A Descriptive Study to Assess the Knowledge and Practices Regarding COPD Prevention and Management among Staff Nurses in Selected Hospital of District Patiala

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International Journal of Trend in Scientific Research and Development (IJTSRD) 
Volume 5 Issue 6, September-October 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 
 
@ IJTSRD   |   Unique Paper ID – IJTSRD47623   |   Volume – 5   |   Issue – 6   |   Sep-Oct 2021 
Page 1387 
A Descriptive Study to Assess the Knowledge and Practices 
Regarding COPD Prevention and Management among 
Staff Nurses in Selected Hospital of District Patiala 
Lovekirat Singh
1
, Dr. Priyanka Chaudhary
2
, Mrs Raman Deep Kaur
3 
1
Student M.Sc. Nursing, 
2,3
Associate Professor 
1,2,3
Desh Bhagat University, Mandi Gobindgarh, Punjab, India 
 
ABSTRACT 
A descriptive study to assess the knowledge and practices regarding 
COPD prevention and management among staff nurses in selected 
hospital of district Patiala. The global burden of disease study reports 
a prevalence of 251 million cases globally in 2016. Globally, it is 
estimated that 3.17 million deaths were caused by the disease in 2015 
(that is, 5% of all deaths globally in that year). COPD is an important 
cause of mortality and morbidity in our country and all over the 
world. Prevalence of COPD is being anticipated to increase due to 
continuing risk factors and aging of society. Although, COPD is a 
disease involving the respiratory medicine experts, its symptoms and 
diagnostic criteria should also be known by the primary healthcare 
providers considering its economic burden. The study is non 
experimental descriptive method and data was collected through 
convenient sampling technique i.e self structured questionnaire and 
check list. The analysis was done through ANNOVA analysis test. 
Practices like hand washing, proper medication, knowledge regarding 
medicines, oxygen therapies, diagnostic 
tests (spirometry), 
pulmonary rehabilitation, infection control techniques, non-invasive 
ventilation, inhalation techniques, and therapeutic outcomes 
regarding COPD prevention and management will be average among 
staff nurses.  
 
 
 
 
 
How to cite this paper: Lovekirat Singh 
| Dr. Priyanka Chaudhary | Mrs Raman 
Deep Kaur "A Descriptive Study to 
Assess the Knowledge and Practices 
Regarding COPD Prevention and 
Management among 
Staff Nurses 
in 
Selected Hospital of 
District 
Patiala" 
Published 
in 
International 
Journal of Trend in 
Scientific Research 
and Development (ijtsrd), ISSN: 2456-
6470, Volume-5 | Issue-6, October 2021, 
pp.1387-1413, 
URL: 
www.ijtsrd.com/papers/ijtsrd47623.pdf 
 
Copyright © 2021 by author (s) and 
International Journal 
of 
Trend 
in 
Scientific Research 
and Development Journal. This is an 
Open Access article distributed under 
the terms of the Creative Commons 
Attribution License (CC BY 4.0) 
(http://creativecommons.org/licenses/by/4.0) 
 
The selected staff nurses in selected hospital were 
taken 100. 5% staff nurses were excellent, 86% were 
good, 9% were at average. 7% had good skills and 
93% had poor skills. Mean of practices was 61.23, 
standard deviation was 29.437 and mean of 
knowledge was 64.64, standard deviation was 9.853. t 
score of practices was 24.197 and knowledge was 
65.605. It was found that association of knowledge 
regarding COPD prevention and management with 
selected demographic variables. The selected 
demographic variables age, gender, professional 
qualification, attended any COPD patient were having 
significant relationship whereas marital status, 
previous rotation in respiratory wards, years of 
experience in respiratory wards were having non 
significant relationship. Göktalay Tugba., et al., who 
conducted a cross-sectional study to determine 
knowledge level of the health care providers about 
COPD and PR in Manisa city. 65.5% of the health 
care providers responded to the survey. Rate of those 
correctly knowing at least one of four items was 
97.2%. Mayhob Mona Mohamed conducted a 
descriptive study to assess nurses knowledge, 
practices and barriers affecting a safe administration 
of oxygen therapy.18% had adequate practices, 40% 
had average practices and 42% had inadequate 
practices. Mahran Ghada., et al., conducted a 
comparative study of critical nurses’ knowledge and 
practice before and after education program about 
acute exacerbation of COPD in Egypt. , internship 
nurses had higher knowledge about previous 
mentioned items (83.33%), (93.33%) and (80%) than 
registered 
nurses 
(26.66%), 
(66.66%) 
and 
(66.66%).Catherine A O'Donnell, Hussein Jabareen, 
et al., [2010] conducted a cross sectional survey to 
identify workload, career intentions and the impact of 
 
