BULLETIN VOL. 2 dyspnea dyspnea - College of Nursing

BULLETIN VOL. 2 dyspnea dyspnea - College of Nursing

research
BULLETIN
Dr. Campbell earned a doctorate in nursing
from the University of Michigan School of
Nursing. She has a master of science in nursing
from Wayne State University and has received
specialized training in bioethics.
Dr. Campbell received the Lifetime Palliative
Care Achievement Award from M.D. Anderson
Cancer Center in 2008 and was named a
Fellow of the Hospice and Palliative Nurses
Association in 2011. Her research has focused on care for patients who
are approaching the end of life and she serves as an expert on palliative
care for many national committees and editorial boards.
selected publications
Campbell, M. L., H. Yarandi, et al. (in press). Oxygen is non-beneficial
for most patients who are near death. Journal of Pain and Symptom
Management.
Campbell, M. L., T. Templin, et al. (2010). A Respiratory Distress
Observation Scale for patients unable to self-report dyspnea. Journal of
Palliative Medicine, 13(3): 285-290.
5557 Cass Avenue
Detroit, Michigan 48202
Campbell, M. L., T. Templin, et al. (2009). Patients who are near death are
frequently unable to self-report dyspnea. Journal of Palliative Medicine,
12(10): 881-884.
Paul E. Massaron
Debbie Dingell, vice chair
Annetta Miller
Eugene Driker
Gary S. Pollard
Diane L. Dunaskiss
Allan Gilmour, ex officio
Danialle Karmanos
(313) 577-4070
nursing.wayne.edu
for end-of-life care
Tina Abbott, chair
dyspnea
Wayne State University Board of Governors
research
Campbell, M. L. (2007) Fear and pulmonary stress behaviors to an
asphyxial threat across cognitive states. Research in Nursing Health, 30(6):
572-583.
BULLETIN
Campbell, M. L. (2008). Psychometric testing of a respiratory distress
observation scale. Journal of Palliative Medicine 11(1): 44-50.
assessing
Campbell, M. L. (2008). Respiratory distress: a model of response and
behaviors to an asphyxial threat for patients who are unable to self-report.
Heart and Lung – The Journal of Acute and Critical Care, 37(1): 54-60.
The Research of
Dr. Margaret Campbell
assessing
dyspnea
for end-of-life care
VOL. 2 n NO. 1
PAID
Margaret L. Campbell joined Wayne State University College of Nursing
as an assistant professor in 2006 and was named an associate professor
in 2012. She was the associate director for research at the Wayne State
University Center to Advance Palliative Care Excellence from 2009
to 2012 and previously served as a nurse
practitioner, Palliative Care and Clinical Ethics,
at DMC Detroit Receiving Hospital.
DETROIT MI
PERMIT NO 3844
Margaret L. Campbell, PhD, RN, FPCN
NON-PROFIT
US POSTAGE
about
research
BULLETIN
Dr. Campbell earned a doctorate in nursing
from the University of Michigan School of
Nursing. She has a master of science in nursing
from Wayne State University and has received
specialized training in bioethics.
Dr. Campbell received the Lifetime Palliative
Care Achievement Award from M.D. Anderson
Cancer Center in 2008 and was named a
Fellow of the Hospice and Palliative Nurses
Association in 2011. Her research has focused on care for patients who
are approaching the end of life and she serves as an expert on palliative
care for many national committees and editorial boards.
selected publications
Campbell, M. L., H. Yarandi, et al. (in press). Oxygen is non-beneficial
for most patients who are near death. Journal of Pain and Symptom
Management.
Campbell, M. L., T. Templin, et al. (2010). A Respiratory Distress
Observation Scale for patients unable to self-report dyspnea. Journal of
Palliative Medicine, 13(3): 285-290.
5557 Cass Avenue
Detroit, Michigan 48202
Campbell, M. L., T. Templin, et al. (2009). Patients who are near death are
frequently unable to self-report dyspnea. Journal of Palliative Medicine,
12(10): 881-884.
Paul E. Massaron
Debbie Dingell, vice chair
Annetta Miller
Eugene Driker
Gary S. Pollard
Diane L. Dunaskiss
Allan Gilmour, ex officio
Danialle Karmanos
(313) 577-4070
nursing.wayne.edu
for end-of-life care
Tina Abbott, chair
dyspnea
Wayne State University Board of Governors
research
Campbell, M. L. (2007) Fear and pulmonary stress behaviors to an
asphyxial threat across cognitive states. Research in Nursing Health, 30(6):
572-583.
