Patient’s Understanding of COPD Exacerbations

Discuss About The Nursing Research Using Historical Methods.

From the previous studies it is evident that patients experienced difficulty in understanding the term exacerbations. Previous research also identified that patient’s use clinical markers for the identification of the exacerbations and contacted healthcare professionals on the basis of these symptoms. In the previous research patients didn’t use experimental knowledge like visible and invisible symptoms for recognising exacerbations of the COPD. Patients in the previous studies found difficult to distinguish between bad day and exacerbations of COPD (Polastri, Pisani, Dell’Amore et al., 2017; Brien et al., 2018). However, patients in the current study could distinguish between bad day and exacerbations of COPD.

This study deals with the patient’s knowledge and understanding of the disease. Patient knowledge can be helpful in early identification of the disease. It can be helpful in early plan for the prevention and treatment of the disease. Patients can verbalize both subjective and objective symptoms of the disease

Main aim of this study is to explore patients’ current understanding and experience in managing and identifying COPD exacerbations at home.

Interview based qualitative study was implemented in this study.

Sampling is the central process in interview based qualitative study design. In this study design, main focus should be on the participants because participants need to talk more and interviewer need to learn more from the participant. Outcome of the study completely depends on the content of the interview questions. In this study, interviews of the recruited patients need to be carried out. In this study semi-structured interviews were conducted (Magnusson and Marecek, 2015).

Questions of these interviews comprises of patient’s knowledge about recognition of the disease symptoms, patient’s experience and their self-management strategy. Answers of these questions can be helpful in achieving aim of the study because aim of this study was to understand patient’s recognising ability and management of COPD. Hence, this interview-based study can be helpful in achieving aim of the study.

In this study, 27 male and 17 female were recruited with the average age of 71 years with range of 55 – 85 years. According to GOLD, COPD patients can be classified into different categories based on their severity. 14, 21 and 9 patients were with GOLD stage II, GOLD stage III and GOD stage IV respectively. Occurrence of duration of symptoms in these patients is in the range of 1 – 25 years. 29 patients are living with spouse or family and 15 patients are living alone.

Interview-Based Qualitative Study for COPD Management

Following are the inclusion and exclusion criteria for participants in the study. Age >40 years. A forced expiratory volume in 1s (FEV1) post-bronchodilator ?80% and predicted ratio of FEV1 to forced vital capacity (FVC) ?0.70. Smoking history >10 pack years.  MRC dyspnoea scale ?2. Registered with a general practice and with an exacerbation of COPD requiring home treatment or hospital admission in the previous year or referred for pulmonary rehabilitation. Absence of other signi?cant lung disease. Absence of chronic heart failure de?ned by the New York Heart Association classi?cation system as severe (Grade IV). Able to give informed consent. Life expectancy of 43 months. Able to adequately understand written and verbal English.

Sample universe can be defined by incorporating inclusion and exclusion criteria in the sample selection. Exclusion and inclusion criteria also can be helpful making decision on sample selection. Identifying exclusion and inclusion criteria can be helpful in identifying patient characteristics. It can be helpful in identifying severity of the disease, exposure to risk factors and presence or absence of co-morbid condition. Identification of these criteria before start of the recruitment can be helpful in the getting robust output. Variability in the outcome of the study can be reduced by recruiting patients through application of inclusion and exclusion criteria (Chesnay, 2015).

Patients were recruited from the different resources like hospital admission records, pulmonary rehabilitation programmes and general practice.

Aim of the study is to understand the patient’s knowledge about the COPD. Sample population recruited in this study were from the respiratory disease specifically COPD. Hence, knowledge of COPD among the patients can be collected from the recruited sample patients. Since, these are the COPD patients, these sample patients are appropriate to gather information related to COPD.

1. How were the data collected?

1. What, specifically, did the researchers do?

Collected data can be considered as the robust data because data was collected by the experienced researcher. Investigator involved in the data collection got extensive training in the qualitative research. Interview questions were of semi-structured type and questions mentioned in these interviews were specific to the aim of the study. These questions comprised of patient’s experience, identification and management of the exacerbations of the COPD at patient’s home. Duration of these interviews were lasted between the 20 to 55 min. Discussions during the interview were noted down. These records of the interview would be helpful in providing more context of interview and effective analysis and monitoring of the interview process. Few of the patients might not be comfortable in verbalising their feelings and experience of the disease conditions. Hence, spouses and family members of the six patients were present at the time of interview.

