· Analyze a professional environment and relevant data, and develo.docx

· Analyze a professional environment and relevant data, and
develop a change strategy (3-5 pages) and discuss how to
implement it successfully.
Introduction
Note: Each assessment in this course builds on the work you
completed in the previous assessment. Therefore, it is
recommended that you complete the assessments in this course
in the order in which they are presented.
Knowing the best practice for our patients is very important in
providing safe and effective care. Understanding best practices
can help nurses identify areas of care that need to be improved.
To identify areas of need, nurses must use evidence from
various sources, such as the literature, clinical practice
guidelines (CPG), professional organization practice alerts or
position papers, and protocols. These sources of evidence can
also be used to set goals for improvement and best practices
with an eye toward improving the care experience or outcomes
for patients.
The challenge facing many care environments and health care
practitioners is how to plan for change and implement changes.
For if we cannot effectively implement changes in practice or
procedure, then our goals of improving care will likely amount
to nothing. This assessment focuses on allowing you to practice
locating, assessing, analyzing, and implementing change
strategies in order to improve patient outcomes related to one or
more clinical goals.
This assessment will take the form of a data table to identify
areas for improvement and to set one or more outcome goals, as
well as a narrative describing a change plan that would help you
to achieve the goals you have set.
Professional Context
One area in health care that it is necessary to consider is the
environment in which nurses work. It is important that this
environment evolves and changes so that all patients are

adequately supported. For this assessment, you will develop a
change strategy to improve the health care environment. These
changes can be rooted in a desire to improve clinical outcomes
and data related to assessment accuracy, drug administration, or
disease recovery rates. A key skill for master's-level nurses is to
be able to evaluate clinical data and create a change plan to help
drive improvements in the data to reach set goals.
Scenario
Consider a current environment. This could be your current care
setting, the care setting presented in the scenario Vila Health:
Using Concept Maps for Diagnosis, or a care setting in which
you are interested in working. For the setting that you choose
you will need to have a data set that depicts sub-optimal
outcomes related to a clinical issue. This data could be from
existing sources in the course, a relevant data set that already
exists (a data set from the case study you used as a basis for
your previous Concept Map assessment or from your current
place of practice), or an appropriate data set that you have
created yourself. (Note: if you choose to create your own data
set, check with your instructor first for approval and guidance.)
After you have selected an appropriate data set, use your
understanding of the data to create at least one realistic goal
(though you may create more) that will be driven by a change
strategy appropriate for the environment and goal.
Potential topics for this assessment could be:
· Consider ways to help minimize the rate of secondary
infections related to the condition, disease, or disorder that you
focused on for your previous Concept Map assessment. As a
starting point, you could ask yourself, "What could be changed
to facilitate safety and minimize risks of infection?"
· Consider how to help a patient experiencing traumatic stress
or anxiety over hospitalization. As a starting point, you could
ask yourself, "How could the care environment be changed to
enhance coping?"
Once you determine the change you would like to make,
consider the following:

· What data will you use to justify the change?
· How can the team achieve this change with a reasonable cost?
· What are the effects on the workplace?
· What other implementation considerations do you need to
consider to ensure that the change strategy is successful?
· How does your change strategy address all aspects of the
Quadruple Aim, especially the well-being of health care
professionals?
· Once the change strategy is implemented, how would you
evaluate the efficiency and effectiveness of the care system if
the desired outcomes are met?
Instructions
Your assessment submission should include a data table that
illustrates the current and desired states of the clinical issue you
are attempting to improve through your application of change
strategies. Additionally, you will need to explain the rationale
for your decisions around your chosen change strategies, as well
as how the change strategies will be successfully implemented.
The bullet points below correspond to the grading criteria in the
scoring guide. Be sure that your change strategy addresses all of
them. You may also want to read the Change Strategy and
Implementation scoring guide and
Guiding Questions: Change Strategy and
Implementation [DOCX] to better understand how each grading
criterion will be assessed.
· Develop a data table that accurately reflects the current and
desired states of one or more clinical outcomes.
· Propose change strategies that will help to achieve the desired
state of one or more clinical outcomes.
· Justify the specific change strategies used to achieve desired
outcomes.
· Explain how change strategies will lead to quality
improvement with regard to safety and equitable care.
· Explain how change strategies will utilize interprofessional
considerations to ensure successful implementation.

