Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD

Aim: The aim of this paper is to highlight evidence and key nursing practice, education, organization and policy recommendations from the original and revised Registered Nurses’ Association of Ontario Best Practice Guideline, Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD). This paper introduces the notion of dyspnea as the sixth vital sign and presents evidence from the RNAO Best Practice Guideline and other relevant literature to support and enhance nursing care of dyspnea in clients with COPD. Background: COPD is an increasingly serious health issue. Nurses have significant opportunity to positively influence client outcomes and quality of life by assessing dyspnea, identifying problems, and applying appropriate evidence-based interventions. Best practice guidelines developed by the RNAO provide a framework to enhance nursing practice and client care. Design: A panel of nurses was assembled for the initial development of the guideline and more recently, the revision to the original guideline. Method: A structured evidence review based on the scope of the original guideline and supported by three clinical questions was conducted to capture the relevant literature and guidelines published since the original publication. Results: As a result of this work recommendations for nursing practice and education are discussed. Organizational and policy recommendations are also outlined. Conclusions: Nurses have opportunity to positively influence client outcomes and quality of life by assessing dyspnea, identifying problems, and applying appropriate evidence-based interventions. Relevance to Clinical Practice: Recommendations made in the best practice guideline will enhance nursing care of dyspnea in clients with COPD and dyspnea should be recognized as the sixth vital sign in individuals with COPD.