 
IJTSRD47623 
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@ IJTSRD   |   Unique Paper ID – IJTSRD47623   |   Volume – 5   |   Issue – 6   |   Sep-Oct 2021 
Page 1388 
professional isolation among practice nurses. Isolated 
nurses worked in practices with smaller list sizes (p = 
0.024) and nursing teams (p = 0.003); were less likely 
to 
have 
someone 
they 
could 
discuss 
a 
clinical/professional (p = 0.002) or personal (p < 
0.001) problem with; used their training and 
qualifications less (p < 0.001); had less productive 
appraisals (p < 0.001); and were less likely to intend 
staying in practice nursing (p = 0.009). The result of 
the present study shows that there is a great need for 
the nurses to update their knowledge so as to save the 
life of the victim. 
1. INTRODUCTION  
BACKGROUND OF THE STUDY: 
Introduction: 
Chronic obstructive pulmonary disease (COPD) is a 
progressive life threatening lung disease that causes 
breathlessness and predisposes to exacerbations and 
serious illness. The global burden of disease study 
reports a prevalence of 251 million cases globally in 
2016. Globally, it is estimated that 3.17 million 
deaths were caused by the disease in 2015 (that is, 5% 
of all deaths globally in that year). More than 90% 
deaths occur in low and middle income countries. The 
primary cause of COPD is exposure to tobacco smoke 
(either active smoking or secondary hand smoke). 
Other risk factors include exposure to indoor and 
outdoor air pollution and occupational dusts and 
fumes. Exposure to indoor air pollution can affect the 
unborn child and represent a risk factor for 
developing COPD in later life. Many cases of COPD 
are prevented by avoidance or early cessation of 
smoking. Hence, it is more important that countries 
adopt the WHO Framework Convention on Tobacco 
Control (WHO-FCTC) and implement the MPOWER 
package of measures so that non-smoking becomes 
the norm globally. COPD is not curable, but treatment 
can relieve symptoms, improve quality of life and 
reduce the risk of death.1 
COPD is a major cause of global morbidity and 
mortality that affected 44 million people in 1990. 
Indeed, almost three million people died from this 
condition in 2000. It is becoming more prevalent 
among western women and is set to increase 
substantially with the export of tobacco to developing 
countries such as India, Mexico, Cuba, Egypt, South 
Africa and China. Despite being such a major health 
concern, only limited therapeutic options are 
available with most of the medications having been 
developed for the treatment.2 
COPD is a major public health problem. COPD is the 
end result of a susceptible lung being exposed to 
sufficient environmental stimulus. Caused principally 
by tobacco, smoking and household air pollution 
(HAP), COPD is a silent killer in low-and middle-
income countries (LMICs): an estimated 328 million 
people have COPD worldwide and in 15 years, 
COPD expected to become the leading cause of 
death. According to global burden of disease (GBD), 
COPD is already third leading cause of death 
worldwide, something that WHO had not predicted to 
occur until 2030. The economic impact of COPD 
among LMICs is expected to increase £1.7 trillion by 
2030. Air pollution is the biggest environmental cause 
of death worldwide, HAP accounting for about 3.5-4 
million deaths every year.3 
In India, Non Communicable Diseases were 
estimated to have accounted for 53% of all deaths and 
44% of disability- adjusted life-years (DALYs) lost in 
2005. Of these chronic respiratory diseases accounted 
for 7% deaths and 3% DALYs lost. India also has had 
the ignominy of experiencing the “highest loss in 
potentially productive years of life worldwide” in 
2005. Crude estimates suggest there are 30 million 
COPD patients in India. India contributes a 
significant and growing percentage of COPD 
mortality which is estimated to be amongst the 
highest in the world; i.e. more than 64.7% estimated 
age standardized death rate per 100,000 amongst both 
sexes. This would translate to about 556,000 in case 
of India (≥20%) out of a world total of 2,748,000 
annually.4 
COPD was the second highest cause of death in India 
after heart disease in 2017, killing 1 million (958,000) 
Indians that year according to University of 
Washington’s Global Burden of Disease study, 2018. 
COPD led to 13% of all deaths in India, and 7.5 
million were at risk of the disease in 2016, 
Indiaspend reported in January 2018. Knowledge 
about non-smoking risk factors for COPD is only 
about a decade old and one of the Reseachers 
instrumental in providing India’s burden primarily 
because of burning biomass for fuel.5 
Latest global estimates illustrate the vast impact of 
the common chronic respiratory diseases, with 3.2 
million deaths from chronic obstructive pulmonary 
disease (COPD) in 2015, according to a new Global 
Burden of Disease study published in The Lancer 
Respiratory Medicine Journal. The number of cases 
and deaths caused by the diseases between 1990 and 
2015. While overall prevalence and death rates have 
reduced since 1990, population growth and the aging 
population mean that the numbers have increased. 
The number of deaths from COPD increased by 
11.6% between 1990 and 2015 (from 2.8 to 3.2 
million deaths), and the number of case increased by 
44.2% (from 121 to 174.5 million cases).6 
India contributes very significantly to mortality from 
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Page 1389 
COPD 102.3/100,000 and 6,740,000 DALYs out of 
world total of 27,256,000 DALYs; thus significantly 
affecting health related quality of life in the country. 
COPD is surpassing Malaria, TB even today and the 
gap would get wider with time in near future. 
Multiple studies from 1994 to 2010 show increasing 
trends of COPD morbidity and mortality. Since most 
inhalation drugs are available in the country there is 
no reason why mortality should not be comparable to 
rest of the world but there is poor adherence to 
treatment guidelines, both national and international.7 
Chronic Obstructive Pulmonary Disease (COPD) is a 
disease state characterized by airflow limitation that 
is not fully reversible. This newest definition of 
COPD, provided by the Global Initiative for Chronic 
Obstructive Lung Disease (GOLD), is a broad 
description that better explains this disorder and its 
signs and symptoms (GOLD, World Health 
Organization [WHO] and National Heart, Lung and 
Blood Institute [NHLBI], 2004). Although previous 
definitions have included emphysema and chronic 
bronchitis under the umbrella classification of COPD, 
this was often confusing because most patients with 
COPD present with over-lapping signs and symptoms 
of these two distinct disease processes. COPD may 
include diseases that cause airflow obstruction (eg, 
emphysema, chronic bronchitis) or any combination 
of these disorders. However, asthma is now 
considered a separate disorder and is classified as an 
abnormal airway condition characterized primarily by 
reversible inflammation. COPD can coexist with 
asthma. Both of these disease have the major 
symptoms.8 
Chronic Obstructive Pulmonary Diseases (COPD) is a 
lung disease characterized by chronic obstruction of 
lung airflow that interferes with normal breathing and 
is not fully reversible. The more familiar terms 
‘chronic bronchitis’ and ‘emphysema’ are no longer 
used, but are now included within the COPD 
diagnosis. COPD is not simply a “smoker’s cough” 
but an under-diagnosed, life threatening lung disease.9 
Chronic bronchitis, a disease of the airways, is 
defined as the presence of cough and sputum 
production for at least 3 months in each of two 
consecutive years.5 It is inflammation and irritation of 
the bronchial tubes.10 
The primary cause of chronic obstructive pulmonary 
disease is tobacco smoke (active as well as passive 
smoking). The causes for COPD have opposite 
patterns according to the geographic areas. In high 
and middle income countries tobacco smoke is the 
biggest risk factor, meanwhile in low income 
countries exposure to indoor air pollution, such as the 
use of biomass fuels for cooking and heating, causes 
the COPD burden. Almost 3 billion people worldwide 
use biomass and coal as their main source of energy 
for cooking, heating and other household needs. In 
these communities, indoor air pollution is responsible 
for a greater fraction of COPD risk than smoking or 
outdoor air pollution. Biomass fuels used by women 
for cooking account for the high prevalence of COPD 
among non-smoking women in parts of Middle East, 
Africa and Asia. Other risk factors for COPD 
includes occupational dusts and chemicals such as 
vapours, irritants and fumes and frequent lower 
respiratory infections during childhood.11 
Risk factors of COPD include environmental 
exposures and host factors. Smoking depresses the 
activity of scavenger cells and affects the respiratory 
tract’s ciliary cleansing mechanism, which keeps 
breathing passages free of inhaled irritants, bacteria, 
and other foreign matter.8 
COPD is characterized by three primary symptoms: 
chronic cough, sputum production and dyspnoea on 
exertion. These symptoms often worsen over time. 
Chronic cough and sputum production often precede 
the development of airflow limitation by many years. 
However not all people with cough and sputum 
production develop COPD. Weight loss is common 
because dyspnoea interferes with eating and the work 
of breathing is energy-depleting. In patients with 
COPD has a primary emphysematous component, 
chronic hyperinflation leads to the “barrel chest” 
thorax configuration.5 An ongoing cough or a cough 
that produces a lot of mucus; that is often called 
smoker’s cough, wheezing or whistling or squeaky 
sound when person breathes and chest tightness are 
some symptoms that will appear in patient with 
COPD.12 
Pulmonary function studies are used to help confirm 
the diagnosis of COPD, determine disease severity 
and monitor disease progression. Spirometry is used 
to evaluate airflow obstruction, which is determined 
by the ratio of FEV1 to forced vital capacity (FVC). 
Arterial Blood Gas measurement may also be 
obtained to assess baseline oxygenation and gas 
exchange and are especially important in advanced 
COPD. In addition chest X ray may be obtained to 
exclude alternative diagnosis. A CT scan is seldom 
diagnostic in COPD is not routinely obtained in the 
diagnosis of COPD. Lastly screening for alpha1 -
antitrypsin deficiency may be performed for patients 
younger than 45 years.5 A blood test can show other 
condition that can cause similar symptoms to COPD, 
such as low iron level (anaemia) and high 
concentration of 
red blood cells 
in blood 
(polycythaemia). Electrocardiogram that measures the 
electrical activity of the heart. Echocardiogram that 
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scans the heart. A peak flow test, breathing test that 
measures how fast one can blow air of his/her lungs, 
which help to rule out asthma.13 
Smoking cessation is the only intervention proven to 
slow the accelerated decline in lung function and 
progression of COPD. Smoking cessation is difficult 
to achieve and even more difficult to sustain in the 
long term. Continued smoking is also more prevalent 
among those with low incomes, low levels of 
education, 
or 
psychological 
problems. 
Bronchodilators relieve broncho spasm and reduce 
airway obstruction by allowing increased oxygen 
distribution throughout the lungs and improving the 
alveolar 
ventilation. 
Inhaled 
and 
systemic 
corticosteroids may also be used in COPD but are 
used more frequently in asthma. A metered dose 
inhaler is a pressurized device that contains an 
aerosolized powder of medication. Oxygen therapy 
can be administered as long-term continuous therapy, 
during exercise, or to prevent acute dyspnoea. 
Surgical management includes bullectomy, lung 
volume reduction surgery and lung transplantation.8 
Reduction of total personal exposure to tobacco 
smoke, occupational dusts and chemicals, and indoor 
and outdoor air pollutants are important goals to 
prevent the onset and progression of COPD. The 
overall approach to managing stable COPD should be 
characterized by stepwise increase in treatment, 
depending on the severity of the disease. The long 
term administration of oxygen to patients with 
chronic respiratory failure has been shown to increase 
survival. Exacerbations of respiratory symptoms 
requiring medical intervention are important clinical 
events in COPD.14 
NEED OF STUDY- 
Currently, COPD is a fourth leading cause of 
mortality and the 12th leading cause of disability in 
the United States; however, by the year 2020 it is 
estimated that COPD will be the 3rd leading cause of 
death and 5th leading cause of disability (Sin, 
McAlister, Man, et al., 2003). In 2001, chronic 
pulmonary disorders caused 123,013 deaths in people 
of all ages, regardless of gender, and male/female 
age-adjusted ratio was 1:4 (Aria, Anderson, Hsiang-
Ching, et al., 2003), the united states have some form 
of COPD. The annual cost of COPD is approximately 
$32.1 billion, including health care expenditures of 
$18.0 billion and indirect costs of $14.1 billion 
(American Lung Association, 2004)8 
Chronic obstructive pulmonary disorders are a 
leading cause of morbidity and mortality in the 
United States. Nurses are involved with patients with 
chronic pulmonary disease across the spectrum of 
care, from outpatient and home care to critical care 
and hospice setting. Patients with chronic pulmonary 
disorders need care from nurses who not only have 
astute assessment and clinical management skills but 
who also understand how these disorders can affect 
quality of end-of-life care is important for affected 
patients. Patient and family teaching is an important 
nursing intervention to enhance self-management in 
patients with any chronic pulmonary disorder.8 
Chronic obstructive pulmonary disease (COPD) 
causes more than 500,000 hospitalizations and more 
than 100,000 deaths in the United States each year. In 
addition, millions of Americans are disabled as a 
result of these disease. Unfortunately, the treatment 
options available to patients with COPD and their 
physicians are limited, and no pharmacologic therapy 
slows the progressive loss of lung function occurs. 
Because of health burden imposed by COPD and the 
urgent need for better management of this disease, the 
National Heart, Lung and Blood Institute (NHLBI) 
convened a working group on March 21-22, 2002 to 
examine needs and opportunities for clinical research 
in COPD.15 
COPD is an important cause of mortality and 
morbidity in our country and all over the world. 
Prevalence of COPD is being anticipated to increase 
due to continuing risk factors and aging of society. 
Although, COPD is a disease involving the 
respiratory medicine experts, its symptoms and 
diagnostic criteria should also be known by the 
primary healthcare providers considering 
its 
economic burden.16 
A study was conducted to assess the knowledge, 
attitudes, and behavioral intentions toward promoting 
pulmonary rehabilitation for patients with chronic 
obstructive pulmonary disease among staff nurses. 
Pulmonary rehabilitation is an effective strategy to 
manage COPD, through its utilization rate is low. One 
reason for this low utilization rate is that nurses do 
not provide COPD patients with enough health 
education to increase the patients’ motivation for 
pulmonary rehabilitation participation. Result showed 
that accuracy rate of knowledge was approximately 
12% and self-evaluated skills were less than 50%, 
self-efficacy in promoting rehabilitation was above 
average i.e. 57%-60% and the strength of attitudes 
and behavioral intentions was over 70%. Education 
courses and clinical practice training should be 
increased in the future to promote pulmonary 
rehabilitation of COPD patients.17 
A study was conducted to evaluate the burden on 
patients with chronic pulmonary disease. High-related 
quality of life measures are widely used in patients 
with COPD. However, they are extremely limited 
when used to evaluate patients outside the clinical 
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trials. The disease mainly affects old men (more than 
50% were over 65 years of age) and non-employed 
men (23% were employed). Of the patients studied, 
22.7% continued smoking, especially men (24.4% of 
men vs. 18.1% of women). Most patients (54%) were 
diagnosed with moderate stage II COPD. Severity of 
COPD was lower in women: 29.6% of men had 
severe COPD compared with 13.7% of women. In 
this study, it is found that near about 36.6% people 
affected with COPD were admitted in hospital.18 
A survey was conducted to assess prevalence and 
associated risk factors of COPD in Iran. The result 
concluded that 1,308 subjects out of 2,200 eligible 
people (59.4%) agreed to take part in the study. The 
enrolled population consisted of 672 women and 636 
men, with an age range of 40-94 years. Overall, 279 
individuals including 62 symptomatic and 217 
asymptomatic cases took part in the study. The 
prevalence was 12.7% in men and 3.9% in females. 
Increasing age is a known risk factor for COPD. The 
older a person gets, the greater the chance of 
continued exposure to smoke and air pollutants. 
Occupation is a risk factor for respiratory illnesses in 
men. There is to increase the awareness about COPD 
and its related factors in our population. And another 
main thing is to cure the disease by the health care 
professionals. Level of knowledge and level of 
practices they perform on patients with COPD.19 
According to European Respiratory Review, COPD is 
responsible for early mortality, high death rates and 
significant cost to health systems. The projection for 
2020 indicates that COPD will be the third leading 
cause of death worldwide (from 6th in 1990) and the 
5th leading cause of years lost through early mortality 
or handicap (disability-adjusted life years) (12th in 
1990). Active smoking remains the main risk factor, 
but other factors are becoming better known, such as 
occupational factors, infections and the role of air 
pollution. Prevalence of COPD varies according to 
country, age and sex. This disease is also associated 
with significant comorbidities, COPD is a disorders 
that includes various phenotypes, the continuum of 
which remains under debate. The major challenge in 
the coming years will be to prevent onset of smoking 
along with early detection of the disease in the 
general population. The prevalence of COPD was 
estimated to be 7.6% independent of the defined 
diagnostic criteria. On the basis of 38 studies, the 
prevalence of chronic bronchitis was estimated to be 
6.4%. The prevalence of emphysema was estimated 
to be 1.8% on the basis of eight studies.20 
From all above studies and surveys, researcher come 
to know that COPD is the most crucial disease among 
people especially, in men. There are many prevalent 
cases in overall world. First priority is to control the 
increasing cases of COPD and second is to enhance 
knowledge and level of practices among staff nurses 
in hospitals.  
During Clinical posting, Researcher observed the 
knowledge level of COPD among staff nurses is 
below the average level and practices that are 
performed on patient are poor in hospital. I found that 
the COPD patients were not properly recovering after 
treatment. Hence, Researcher felt that knowledge and 
practices regarding COPD are to be assessed so as to 
enhance the care of COPD patient, reduce the 
complications that may arise during providing 
practical care to the patient. Thus, study aims to 
assess the knowledge and practices regarding COPD 
prevention and management among staff nurses was 
planned to conduct. 
PROBLEM STATEMENT: 
A descriptive study to assess the knowledge and 
practices 
regarding COPD prevention 
and 
management among staff nurses in selected hospital 
of district Patiala. 
OBJECTIVES: 
1. To assess the knowledge regarding COPD 
prevention and management among staff nurses. 
2. To determine the practices of COPD prevention 
and management among staff nurses. 
3. To compare the knowledge and practices 
regarding COPD prevention and management 
among staff nurses. 
4. To find out the association of knowledge 
regarding COPD prevention and management 
with selected demographic variables among staff 
nurses. 
5. To provide pamphlet regarding COPD prevention 
and management among staff nurses. 
OPERATIONAL DEFINITIONS: 
Knowledge: It 
refers 
to 
the awareness or 
understanding of something which is acquired 
through theoretical learning of a subject.  
Practices: It refers tothe actual use of an idea, belief, 
or method, as opposed to theories relating to it. 
COPD: It is a Chronic Obstructive Pulmonary 
Disorder characterized by obstruction or blocking of 
airflow in the lungs which interferes the normal 
breathing and is not fully reversible. It is the 
combination of two diseases i.e. chronic bronchitis 
and emphysema. 
Staff Nurse: a person who works in a hospital to take 
care of the ill and injured whose rank is below than 
that of a sister. 
 
