lts, the necessary coping strategies were given to the patients. In the process, Patients gain a sense of control and security over their illness. Bond [38] also found similar results, some patients believed that they are involved in medical decisions, but some patients thought the use of the remote device to be a burden for them. This is understandable, because it can be difficult for COPD patients to detect and respond appropriately to worsening conditions. And that the details were worked out by the nurse and patient is still in a passive position, the hoped-for “participatory health” into a “medical paternalism”. Relevant studies [29] also prove this point, the researcher thought most of the current studies described relationship of empowerment between doctors and patients as “authorization” and “obedience”, ignoring the patient’s subject status in the process of empowering. Lilholt, Haesum, and Hejlesen [42] have also proved that telemedicine can improve ability of disease management, but the difference is that It’s a pure quantitative study. In China, relevant studies conducted by Luan [43] and Li [44] have also confirmed that telemedicine has great benefits in self-management and self-efficacy of COPD patients.

The effects of telemedicine devices are considerable. A common feature of these studies is that as patients spend more time using telemedicine devices, their disease management ability, quality of life and emotional improvement also increase. Rixon et al. [45] also demonstrated the viewpoint.

4.6. Website Communication

The development of the Internet has provided a new platform for empowerment. Through online conversations with 398 COPD patients, Wentzer and Bygholm [29] concluded that online support group was an important resource for empowerment, and developed corresponding coping strategies based on the most talked about topics (smoking cessation and rehabilitation courses).Lu and Zheng [46] developed a network platform for patient of COPD, although the purpose was to confirm whether the relevant volunteers were COPD patients, patients actively participated in this process during the collection of disease information and improved their disease management ability.

5. Factors Influencing the Empowerment of Patients with COPD

Although a lot of researches shown that empowerment can improve patientsability of disease management, not all patients respond to empowerment in this process [47] . In other words, the level of receive empowerment depends on their participation about health issues [48] . If only empowering rights of patients without evaluation, it may lead to the aggravation of the patient’s illness and even death [49] . Therefore, “patient activation” is also the focus of many researchers, most of whom measure the activation degree and ability of patients after empowerment through the PAM-13 scale.

Studies indicated that relevant factors mainly include psychological factors (such as not wanting to face the occurrence or aggravation of the disease), no experience in coping with the disease, and lack of external support, but external support is also proposed as a contributing factor [50] [51] [52] . Mullerova et al. [53] concluded that high expectations of disease, poor health, and low satisfaction with health care workers are also barriers. Stoilkova-Hartmann, Franssen, Augustin, Wouters, and Barnard [54] further refined the obstacles in the process of disease management, such as social support, environment and lifestyle in external factors, health belief and internal motivation in internal factors [Table 2]. The results of these studies suggest that the quality of life and self-management of disease in patients with COPD are dependent on the individual’s condition after empowerment.

6. Summary

From the above, empowerment theory is a process in which patients gain the ability to cope with diseases and improve their sense of self-efficacy and have necessary knowledge, skills and attitudes. In addition, the empowerment process emphasizes patient involvement. More and more attention has been paid to the application of empowerment theory in patients with COPD. In view of the current situation, the following outlook is proposed:

At present, the measurement tools for chronic diseases are diversified, and it’s applied to different specialist areas. Since most of them are introduced from foreign countries, we need to verify whether they are practical in application. PAM-13

Table 2. Influencing factors of COPD patient empowerment.

is widely used in foreign countries for COPD empowerment measurement tools, but it has not been sinicized at present, which is a direction of future research. In addition, in the process of using and developing the scale, the influencing factors of empowerment should be fully considered. A large number of studies are still needed to explore which factors can be corrected, and then improve patients’ ability to accept empowerment and enjoy a higher quality of life. In the study, we should pay attention to the heterogeneity of patient characteristics and formulate different intervention measures according to different characteristics.

Empowerment has a significant effect on the etiology prevention, exercise, breathing exercise, telemedicine and website communication about COPD patients. Considering the complexity, repetition, and progressiveness of COPD, empowerment had little effect on readmission rates, only shortened the readmission time. We need more comprehensive disease management programme to improve outcomes in the future. In order to adapt to the economic restructuring, chronic disease management is particularly important. But due to the heterogeneity of COPD, we must take into account the impact of a patient’s unique environment when caring for them. COPD patients still need regular outpatient follow-up in the stable stage of the disease, so as to detect the progress of the disease, but it also causes increased pressure on outpatient visits. As a new empowerment tool, telemedicine reduces the pressure on the number of patients in medical departments and optimizes the health resources, which is the trend of smart medical research and direction of future research. Besides, monitoring the use of telemedicine is extremely important, because we don’t just keep track of the data, we need to make professional judgments about the progress of the disease. The expertise of professionals is the lifeblood of remote device use, which cannot be ignored in future studies.