Inclusion and Exclusion Criteria for Recruitment of COPD Patients

In the data collection process, questions related to identification and management of the COPD were discussed. These questions can give data related to the patient’s understanding about different aspects of COPD. Hence, data collection can be helpful in achieving aim of the study. d.    What might have been some advantages and disadvantages of this method of data collection?

Following are the advantages of the interview-based data collection: Accurate screening can be provided because patient being interviewed cannot provide false information like age and gender. Both verbal and non-verbal ques can be obtained in the interview process hence level of information and discomfort can easily be assessed. More focus on the data collection can be achieved during the interview process because distractions can be effectively eliminated. Emotions and behaviour of the patient can be effectively captured during the interview process. Following are the disadvantages of interview-based data collection: Cost can be the major disadvantage of interview because interviewer need to visit each patient’s home to conduct interview. There can be limitation of the sample size in interview process based on the number of interviewers incorporated in the study. In this study also, one interviewer is incorporated hence sample size is less (Seidman, 2015).

From your understanding of the weekly readings, what if any, are some alternative methods of data collection that these researchers could have chosen?

In qualitative research, interview is one of the most commonly used methods for data collection. However, researchers could have used other methods of data collection like observations and textual or visual analysis (eg from books or videos) (Brinkmann, 2013).

1. How was the data analysed?

Multiple steps were incorporated in the data analysis. Collected data were stored and organised prior to analysis. For the analysis of the data, audio-recorded data were transcribed into the verbatim and anonymised transcripts were imported into the NVIVO 10 (qualitative software data programme). Grounded theory approach and constant comparative method were implemented for the analysis of the data. To avoid biasness in the analysis of the data open, axial and selective coding was implemented.

1. Why is it important to select applicable methods of data analysis in qualitative research?

It is important to select applicable methods in analysis of qualitative research because it is based on the data collection through questions and analysis of the collected data (Josselson, 2013).

Coding was performed by the experienced qualitative researcher who was not part of the project. Effective analysis of the collected data can be carried out by memo-writing which can be helpful in identifying theoretical links and concepts from the data. Analysis and interpretation of the data was performed by extensive discussion among the experienced researchers in the department. Coding and subsequent elimination of the biasness resulted in the transparency of the study. Involvement of experienced researchers and discussion on regular basis resulted in improving credibility of the findings.

Patients identified COPD exacerbations by the assessment of visible symptoms related to the clinical parameters and invisible symptoms related to the experimental knowledge. Patients with past history of exacerbations understood the signs and symptoms of exacerbations and the time at which they were exacerbating. Patients learned and understood self-medication techniques like pacing and breathing techniques. Patients were also well aware of the purpose of antibiotic antibiotics and steroids. Patient’s also expressed that they can identify and monitor course of COPD exacerbations and seek assistance of health-care professionals for improving their condition. Hence, further deterioration of the patient can be effectively reduced by providing early treatment. Findings of the study were the aim of the study because from the findings it is evident that patient’s understood the symptoms and medications strategies for COPD.

These findings can be implemented in other long-term care facilities like diabetes and obesity care. In these care facilities also, experimental knowledge can be helpful in identifying visible and invisible symptoms (Josselson, 2013).

References:

Brinkmann, S. (2013). Qualitative Interviewing. OUP USA.

Brien, S.B., Stuart, B., Dickens, A.P, Kendrick, T., Jordan, R.E., Adab, P., and Thomas, M. (2018). Independent determinants of disease-related quality of life in COPD – scope for nonpharmacologic interventions? International Journal of Chronic Obstructive Pulmonary Disease,  13, 247-256.

Chesnay, M.D. (2015). Nursing Research Using Historical Methods: Qualitative Designs and Methods in Nursing. Springer Publishing Company.

Josselson, R. (2013). Interviewing for Qualitative Inquiry: A Relational Approach. Guilford Press.

Magnusson, E., and Marecek, J. (2015). Doing Interview-based Qualitative Research: A Learner’s Guide. Cambridge University Press.

Polastri, M., Pisani, L., Dell’Amore, A., and Nava, S. (2017). Revolving door respiratory patients: A rehabilitative perspective. Monaldi Archives for Chest Disease, 87(3):857.

Seidman, I. (2015). Interviewing as Qualitative Research: A Guide for Researchers in Education and The Social Sciences. Teachers College Press.