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Page 1392 
ASSUMPTIONS:  
The knowledge of COPD will be below the average 
level among staff nurses in a selected hospital of 
district Patiala. Practices like hand washing, proper 
medication, knowledge regarding medicines, oxygen 
therapies, diagnostic tests (spirometry), pulmonary 
rehabilitation, infection control techniques, non-
invasive ventilation, inhalation techniques, and 
therapeutic outcomes regarding COPD prevention 
and management will be average among staff nurses. 
DE-LIMITATIONS: 
The study was de-limited to- 
 Staff nurses only. 
 100 sample only. 
 Rajindra Hospital of District Patiala.  
2. REVIEW OF LITERATURE 
Review of literature is a key step in the research 
process. Review of literature refers to extensive, 
exhaustive and systematic examination of publication 
of relevant to research project.  
The related literature for the present study was 
organized and presented under following headings: 
SECTION – A: REVIEWS REGARDING 
KNOWLEDGE OF COPD PREVENTION AND 
MANAGEMENT AMONG STAFF NURSES 
Rebecca Nantanda, Gerald Kayingo, et al., [2020] a 
cross sectional study was conducted among primary 
care health workers, specialist physicians and 
healthcare planners to assess gaps in knowledge and 
skills and, training needs in managing respiratory 
illnesses.Data were collected using questionnaires, 
patient panel discussions and review of pre-service 
training curricula for clinicians and nurses.A total of 
104 respondents participated in the survey and of 
these, 76.9% (80/104) were primary care health 
workers, 16.3% (17/104) specialist clinicians and 
6.7% (7/104) healthcare planners. Over 90% of the 
respondents indicated that more than half of the 
patients in their clinics presented with respiratory 
symptoms. More than half (52%) of the primary care 
health workers were not comfortable in managing 
chronic respiratory diseases like asthma and COPD. 
Only 4% of them were comfortable performing 
procedures like pulse oximetry, nebulization, and 
interpreting x-rays. Majority (75%) of the primary 
care health workers had received in-service training 
but only 4% of the sessions focused on respiratory 
diseases. The pre-service training curricula included a 
wide scope of respiratory diseases, but the actual 
training had not sufficiently prepared health workers 
to manage respiratory diseases. The patients were 
unsatisfied with the care in primary care and reported 
that they were often treated for the wrong illnesses.21 
Ma Yiming, Peng Yating, et al., [2019] conducted a 
descriptive cross-sectional study to investigate 
COPD-related knowledge levels among internal 
medicine nurses in large top-ranked tertiary hospital 
in China from August 2019 to September 2019. There 
were two target populations: (1) Respiratory nurses 
(2) Non-respiratory nurses. This study is aimed to 
assess COPD-related knowledge in internal medicine 
nurses. The Bristol COPD knowledge questionnaire 
(BCKQ) was used to test COPD-related knowledge 
levels in the participants. Questionnaires were 
initially distributed to 180 nurses who met the 
inclusion criteria, five nurses were excluded because 
of going on vacation (n=3) or going out for training 
(n=2). Therefore there were total 175 nurses included 
in this study. Overall BCKQ score for all nurses in 
this study was 35.76 ± 5.49. In comparison with non-
respiratory nurses, 
the overall score among 
respiratory nurses was significantly higher (39.01 ± 
3.95 vs 33.32 ± 5.23, p <0.001). Overall knowledge 
regarding COPD to all nurses were on the following 
basis- a)Epidemiology- 50.4%, b)Etiology- 72.6%, 
c)Symptoms- 60.4%, d)Breathlessness- 36.4%, 
e)Phlegm- 75.8%, f)Infections- 68.6%, g)Exercise- 
60%, h)Smoking- 60.2%, i)Vaccination- 68.2%, 
j)Inhaled bronchodilators- 63.8%, k)Antibiotics- 
72.8%, l)Oral steroids- 51.6% and m)inhaled steroids- 
34.2%. Internal medicine nurses at this tertiary 
hospital 
showed 
deficits 
in COPD-related 
knowledge.22 
Guo Su-Er, Shen Hsueh-Chen., et al., [2018] 
conducted a cross sectional correlational study to 
examine knowledge, attitudes, and behavioral 
intention toward PR promotion in Taiwan. This study 
also investigated the correlates of behavioral 
intentions to promote PR among pulmonary nurses. 
Overall, 284 nurses (all women) from chest medicine 
and general internal medicine wards in 3 hospitals 
within Midwest 
Taiwan 
were 
recruited. 
Questionnaires tool was used to collect data. Two 
groups of nurses (i.e. chest medicine, general 
medicine) showed no differences in PR knowledge, 
attitudes, or behavioral intentions, they lacked 
sufficient PR knowledge and skills. The accuracy rate 
of PR knowledge was approximately 12% and self-
evaluated PR skills were less than 50%. Self-efficacy 
in promoting PR was above average (i.e. 57%-60%), 
and the strength of attitudes and behavioral intentions 
was over 70%. Questionnaires were distributed to 356 
nurses who met the inclusive criteria, and 300 
participants were initially included. 16 participants 
were excluded due to missing information; therefore, 
284 valid questionnaires were included for data 
analysis. Pulmonary rehabilitation-related knowledge 
and skills were lower than 15.0% and 50.0% of total 
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scores, respectively; knowledge about COPD and 
self-efficacy were both approximately 60%; and 
attitudes toward PR and behavioral intentions toward 
PR promotion were higher than 70%. Moreover, only 
29.1% of nurses would actively promote PR and 8.3% 
of them acknowledged that PR-related health 
education is the most important for patients with 
COPD.23 
Godoy Ilda De, Godoy Irma., et al., [2016] conducted 
a cross sectional study to evaluate the knowledge of 
nurses from the health care network of Botucatu, SP, 
Brazil, about COPD. 243 nurses from primary care 
and hospital care were invited to participate of study. 
81.6% of nurses defined COPD incorrectly, 76.1% 
considered spirometry not necessary for diagnosis, 
79% did not answer correctly the questions related to 
Bronchodialtors and technique of use of inhaled 
medications was known by only 15.4%. Vaccines 
were recommended for COPD was unknown for 47%. 
They concluded that nurses have gap in their 
knowledge about: COPD definition, risk factors for 
disease, diagnostic tools, and management of stable 
of exacerbated diseases, guidance and supervision of 
treatment, mainly of inhaled drugs, vaccines and 
long- term oxygen therapy. Nurses are not ready to 
deal with COPD patients; however, they recognize 
that there knowledge about the disease is incomplete 
and express the desire to be trained and oriented to 
delivery effective prevention and management.24 
Kathleen Moreo, Laurence Greene, and Tamar Sapir, 
[2016] conducted aQI project to identify inter 
professional and coproductive correlates of COPD 
care quality in the context of a continuing education 
program designed to advance knowledge and skill 
among patients, providers, and the inter professional 
COPD team regarding coproductive COPD care. 
Participants in the program included providers in 30 
primary care practices across the U.S. In addition, 
more than 1,000 additional providers and 200 patients 
participated in just the online/mobile education. As 
indicated in self-assessment evaluations following the 
on-demand online and mobile educational activities, 
the 30 primary care providers in the cohort 
significantly improved their knowledge, attitudes, and 
beliefs related to coproductive COPD care. All cohort 
providers expressed confidence in being able to 
achieve their personal action plans over the next six 
months to improve the quality of their COPD patients' 
care. From pre- to post-program, there was a 55% 
increase in providers' self-reported ability to discuss 
referrals for case management, skilled nursing, and 
palliative care with COPD patients; a 32% increase in 
recognizing benefits of pulmonary rehabilitation; and 
a 36% increase in providers' self-rated ability to 
discuss COPD prognosis/progression and available 
pharmacologic 
options with 
their 
patients. 
Improvements were also seen among the more than 
1,000 inter professional learners nationwide who 
accessed the online activities (43% primary care; 12% 
physician specialists; 34% nurse case managers; 7% 
pharmacists; 4% physician assistants). There was a 
43% increase in learners' self-reported ability to 
discuss referrals for case management, skilled 
nursing, and palliative care with COPD patients; a 
25% increase in recognizing benefits of pulmonary 
rehabilitation; and a 47% increase in self-rated ability 
to discuss COPD prognosis/progression and available 
pharmacologic options with COPD patients.25 
Barbara P. Yawn, 1 Peter C. Wollan, et al.,[2016] 
conducted a Survey to assess current primary care 
physicians’, nurse practitioners’ (NP) and physicians 
assistants’ (PA) knowledge, attitudes and beliefs 
regarding chronic obstructive pulmonary disease 
(COPD). 26 primary care clinicians (278 medical 
doctors [MDs] and doctors of osteopathic medicine 
[DO] and 148 NPs/PAs) provided useable responses 
(overall response rate 61%). This is a survey study of 
clinician attendees at 3 large regional continuing 
medical education (CME) programs designed to 
provide didactic presentations on a broad range of 
primary care topics including a 60 to 90 minute 
presentation on COPD. Overall 436 surveys (278 
MD/doctor of osteopathic medicine [DO] and 148 
NP/PA) were returned with all or most (>95%) 
questions answered (questionnaire). The response rate 
varied by site from 75% and 81% for the 2 Florida 
events to 44% from the Chicago event for an overall 
response rate of 61%. Information is not available on 
response rate by level of training. Physician 
respondents were older, less likely to be women and 
have more years in practice than NPs/Pas. Overall, 
more than 70% of the respondents practiced in 
communities > 50,000 residents with about 8.0% of 
physicians and 10.8% of NPs/PAs practicing in rural 
communities. Half of the physicians practiced in 
single specialty primary care groups and 66.2% in 
groups of 5 or fewer physicians. Of the NPs, 15 of 56 
(26.8%) worked in NP only offices. NPs and PAs 
reported that 57% had 5 physicians or fewer in their 
offices. NPs and PAs were slightly but not 
significantly less likely to work in single specialty 
practices compared to physicians. The only 
significant difference between Florida and Chicago 
respondents was that the Chicago clinicians were on 
average older than those from Florida. About half of 
the respondents reported awareness and use of COPD 
guidelines (49.9% of physicians versus 46.0% 
NPs/PAs) with 31.7% versus 27.0% respectively, 
reporting lack of awareness or use of any COPD 
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guideline. The rest reported awareness that COPD 
guidelines were available but did not use them in 
daily practice. Only about one quarter of respondents 
thought that COPD patients’ symptoms were usually 
delayed until after 60 years of age and less than 10% 
considered COPD primarily a disease of men.26 
GöktalayTuğba, Tuncal Ayşe Nur., et al., [2015] 
conducted a cross-sectional study to determine 
knowledge level of the health care providers about 
COPD and PR in Manisa city. Questionnaire was 
used to collect data from the sample. 65.5% of the 
health care providers responded to the survey. Rate of 
those correctly knowing at least one of four items was 
97.2%. No responder knew all items correctly. 
Average value for correct answers was 5.30 ± 2.1 
(range; 1-10). The physicians, men and those working 
in family health centers had higher level of 
knowledge on COPD compared to non-physician 
health care providers (p = 0.006), women (p = 0.002), 
and those are working in other practices (p = 0.019), 
respectively. Knowledge level of the primary 
healthcare providers on COPD and PR remains 
adequate.27 
SECTION – B: REVIEWS REGARDING 
PRACTICES OF COPD PREVENTION AND 
MANAGEMENT AMONG STAFF NURSES 
Bove D.G., Jellington M.O., et al., [2019] conducted 
a qualitative study to explore COPD patient’s 
experiences with the new palliative organization 
named Comprehensive and Prospective Treatment 
and Individual Nursing (CAPTAIN) in Denmark in 
2019. This aim of this study was to explore COPD 
patient’s experiences with a new and altered palliative 
organization. 
Semi-structured 
interview was 
conducted with patients with severe COPD. Interview 
was taken from 10 patients. Patients described how 
the professional and the availability of their nurse was 
considered as the most important and positive change. 
It made patients feel safe, 
in control, and 
subsequently influenced their ability to self-manage 
their life and prevent being hospitalized. The patient 
did not emphasize the advanced care planning 
dialogues as something special or troublesome. It 
showed that it is relevant and meaningful to establish 
a structure that supports professional relationships 
between patient, nurse and physician based on 
patient’s needs. The new way of structuring the 
outpatient care was highly appreciated by COPD 
patients and made them safe which brought 
confidence in self-management abilities. Analysis 
revealed that the new organization contributed to 
increased quality of life for patients with COPD, 
although a few also described being worried and 
skeptical toward the new structure of outpatient care. 
