Patients’ experience of identifying and managing exacerbations in COPD: a qualitative study

This article analysis focuses on the study of ways through which chronic obstructive pulmonary disease patients manage exacerbations at home to reduce their rate of readmission. The study used grounded theory approach to collect data through interviewing respondents with the experience of the phenomenon until saturation is reached. The findings indicated that managing of exacerbations by patients reduces the rate of admission of COPD patients.

Running head: ARTICLE ANALYSIS
Williams, V., Hardinge, M., Ryan, S., & Farmer, A. (2014). Patients’ experience of
identifying and managing exacerbations in COPD: a qualitative study. Primary Care
Respiratory Society, 1-6.
Student’s Name
University

ARTICLE ANALYSIS
1. Background of the study
a. The health issues
The health issue of study is identification of ways in which chronic obstructive pulmonary
disease patients manage exacerbations at home to reduce their rate of readmission.
b. Results of previous studies
The analysis of Williams, Hardinge, Ryan, & Farmer (2014) showed that there have been
inadequacies identifying methods of managing exacerbations since they have mostly failed
to identify ways through which patients can be assisted to manage exacerbations due to poor
methodologies in research that have thus failed to quantify propers strategies to be used in
management.
c. The significance of this study
The role of the study was to identify ways through which exacerbations can be managed to
reduce hospital admissions as a result of complicated cases of exacerbations. Since chronic
obstructive pulmonary disease exacerbations can be managed at the individual level, then
teaching patients who determine exacerbations early and seek proper medical mechanisms
can reduce the rate of admission and fatal cases that take place in patient settings (Williams,
Hardinge, Ryan, & Farmer, 2014).
2. Overview of research design
a. Aim of the research
Study ways through which patients can manage exacerbations by responding to problem-
related to chronic obstructive pulmonary disease
b. What research design was used?
The researcher used grounded theory where they collect data through interviewing
respondents with the experience of the phenomenon until saturation is reached.
c. Describe the main characteristics of the research design identified.

ARTICLE ANALYSIS
The grounded theory approach is characterised by interaction between sampling methods and
data collection thus allowing the researcher to gather data on a rolling basis until the
saturation limit is reached (El-Hussein, Hirst, Salyers, & Osuji, 2014). This study only deals
with participants who have experience with the phenomenon of managing exacerbations
related to which chronic obstructive pulmonary disease.
The researcher uses a questioning theme that starts from the general to specific questions
where they are organised in a logical order to unearth the findings that the researcher seeks to
find (Strauss & Corbin, 2008). The questioning for each theme must be explored to saturation
before the researcher completes the study.
d. How did the research design chosen meet the aim(s) of the study?
Polit & Beck (2010) suggests that the grounded theory is fit for clinical research since it
provides guidelines for the researcher to follow during the research thus making the
qualitative research more clearer. Gelling (2014) adds that since it does not start with
hypothesis testing, but rather uses empirical data thus allowing room for creativity in data
collection leading to greater results than any other study.
3. Sampling
a. Characteristics of the participants
The study focused on patients who had once been admitted in the hospital with COPD related
cases or those who have prior experience in managing the disease. They were gathered from
rehabilitation programs, hospital records and practising nurse records.
b. The inclusion and exclusion criteria of the sample
The inclusion criteria was patients who had once suffered from COPD exacerbations thus
those who understood or had experience with management of exacerbations at home or on
their own.
c. Important of identify criteria for recruitment

ARTICLE ANALYSIS
The successfulness of any research study is dependent on the ability of the researcher to
identify the right respondents group that meets the required characteristics of the research
problem (Bhakar & Nathani, 2015). This leads to increased reliability of the findings since
the researcher purposely selected the required respondents and excludes those that do not
meet the required criteria.
d. What sampling technique was used in this study?
The sampling technique for the study was both purposive and snow balling. Purposive
sampling is seen in the exclusion/inclusion criteria where the researcher developed a formula
for picking the respondents that meet the specific requirements related to the research topic.
By selecting the patients with the experience of managing exacerbations related to chronic
obstructive pulmonary disease, the researcher used purposive sampling as a way of ensuring
that the right respondents are included in the study (Donald & White, 2014). On the other
hand, snow ball sampling is a technique where the researcher recruits respondents on a
rolling basis as the data collection grows. Each patient recruited in the study leads to the next
respondent until the researcher has reached saturation limit in collection of data.
e. How was this sample appropriate for meeting the research aim?
The purposive sampling approach is relevant to the study since it allows the researcher to
determine the right participants to be included in the study (Shaughnessy, Zechmeister, &
Jeanne, 2011). Since qualitative research allows the researcher to manipulate the data in any
way that fits the researcher, then this sampling approach is useful in ensuring that only those
who meet the inclusion criteria can be used in the research study. When the researcher works
out using the criteria of age, gender, length and frequency of admission to select the right
respondents for the study, this means that purposive sampling allows collection of the right
requirements from the respondents.

