because they are located at the patient’s bedside; they could initiatie proper oxygen therapy to these patients or decrease the oxygen therapy when being brought to the emergency department by emergency medical services. According to Rhinehart (2018), bedside care “is the process where the nurse provides emotional support and advocates for the patient.”

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What are the challenges or barriers in regards to the nurse's participation?

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What are the challenges or barriers in regards to the nurse's participation?

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The nurse’s participation is limited in COPD patient’s who come to the emergency department in respiratory distress. One reason being that most hospitals staff respiratory therapists. According to the American Association of Respiratory Care (2018), respiratory therapists are trained to assess the patients cardiopulmonary system, initiate interventions, and assess the patient’s response to these interventions. Some nurses rely solely on respiratory therapists to initiate interventions for COPD patients. Another barrier is the lack of education regarding COPD patients in respiratory distress.

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Nurses need to be educated. Holding a symposium regarding this issue for emergency department nurses could increase their awareness of this potentially fatal risk.

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Nursing staff could implement protocols for these patients to include: obtaining a VBG or an ABG on arrival, keeping the patient NPO, elevating the HOB, assessing their baseline oxygen saturation, and titrating oxygen therapy to reach 88-92%.

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One curricular concept taught at SCOHS was effective communication. According to Sullivan (2013), collaboration among healthcare professionals is crucial to the safety and care of patients. In the context of this issue, nurses need to have effective communication with physicians and respiratory therapists to properly care for this patient population.

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A second curricular concept taught at SCOHS was evidence-based practice. According to MeInyk and Fineout-Overholt (2015) "Evidence-based practice (EBP) is key to delivering the highest quality of healthcare and ensuring the best patient outcomes at the lowest costs" (p. 3). In the context of this issue, EBP has shown that best practice for oxygen therapy in COPD patients is to titrate it to reach an oxygen saturation of 88-92% (Cousins, et al., 2016).