The patients described very consistently that it was 
the professional relationship with their c-nurse they 
valued most and that the relationship with their c-
nurse positively influenced their ability to self-
manage their life. Anxiety is highly prevalent in 
COPD, with prevalence rates up to 46% in 
outpatients. Findings showed that self-management 
support must combine care and support regarding 
medication and other COPD specific interventions 
combined with psychosocial support. The new 
palliative 
structure CAPTAIN supported an 
individualized professional relationship between 
patient and c-nurse and this relationship positively 
impacted patient’s ability to self-manage their life 
with COPD.28 
Gustafsson Tanja and Nordeman Lena [2018] 
conducted a descriptive qualitative study to describe 
asthma and chronic obstructive pulmonary disease 
nurse’s experiences of caring for patients with 
chronic obstructive pulmonary disease in primary 
health care. 10 asthma and COPD specialized nurses 
were interviewed. Two main categories were found: 
the patient-nurse relationship and available resources. 
Several challenges emerged when connecting with 
patients and the nurses found it difficult to 
individualized care. They struggled with a lack of 
time and support from other professionals. Being 
responsible for asthma and COPD practice was 
experienced as positive, but could become 
overwhelming. The asthma and COPD nurses 
described several challenges and the need for support 
and resource to provide the best possible care for 
patients with COPD. The aim of the study was to 
describe ACNs’ experiences of caring for patients 
with COPD in primary health care. COPD is a 
complex disease making great demands on primary 
health care. This study indicates that caring for 
patients with COPD is a challenge to the ACN.29 
N. Siouta, P. Clement, et al., [2018] conducted a 
qualitative study to examine the perceptions of health 
care professionals and the current practices of 
integrated 
palliative 
care 
(IPC) 
in 
Belgium.Cardiologists and pulmonologists, working 
in primary care hospitals in Belgium, participated in 
this study with semi-structured interviews based on 
IPC indicators. One researcher collected, transcribed 
verbatim the interviews and carried out their thematic 
analysis. To increase the reliability of the coding, a 
second researcher coded a random 30% of the 
interviews.A total of 22 CHF/COPD specialists 
participated in the study. The results show that IPC 
and its potential benefits are viewed positively. A 
number of IPC components like the holistic approach 
(physical, psychological, social, spiritual aspects) via 
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multidisciplinary teams, prognosis discussion and 
illness 
limitations, patient goals assessment, 
continuous goal adjustment, reduction of suffering 
and advanced care planning are partially implemented 
in several health centers. However, PC specialists are 
absent from such implementations and PC is still an 
end-of-life care.30 
Hua Yin, Ling Yangand Qiao Ye, [2018] conducted a 
review studyto examine the effectiveness of CNS 
interventions in patients with COPD.A randomized 
controlled trial (RCT), which is in the top position of 
the evidence hierarchy, is qualified and suitable to 
answer this kind of question.Therefore, only RCTs 
were included in this review.There is low- to 
moderate-quality evidence indicating that home 
nursing support interventions may have a References 
positive effect on mortality (low-quality evidence) 
and quality of life (moderate-quality evidence). There 
is moderate-quality evidence that no significant 
difference in quality of life has been found between 
the CNS-supported discharge intervention and the 
usual service. When CNSs participate in a 
multidisciplinary cooperation program, the effect of 
this intervention is evaluated as a whole. A moderate 
level of evidence has been found illustrating that this 
intervention probably has a positive effect on quality 
of life of patients with COPD. Both nurse-led care 
and self-care management education intervention 
likely have a positive effect on mortality of patients 
with COPD. This evidence is of moderate quality.31 
Zwakman Marieke., et al., [2017] conducted a 
qualitative study to explore patients’ experiences 
regarding the COPD-Guidance Research on Illness 
Perception (COPD-GRIP). Semi-structured interview 
was conducted to collect data from patients. 16 
patients were interviewed. All patients were positive 
and experienced an additional value of the COPD-
GRIP intervention in different areas. Three main 
themes were identified and show that taking part in 
this intervention made the patients feel ‘listened to 
and acknowledged’, improved their awareness of the 
disease and its management and helped them to make 
lifestyle changes. Some patients suggested that 
individualized care plan could be improved and to 
start the intervention immediately after being 
informed of the COPD diagnosis. All patients 
recommended this information. The result of this 
study indicates that patients acknowledge that the 
COPD-GRIP intervention is a useful and promising 
tool for providing individualized COPD care.32 
Jennifer Y Verma, Claudia Amar, et al., [2017] 
conducted a mixed-methods summative approach to 
improve care for advanced COPD through practice 
change relying on collated quantitative data, team 
documents, and surveys sent to core members of the 
19 teams. Survey questions included a series of 
multiple-choice responses, Likert scale ratings, and 
open-ended questions. Collectively, the 19 teams 
have reached more than 1000 patients. Preliminary 
results (to be reported in detail later) suggest similar 
outcomes to the Halifax-based programs patients and 
families consistently report greater self-confidence in 
symptom management, returns to daily activities, and 
enjoyment of enhanced functional status. Similar to 
outcomes in Halifax, teams have also reported 
substantially fewer ED visits and hospitalizations 
(40–80%) among those enrolled.We present results 
relating to delivery of the collaborative under four 
subheadings: (i) the most significant achievements, 
cultural changes, and new work practices, (ii) team 
skills acquisition and improvement capability, (iii) the 
collaborative approach—the components of the 
INSPIRED QIC and related team feedback, and (iv) 
sustainability. Teams reported a number of gained QI 
skills, for example, 35/46 respondents (76%) 
indicated they became better able to “design 
innovative 
solutions 
(e.g. 
suite of COPD 
interventions, effective team-based care, etc.)”, and 
the majority reported they became better equipped to 
develop benchmarks/targets for improvement (33/46, 
76%), develop tools and processes to lead change in 
health-care 
improvement 
(33/46, 76%), and 
communicate improvement goals and outcomes to 
motivate staff to get and stay involved (32/45, 
71%).33 
SW Weldam, JJ Lammers., et al., [2016] conducted a 
mixed method study to explore the nurses’ 
experiences with applying the new COPD-GRIP in 
Europe. Pre-intervention questionnaires were sent to 
all participating nurses 
(n=24) 
to 
identify 
expectations. 
Post-intervention 
questionnaires 
identified experiences after applying the intervention 
followed by two focused groups to further extend 
exploration of findings. Barriers were encountered, 
especially in patients with lower economic status, in 
patients with a lower health literacy and in patients 
with other cultural background. Nurses perceived the 
COPD-GRIP intervention as a feasible, individualized 
tool. According to the nurses, the intervention is a 
valuable improvement in the care for COPD 
patients.34 
Hannah ML Young,Lindsay D Apps., et al., [2015] 
conducted a qualitative study toof nurses’ and allied 
health professionals’ perceptions of implementing 
self-management for patients with COPD. This study 
explores nurses’ and AHPs’ understanding and 
implementation of supported COPD self-management 
within routine clinical practice.Nurses and AHPs 
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participated in face-to-face semi-structured interviews 
to explore their understanding and provision of 
COPD self-management, as well as their perceptions 
of the challenges to providing such care. Purposive 
sampling was used to select participants from a range 
of professions working within primary, community, 
and secondary care settings. A total of 14 participants 
were interviewed. Nurses and AHPs viewed self-
management as an important aspect of COPD care, 
but often misunderstood what it involved, leading to 
variation in practice. A number of challenges to 
supporting self-management were identified, which 
related to lack of time, lack of insight regarding 
training needs, and assumptions regarding patients’ 
perceived self-management abilities.35 
Catherine A O'Donnell, Hussein Jabareen, et al., 
[2010] conducted a cross sectional survey to identify 
workload, career intentions and the impact of 
professional isolation among practice nurses. This 
study aimed to describe that role, identify how 
professionally supported they felt and their career 
intentions. An additional aim was to explore whether 
they felt isolated and identify contributory factors. A 
cross-sectional questionnaire survey in one large 
urban Scottish Health Board, targeted all practice 
nurses (n = 329). There were 200 responses (61.0% 
response rate). Most respondents were aged 40 or 
over and were practice nurses for a median of 10 
years. Commonest clinical activities were coronary 
heart disease management, cervical cytology, diabetes 
and the management of chronic obstructive 
pulmonary disease. Although most had a Personal 
Development Plan and a recent appraisal, 103 
(52.3%) felt isolated at least sometimes; 30 (15.5%) 
intended leaving practice nursing within 5 years. 
Isolated nurses worked in practices with smaller list 
sizes (p = 0.024) and nursing teams (p = 0.003); were 
less likely to have someone they could discuss a 
clinical/professional (p = 0.002) or personal (p 
<0.001) problem with; used their training and 
qualifications less (p < 0.001); had less productive 
appraisals (p < 0.001); and were less likely to intend 
staying in practice nursing (p = 0.009). Logistic 
regression analysis showed that nurses working alone 
or in teams of two were 6-fold and 3.5-fold more 
likely to feel isolated. Using qualifications and 
training to the full, having productive appraisals and 
planning to remain in practice nursing all mitigated 
against feeling isolated.36 
Nicholas Zwar,Oshana Hermiz, et al., [2008] 
conducted a cluster randomised controlled trial of a 
cluster randomised controlled trial of nurse and GP 
partnership for care of Chronic Obstructive 
Pulmonary Disease. This randomised controlled trial 
aims at testing a new approach that involves a 
registered nurse working in partnership with patients, 
general practitioners (GPs) and other health 
professionals to provide care to patients according to 
the evidence-based clinical practice guidelines. The 
aim is to determine the impact of this partnership on 
the quality of care and patient outcomes.A cluster 
randomised control trial design was chosen for this 
study. Randomisation occurred at practice level. GPs 
practising in South Western Sydney, Australia and 
their COPD patients were recruited for the study.Data 
collection includes patient demographic profiles and 
their co-morbidities.At least 20 practices in each 
group and at least 10 patients per practice and that is 
at least 200 subjects in each group. The prevalence of 
COPD among general practice patients would be 
about 4.0%, slightly higher than population estimates. 
Assuming that there are 1,500 adult patients 
registered with each GP then would expect that there 
would be 60 patients with COPD. If a third of these 
patients would be eligible and consent to participate 
in the study, thus will recruit 20 patients per practice. 
Taking a conservative approach and assuming 10 
patients consent per practice, then to achieve 400 
patients will need to recruit 40 GP practices. As 
previously stated there are currently 785 GPs in 467 
practices in SWS. Based on our previous experience 
of EPC evaluation where 71% of the GPs contacted 
took part in the research we expect to be able to 
recruit the numbers of GPs and practices needed for 
this efficacy trial.37 
Jörgen Thorn, Maria Norrhall, et al., [2008] 
conducted aquestionnaire survey to assess the primary 
care management of chronic obstructive pulmonary 
disease (COPD) in relation to COPD guidelines in 
western Sweden. A postal questionnaire was sent out 
to all Primary Health Care Centres (PHCCs) in 
western Sweden (n=232). The response rate was 
75%.A majority of the PHCCs had a nurse and 
physician responsible for COPD care. They used 
spirometry equipment regularly, but only 50% 
reported that they calibrated it at least weekly. Less 
than 30% of the PHCCs reported access to a dietician, 
occupational therapist or physiotherapist. There was a 
structured smoking cessation program in 50% of the 
PHCCs. Larger PHCCs were more likely to use 
spirometry equipment regularly and to have specific 
personnel for COPD care.There is a need to establish 
structured programs for COPD care including 
smoking cessation programs for COPD patients with 
special trained staff. Larger PHCCs have a better 
infrastructure for providing guideline-defined COPD 
care.38 
 
