The effect of pulmonary rehabilitation program on self-efficacy and severity of symptoms among patients with chronic obstructive pulmonary disease

intervention group recieve pulmonary rehabilitation program. One of the Researchers instructed the pulmonary rehabilitation program to the experimental group. Educational session was held in single day and 3 part of 30 minutes. One part abut self care education, second about breathing techniques and last was exercise. Each time, patients feel tired the researcher renews practices after a period of rest. Pulmonary rehabilitation program included self care and self management education, nutrition recommendations, stress reduction methods (deep breathing, exercises, visual imagery, and progressive muscle relaxation), effective cough, breathing exercises (deep breathing, pursed lip breathing and diaphragmatic breathing), control of breathing in crucial situations, and muscle stretching exercises. In order to develop opportunities for enactive vicarious experience, researcher had performed Breathing exercises and muscle stretching exercises as a successful model and then asked patient to perform in front of her. Accuracy of learning checked and corrected by researcher in class. Then patients were asked to perform exercise at home for 20 minutes 3 times a week for 7 week. Stretch muscle exercise program consisted 3 parts of warming, exercise, and cooling that had been accomplished morning and 1.30 hour after breakfast. Time of exercise gradually increased from base of 5 minutes to 20 minutes by adding 3 minutes per week. Also, patients were asked to perform breathing exercises three to four times a day and along with exercises. The usage of Respiratory exercise, muscle stretching exercises, effective cough, stress reduction methods and nutritional recommendations was checked by phone and record on usage checklists by patients and researchers separately. All of educational components with instruction of pulmonary rehabilitation program gathered in booklets which content were validated by 3 nursing experts and delivered to patient after educational sessions. We developed the pulmonary rehabilitation program base on Bandura’s theory of self efficacy. So the program included components to develop the four sources of self-efficacy: 1- Mastery experiences: pulmonary rehabilitation program was accessible. Main goal for all patients was successful performance of pulmonary rehabilitation program. We increased the intensity of program gradually and fallowed patients by phone and answered to their questions. Hence attainment to mastery experience was predictable), 2- Verbal persuasion (telephone follow up intervention was conducted by researcher to reinforcement and assure the patient that they can do activities successful gradually), 3-Vicarious experiences (researcher modeled breathing and Stretch muscle exercises), and 4- Emotional arousal (we instructed patients about stress reduction methods, dyspnea management strategy, effective cough and exercise). Telephone follow-up program provided according to self efficacy Bandura's theory and performed weekly for 7 week. Each telephone call lasted an average 15 minutes and consisted 4 parts: health behaviors assessment, reinforcement of education, answers to the patient questions and encourage patients to continue the performance. If there was non-adherence, the situation was analyzed and helps the patient to solve their problems. Data were collected at baseline and after 7 week of intervention and analyzed.