· Communicate the change plan in a way that makes the data
and rationale easily understood and compelling.
· Integrate relevant sources to support assertions, correctly
formatting citations and references using current APA style.
Example assessment: You may use the assessment example,
Assessment 2 Example [PDF], to give you an idea of
what a Proficient or higher rating on the scoring guide would
look like.
Submission Requirements
· Length of submission: 3–5 double-spaced, typed pages, not
including the title and reference pages. Your plan should be
succinct yet substantive.
· Number of references: Cite a minimum of 3–5 sources of
scholarly or professional evidence that supports your goal
setting, proposed change strategies, quality improvement, and
interprofessional considerations. Resources should be no more
than five years old.
· APA formatting: The
APA Template Tutorial [DOCX] can help you in writing
and formatting your analysis. No abstract is required.
Competencies Measured
By successfully completing this assessment, you will
demonstrate your proficiency in the following course
competencies and scoring guide criteria:
· Competency 1: Design patient-centered, evidence-based,
advanced nursing care for achieving high-quality patient
outcomes.
19. Develop a data table that accurately reflects the current and
desired states of one or more clinical outcomes.
· Competency 2: Develop change strategies for improving the
care environment.
20. Propose change strategies that will help to achieve the
desired state of one or more clinical outcomes.
20. Justify the specific change strategies used to achieve desired

outcomes.
· Competency 3: Apply quality improvement methods to
practice that promote safe, equitable quality of care.
21. Explain how change strategies will lead to quality
improvement with regard to safety and equitable care.
· Competency 4: Evaluate the efficiency and effectiveness of
interprofessional care systems in achieving desired health care
improvement outcomes.
22. Explain how change strategies will utilize interprofessional
considerations to ensure successful implementation.
· Competency 5: Communicate effectively with diverse
audiences, in an appropriate form and style, consistent with
organizational, professional, and scholarly standards.
23. Convey purpose of the assessment narrative in an
appropriate tone and style, incorporating supporting evidence,
and adhering to organizational, professional, and scholarly
communication standards.
1
Change Strategy and Implementation
Alexandra Sanders
Capella University
NURS-FPX6021 Biopsychosocial Concepts for Advanced
Nursing Practice 1
Dr. Katie Hooven
November 2021

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2
An overwhelming 10.5 percent of the American population has
been diagnosed with
diabetes (National Institute of Diabetes and Digestive and
Kidney Diseases, n.d.) Diabetes is a
chronic metabolic disease characterized by elevated blood
glucose levels that can lead over time
to severe damage to the heart, blood vessels, eyes, kidneys, and
nerves (World Health
Organization [WHO], 2021). When blood glucose levels run too
high, diabetes occurs. There are
three main types of diabetes: type I, type II, and gestational. In
type I, the body does not produce
insulin. People with type I are placed on insulin and a proper
diet and exercise to live productive

lives. Type II diabetes is the most common form of diabetes. In
type II, bodies do not use insulin
properly. A proper diet and exercise regimen helps treat type II
along with insulin or oral
medication. Gestational diabetes occurs in women who are
pregnant who have never had a
diagnosis of diabetes. It is treated much like type II (American
Diabetic Association [ADA],
2021).
Diabetes is very underrated as a global health issue. It is
considered the greatest epidemic
in human history, affects the highest number of people globally,
and costs the most money in
treatment and research (Zimmet, 2017). Nearly 422 million
people worldwide have diabetes, the
majority living in low-and middle-income countries, and 1.5
million deaths are directly attributed
to diabetes each year (World Health Organization [WHO],
2021). Globally the target goal is to
stop the rise in diabetes and obesity by 2025. Several factors
come into play to improve quality
of life and longevity when dealing with diabetes and patients
with diabetes. Patients need to
understand what diabetes is and how it affects their bodies; they

need support from family,
friends, and healthcare staff. One of the most critical factors in
diabetes is understanding the
ramifications of being non-compliant with their diabetes.
3
Kidney Disease and Diabetes
Chronic kidney disease (CKD) is a common diagnosis in
patients with diabetes. CKD can
be a devastating diagnosis and lead to shorter life spans and
poor quality of life (McFarlane et
al., 2018). Damage to the kidneys can lead to kidney failure and
ultimately need for dialysis or
transplant. Ensuring that blood glucose levels are kept under
control, eating a healthy diet, and
maintaining a healthy weight can help decrease the chances of a
diabetic developing CKD (The