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SECTION – C: REVIEWS REGARDING 
KNOWLEDGE AND PRACTICES OF COPD 
PREVENTION AND MANAGEMENT AMONG 
STAFF NURSES 
Mayhob Mona Mohamed [2018] conducted a 
descriptive study to assess nurses knowledge, 
practices and barriers affecting a safe administration 
of oxygen therapy. A purposeful sampling technique 
was used to recruit 50 nurses from different 
departments in one of the educational hospitals in 
Cairo. This study proved that only less than 10th and 
less than fifth of the studied sample has satisfactory 
level of knowledge and adequate practices, while, the 
rest were ranged between average and unsatisfactory. 
With regard to the common barriers affecting safe 
oxygen therapy reported by the nurses are 
unavailability of protocol, lack of maintenance of the 
equipment used for oxygen therapy, and incomplete 
unclear written prescription for oxygen therapy.54%, 
58%, 80% and 50% sample has satisfactory level 
knowledge 
in relation 
to knowing aim of 
administering oxygen therapy, different methods used 
to assess oxygen saturation in the blood, precautions 
should be taken during administering oxygen therapy, 
and nursing interventions regarding administering 
oxygen therapy respectively.18% had adequate 
practices, 40% had average practices and 42% had 
inadequate practices. 64% nurses were lacking 
knowledge, 68% were lacking awareness, 86% were 
lacking training courses. This study concluded that, a 
minority of the studied sample unsatisfactory level of 
knowledge and less than fifth had adequate level of 
practices. The most common reported barriers; 
absence of protocol for oxygen therapy could be 
followed, and unavailability of well-functioning 
equipment.39 
MahranGhada, Radwan Marwan., et al., [2018] 
conducted a comparative study of critical nurses’ 
knowledge and practice before and after education 
program about acute exacerbation of COPD in Egypt. 
The aim of this study is to evaluate nurses’ 
knowledge and practice before and after education 
program about AECOPD. 60 nurses were divided into 
two groups (30 registered nurses and 30 internship 
nurses). Before the education program both groups 
had lower knowledge about AECOPD as clinical 
manifestations, diagnosis, nursing management and 
rehabilitation. But after the education program, 
internship nurses had higher knowledge about 
previous mentioned items (83.33%), (93.33%) and 
(80%) than registered nurses (26.66%), (66.66%) and 
(66.66%). Also patients assigned to the internship 
nurses group after the education program had lower 
dyspnoea level (0.87 + 0.97) than those assigned 
nurses’ group (1.67 + 1.24) which means higher 
performance of internship nurses than registered 
nurses. CCN’s and internship needs continuing 
education and training about the various critical cases 
as AECOPD to strengthen their role to plan and 
deliver more strategies to improve the quality of life 
of AECOPD patients.40 
3. METHODOLOGY 
Research methodology is the systematic, theoretical analysis of the methods applied to a field of study. It 
comprises the theoretical analysis of the body of methods and principles associated with a branch of 
knowledge.(Kara, Helen (2015) 
Research methodology refers to the methods that are used in research for gathering and analyzing the data. The 
methodology is the most important part of the research as it is the framework for conducting the study. It 
indicates the general pattern for organizing the procedures together valid and reliable data for the investigations.  
The chapter includes:- 
 Research Approach  
 Research Design  
 Research setting  
 Target Population  
 Sample Size & Sampling technique  
 Variables 
 Criteria Measures: Inclusion and exclusion criteria 
 Development & description of the tools  
 Validity of the tool 
 Pilot study 
 Reliability of the tool  
 Ethical consideration  
 Data collection procedure  
 Plan for data analysis  
 Summary  
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Research Design 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1 Schematic Representation of Research Methodology 
RESEARCH APPROACH: 
A quantitative research approach is used for the present study to assess the knowledge and practices regarding 
COPD prevention and management among staff nurses in selected hospital of district Patiala. This approach is 
an experimental approach which will be conducted by conducting an experiment on sample. 
RESEARCH DESIGN: 
The term research design is defined as a blueprint for conducting a study with maximum control over factors that 
may interfere with the validity of findings (Burns and Grove 2003). 
Descriptive research design is used to conduct this study. The design is best suited to assess the knowledge and 
practices regarding COPD prevention and management among staff nurses in selected hospital of district Patiala. 
RESEARCH SETTING: 
Setting is the physical location and condition in which the data takes place in a study “as said by Polit and 
Hungler”. The criterion for selection of this setting is feasibility of conducting study in the setting and 
investigators familiarity with the setting and people. 
Research Setting 
Rajindra Hospital, Patiala 
Target Population 
Staff Nurses 
Sampling Technique 
Convenient sampling technique 
Sample Size 
100 Students (N=100) 
Tool of Data Collection  
Checklist 
Socio- Self Structured Questionnaire 
Analysis and Interpretation of data 
Descriptive and inferential statistics 
Mean, Mode and ANOVA 
Non experimental Descriptive Research Design 
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The study is conducted in the selected Hospital i.e., Rajindra Hospital, Patiala, Punjab. The total nurses in 
hospital are around 500. This setting is selected due to flexibility for conducting study and expected cooperation 
from the sample. This setting was easy to conduct study for the researcher and was very convenient for him to 
conduct study. 
TARGET POPULATION: 
Polit and Hungler (1991) described “population as the entire set of individuals having some common 
characteristics”.  
Staff nurses of Rajindra Hospital, Patiala, Punjab. Only the convenient staff was taken as a sample. There were 
many who were absent and were limited for my study. Only 100 staff nurses were the target population. 
SAMPLE SIZE AND SAMPLING TECHNIQUE:- 
Polit and Hungler said, “sample is a subject of population selected to participate in a research study”. 
S.K Sharma, 2011 said that “Sample consists of subsets of units which comprise the population selected by 
investigators or researcher to participate in their research project”. 
100 staff nurses of Rajindra Hospital, Patiala, Punjab are taken to assess the knowledge and practices regarding 
COPD prevention and management which was selected through the convenient sampling technique. Through 
this sampling technique, researcher selected only those staff nurses which were present at the time of study.  
VARIABLES UNDER STUDY: 
Demographic Variables: - Age, gender, marital status, professional qualification or education, attended any 
COPD patient, previous rotation in respiratory wards, any experience.These all were Socio-demographic 
variables. 
Research Variables: - knowledge and practices regarding COPD prevention and management. It includes various 
types of questions regarding COPD. Also along with checklist for assessing practices. 
INCLUSION CRITERIA AND EXLUSION CRITERIA:  
INCLUSION CRITERIA:  
Staff nurses who were: 
1. Working in Rajindra Hospital, Patiala, Punjab. 
2. Interested to participate in study.  
3. Present at the time of data collection.  
EXCLUSION CRITERIA:  
Staff nurses who were: 
1. Working in blood bank, ortho unit, pediatric unit, neuro unit, nephro unit etc. 
2. Staff who were absent on the day when study was conducted. 
DESCRIPTION OF TOOL:  
Self-structured tool (Questionnaire and Checklist) is use for the assessment ofknowledge and practices regarding 
COPD prevention and management among staff nurses in selected hospital of district Patiala. The tool contains 2 
parts:  
Part 1: Demographic variables: - this part of tool contains items which include Age, professional qualificationor 
education, attended any COPD patient, previous rotation in respiratory wards, any experience. 
Part 2: knowledge and practices regarding COPD prevention and management 
This part contains 2 sections: 
Section 1: consists of knowledge which contain full form, definition, causes and risk factors, clinical 
manifestations, characteristic sign, cardinal sign, overall treatment, whether medical, surgical as well as nursing 
and prevention and many other questions related to COPD. 
Section 2: consists of practices regarding COPD prevention and management assessment which contain hand 
washing, proper medication, and knowledge regarding medicines, oxygen therapies, diagnostic tests (spirometry 
etc.), infection control techniques, inhalation techniques, and therapeutic outcomes, respiratory status etc. 
VALIDITY OF TOOL:  
Polit and Beck (2008) state that validity is the degree to which an instrument measures what it is supposed to 
measure. 
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The tool used for the study was self-structured questionnaire and checklist schedule however to get the opinions 
of the different experts for suitability and for validation of demographic variables for COPD prevention and 
management, it was given to experts of different specialty. The experts were from the community department, 
medical department, and surgical department. The final tool was prepared for further use in the research study. 
All of the experts gave their views on tool validation and corrected errors.  
PILOT STUDY: 
Polit and Beck (2012) state that a pilot study is a small- scale version or trial run designed to test the methods to 
be used in a larger, more rigorous study. Data from Pilot testing intervention can shed light on a number of 
things including the acceptability of the intervention to intended beneficiaries, intervention agent, the adequacy, 
comprehensiveness and clarity of intervention protocol, the appropriateness of the intervention, the extent to 
which intervention fidelity can be maintained, the rate of retention in intervention and safety of the intervention. 
The outcomes of Pilot study provide invaluable lessons that can inform subsequent efforts to generate valid 
evidence for nursing practice. 
Pilot study was conducted in the date 20 may, 2021 to check the feasibility and reliability of the study. It was 
conducted in the AP Jain Hospital of district Patiala, Punjab. The permission was taken from the SMO to 
conduct the pilot study. 10 sample were selected for pilot study. The study was conducted to assess the 
knowledge and practices regarding COPD prevention and management among staff nurses. At the end, study 
was feasible and practicable to conduct the main study.  
RELIABILITY OF TOOL:  
The reliability of an instrument is a major criterion for assessing its quality and adequacy. It is the ability of the 
data gathering device to obtain consistent result. 
Polit and Beck (2011) state that the reliability of an instrument is the degree of consistency with which it 
measures the attributes it is supposed to be measuring. 
The reliability of the tool was established by split half method. The tool was found to be highly reliable. 
Reliability of knowledge is 0.82 and practices is 0.94. 
  ∑(x-x) ∑(y-y) 
√∑(x-x)2∑(y-y)2 
The tool was found to be reliable after conducting pilot study. The reliability of knowledge is 0.82 and practices 
is 0.94, assessed through Karl Pearson’s Coefficient.  
ETHICAL CONSIDERATION: 
The main study was approved by the researcher and ethical committee. The written permission was taken from 
the Rajindra Hospital and the study subjects. The study subjects were explained about the objectives of the 
study, method of data collection and duration of study. The subjects were given the full autonomy to withdraw 
themselves from the study anytime. Confidentiality of subjects was maintained and data was used only for 
research purpose. This is the main part of the study that is to be kept in view. Confidentiality is main key to the 
conducting of study. 
PROCEDURE OF DATA COLLECTION:  
The main study was conducted after formal permission from the 10 June 2021 till 20 June 2021 and study 
subjects. The study was conducted on date 20 June 2021. The survey of the hospital was done to assess the 
knowledge and practices regarding COPD prevention and management among staff nurses of district Patiala.  
Questionnaireand checklist schedule were used to collect data. The subjects were assured anonymity and 
confidentiality of the information provided by them and informed by them and informed consent was obtained. 
As I need 100 samples, so I took 100 samples from selected hospital, Patiala. Whole data was filled by the 
sample itself. 
Target population of pilot study was at A.P Jain Hospital and during main study it was Rajindra Hospital, 
Patiala. This was done to prevent biasness and errors in result. Permission was taken from both the hospitals to 
keep the study in flow of order ad to reduce errors. A formal letter written permission was taken from our own 
principal of college to grant permission to conduct data collection.  
It took 10 days to collect data so as it was according to my convenience regarding time and also due to shifts of 
staff nurses and to reduce biasness to prevent similarity of same staff on next day too. 
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PLAN OF DATA ANALYSIS:  
Data analysis is the process of systematically applying statistical and logical techniques to describes and 
illustrate, condense and recap, and evaluate data. The investigator planned to analyses the data on the basis of the 
objectives and the assumptions of study. The obtained was analyzed in the following ways: 
1. Data was organized in the master data sheet. 
2. Analysis of data was done on the basis of objectives of the study. 
3. Computation of frequencies and percentage for the analysis of socio demographic variables. 
4. ANNOVA test was used to determine association between knowledge and practices regarding management 
and prevention of staff nurses, 
The data was analyzed by using the descriptive and inferential statistics such as frequency percentage and chi 
square. The level of significance chosen was P>0.05.  
SUMMARY: -  
This chapter deals with the research approach and research design, research setting, target population, sample 
and sampling technique, inclusion and exclusion criteria, selection and description of tool, validity of tool, pilot 
study, reliability of tool, ethical consideration, procedure of data collection, plan of data analysis of the study. 
There was no any other difficulty faced by the research except the timing problem of the researcher while 
collecting data. As it was very problematic for one to collect data of the sample who are on three different shifts 
(morning, evening and night). But anyhow, researcher collected the data overcoming those diificulties. 
4. ANALYSIS AND INTERPRETATION OF DATA 
Analysis and interpretation of data is the most important phase of research process, which involves the 
Computation of certain measures along with searching for patterns of relationship that exist among the data 
group. Data collection is followed by analysis and interpretation of data in accordance with study objectives.  
S.K SHARMA (2011) defines analysis as a process of systematically applying statistical and logical techniques 
to describe, summarize and compare data.  
OBJECTIVES 
1. To assess the knowledge regarding COPD prevention and management among staff nurses. 
2. To determine the practices of COPD prevention and management among staff nurses. 
3. To compare the knowledge and practices regarding COPD prevention and management among staff nurses. 
4. To find out the association of knowledge regarding COPD prevention and management with selected 
demographic variables among staff nurses. 
5. To provide pamphlet regarding COPD prevention and management among staff nurses. 
ORGANIZATION OF STUDY FINDINGS  
Section A: - Description of Demographic data. 
Section B:- Determination of practices of COPD prevention ad management among staff nurses.  
Section C: -Comparison of knowledge and practices regarding COPD prevention and management among staff 
nurses. 
Section D: -Association of knowledge regarding COPD prevention and management with selected demographic 
variables among staff nurses. 
SECTION A 
DESCRIPTION OF DEMOGRAPHIC DATA  
The section describes the demographic characteristics ofstaff nurses of selected hospital of district Patiala 
regarding management and practices of COPD under the study. The demographic characteristics are described in 
terms of Age, Gender, marital status, professional qualification or education, attended any COPD patient, 
previous rotation in respiratory wards, any experience. 
Frequency and percentage distribution of Demographic characteristics are computed for describing the sample 
characteristics. These findings are presented in table- 
  
