Results support the use of a community-screening program to identify and help modify risk factors for COPD. IMPLICATIONS FOR NURSING PRACTICES: This project provides an example of how a clinical nurse specialist (CNS) can exercise all the spheres of CNS influence: the patient/client sphere, the nursing personnel sphere, and the organization sphere. In addition, the COPD screening project demonstrated how a CNS can successfully lead and direct a community initiative and influence others in changing behavior to enhance their state of health.

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One hundred forty-six trauma patients discharged from an acute care setting to home were followed during a 6-month period after discharge to determine functional problems they experienced and the time required to return to normal activity levels. At 1 week, 58% were unable to drive a care, 59% experienced difficulty with lifting, and 76% were unable to return to work. At 1 month, 27% continued to have trouble driving, 32% had trouble lifting, and 37% had not returned to work yet. Head injury patients and those with orthopedic injuries of the extremities or pelvis experienced problems returning to work. The head injury group also experienced vocational problems. By 6 months, 89% of the patients reported a return to normal activities. Findings suggest that a return to normal functioning level is a long-term process, and that certain injury types are at high risk for experiencing specific identifiable problems.

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