Acknowledgements

This study was supported by Hubei Natural Science Fund Project (2017CFB786).

Cite this paper
Wu, Y. , Zhang, L. and Peng, X. (2019) Current Status of the Application of the Empowerment Theory in Patients with Chronic Obstructive Pulmonary Disease. Yangtze Medicine, 3, 212-224. doi: 10.4236/ym.2019.33021.
References

[1]   Wang, L., Martensson, J., Zhao, Y. and Nygardh, A. (2018) Experiences of a Health Coaching Self-Management Program in Patients with COPD: A Qualitative Content Analysis. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1527-1536.
https://doi.org/10.2147/COPD.S161410

[2]   Shafuddin, E., Chang, C.L., Cooray, M., McAnulty, K.A., Karalus, N.C., Lee, M. and Hancox, R.J. (2018) Cardiac Dysfunction in Exacerbations of Chronic Obstructive Pulmonary Disease Is Often Not Detected by Electrocardiogram and Chest Radiographs. Internal Medicine Journal.
https://doi.org/10.1111/imj.14144

[3]   Lipworth, B., Wedzicha, J., Devereux, G., Vestbo, J. and Dransfield, M.T. (2016) Beta-Blockers in COPD: Time for Reappraisal. The European Respiratory Journal, 48, 880-888.
https://doi.org/10.1183/13993003.01847-2015

[4]   Li, L.S., Paquet, C., Johnston, K. and Williams, M.T. (2017) What Are My Chances of Developing COPD If One of My Parents Has the Disease? A Systematic Review and Meta-Analysis of Prevalence of Co-Occurrence of COPD Diagnosis in Parents and Offspring. International Journal of Chronic Obstructive Pulmonary Disease, 12, 403-415.
https://doi.org/10.2147/COPD.S123933

[5]   Cannon, D., Buys, N., Sriram, K.B., Sharma, S., Morris, N. and Sun, J. (2016) The Effects of Chronic Obstructive Pulmonary Disease Self-Management Interventions on Improvement of Quality of Life in COPD Patients: A Meta-Analysis. Respiratory Medicine, 121, 81-90.
https://doi.org/10.1016/j.rmed.2016.11.005

[6]   Figueira, G.J., Martin, M.M., Perez, M.L., Garcia, B.M., Garcia-Talavera, I., Hernandez, S.G., Diaz, P.D. and Bethencourt, M.N. (2018) Health Status in Patients with COPD According to GOLD 2017 Classification: Use of the COMCOLD Score in Routine Clinical Practice. COPD, 15, 326-333.
https://doi.org/10.1080/15412555.2018.1531388

[7]   Enocson, A., Jolly, K., Jordan, R.E., Fitzmaurice, D.A., Greenfield, S.M. and Adab, P. (2018) Case-Finding for COPD in Primary Care: A Qualitative Study of Patients’ Perspectives. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1623-1632.
https://doi.org/10.2147/COPD.S147718

[8]   Xia, Y., Chen, Y., Wu, J.F., Wu, J., Guo, Q. and Xiong, H. (2011) Influence of Bandura Learning Theory on Recognition of Patients with COPD. Chinese Nursing Research, 25, 3349-3350.

[9]   Huang, H. and Ou, Y.Y. (2017) Effect of Self-Management Intervention Based on Self-Efficacy Theory in Patient with Chronic, Obstructive Pulmonary Disease. Journal of Bengbu Medical College, 42, 1696-1700.

[10]   Chen, X., Yang, X.Y. and Liu, S.M. (2018) Effects of Rehabilitation Exercise Intervention on the Pulmonary Function and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease Based on Trans-Theoretical Model. Chinese General Practice, 21, 3240-3245.

[11]   Shen, J. and Zhao, W.F. (2018) Effects of Cross-Theoretical Models on Respiratory Exercise and Self-Management in Patients with Chronic Obstructive Pulmonary Disease. Journal of Nurses Training, 33, 849-851.