 
 
 
 
 
 
 
 
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  N=100 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Data presented in Table 1 depicts the sample characteristics in frequency and percentage distribution of staff 
nurses that was age, gender, marital status, professional qualification, attended any COPD patient, previous 
rotation in respiratory wards, experience if any. 
According to age, 89% were in the age group of 22-30, 11% in the age group of 31-39 and (0%) in both 40-49 
and more than 50.  
According to gender, 88% were females and 12% were males. 
 According to marital status 76% were unmarried and 24% were married and (0%) were divorced and widowed.  
According to professional qualification or education, 65% were B.Sc. Nursing, 19% were GNM, 8% were Post 
Basic B.Sc. Nursing and 8% were M.Sc. Nursing.  
Regarding attended any COPD patient, 67% attended COPD patient and 33% did not attended any COPD 
patient.  
According to previous rotation in respiratory wards, 54%) have been previously rotation in respiratory wards and 
46% have not been previously rotation in respiratory wards. 
According to experience, 36% had experience for 2 years, 29% had experience for 1 year, 9% for 4 and 9% for 4 
or more. 
Sr. No. 
Demographical Variables 
Frequency % 
1 
AGE 
22-30 
89 
89 
31-39 
11 
11 
41-49 
0 
0 
50 and above 
0 
0 
2 
GENDER 
Male 
12 
12 
Female 
88 
88 
3 
MARITAL STATUS 
Married 
24 
24 
Unmarried 
76 
76 
Divorced 
0 
0 
Widowed 
4 
PROFESSIONAL QUALIFICATION OR EDUCATION 
GNM 
19 
19 
B.Sc. Nursing 
65 
65 
Post Basic B.Sc. Nursing 
8 
8 
M.Sc. Nursing 
8 
8 
5 
ATTENDED ANY COPD PATIENT 
Yes 
67 
67 
No 
33 
33 
6 
PREVIOUS ROTATION IN RESPIRATORY WARDS 
Yes 
54 
54 
No 
46 
46 
7 
EXPERIENCE IF ANY 
1 
29 
29 
2 
36 
36 
4 
9 
9 
4 or more 
9 
9 
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Fig. 1 Bar graph representing demographic variable age of staff nurses 
 
Fig. 2 Bar graph representing demographic variable gender of staff nurses 
 
Fig. 3 Bar graph representing demographic variable marital status of staff nurses 
 
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Fig. 4 Bar graph representing demographic variable education of staff nurses 
 
Fig. 5 Bar graph representing demographic variable attended any COPD patient of staff nurses 
 
Fig. 6 Bar graph representing demographic variable previous rotation in respiratory ward of staff 
nurses 
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Fig. 7 Bar graph representing demographic variable years of experience of staff nurses 
SECTION B 
DETERMINATION OF PRACTICES OF COPD PREVENTION AD MANAGEMENT AMONG STAFF 
NURSES 
The section describes the findings related to determination of practices of COPD prevention and management 
among staff nurses of selected hospital of district Patiala. One way ANOVA test was used to determine the 
practices among staff nurses. 
 N=100 
 
 
 
 
Table 2: Representing data of practices among sociodemographic variable i.e. age. 
The data presented in the table shows that socio-demographic variable age 22-30, total were 90, mean was 71.30, 
standard deviation was 28.206. Between age group 31-39, there were 8, mean was 68.00, standard deviation was 
39.652. between age group 41-49, there were 1 only, mean was 38.00 and standard deviation was 29.098. 
         N=100 
 
 
 
Table 3: Representing data of practices among sociodemographic variable i.e. gender. 
The data presented in the table shows that sociodemographic variable, gender, total number of males were 12, its 
mean was 66.50, standard deviation was 29.306. total number of females were 88, its mean was 71.28, standard 
deviation was 29.192.  
  N=100 
 
 
 
 
 
Table 4: Representing data of practices among sociodemographic variable i.e. marital status. 
The data presented in the table shows that sociodemographic variable, marital status, married were 25, its mean 
was 68.21, standard deviation was 20.705. unmarried were 75, its mean was 71.49, standard deviation was 
31.391. there were no divorced and widowed among 100 samples. 
Age 
n Mean 
SD 
22-30 
90 71.30 28.206 
31-39 
8 
68.00 39.652 
41-49 
1 
38.00 29.098 
50 and above 0 
0 
0 
GENDER n Mean 
SD 
Male 
12 66.50 29.306 
Female 
88 71.28 29.192 
MARITAL STATUS n Mean 
SD 
Married 
25 68.21 20.705 
Unmarried 
75 71.49 31.391 
Divorced 
0 
0 
0 
Widowed 
0 
0 
0 
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           N= 100  
 
 
 
