Ask an answerable question (PICO)：
Chronic Obstructive Pulmonary Disease (COPD) is an irreversible obstruction of the respiratory tract. The main symptom is dyspnea. Patients often suffer from physical and mental torture due to the symptoms, which directly affects the quality of life. Dyspnea is a conscious subjective feeling. The human face has an upper respiratory tract receiver, which is mainly dominated by the trigeminal nerve. If you use cold air on the face, it can reduce the intensity of dyspnea and reduce respiratory discomfort (Schwartzstein, 2019). In addition to drug therapy, dyspnea can be relieved if non-medical intervention strategies can be used to provide patients with sufficient airflow based on the knowledge of respiratory physiology, thereby relieving the feeling of dyspnea. An empirical method is used to explore the effect of fans on dyspnea by attempting to provide better airflow.
The Method and Analysis of Literature Review：
By forming an answerable clinical question based on empirical nursing steps and using "PICO" keywords P: Pulmonary Disease Chronic Obstructive, I: Fan Therapy, O: Aware Dyspnea, use MeSH term to search for synonyms on PubMed, Embase, Airiti Library, Taiwan Ph.D. Dissertation System, Cochrane Library, limited to people and SR of RCTs, in the English language. Initially, 123 articles were searched, 28 duplicate articles were deleted, and 82 articles were excluded for not matching the topic. After reading the abstract sections and deleting the study design nonconformities, 2 systematic reviews were remaining.
Critical Appraisal：
CASP Checklist: 10 questions of a Systematic Review review tool to critically review the literature. According to the Oxford Centre’s (2011) research on the level of evidence strength, these two articles are Level 2 and Level 1. The GRADE scoring system is used for evaluation. Deviation evaluation, due to the following reasons: fan intervention unable to be randomized and blinded, different time and methods of fan use, and different measurement indicators resulted in the selection bias being high and rated as low to medium. The literature results show that a fan blowing on the face for 5 minutes can alleviate the patient's conscious breathing difficulties. However, the number of integrated studies are small, and the quality of the evaluation evidence is "medium". The strategy is effective and risk-free.
Clinical Application of Evidence：
According to the literature review results, the intervention measures were proposed to provide a handheld electric fan for patients to blow on their face for 5 minutes. The wind speed and distance are not limited, and the intervention time is when the patient complains of dyspnea. The measurement index is the dyspnea digital score scale (NRS). After the patient uses the fan for 5 minutes, measure the NRS phase. If the score is lower than the first evaluation, the handheld fan can be used continuously. If the NRS score increased, the routine treatment should be performed instead.
Evaluation of Effectiveness：
During the implementation period, 15 cases were performed and collected over a total of 3 weeks. The NRS decreased from 5.33 points, before the intervention, to 2.80 points after the intervention, showing that the fan blowing the face has a significant effect on alleviating conscious breathing difficulties. The overall satisfaction with improvement in dyspnea was 94.4%, with good satisfaction.
Conclusions and Recommendations：
Patients with Chronic Obstructive Pulmonary Disease can use a fan to blow their face to alleviate feelings of breathing difficulties. The fan strategy is a safe and economical measure as it poses no harm nor special safety issues and is an extremely effective way to reduce anxiety thus increasing physical activity. It is one of the feasible strategies to improve patient comfort and quality of life.