[12]   Castro, E.M., Van Regenmortel, T., Vanhaecht, K., Sermeus, W. and Van Hecke, A. (2016) Patient Empowerment, Patient Participation and Patient-Centeredness in Hospital Care: A Concept Analysis Based on a Literature Review. Patient Education and Counseling, 99, 1923-1939.
https://doi.org/10.1016/j.pec.2016.07.026

[13]   Gong, B.X. and Fu, W. (2016) Research Progress on the Empowerment of Patients with Chronic Diseases in China. Chinese Journal of Social Medicine, 33, 532-535.

[14]   Kaptein, A.A., Fischer, M.J. and Scharloo, M. (2014) Self-Management in Patients with COPD: Theoretical Context, Content, Outcomes, and Integration into Clinical Care. International Journal of Chronic Obstructive Pulmonary Disease, 9, 907-917.
https://doi.org/10.2147/COPD.S49622

[15]   Robinson, K., Lucas, E., van den Dolder, P. and Halcomb, E. (2018) Living with Chronic Obstructive Pulmonary Disease: The Stories of Frequent Attenders to the Emergency Department. Journal of Clinical Nursing, 27, 48-56.
https://doi.org/10.1111/jocn.13842

[16]   Ou, Y.J. and Jiang, H.R. (2018) Research on the Application of Empowerment Theory in Patient Health Education. Chinese Nursing Research, 32, 1001-1004.

[17]   Jerofke, T.A. (2013) Concept Analysis of Empowerment from Survivor and Nurse Perspectives within the Context of Cancer Survivorship. Research and Theory for Nursing Practice, 27, 157-172.
https://doi.org/10.1891/1541-6577.27.3.157

[18]   Fotokian, Z., Shahboulaghi, F.M., Fallahi-Khoshknab, M. and Pourhabib, A. (2017) The Empowerment of Elderly Patients with Chronic Obstructive Pulmonary Disease: Managing Life with the Disease. PLoS ONE, 12, e0174028.
https://doi.org/10.1371/journal.pone.0174028

[19]   Sun, Y.Q. and Jiang, A.L. (2017) Advances in Research on Empowerment Measurement Tools for Patients with Chronic Diseases. Chinese Journal of Nursing, 52, 481-485.

[20]   Qi, M.M. and Li, Z.K. (2016) The Development and Application of Empowerment Tools for Patients and Their Families. Chinese Nursing Research, 30, 2318-2321.

[21]   Hu, B.B. (2010) A Preliminary Study on the Revision and Application of Simplified Chinese Diabetes Scale. Zhejiang University, Hangzhou.

[22]   Lei, M.J., Liu, Y.Q., Zhang, C.M., Liu, T.T., Meng, L.N., Sang, M. and Jin, C.D. (2018) Reliability and Validity of the Chinese Version of the Simplified Elders Health Empowerment Scale. Journal of Nursing Science, 33, 83-85.

[23]   Li, X. (2017) Chinese Revision of Chronic Disease Aptitude Scale and Reliability and Validity Study in Elderly Patients in Community. Southern Medical University, Guangzhou.

[24]   Zhang, X.B. and Li, B.E. (2014) The Development, Reliability and Validity Test of the Evaluation Scale for Stroke Patients with Empowerment Nursing. Chinese Nursing Management, 29, 30-33.

[25]   Hernandez, C., Alonso, A., Garcia-Aymerich, J., Serra, I., Marti, D., Rodriguez-Roisin, R., Narsavage, G., Carmen, G.M. and Roca, J. (2015) Effectiveness of Community-Based Integrated Care in Frail COPD Patients: A Randomised Controlled Trial. NPJ Primary Care Respiratory Medicine, 25, 15022.
https://doi.org/10.1038/npjpcrm.2015.22

[26]   Phanareth, K., Vingtoft, S., Christensen, A.S., Nielsen, J.S., Svenstrup, J., Berntsen, G.K.R., Newman, S.P. and Kayser, L. (2017) The Epital Care Model: A New Person-Centered Model of Technology-Enabled Integrated Care for People with Long Term Conditions. JMIR Research Protocols, 6, e6.
https://doi.org/10.2196/resprot.6506