 
Table 5: Representing data of practices among sociodemographic variable i.e. professional 
qualification or education 
The data presented in the table shows that the sociodemographic variable professional qualification or education. 
19 staff nurses were GNM qualified, mean was 69.84 and standard deviation was 32.796. 64 staff nurses were 
B.Sc. Nursing qualified, its mean was 75.60 and standard deviation was 29.567. 8 staff nurses were post basic 
B.Sc. Nursing qualified, its mean was 50.38, and standard deviation was 13.575. 9 staff nurses were M.Sc. 
Nursing qualified, its mean was 56.22 and standard deviation was 13.255. 
      N=100 
 
 
 
Table 6: Representing data of practices among sociodemographic variable i.e. attended any COPD 
patient. 
The data presented in the table shows that sociodemographic variable i.e. attended any COPD patient, staff 
nurses who attended COPD patient were 68, mean was 68.07, standard deviation was 28.143. Staff nurses who 
did not attended any COPD patient were 32, its mean was 76.19, standard deviation was 30.731.  
          N=100 
 
 
 
Table 7: representing the data of practices among sociodemographic variable i.e. previous rotation in 
respiratory wards. 
The data presented in the table shows that sociodemographic variable i.e. previous rotation in respiratory wards, 
there were total 60 staff nurses who previously rotated in respiratory wards, mean was 60.06 and standard 
deviation was 30.345. there were 40 staff nurses who did not previously rotated in respiratory wards, its mean 
was 58.87, standard deviation was 39.298. 
N=100  
 
 
 
 
 
Table 8: representing the data of practices among sociodemographic variable i.e. years of experience 
in respiratory wards. 
The data presented in the table shows that socio demographic variable i.e. years of experience in respiratory 
wards, staff nurses who had 1 year of experience were 35, its mean was 63.45, standard deviation was to 9.123. 
Staff nurses who had 2 years of experience were 44, its mean was 62.32 and standard deviation was 12.362. 
Staff nurses who had 3 years of experience were 44, its mean was 69.12 and standard deviation was 7.731. Staff 
nurses who had 4 years of experience or more were 11, its mean was 65.21 and standard deviation was 8.186. 
SECTION C 
COMPARISON OF KNOWLEDGE AND PRACTICES REGARDING COPD PREVENTION AND 
MANAGEMENT AMONG STAFF NURSES. 
This section describes the Comparison of knowledge and practices regarding COPD prevention and management 
among staff nurses of selected hospital of district Patiala. 
PROFESSIONAL QUALIFICATION OR EDUCATION n Mean 
SD 
GNM 
19 69.84 32.796 
B.Sc. nursing 
64 75.60 29.567 
Post basic B.Sc. nursing 
8 
50.38 13.575 
M.Sc. Nursing 
9 
56.22 13.255 
ATTENDED ANY COPD PATIENT n Mean 
SD 
Yes 
68 68.07 28.143 
No 
32 76.19 30.731 
PREVIOUS ROTATION IN RESPIRATORY WARDS N Mean 
SD 
Yes 
60 60.06 30.345 
No 
40 58.87 39.298 
YEARS OF EXPERENCE IN RESPIRATORY WARDS N Mean 
SD 
1 
35 63.45 
9.123 
2 
44 62.32 12.362 
3 
10 69.12 
7.731 
4 or more 
11 65.21 
8.186 
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Frequency and percentage distribution of criteria measurement to assess the knowledge and practices of staff 
nurses is computed for describing sample characteristics. The findings are present in Table 2 
Objective 1: -To assess the level of knowledge among staff nurses of selected hospital of district Patiala. 
  
 
 
 
 
 
 
 
 
 
  N=100 
Level of Knowledge Frequency(f) Percentage (%) 
Excellent 
5 
5% 
Good 
86 
86% 
Average 
9 
9% 
Below average 
0 
0% 
Table 9: Level of knowledge among Staff nurses 
Objective 2: - To assess the level of practices among staff nurses of selected hospital of district Patiala. 
N=100 
Checklist 
Frequency(f) Percentage (%) 
Good practice 
93 
93% 
Poor skills 
7 
7% 
Table10: Level of practices among staff nurses 
Table 2 Illustrate that out of 100 staff nurses 5% have excellent knowledge regarding COPD, 86% have good 
knowledge, 9% have average knowledge and 0% have below average regarding COPD management. 
Table 3 depicts that 93% staff nurses have good practicing skills and 7% have poor skills regarding management 
and practices of COPD. 
0
10
20
30
40
50
60
70
80
90
100
Excellent
Good
Average
Below Average
Level of Knowledge
 
Fig: 8 showing levels of knowledge 
0
10
20
30
40
50
60
70
80
90
100
good practices
poor skills
 
Fig 9: showing level of practices 
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     N=100 
 
 
Table 11: Showing Descriptive Statistics 
 
Fig:10 Showing Descriptive Statisctics 
Table 4 and Fig:12 showing Descriptive Statistics. This showed that median score was 65.0 followed by mean 
score was 64.64, Moreover, S.D score was only 9.853. 
 
n mean Standard deviation Standard error mean 
Total of practices 
100 71.23 
29.437 
2.944 
Total of knowledge 100 64.64 
9.853 
0.985 
Table 12: showing one sample statistics 
Table 5 shows one sample statistics. Mean of knowledge was 64.64 and mean of practice is 71.23. 
Test value = 0 
 
t 
df Sig. (2-tailed) Mean difference 
95% confidence interval 
of the difference 
lower 
upper 
Total of practices 
24.197 99 
0.000 
71.230 
65.39 
77.07 
Total of knowledge 65.605 99 
0.000 
64.640 
62.68 
66.60 
Table 13: showing one sample test 
Table 6 depicts one sample test (the mean difference between both knowledge and practices) by applying t test 
formula. Mean difference of practice is 71.230 and knowledge is 64.640. T test value for practice is 24.197 and t 
test for knowledge is 65.605. 
SECTION D ASSOCIATION OF KNOWLEDGE WITH SELECTED DEMOGRAPHIC VARIABLES. 
This section deals with the findings related to association between the knowledge with selected demographic 
variables. The One-Way ANOVA test was used to determine the association between the level of knowledge 
with selected demographic variables. The One-Way ANOVA values showing the association between level of 
knowledge with their demographic variables of Staff nurses. 
Objective 1: To find out the association between knowledge with their selected demographic variables. 
          N=100 
 
 
 
 
Table No 14: Represent Association between age and knowledge among the staff nurses 
Descriptive Statistics Mean Median S. D Maximum Minimum Range 
Knowledge 
64.64 
65.0 
9.853 
103 
34 
69 
Age 
n Mean 
SD 
df 
F 
22-30 
90 64.82 
9.761 96 
(0.704)* 
31-39 
8 
62.00 12.306 
 
41-49 
1 
68.00 
9.908 
 
50 and above 0 
0 
0 
 
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The data presented in the table 7 shows that socio-demographic variable age 22-30, total were 90, mean was 
64.82, standard deviation was 9.761. Between age group 31-39, there were 8, mean was 62-00, standard 
deviation was 12.306. between age group 41-49, there were 1 only, mean was 68.00 and standard deviation was 
9.908. Age group 50 and above, there were 0. The degree of freedom of socio demographic variable age was 96. 
The sample of 100 staff nurses in which the association between demographic variable of age and knowledge is 
significant by 0.704.  
      N= 100 
 
 
 
Table No 15: Represent Association between gender and knowledge among the staff nurses. 
The data presented in the table 8 shows that sociodemographic variable, gender, total number of males were 12, 
its mean was 65.17, standard deviation was 11.519. total number of females were 88, its mean was 64.55, 
standard deviation was 9.732. The degree of freedom of sociodemographic variable gender was 97. The sample 
of 100 staff nurses in which the association between demographic variable of gender and knowledge is 
significant by 0.863. 
                    
 
 
 
 
  N=100 
 
 
 
 
 
Table No 16: Represent Association between marital status and knowledge among the staff nurses. 
The data presented in the table 9 shows that sociodemographic variable, marital status, married were 25, its 
mean was 60.42, standard deviation was 10.073. unmarried were 75, its mean was 65.97, standard deviation was 
9.525. there were no divorced and widowed among 100 samples. The degree of freedom of socio demographic 
variable marital status was 97.The sample of 100 staff nurses in which the association between demographic 
variable of marital and knowledge is not significant by 0.627. 
    N= 100 
Table No 17: Represent Association between professional qualification or education and knowledge 
among the staff nurses. 
The data presented in the table 10 shows that the sociodemographic variable professional qualification or 
education. 19 staff nurses were GNM qualified, mean was 65.89 and standard deviation was 7.564. 64 staff 
nurses were B.Sc. Nursing qualified, its mean was 64.03 and standard deviation was 10.374. 8 staff nurses were 
post basic B.Sc. Nursing qualified, its mean was 63.63, and standard deviation was 13.742. 9 staff nurses were 
M.Sc. Nursing qualified, its mean was 67.89 and standard deviation was 7.114. the degree of freedom of socio 
demographic variable professional Qualification or education was 95. The sample of 100 staff nurses in which 
the association between demographic variable of professional qualification and knowledge is significant by 
0.627. 
  
 
 
 
 
 
 
      N=100 
 
 
Table No 18: Represent Association between attended any COPD patient and knowledge among the 
staff nurses. 
GENDER n Mean 
SD Df 
F 
Male 
12 65.17 11.519 97 
(0.863)* 
Female 
88 64.55 
9.732 
 
MARITAL STATUS n Mean 
SD DF 
F 
Married 
25 60.42 10.073 97 
NS 
(0.022) 
Unmarried 
75 65.97 
9.525 
 
Divorced 
0 
0 
0 
 
 
 
 
Widowed 
0 
0 
0 
 
PROFESSIONAL QUALIFICATION OR EDUCATION n Mean 
SD 
df 
F 
GNM 
19 65.89 
7.564 
95 (0.627)* 
B.Sc. nursing 
64 64.03 10.374 
Post basic B.Sc. nursing 
8 
62.63 13.742 
 
M.Sc. Nursing 
9 
67.89 
7.114 
 
 
ATTENDED ANY COPD PATIENT n Mean 
SD 
df 
F 
Yes 
68 65.13 
7.750 97 
(0.542)* 
No 
32 63.56 13.431 
 
