Pre‐procedure

ActionRationale

1. 1.Show
   Introduce self to patient and carers.
   To establish professional and clinical rapport and comply with professional codes of conduct (NMC [202], C).
2. 2.Show
   Gain consent from the patient to assess their medical and psychosocial history.
   To understand the background for the presentation and any treatments undergone to treat the reversible causes of breathlessness. E
3. 3.Show
   Carry out an assessment of breathlessness including taking a measure of breathlessness at baseline (e.g. visual analogue scale, VAS, or numerical rating scale, NRS [Figure 27.25]) and a subjective descriptor from the patient if indicated.
   To obtain a baseline objective and subjective assessment of breathlessness to measure change against (Booth et al. [19], R).
4. 4.Show
   Discuss the use of the handheld fan. Explain and discuss the procedure with the patient.
   To ensure that a trial of the intervention is acceptable and could be effective for the patient and that they understand the procedure and give their valid written consent (NMC [199], C).
5. 5.Show
   Gain agreement to discontinue the intervention if it is not found to be clinically effective on that day.
   To ensure that the patient is not left with equipment of no benefit. E
6. 6.Show
   Introduce the basic principles of resting positions as shown in Figure 27.26.
   To promote an energy‐efficient position for the duration of the intervention (Galbraith et al. [109], R).

Procedure

1. 7.Show
   Introduce the handheld device and regulate the speed and direction so that a flow is directed against the patient's face at the level of the cheek.
   To stimulate the area innervated by the second and third branches of the trigeminal nerve (Galbraith et al. [109], R).
2. 8.Show
   Ask the patient what they felt the effect of the intervention was and record the measure of breathlessness again (e.g. VAS or NRS).
   To establish any clinical effect due to the intervention (Galbraith et al. [109], R).
3. 9.Show
   If the fan was thought to be effective by the patient subjectively or objectively and they want to continue to use the intervention, teach them how to place the fan for best effect.
   To enable the patient to continue the intervention as a tool to self‐manage their breathlessness as they require on exercise or at rest (Booth et al. [19], R; Galbraith et al. [109], R).
4. 10.Show
   Leave written instructions and teach any family or carers to use the device.
   To provide ownership of the sessions to patients and their carers and enable ongoing practice (Schneiders et al. [250], C).
5. 11.Show
   If the intervention was not subjectively or objectively effective for the patient, discuss this with the patient and gain agreement to discontinue the intervention.
   In order not to increase any treatment burden for the patient or their carers. E

Post‐procedure

1. 12.Show
   Document the intervention and its effect in the patient record.
   Legal requirement of professional body and employing institution (NMC [202], E).
2. 13.Show
   Review of the session as per procedure after an agreed interval to modify or discontinue the intervention as required.
   To enable informed expert review and modification of the intervention as required. E