[27]   Lim, T.K., Chee, C.B., Chow, P., Chua, G., Eng, S.K., Goh, S.K., Kng, K.K., Lim, W.H., Ng, T.P., Ong, T.H., Seah, S., Tan, H.Y., Tee, K.H., Palanichamy, V. and Yeung, M.T. (2018) Ministry of Health Clinical Practice Guidelines: Chronic Obstructive Pulmonary Disease. Singapore Medical Journal, 59, 76-86.
https://doi.org/10.11622/smedj.2018015

[28]   Kaptein, A.A., Tiemensma, J., Broadbent, E., Asijee, G.M. and Voorhaar, M. (2017) COPD Depicted-Patients Drawing Their Lungs. International Journal of Chronic Obstructive Pulmonary Disease, 12, 3231-3236.
https://doi.org/10.2147/COPD.S139896

[29]   Wentzer, H.S. and Bygholm, A. (2013) Narratives of Empowerment and Compliance: Studies of Communication in Online Patient Support Groups. International Journal of Medical Informatics, 82, e386-e394.
https://doi.org/10.1016/j.ijmedinf.2013.01.008

[30]   Desveaux, L., Rolfe, D., Beauchamp, M., Goldstein, R. and Brooks, D. (2014) Participant Experiences of a Community-Based Maintenance Program Post-Pulmonary Rehabilitation. Chronic Respiratory Disease, 11, 23-30.
https://doi.org/10.1177/1479972313516880

[31]   Dobbels, F., de Jong, C., Drost, E., Elberse, J., Feridou, C., Jacobs, L., Rabinovich, R., Frei, A., Puhan, M.A., de Boer, W.I., van der Molen, T., Williams, K., Pinnock, H., Troosters, T., Karlsson, N., Kulich, K. and Rudell, K. (2014) The PROactive Innovative Conceptual Framework on Physical Activity. The European Respiratory Journal, 44, 1223-1233.
https://doi.org/10.1183/09031936.00004814

[32]   Koldkjaer, S.I., Caroe, P., Lindgren, K. and Mathiesen, K.S. (2015) Online Communication and Chronic Obstructive Pulmonary Disease (COPD). Studies in Health Technology and Informatics, 216, 910.

[33]   Jiang, J.M. (2016) The Application of Empowerment Mode Training in COPD Patients Self-Management Skills. Nursing Practice and Research, 13, 7-9.

[34]   Zhang, D.F. and Luo, C.F. (2014) Effects of Incapacitating Respiratory Rehabilitation Training on Self-Efficacy in Patients with Chronic Obstructive Pulmonary Disease. Guangdong Medical Journal, 35, 3932-3933.

[35]   Early, F., Young, J.S., Robinshaw, E., Mi, E.Z. and Fuld, J.P. (2017) A Case Series of an Off-the-Shelf Online Health Resource with Integrated Nurse Coaching to Support Self-Management in COPD. International Journal of Chronic Obstructive Pulmonary Disease, 12, 2955-2967.
https://doi.org/10.2147/COPD.S139532

[36]   Collinsworth, A.W., Brown, R.M., James, C.S., Stanford, R.H., Alemayehu, D. and Priest, E.L. (2018) The Impact of Patient Education and Shared Decision Making on Hospital Readmissions for COPD. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1325-1332.
https://doi.org/10.2147/COPD.S154414

[37]   Lavesen, M., Ladelund, S., Frederiksen, A.J., Lindhardt, B.O. and Overgaard, D. (2016) Nurse-Initiated Telephone Follow-Up on Patients with Chronic Obstructive Pulmonary Disease Improves Patient Empowerment, But Cannot Prevent Readmissions. Danish Medical Journal, 63, pii: A5276.

[38]   Bond, C.S. (2014) Telehealth as a Tool for Independent Self-Management by People Living with Long Term Conditions. Studies in Health Technology and Informatics, 206, 1-6.

[39]   Cruz, J., Brooks, D. and Marques, A. (2014) Home Telemonitoring Effectiveness in COPD: A Systematic Review. International Journal of Clinical Practice, 68, 369-378.
https://doi.org/10.1111/ijcp.12345

[40]   Haesum, L.K., Ehlers, L. and Hejlesen, O.K. (2013) Telehomecare Technologies Enhance Self-Management and Empowerment among Patients with Chronic Obstructive Pulmonary Disease (COPD)—Where Does Health Literacy Fit into This Equation? Studies in Health Technology and Informatics, 192, 1182.