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The data presented in the table 11 shows that sociodemographic variable i.e. attended any COPD patient, staff 
nurses who attended COPD patient were 68, mean was 65.13, standard deviation was 7.750. Staff nurses who 
did not attended any COPD patient were 32, its mean was 63.56, standard deviation was 13.431. The degree of 
freedom of socio demographic variable i.e. attended any COPD patient is 97. The sample of 100 staff nurses in 
which the association between demographic variable of attended any COPD patient and knowledge is significant 
by 0.542. 
 N=100 
Table No 19: Represent Association between previous rotation in respiratory wards and knowledge 
among the staff nurses. 
The data presented in the table 12 shows that sociodemographic variable i.e. previous rotation in respiratory 
wards, there were total 60 staff nurses who previously rotated in respiratory wards, mean was 65.35 and standard 
deviation was 9.433. there were 40 staff nurses who did not previously rotated in respiratory wards, its mean was 
63.58, standard deviation was 10.843. The degree of freedom of sociodemographic variable i.e. previous rotation 
in respiratory wards is 98. The sample of 100 staff nurses in which the association between demographic 
variable of previous rotation in respiratory wards and knowledge is not significant by 0.391. 
    N=100 
Table No 20: Represent Association between years of experience in respiratory wards and knowledge 
among the staff nurses. 
The data presented in the table 13 shows that socio demographic variable i.e. years of experience in respiratory 
wards, staff nurses who had 1 year of experience were 35, its mean was 62.74, standard deviation was to 8.856. 
Staff nurses who had 2 years of experience were 44, its mean was 65.27 and standard deviation was 11.382. 
Staff nurses who had 3 years of experience were 44, its mean was 65.27 and standard deviation was 8.731. Staff 
nurses who had 4 years of experience or more were 11, its mean was 68.45 and standard deviation was 6.186. 
The degree of freedom was 96. The sample of 100 staff nurses in which the association between demographic 
variable of years of experience in respiratory wards and knowledge is not significant by 0.267. 
SUMMARY 
This chapter deals with the frequency and percentage 
table and graphs representing the Knowledge with 
selected demographic variables of staff nurses 
working in Rajindra Hospital, Patiala,Punjab. A One-
Way ANOVA test was done to determine the 
association between knowledge with their selected 
Demographic variables. This chapter shows that how 
many socio-demographic variable are significant and 
how many are non-significant. It also shows 
comparison of knowledge and practices. All the data 
of this chapter is further compared with review of 
literature in next chapter. It shows graphical 
representation of all data. It includes many tables and 
graphs which shows simplified data of total sample of 
staff nurses i.e 100. 
5. DISCUSSION 
In this section, the investigator discussed the results 
of the study, the results and discussion of the study ae 
the research opportunity to examine the methods and 
analysis. 
The findings of the study have been discussed in 
accordance with the objectives of research and 
literature reviewed. 
OBJECTIVE 1: To assess the knowledge 
regarding COPD prevention and management 
among staff nurses. It was found that the selected 
staff nurses in selected hospital were 100. Level of 
knowledge was calculated in the form of excellent, 
good, average, below average. 5% staff nurses were 
excellent, 86% were good, 9% were at average and 
0% at below average. The above findings were in 
compliance with the findings of GöktalayTuğba, 
Tuncal Ayşe Nur., et al.,36 [2015] who conducted a 
cross-sectional study to determine knowledge level of 
the health care providers about COPD and PR in 
Manisa city. 65.5% of the health care providers 
PREVIOUS ROTATION IN RESPIRATORY WARDS N Mean 
SD 
df 
F 
Yes 
60 65.35 
9.433 98 
NS 
(0.391) 
No 
40 63.58 10.843 
 
YEARS OF EXPERENCE IN RESPIRATORY WARDS N Mean 
SD 
df 
F 
1 
35 62.74 
8.856 96 
NS 
(0.267) 
2 
44 65.27 11.382 
 
3 
10 64.30 
8.731 
 
4 or more 
11 68.45 
6.186 
 
 
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responded to the survey. Rate of those correctly 
knowing at least one of four items was 97.2%. No 
responder knew all items correctly. Average value for 
correct answers was 5.30 ± 2.1 (range; 1-10).  
OBJECTIVE 2: To determine the practices of 
COPD prevention and management among staff 
nurses.It was found that practices of COPD 
prevention and management among staff nurses was 
divided among good practices and poor skills. 7% had 
good skills and 93% had poor skills. The above 
findings were in compliance with the findings of 
Mayhob Mona Mohamed [2018]26 conducted a 
descriptive study to assess nurses knowledge, 
practices and barriers affecting a safe administration 
of oxygen therapy.18% had adequate practices, 40% 
had average practices and 42% had inadequate 
practices.  
OBJECTIVE 3: To compare knowledge and 
practices regarding COPD prevention and 
management with selected demographic variables 
among staff nurses.It was found that comparison of 
knowledge and practices regarding COPD prevention 
and management with selected demographic 
variables.Total of practices and total of knowledge 
were compared. Mean of practices was 61.23, 
standard deviation was 29.437 and mean of 
knowledge was 64.64, standard deviation was 9.853. t 
score of practices was 24.197 and knowledge was 
65.605. Good practice skills were 93% and poor skills 
were 7%. The above findings were in compliance 
with the findings of MahranGhada, Radwan Marwan., 
et al., [2018]20 conducted a comparative study of 
critical nurses’ knowledge and practice before and 
after education program about acute exacerbation of 
COPD in Egypt. The aim of this study is to evaluate 
nurses’ knowledge and practice before and after 
education program about AECOPD. 60 nurses were 
divided into two groups (30 registered nurses and 30 
internship nurses). Before the education program both 
groups had lower knowledge about AECOPD as 
clinical 
manifestations, 
diagnosis, 
nursing 
management and rehabilitation. But after the 
education program, internship nurses had higher 
knowledge about previous mentioned items (83.33%), 
(93.33%) and (80%) than registered nurses (26.66%), 
(66.66%) and (66.66%). Also patients assigned to the 
internship nurses group after the education program 
had lower dyspnoea level (0.87 + 0.97) than those 
assigned nurses’ group (1.67 + 1.24) which means 
higher performance of internship nurses than 
registered nurses. CCN’s and internship needs 
continuing education and training about the various 
critical cases as AECOPD to strengthen their role to 
plan and deliver more strategies to improve the 
quality of life of AECOPD patients. 
OBJECTIVE 4: To find out the association of 
knowledge regarding COPD prevention and 
management with selected demographic variables 
among staff nurses. It was found that association of 
knowledge 
regarding COPD prevention and 
management with selected demographic variables. 
The selected demographic variables age, gender, 
professional qualification, attended any COPD patient 
were having significant relationship whereas marital 
status, previous rotation in respiratory wards, years of 
experience in respiratory wards were having non 
significant relationship.The above findings were in 
compliance with the findings of Catherine A 
O'Donnell, Hussein Jabareen, et al., [2010] conducted 
a cross sectional survey to identify workload, career 
intentions and the impact of professional isolation 
among practice nurses. Isolated nurses worked in 
practices with smaller list sizes (p = 0.024) and 
nursing teams (p = 0.003); were less likely to have 
someone they could discuss a clinical/professional (p 
= 0.002) or personal (p < 0.001) problem with; used 
their training and qualifications less (p < 0.001); had 
less productive appraisals (p < 0.001); and were less 
likely to intend staying in practice nursing (p = 
0.009).  
SUMMARY: 
This chapter includes comparison and discussion of 
our study with respect to review of literature that we 
have collected in our study. So, researcher have 
compared his study with other studies which were 
closely related to each other. 
6. SUMMARY, CONCLUSION, IMPLICATION 
AND RECOMMENDATIONS 
The chapter gives a brief account of the study 
including conclusion drawn from the findings, 
limitations of 
the 
study and 
implications, 
recommendations for future research. 
SUMMARY 
The study was conducted to assess the knowledge and 
practices 
regarding COPD prevention 
and 
management among staff nurses in selected hospital 
of district Patiala. 
The knowledge and practices regarding COPD 
prevention and management among staff nurses was 
assessed by doing the survey of Rajindra Hospital, 
Patiala. Data was collected through self structured 
questionnaire and checklist tool. 100 samples were 
selected by the convenient sampling technique. 5% 
staff nurses were excellent, 86% were good, 9% were 
at average and 0% at below average. 93% had good 
skills and 7% had poor skills. 
 
International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 
@ IJTSRD   |   Unique Paper ID – IJTSRD47623   |   Volume – 5   |   Issue – 6   |   Sep-Oct 2021 
Page 1412 
CONCLUSION 
The study findings revealed that knowledge and 
practices of COPD prevention and management 
among staff nurses of district Patiala. 86% were 
having good knowledge and 93% were having good 
practices. It concluded that most of the nurses have 
good knowledge but with poor practices. 
Among all socio demographic variables, the selected 
demographic variables age, gender, professional 
qualification, attended any COPD patient were having 
significant relationship whereas marital status, 
previous rotation in respiratory wards, years of 
experience in respiratory wards were having non 
significant relationship. 
IMPLICATIONS 
The findings of the study have implications in the 
various fields of nursing. The dissemination of 
knowledge will take place when the research findings 
will be used in following fields: 
A. Nursing practice 
B. Nursing education 
C. Nursing administration 
D. Nursing research 
NURSING PRACTICE 
This study has been based on practical skills of staff 
nurses regarding COPD prevention and management 
among staff nurses. Research is great example of 
improving practical skills among staff nurses and 
strengthening their knowledge. 
Nurses are in strategic position to assess knowledge 
and practices of COPD among staff nurses. in people. 
Nursing staff and community health nurse can use the 
study in the following ways: 
 Can check knowledge among staff nurses 
regarding COPD prevention and management. 
 Can check practices among staff nursing 
regarding COPD prevention and management.  
 Can check knowledge and practices among staff 
nurses 
regarding COPD prevention and 
management. 
NURSING EDUCATION 
Education is a key component in improving the 
knowledge of an individual. The right method of 
education with an opportunity to practice and apply 
what has been taught is essential, “quality care 
through excellence in advance nursing education” is 
just about to meet the increasing demand of good 
quality of nursing. 
Education is an integral part of the governance 
agenda, which includes education research and 
development and open ness. The nursing education 
programme 
is 
essential 
such as 
seminars, 
demonstrations, 
remonstrations 
to update 
the 
knowledge as well as skills of the nursing students so 
as to provide standard and quality nursing care this 
study has provided the important of improving the 
knowledge of nursing student regarding COPD. 
One of the leading functions of nursing is imparting 
education, with newer knowledge; the scope of 
education also increases. Nursing educator should get 
the benefit of the study:- 
 To include them in their class on teaching to 
enhance the knowledge of student. 
  In community, there is the need to plan the 
education programs according to level of 
understanding of the beneficiaries. 
 To plan the awareness camps as well as classroom 
teaching to incorporate in the content of health 
education. 
NURSING ADMINISTRATION 
In the era of knowledge explosion and technological 
changes nursing has become a complex discipline 
with a rapidly with a rapidly growing body of 
knowledge. Continuing education is a lifelong 
process. It enable the learner to keep a changes in the 
field of speciality. Nursing administration are the key 
to plan, organize and conduct in service education, 
programme to nursing personnel.  
Nurse as an administrator has a crucial role in 
planning the policies of imparting health information 
to the patients. Nursing administration must see that a 
separate budget should be allocated for in service 
education in the nursing department.  
 The nursing administration faces a challenging 
role in these days. The nurse needs to know the 
recent developments, the new method and 
technologies getting in touch with the new 
findings will strengthen her/his self position and 
self confidence 
  Nursing administration should anticipate need of 
the time and community health nurses should 
disseminate knowledge to the adults and family 
regarding the low back pain. 
 Nurses who are in administrative role like District 
Public health nurse should implement and 
organize planned teaching program on low back 
pain in the hospital and community settings. 
NURSING RESEARCH 
Research can help increase the body of the nursing 
knowledge which improves the care provided. 
Although actual performance is important, use of 
observation to explore nurse performance is limited is 
in clinical setting and potential of observation in 
research in this nature has yet to be fully exploited. A 
study reported that an improvement in knowledge 
after the end of the course. After the laps of six 
months when tested at a refresher course, the