ARTICLE ANALYSIS
On the other hand, Weathington, Cunningham, & Pittenger (2015) suggests that snow balling
is a grounded theory approach that allows the researcher to collect information until
saturation level is reached. Themes are used to define the nature of organising the sampling
information until they researcher reaches saturation limit of the study where no more
information can be collected.
4. Data collection
a. How were the data collected?
In-depth interviews were used to collect the data from the respondents where the interviews
were recorded, translated into text.
b. What, specifically, did the researchers do?
The process of the research started by seeking approval from the Ethics Committee which is
in charge of research and later the researcher sought permission from Oxford Health NHS
Foundation to access the relevant patient information where participants were recruited from.
After identifying the number of patients for the study, the researcher developed consent forms
that were used to seek consent of every participant as part of ethical requirements of the
research (Williams, Hardinge, Ryan, & Farmer, 2014). Once all this had been done, the
researcher started the data collection process by applying the grounded theory approach
c. How did data collection fit the aims of this study?
For the data collection to meet the aims of the study, the researcher has to use a data
collection method that is in line with the research design. For grounded theory, interviews
offer the best collection method since the questions are organised in themes that address
different areas of the study (Cooper & Schindler, 2011). This leads to an exhaustive
collection of data until the saturation limit has been reached. With the interview, the
researcher uses different questioning skills that fit the characteristics of the respondent and at
the same time following up some questions to ensure that the right data has been collected.

ARTICLE ANALYSIS
d. What might have been some advantages and disadvantages of this method of
data collection?
One advantage that the interview method offers is the ability of the researcher to use a
questioning approach that starts from a general view to a detailed analysis that allows the
respondent to give detailed information (Franklin, 2015). Since the method is qualitative, the
researcher explores all the available responses from the interviewee by exploring different
mechanisms to gather relevant data. The researcher also allows the researcher to explore
causes in the problems that the respondents have. This is through seeking clarification from
the respondent in the cases where the answer is not clear.
However, the method can be subject to bias depending on the questioning method of the
researcher. The questions can be skewed to favour the results that are reported (Howell,
2013). Also the method limits the number of respondents unlike the use of questionnaires
where the researcher circulates the questionnaires to respondents.
e. Alternative method
Questionnaires have been widely used for self-assessment since they allow the researcher to
reach out to a larger population and limit biasness of the researcher.
5. Data analysis/results (Total: 20 marks)
a. How was the data analysed?
The data analysis method was analysed through NVIVO 10 software using a grounded theory
approach and constant comparative method to create links between the findings.
b. Why is it important to select applicable methods of data analysis in
qualitative research?
Applicable data analysis method in qualitative studies ensures that the collected data is
analysed in format that is easily understood by the reader. Without proper analysis, it can be
difficult to simplify the findings of the study into what can be easily understood.

ARTICLE ANALYSIS
c. What did the researchers say about the rigour of their analysis?
The qualitative data is difficult to analyse and present as compared to quantitative data.
d. What were the study findings?
The findings indicated that although most patients did not understand the term exacerbations,
they used other terms to describe exacerbations and had developed mechanisms of dealing
with them when they arise. Managing of exacerbations by patients reduces the rate of
admission of COPD patients. Further, nurses need to be educated to be more proactive in
assisting patients manage exacerbations (Williams, Hardinge, Ryan, & Farmer, 2014).
Nursing education is helpful in developing clinical competencies of patients and making them
understand how to identify exacerbations early and seek over the counter medications without
necessarily admitting themselves to the hospital.
e. Other settings can these findings be transferred
The findings of any good research need to be replicated to industry to meet the requirements
of a grand challenge. Since the ability of management of exacerbations is important in
reducing hospital admission, then the findings of this study can be used in developing ways
of making patients more empowered to manage exacerbations.

ARTICLE ANALYSIS
References
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Williams, V., Hardinge, M., Ryan, S., & Farmer, A. (2014). Patients’ experience of
identifying and managing exacerbations in COPD: a qualitative study. Primary Care
Respiratory Society, 1-6.