Cleveland Clinic, n.d.).
Depression and Diabetes
Being diagnosed with diabetes can lead to emotions of stress,
grief, and frustration. These
emotions can trigger depression. In newly diagnosed patients,
depression is commonly seen but
can also affect patients who have had diabetes a long time.
Emotional issues can lead to poor
diet, lack of exercise, and higher blood glucose levels (The
Cleveland Clinic, n.d.). Patients with
diabetes are more likely to suffer from depression than a patient
without diabetes.
Change Strategies
When patients are diagnosed with diabetes, they must
understand and make an effort to
learn more about diabetes and its diagnosis. Education is the
foundation for the management and
care of diabetes and is an essential part of health planning. It
involves the patient and their
family, diabetes care team, community, and decision-makers in
the education process (Rashed et
al., 2016). Healthcare providers should enhance the quality of
patient care by providing

multimedia diabetes health education (Huang et al., 2016).
Teaching patients about a healthy
diet, exercise, taking medications, and reducing stress are some
of the critical components to
controlling diabetes (Centers for Disease Control and
Prevention [CDC], 2021). The Diabetes
Knowledge Questionnaire ( DKQ-24) is a tool used to test
patients' knowledge of diabetes. In
4
one, 50 patients took the DKQ-24, and they got sixty percent of
the questions correct. The
majority of these participants had had prior diabetes education.
The study showed that providing
adequate education is imperative to reduce the burden of this
condition (Formosa & Muscat,
2016). For patients to understand diabetes, a multidisciplinary
team is necessary. The team would

consist of a primary care physician, nurse educator, dietician,
and patient family. If indicated, an
endocrinologist and podiatrist could be added to the team.
Diabetic foot care is one of the number one needs of a diabetic
patient. Proper footwear
and proper care of the feet can decrease the chances of diabetic
foot ulcers and potential loss of
limbs. A nurse and or podiatrist can teach about foot care. A
dietician and diabetic education are
crucial members of the team. They help pave the way for proper
nutrition and food selection and
teach how food affects blood glucose levels. Teaching how to
check blood glucose levels and
how to take medication are essential roles of these clinicians.
Having this multidisciplinary team
helps the primary care physician and the patient to manage
diabetes better.
Ensuring patients have support from family and mutual trust for
the healthcare team aids
in giving a positive outlook for the patient regarding the
diabetes diagnosis and necessary
lifestyle changes. The support leads to compliance from the
patient also. Noncompliance in
diabetes can lead to kidney disease, heart disease, loss of

eyesight, and loss of limbs, to name a
few (Lofty et al., 2017).
Teaching patients about checking blood glucose levels
regularly, the importance of taking
medications, coping mechanisms, and overall understanding and
managing the disease will help
patients to lead healthier lives. It is crucial to know a patient's
educational level when teaching
begins and to assess learning frequently. Difficulties may arise
if patients are unable to
comprehend teaching. In these cases, the educators will need to
work with the patient and
5
understand how they best learn and apply the education in a
form that is understandable to the
patient.

Treating the depression may necessitate placing the patient on
medications. Including
psychotherapy may also be helpful. Support groups may also be
beneficial. Feeling physically
good with diabetes is half the battle and feeling mentally sound
is the other half (American
Diabetic Association [ADA], 2021). Not all patients are willing
to admit they need help, and not
all accept help. They may be embarrassed or not inclined to
share their feelings with others. This
may cause a challenge in getting help.
Current Outcomes Change Strategies Expected Outcomes
Patients who are diagnosed
with diabetes do have
adequate education regarding
kidney disease and treatment
for depression:
a) Many patients do not
know the signs and
symptoms of kidney
disease
b) Many patients with
diabetes experience
depressive symptoms
that are related to poor
blood glucose control
To ensure patients receive the

care they need, specific
measures should be met:
kidney disease should
be discussed with
patients.
be accessible to
patients who could
benefit from the help
depression & urine
home kits for testing
Patients with diabetes will
have appropriate access to
healthcare providers and
support groups to help with
their physical and mental
well-being :
a) Patients will have
Blood work drawn
every 2-3 months to
assess kidney function
and blood glucose
averages (Centers for
Disease Control and
Prevention [CDC],
2021)
b) Patients with
depression will have

help through
medication, therapy,
and support groups
(American Diabetic
Association [ADA],
2021).
Conclusion
6
Diabetes, if not appropriately managed, can lead to heart and
kidney issues, blindness,
loss of limbs, and even death. When patients are appropriately
educated on diabetes and the other
risk factors related to the disease, they are more likely to live
longer. Helping patients who
develop depression due to the stress and emotional toll diabetes
can have on them improves their
quality of life. All patients should have access to the healthcare
and education they deserve,

