Fatigue in people with chronic obstructive pulmonary disease: development of an assessment tool.

AIM: To develop a tool that would allow a fatigue assessment for chronic obstructive pulmonary disease patients that nurses could use irrespective of the level of response available from the patient. BACKGROUND: It is important that nurses are able to undertake a full assessment of chronic obstructive pulmonary disease patients before determining care. However, no suitable tools are available to assess fatigue in patients that are acutely unwell and dyspnoeic with difficulty speaking. DESIGN AND METHOD: Qualitative research methods were used to allow new areas of knowledge to be explored and to gain fresh perspectives on care. Participants were identified using snowball sampling amongst experienced nurses who regularly cared for patients with chronic obstructive pulmonary disease. The interview schedule was developed using defining attributes of fatigue according to the literature. RESULTS: Two pilot and nine main semi-structured interviews were conducted which were tape recorded and transcribed. Data analysis used techniques of content analysis which took into account a three stage analysis; data reduction, data display and conclusion drawing. Four main themes emerged; interest in surroundings, physical capacity, personality and mental state and physical appearance. The themes and categories from the analysis were used to develop the fatigue tool. CONCLUSIONS: Nurses caring for chronic obstructive pulmonary disease patients should be able to assess for the presence, characteristics, severity and effects of fatigue and require assistance to differentiate it from other symptoms. The first stage in the development of a tool to achieve this has been completed. RELEVANCE TO CLINICAL PRACTICE: The fatigue tool is intended to be used by nurses to assess fatigue levels either in conjunction with the patient and as a vehicle for discussion about how they feel and experience fatigue, or through observation of the patient. Assessment can therefore be undertaken even when the patient may be too ill to respond verbally.