BULLETIN
Campbell, M. L. (2008). Psychometric testing of a respiratory distress
observation scale. Journal of Palliative Medicine 11(1): 44-50.
assessing
Campbell, M. L. (2008). Respiratory distress: a model of response and
behaviors to an asphyxial threat for patients who are unable to self-report.
Heart and Lung – The Journal of Acute and Critical Care, 37(1): 54-60.
The Research of
Dr. Margaret Campbell
assessing
dyspnea
for end-of-life care
VOL. 2 n NO. 1
PAID
Margaret L. Campbell joined Wayne State University College of Nursing
as an assistant professor in 2006 and was named an associate professor
in 2012. She was the associate director for research at the Wayne State
University Center to Advance Palliative Care Excellence from 2009
to 2012 and previously served as a nurse
practitioner, Palliative Care and Clinical Ethics,
at DMC Detroit Receiving Hospital.
DETROIT MI
PERMIT NO 3844
Margaret L. Campbell, PhD, RN, FPCN
NON-PROFIT
US POSTAGE
about
assessing
dyspnea to provide appropriate end-of-life care
M
Dr. Campbell has conducted a series
of studies to guide assessment and
treatment of patients at the end of life.
argaret Campbell, PhD, RN, FPCN, associate
professor at the Wayne State University College of
Nursing, has been a palliative care nurse practitioner
for 24 years with extensive experience treating patients at the
end of life. She observed many patients approaching the end
of life with dyspnea who were unable to express how they felt
because of cognitive problems, diminished strength or lack of
consciousness due to medication or the illness. Without the
ability to evaluate the patient’s condition, the proper course
of treatment may be unclear. Dr. Campbell has conducted a
series of studies to generate knowledge to guide assessment
and treatment of patients at the end of life.
“The risk of being short of breath at the end of life is high.
Less is known about how to assess and treat breathlessness
compared to other symptoms experienced by terminally
ill patients. The best patient-centered treatments need to
be investigated,” explained Dr. Campbell. Breathing
difficulties are very common at the end of life,
especially for patients with lung cancer, other lung
diseases or advanced heart disease.
Dr. Campbell has refined and validated the RDOS (shown on the computer screen
and above right) as an effective way to evaluate breathing discomfort among
dying patients.
Dr. Campbell has developed, tested and
refined the Respiratory Distress Observation
Scale (RDOS), which can be administered by
a clinician in less than five minutes to assess
dyspnea when a patient cannot self-report it. The
RDOS has eight variables to guide assessment:
respiration rate, heart rate, increased use of chest
muscles, paradoxical breathing, grunting after a breath,
nasal flaring, restlessness, and a fearful facial expression. This
observation scale has been validated in two studies and Dr. Campbell recently
received a grant from the National Institute of Nursing Research to develop
and test a special version of the RDOS for family caregivers. Inter-rater
reliability between a trained research RN and family caregivers will be tested
as part of this study. In addition, patient participants who are able to respond
to questions will be asked whether they are short of breath, responding on a
numeric rating scale and with verbal descriptors. Correlation of the patient
descriptors of breathing difficulty with the researchers’ evaluations using the
RDOS will help establish RDOS cut-points for mild, moderate and severe
breathing distress.
Patients in palliative care are often given oxygen even if they are unable to
respond to clinicians about possible discomfort. The standard of care is to
provide oxygen, according to Dr. Campbell, although the patient may not
be suffering. Sometimes family members advocate for oxygen or medication
The RDOS variables, shown
above, provide a valid and
reliable way to assess
breathing discomfort
for patients who can’t
self-report.
because they worry that the patient may be
uncomfortable. In another study funded
by the Blue Cross Blue Shield of Michigan
Foundation, Dr. Campbell evaluated the
usefulness of oxygen therapy for patients
near death and found that most are not
experiencing distress and do not need oxygen.
An additional grant from the Blue Cross
Blue Shield Foundation allows Dr. Campbell
to study breathing distress among dying
patients. In this investigation, “Is death
rattle a phenomenon that requires medical
treatment?”, the RDOS will be used to assess 160 dying patients in
inpatient hospice or hospital to determine whether those with death
rattle are experiencing any distress.
Dyspnea is prevalent
across all respiratory
diagnoses, shown at left.
A related area of Dr. Campbell’s research is the process of weaning
terminally ill patients from a ventilator. There is no standardized
treatment for these patients and it is unclear which method of
withdrawing life support provides the most comfort. A grant application
for funding is in development.
Dr. Campbell’s work addresses an under-investigated and important
area of clinical care, that is, the patient approaching the end of life.
“When cure or prolongation are no longer possible, nurses are integral
to the continuing care of patients at the end of life. My program of
research is targeted at providing the evidence to guide nursing care at
this transitional time.”