regardless of socioeconomic status. Assuming a patient does not
want or can not afford
treatments or medications places that patient in a position for
increased complications. Making
care easy to access and understand will help all patients
suffering from diabetes and its
comorbidities.
Having an open and trusting relationship with their healthcare
provider will enable a
patient to feel free to discuss issues and concerns. They may not
want to take medications for
depression or seek out support groups due to the stigma
attached to reaching out for help
(Martinez et al., 2017). A patient with an interprofessional team
caring for them will have the
best chance of succeeding and managing their diabetes.

7
References
American Diabetic Association. (2021). The path to
understanding diabetes starts here.
https://www.diabetes.org/. https://www.diabetes.org/diabetes
Centers for Disease Control and Prevention. (2021, August 10).
Diabetes education and support.
https://www.cdc.gov.
https://www.cdc.gov/diabetes/managing/education.html
Formosa, C., & Muscat, R. (2016). Improving diabetes
knowledge and self-care practices.
Journal of the American Podiatric Medical Association, 106(5),
352–356.
https://doi.org/10.7547/15-071
Huang, M.-C., Hung, C.-H., Yu, C.-Y., Berry, D. C., Shin, S.-J.,
& Hsu, Y.-Y. (2016). The
effectiveness of multimedia education for patients with type 2
diabetes mellitus. Journal
of Advanced Nursing, 73(4), 943–954.
https://doi.org/10.1111/jan.13194
Lofty, M., Adeghate, J., Kalasz, H., Singh, J., & Adeghate, E.
(2017). Chronic complications of
diabetes mellitus: a mini review. Current Diabetes Reviews,

13(1), 3–10.
https://www.ingentaconnect.com/content/ben/cdr/2017/0000001
3/00000001#expand/coll
apse
Martinez, L. R., Xu, S., & Hebl, M. (2017). Utilizing education
and perspective taking to
remediate the stigma of taking antidepressants. Community
Mental Health Journal, 54(4),
450–459. https://doi.org/10.1007/s10597-017-0174-z
McFarlane, P., Cherney, D., Gilbert, R. E., & Senior, P. (2018).
Chronic kidney disease in
diabetes. Canadian Journal of Diabetes, 42, S201–S209.
https://doi.org/10.1016/j.jcjd.2017.11.004
National Institute of Diabetes and Digestive and Kidney
Diseases. (n.d.). Diabetes Statistics.
https://www.niddk.nih.gov. https://www.niddk.nih.gov/health-
information/health-

8
statistics/diabetes-
statistics#:~:text=Diabetes%20Facts%20and%20Statistics
%201%20Total%3A%20An%20estimated,are%20undiagnosed%
20%2823.8%20percent
%20of%20people%20with%20diabetes%29
Rashed, O. A., Sabbah, H., Younis, M. Z., Kisa, A., & Parkash,
J. (2016). Diabetes education
program for people with type 2 diabetes: An international
perspective. Evaluation and
Program Planning, 56, 64–68.
https://doi.org/10.1016/j.evalprogplan.2016.02.002
The Cleveland Clinic. (n.d.-a). Diabetes: stress & depression.
https://my.clevelandclinic.org.
https://my.clevelandclinic.org/health/articles/14891-diabetes-
stress--depression
The Cleveland Clinic. (n.d.-b). Kidney disease / chronic kidney
disease.
https://my.clevelandclinic.org.
https://my.clevelandclinic.org/health/diseases/15096-
kidney-disease-chronic-kidney-disease
World Health Organization. (2021). Diabetes.

https://www.who.int. https://www.who.int/health-
topics/diabetes#tab=tab_1
Zimmet, P. Z. (2017). Diabetes and its drivers: The largest
epidemic in human history? Clinical
Diabetes and Endocrinology, 3(1).
https://doi.org/10.1186/s40842-016-0039-3
Powered by TCPDF (www.tcpdf.org)
http://www.tcpdf.org
1
Copyright ©2018 Capella University. Copy and distribution of
this document are prohibited.
Learner’s Name
School of Nursing and Health Sciences, Capella University
NURS-FPX6021 Biopsychosocial Concepts for Advanced

