**6. Changes in personal effectiveness**

Leidy & Haase (1999) noted physical effectiveness as a core component of personal integrity that is challenged in COPD. Effectiveness is expressed as 'being able'; the body's predictability in doing what we expect or desire it to do. In sharp contrast, the failing body in COPD is nothing like what is presumed for, or wished of the body (Nicolson & Anderson, 2003). Physical effectiveness is just as much an interpersonal process that includes doing for others, as well as for one's self. This notion of contribution is an important one to most wellsocialised adults. When the ability to contribute is lost to ineffectiveness and dependence, then people feel shame, self-blame and perceive the blame of others (Lindqvist & Hallberg, 2010, Barnett, 2004).

COPD symptoms often begin during a person's productive, working life. For many, there is an assumed level of physical adeptness and a physical and aesthetic appearance that has constituted their body as it is known to themselves in its predictability, and known to others in its apparent wholeness and application to visible tasks. Even though women are long established in the workforce, men still tend to perceive themselves as 'the breadwinner' and this forms an important part of their self-concept that becomes threatened in chronic illness. For men, heavier household tasks such as mowing lawns and managing gardens are frequently tied to their own and their family's perception of them in their gendered roles. Mary recalled of her husband Keith, *"…because he's always been the really strong one… He did marvellous things around the house… He doesn't do anything now… He can't, he gets too breathless. … and he's very conscious of this and it upsets him.*"(Gullick, 2008).

For men, these heavier tasks are eventually taken over by another family member, or by paid help. For women with COPD, there tends to be a sense of ownership and obligation towards housework, and they will tolerate significant symptoms to retain these duties. As the disease progresses there are often visible changes such as development of the classic 'barrel chest', significant weight loss and for some, facial and postural changes from

Breathlessness requires the person with COPD to consider the task, the steps they need to go through to undertake it and their particular physical effectiveness on that day. They may need to research how far they have to walk, whether there may be stairs and whether a toilet is close. People need to allow more time in order to avoid having to rush or keep up. The use of oxygen bottles takes considerable planning in relation to the cylinder's duration and portability. Even just walking from one room to the next may require rest stops. Patricia (63 yrs) lamented, *"Coming out to the lounge room where the nebuliser is, opening the blinds and curtains, then sitting down to get on my nebuliser. I have to stop about five times just doing that".*

Attending to day-to-day activities means pacing the body and spacing out activities that tax the body's breathing. Pacing of movement and activities with frequent breaks and aligning activities into sequential rather than combined tasks allows the person to recover their breathing along the way. Because of the daily variability in symptoms, people may need to take on a flexible approach to assessing, on the day, outings they have planned in advance (Barnett, 2004). Those who adjust most effectively to their bodily restrictions *listen* to their body, plan, pace, prioritise and balance their activity with capacity on that day, and try hard to achieve a certain level of contribution within realistic parameters (Lindqvist & Hallberg,

Leidy & Haase (1999) noted physical effectiveness as a core component of personal integrity that is challenged in COPD. Effectiveness is expressed as 'being able'; the body's predictability in doing what we expect or desire it to do. In sharp contrast, the failing body in COPD is nothing like what is presumed for, or wished of the body (Nicolson & Anderson, 2003). Physical effectiveness is just as much an interpersonal process that includes doing for others, as well as for one's self. This notion of contribution is an important one to most wellsocialised adults. When the ability to contribute is lost to ineffectiveness and dependence, then people feel shame, self-blame and perceive the blame of others (Lindqvist & Hallberg,

COPD symptoms often begin during a person's productive, working life. For many, there is an assumed level of physical adeptness and a physical and aesthetic appearance that has constituted their body as it is known to themselves in its predictability, and known to others in its apparent wholeness and application to visible tasks. Even though women are long established in the workforce, men still tend to perceive themselves as 'the breadwinner' and this forms an important part of their self-concept that becomes threatened in chronic illness. For men, heavier household tasks such as mowing lawns and managing gardens are frequently tied to their own and their family's perception of them in their gendered roles. Mary recalled of her husband Keith, *"…because he's always been the really strong one… He did marvellous things around the house… He doesn't do anything now… He can't, he gets too breathless.* 

For men, these heavier tasks are eventually taken over by another family member, or by paid help. For women with COPD, there tends to be a sense of ownership and obligation towards housework, and they will tolerate significant symptoms to retain these duties. As the disease progresses there are often visible changes such as development of the classic 'barrel chest', significant weight loss and for some, facial and postural changes from

2010, Leidy & Haase, 1999, Gullick & Stainton, 2008, Fraser et al., 2006).

*… and he's very conscious of this and it upsets him.*"(Gullick, 2008).

**6. Changes in personal effectiveness** 

2010, Barnett, 2004).

prolonged steroid use. Norman described changes to his wife Catherine (58 yrs), a once, striking woman who ran an exclusive boutique, *"She had this sort of wheezy voice, and she was beginning to get hunched shoulders."*

The net result of this changed capacity and appearance is that people lose a variety of modes of self-expression (Leidy & Haase, 1999). Andy, (57 yrs) explains: "*I had to give up sport, I'm a real sport nut. I had to give up walking… Of course sex was out of the question".* Each task is considered as to whether the reward, for themselves or others, will outweigh any distressing symptoms. If the real or anticipated discomfort is thought to be greater than the perceived benefit, that task will be avoided. Rewards include either personal pleasure and fulfilment, or a task that is to the benefit or welfare of others (Leidy, 2008, Shackell et al., 2007).