[41]   Nissen, L. and Lindhardt, T. (2017) A Qualitative Study of COPD-Patients’ Experience of a Telemedicine Intervention. International Journal of Medical Informatics, 107, 11-17.
https://doi.org/10.1016/j.ijmedinf.2017.08.004

[42]   Lilholt, P.H., Haesum, L.K. and Hejlesen, O.K. (2015) Exploring User Experience of a Telehealth System for the Danish TeleCare North Trial. Studies in Health Technology and Informatics, 210, 301-305.

[43]   Luan, Q.H. (2017) Effects of Telemedicine on Self-Measured Health of Patients with Stable COPD. Shandong University, Jinan.

[44]   Li, J. (2016) Effects of Telemedicine on Self-Efficacy of Patients with Chronic Obstructive Pulmonary Disease in Home Wards. Shandong University, Jinan.

[45]   Rixon, L., Hirani, S.P., Cartwright, M., Beynon, M., Doll, H., Steventon, A., Henderson, C. and Newman, S.P. (2017) A RCT of Telehealth for COPD Patient’s Quality of Life: The Whole System Demonstrator Evaluation. The Clinical Respiratory Journal, 11, 459-469.
https://doi.org/10.1111/crj.12359

[46]   Lu, H.N., Zheng, Z.G., Liu, N., Wang, X.N., Zhou, R.X. and Chen, R.C. (2016) Discussion on the Application of Network-Assisted Diagnosis and Treatment Platform for Chronic Obstructive Pulmonary Disease. Chinese General Medicine, 19, 3799-3802.

[47]   Korpershoek, Y., Bos-Touwen, I.D., de Man-van, G.J., Lammers, J.W., Schuurmans, M.J. and Trappenburg, J. (2016) Determinants of Activation for Self-Management in Patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease, 11, 1757-1766.
https://doi.org/10.2147/COPD.S109016

[48]   Luhr, K., Holmefur, M., Theander, K. and Eldh, A.C. (2018) Patient Participation during and after a Self-Management Programme in Primary Healthcare—The Experience of Patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure. Patient Education and Counseling, 101, 1137-1142.
https://doi.org/10.1016/j.pec.2017.12.020

[49]   Sohanpal, R., Epiphaniou, E. and Taylor, S. (2014) Self-Management for COPD? Why Does It Generate Negative Connotations? British Journal of General Practice, 64, e522-e524.
https://doi.org/10.3399/bjgp14X681157

[50]   Halding, A.G. and Grov, E.K. (2017) Self-Rated Health Aspects among Persons Living with Chronic Obstructive Pulmonary Disease. International Journal of Chronic Obstructive Pulmonary Disease, 12, 1163-1172.
https://doi.org/10.2147/COPD.S129325

[51]   Hillebregt, C.F., Vlonk, A.J., Bruijnzeels, M.A., van Schayck, O.C. and Chavannes, N.H. (2017) Barriers and Facilitators Influencing Self-Management among COPD Patients: A Mixed Methods Exploration in Primary and Affiliated Specialist Care. International Journal of Chronic Obstructive Pulmonary Disease, 12, 123-133.
https://doi.org/10.2147/COPD.S103998

[52]   Roberts, N.J., Kidd, L., Dougall, N., Patel, I.S., McNarry, S. and Nixon, C. (2016) Measuring Patient Activation: The Utility of the Patient Activation Measure within a UK Context-Results from Four Exemplar Studies and Potential Future Applications. Patient Education and Counseling, 99, 1739-1746.
https://doi.org/10.1016/j.pec.2016.05.006

[53]   Mullerova, H., Landis, S.H., Aisanov, Z., Davis, K.J., Ichinose, M., Mannino, D.M., Maskell, J., Menezes, A.M., van der Molen, T., Oh, Y.M., Tabberer, M. and Han, M.K. (2016) Health Behaviors and Their Correlates among Participants in the Continuing to Confront COPD International Patient Survey. International Journal of Chronic Obstructive Pulmonary Disease, 11, 881-890.
https://doi.org/10.2147/COPD.S102280

[54]   Stoilkova-Hartmann, A., Franssen, F.M.E., Augustin, I.M.L., Wouters, E.F.M. and Barnard, K.D. (2018) COPD Patient Education and Support—Achieving Patient-Centredness. Patient Education and Counseling, 101, 2031-2036.
https://doi.org/10.1016/j.pec.2018.05.024

 
 
Top