Nursing Practice I
Instructor's Name
April, 2022
2
Patients often present with respiratory issues of varying
severity; these can range from
breathing difficulties to dry or wet coughs. Patients that do
present with these issues are admitted
to the pulmonary ward to treat the issue at hand. Chronic
obstructive pulmonary disorder
(COPD) is one of the primary issues among these. Each patient
receives treatment based on the
severity of his or her condition. The treatment can include
prescribing antibiotics, non-invasive
ventilation, and pulmonary rehabilitation. Pulmonary
rehabilitation involves a program of
exercise and education specifically designed to help individuals
with pulmonary issues such as

COPD (NHS, 2016a).
The treatment for COPD is aimed at improving the physical
health of patients admitted
to the ward. However, it does not take into consideration the
mental health of these individuals.
There exists a strong positive correlation between COPD and
anxiety and depression (Pooler &
Beech, 2014), which means that patients who present with
COPD are likely to be comorbid with
anxiety, depression, or both. Further, COPD patients who are
comorbid with depression and
anxiety are statistically more likely to be hospitalized; these
patients are also likely to require
longer periods of hospitalization and face a greater risk of
mortality after they are discharged.
Considering these factors, it is necessary to address mental
health issues simultaneously with
physical issues to ensure that these patients can manage their
overall health more effectively.
Left untreated, both anxiety and depression can lead to
significant implications for compliance to
medical treatment (Pooler & Beech, 2014).
Anxiety and COPD

Some of the symptoms associated with COPD overlap with
those associated with anxiety.
Dyspnea or shortness of breath is particularly distressing for
patients and is common to both
COPD and anxiety. A COPD patient with anxiety might
interpret dyspnea in an exaggerated
3
manner, often correlating this symptom with an inability to
breathe or even an imminent death
(Heslop, Newton, Baker, Burns, Carrick-Sen, & De Soyza,
2013). Anxiety might not be the
cause of dyspnea in COPD patients, but it can be viewed as an
indicator of acute exacerbation in
such patients (Pooler & Beech, 2014).
Depression and COPD
As mentioned above, there exists a significant correlation
between COPD and depression.
The effect that depression has on COPD patients is different
from the effect produced by anxiety.
Depression has been significantly linked to a perceived decrease

in quality of life as well as in
physical activity. Pooler and Beech (2014) also note that
depression is likely to be
underdiagnosed and undertreated for individuals with COPD.
Patients who suffer from COPD and depressive symptoms are
less likely to follow
through on their recommended physical therapy. Consequently,
their COPD becomes
aggravated, requiring them to receive further treatment. For
most patients, particularly in cases of
acute exacerbation, further treatment would require
hospitalization. However, this might cause
patients to feel that they are unable to care for themselves; they
may experience inferiority or a
diminished sense of autonomy. As a result, patients are often
stuck within this cycle of
deteriorating health, leading to a decline in the state of their
mental health. The only effective
method to treat patients in such a situation is to address both
their physical and psychological
issues (Dursunoğlu et al., 2016).
Change Strategies
Both depression and anxiety require attention from a mental

health professional to
adequately and effectively help patients. Cognitive behavioral
therapy (CBT) has been proven to
be an effective method of managing anxiety, depression, and a
range of other mental health
4
conditions. In a typical CBT session, a patient and a therapist
work together to break down one
of the patient’s problems into its separate parts. Some of these
parts could be how the patient
thinks about the problem, how he or she feels physically about
it, and how he or she acts in
response to it. The patient and the therapist then evaluate these
parts and figure out what might
be unhelpful or unrealistic as well as the effect that these parts
have on each other and on the
patient (NHS, 2016b).
By identifying these parts, the therapist can figure out a plan of
action for the patient to
change thoughts and behaviors that are counterproductive. The
patient will then be asked to
practice these changes in his or her life and report back on

whether he or she was able to enact
the changes and how effective they were. By using this method,
the patient would eventually be
able to apply the skills that he or she has learned in the sessions
to his or her life. This would
help the patient manage his or her issues even after the course
of treatment is complete (NHS,
2016b). For example, individuals with COPD and anxiety might
be able to better manage their
anxiety by not associating shortness of breath with more
catastrophic outcomes.
However, CBT has certain drawbacks. It requires patients to be
willing to confront their
emotions and anxieties, which can be uncomfortable. Further,
CBT requires patients’
commitment to the process and their cooperation to help
themselves get better. The therapy can
be guided, but ultimately the outcome of therapy is determined
by the patients’ participation
(NHS, 2016b). On a practical level, it can be difficult for
hospitals to accommodate an adequate
number of therapists for patients or to provide an efficient
therapist-to-patient ratio.
To address this, it would be necessary for group therapy

