Reflective Essay

Reflective Essay   Catherine Nolan
This essay is all my own work and patient anonymity has been maintained.
The reflective model I am using in this essay is ‘What? So What? and Now What’ model suggested in the course notes.
I work as a Practice Nurse in a GPs practice in a suburb of Newcastle upon Tyne; Patients are mainly in socio-economic group A-C2 with some in groups D and E. The practice has a list size of 12,000+ patients with a Chronic Obstructive Pulmonary Disease (COPD) register containing 154 patients. I have worked there for 11years; I have been involved in doing spirometry, both in Chronic Obstructive Pulmonary Disease (COPD) annual reviews and new diagnostic spirometry, for approx. 9 years.
My practice does not carry out routine screening of smokers age 35 and over as advocated by Ferguson et al (2000) but agrees with Lin et al (2008) who state that routine screening for COPD using spirometry overestimates the condition in patients over 70 who have never smoked and also identifies mild to moderate airflow obstruction in asymptomatic patients.
At present we carry out annual spirometry on all patients with a known diagnosis of COPD as part of their annual review and on any patient presenting to the doctor with a persistent cough and increasing shortness of breath to aid in their diagnosis.
At the first session of this course we discussed the need for patients to be given information about spirometry before an appointment. I realised that I did not know what information if any my practice sent out to our patients prior to their appointments. I had noticed that we had a fairly high DNA rate (did not attend) for COPD recall patients and also patients attending for spirometry who were contraindicated in some way, e.g. with an infection or who had had surgery in the past 3 months (Levy et al 2009)
Also some patients that were asked to come for diagnostic spirometry had no idea what was going to happen and so were often anxious prior to the test or came...