sessions to be conducted in
conjunction with one-on-one sessions. This would enable a
wider range of individuals to access
the necessary treatment for their psychological condition, and it
might be less intimidating for
5
them if it is a group activity. Further, nurses could be trained in
CBT, or those trained in CBT
could be hired to facilitate more one-on-one sessions. Patients
who are provided with access to
these treatment options in addition to the treatment they receive
for their COPD will have a
higher quality of life and be able to manage both their physical
and mental conditions more
effectively than before (Howard & Dupont, 2014).
Pharmacological interventions can also be used to treat anxiety
and depression.
Treatment doses vary based on the severity of the disorder and

can have a variety of side effects.
Most antidepressants are not contraindicated; however, caution
is necessary while prescribing
certain types such as tricyclic antidepressants. Benzodiazepines
have the potential to cause
respiratory depression and should not be administered to COPD
patients who retain CO2.
Standard antidepressants such as selective serotonin reuptake
inhibitors can often have side
effects such as headaches, tremors, gastrointestinal distress, and
either psychomotor activation or
sedation. These side effects occur during the initial phase of
treatment and can be problematic
when coupled with the existing conditions of COPD patients. In
contrast, CBT and group therapy
are nonpharmacological interventions and would not result in
contraindications. It is also
difficult to implement the pharmacological treatment of
depression and anxiety on the level of
policy as the medication and doses required would be based on
the needs of individual patients.
Further, patients who suffer from COPD might be unwilling to
take medication for depression or
anxiety along with the medication that they might already be

taking. This could possibly result
from the stigma that surrounds mental illnesses or the
reluctance of patients to accept their
diagnosis (Tselebis et al., 2016).
Data Table
Current Outcomes Change Strategies Expected Outcomes
6
Patients who suffer from
COPD do not have adequate
access to mental health
facilities:
a) Many COPD patients
experience anxiety
resulting from dyspnea.
b) Patients with COPD are
likely to experience
depressive symptoms that
have been positively
correlated with the
worsening of COPD
symptoms.
To ensure that patients

receive the care they need,
certain measures are
necessary:
• Therapists should be
made available to COPD
patients.
• Nurses should be trained
in CBT, or nurses who are
trained in CBT should be
hired.
• Group therapy sessions
should be conducted
regularly for COPD
patients who are
comorbid with anxiety,
depression, or both.
Patients who suffer from
COPD will have adequate
access to mental health
facilities and will be able to
manage both their physical
and mental conditions more
effectively than before:
a) Patients who are
comorbid with COPD and
anxiety will be able to
distinguish between their
anxiety and an
aggravation of their
COPD symptoms
(Howard & Dupont,

2014).
b) Patients who are
comorbid with COPD and
depression will be better
prepared to manage both
their COPD and their
depressive symptoms
(Dursunoğlu et al., 2016).
7
References
Dursunoğlu, N., Köktürk, N., Baha, A., Bilge, A. K., Börekçi,
Ş., Çiftçi, F., . . . Turkish Thoracic
Society-COPD Comorbidity Group. (2016). Comorbidities and
their impact on chronic
obstructive pulmonary disease. Tüberküloz ve Toraks, 64(4),
289–298.
Heslop, K., Newton, J., Baker, C., Burns, G., Carrick-Sen, D.,
& De Soyza, A. (2013).
Effectiveness of cognitive behavioural therapy (CBT)
interventions for anxiety in patients
with chronic obstructive pulmonary disease (COPD) undertaken
by respiratory nurses:

The COPD CBT CARE study: (ISRCTN55206395). BMC
Pulmonary Medicine, 13(1).
Howard, C., & Dupont, S. (2014). ‘The COPD breathlessness
manual’: A randomised controlled
trial to test a cognitive-behavioural manual versus information
booklets on health service
use, mood and health status, in patients with chronic obstructive
pulmonary disease. npj
Primary Care Respiratory Medicine, 24.
NHS. (2016a). Chronic obstructive pulmonary disorder (COPD).
https://nhs.uk/conditions/chronic-obstructive-pulmonary-
disease-copd/treatment/
NHS. (2016b). Cognitive behavioral therapy (CBT).
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