Patients’ Experience of identifying and managing Exacerbations in COPD: A Qualitative Study

This article discusses a qualitative study on the management of exacerbations in COPD patients. The researchers aimed at studying the ways through which the patients can identify and self-manage exacerbations even without the support of the healthcare providers. The study was conducted using a qualitative research method, and data was collected through in-depth interviews. The major finding of this research was that the patients were able to identify the occurrence of exacerbation by relying on the visible and invisible symptoms.

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Research
Name
Institution

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“Patients’ Experience of identifying and managing Exacerbations in COPD: A Qualitative
Study”
1. Background of the study
“Patients’ Experience of identifying and managing Exacerbations in COPD: A
Qualitative Study”is an article that was written by Andrew Farmer, Maxine Hardinge,
Veronika Williams, and Sara Ryan and published in 2014 by the Primary Care Respiratory
Society UK/Macmillan Publishers Limited. The research was aims at studying about the
management of exacerbations in the COPD patients. Exacerbation refers to a situation in
which COPD symptoms like phlegm quantity and breath shortness suddenly worsens.
According to the study conducted by these researchers, the management of exacerbations has
been posing great challenge to the patients and even the medics (Williams, Hardinge, Ryan &
Farmer, 2014). The patients have been facing difficulties in identifying and managing the
condition on their own because they do not have a deeper understanding about its signs and
symptoms.
The researchers, therefore, aimed at studying the ways through which the patients can
identify and self-manage exacerbations even without the support of the healthcare providers.
Research has established that effective self-management is a core component of the
eradication of COPD. It can help in minimizing the cases of hospital admission. Research has
also found out that the COPD patients have not been properly managing their exacerbation
conditions because they lack understanding and do not know much about how to do it. At the
same time, there are patients who are still reluctant to consult the medics to help in providing
them with the necessary skills to use in the management of their exacerbation conditions
(Williams, Hardinge, Ryan & Farmer, 2014). Based on this background study, the researchers
committed themselves to carrying out a further research to fill the missing gap in knowledge.

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This means that the research is important because its findings will be relied upon to empower
the patients to understand and adopt self-management as far as exacerbation is concerned.
2. Overview of research design
The aim of the research was to study the level of understanding of the patients on the
identification and management of exacerbation at home. According to these scholars, COPD
always poses a great challenge especially to the home-based COPD patients because the
disease is associated with exacerbation conditions that might appear at any time (Jones,
Green, Clark, Dickson, Nolan, Moloney & Bell, 2014). However, most patients cannot cope
up with it because they lack knowledge on how to identify these exacerbation symptoms. At
the same time, they do not how to manage the condition. This, according to the researchers,
might be disastrous because the patients who are at home need to have self-management
skills since most of the time; they are without a healthcare provider.
In order to respond to the research question and accomplish their aim, the researchers
sought to use a qualitative research method. It is a research design which mainly uses non-
numerical data to gain an understanding, describe and interpret it (Williams, Hardinge, Ryan
& Farmer, 2014). It is an exploratory type of study that is geared towards creating an
understanding on the motivations, reasons, and opinions of people towards certain
phenomenon. Its features are, therefore, that it is descriptive, detailed, non-numerical,
subjective, and involves the use of objects, pictures or words to present the results.
Qualitative research is subjective because it involves the researchers who oversee the
collection and analysis of data (Neuman, 2013). The use of qualitative design was
appropriate for this study because it enabled the researchers to meet the aims of the study
which was, of course, to explore the home-based patients’ understanding on the management
of COPD exacerbations. It gave the scholars an ample opportunity to collect a detailed and
comprehensive data that adequately responded to the research question.

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3. Sampling
The research was based on a human population. Its target was the patients who had
been admitted to a healthcare facility in Oxford. Since it was not possible to include everyone
in study, the researchers chose to take only a small sample size to represent the entire
population. So, the researchers sought to use a purposeful sampling technique. This is a
sampling strategy which is non-probability in nature. Its use enabled the researchers to get a
sample of 44 people to participate in the study. It was made up of males, females, patients of
the required age and must have been admitted into the healthcare facilities for COPD-related
illnesses (Williams, Hardinge, Ryan & Farmer, 2014). This number was appropriate because
it proportionately represented the entire population without any bias since all participants
were given equal changes of selection. The use of such a proportional sample also helped in
eliminating any cases of biasness that might have been experienced because they might
interfere with the reliability and validity of the data.
However, for anyone to be selected to participate in the study, he or she had to meet
the inclusion and exclusion criteria. The inclusion criteria were determined by the patient’s
age, severity of illness, duration of symptoms, marital status, and ability to speak and
understand English. Only those who meet these criteria were allowed to participate in the
research. Meaning, those who fail to meet the criteria had to be excluded because they were
undesirable (Taylor, Bogdan & DeVault, 2015). The use of inclusion and exclusion criteria
was appropriate for this research. It enabled the researchers to use only those whose
participation would bring an impact on the research and help in responding to the research
question, aims and objectives. That is why the inclusion and exclusion criteria had to be set
before the actual study began.
4. Data Collection

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The data was collected using in-depth interviews. The researchers settled on the
interview because it is the best instrument for the collection of data that was required. Data-
collection process was done in an organized manner. Once the participants were selected, the
researchers contacted them and scheduled for interviews. The researchers honoured the
appointment and went to the participants’ homes where a short interview lasting for between
20 and 55 minutes was administered. During the interviews, the researcher asked a
combination of short and long questions on the research topic (Silverman, 2016).
The benefit of the interview is that it produces accurate and comprehensive data that
can be relied upon to respond to the research question. The direct involvement of the
researcher was crucial because it gave them an opportunity to collect first-hand information
and be able to ask further questions to get all the clarifications that were needed (Nici, 2014).
At the same time, interviews were appropriate because they were conducted in a favourable
environment in which the participants were free to respond to the questions asked. All these
justified why the researchers were right for opting for interviews as the only instrument for
the collection of data.
However, the disadvantage of this instrument is that it was quite cumbersome and
money and time-consuming since the researchers had to create time to personally conduct the
interview in each of the patient’s homes. At the same time, the presence of the researchers
might have altered the responses because it might have influenced the way the participants
answered the questions. This might have resulted into the collection of biased and invalid
data (Williams, Hardinge, Ryan & Farmer, 2014). Therefore, if there were other
opportunities, the researchers would have used questionnaire. It is the best alternative because
it can help in overcoming the drawbacks of the interviews. If the researchers used the
questionnaires, they would save time and other travelling costs as well as collect accurate
data given by the participants without the influence of the researchers.

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5. Data Analysis/Results
Data analysis was done by using software called NVIVO. The analysis was conducted
following a successful transcription and coding of the audio-recoded interviews which had
been conducted. The analysis process was based on the grounded theory approach. The
theoretical link of the data was identified through memo-writing, axial selective coding, and
constant comparative procedures (Williams, Hardinge, Ryan & Farmer, 2014). The data
analysis tool was appropriate for the type of research because it has been found to be
effective in the facilitation of the synthesis, organization, and storage of qualitative data
(Leung, 2015). The suitability of the analysis was enhanced by the rigorous way in which the
whole coding process was performed. According to the article, coding was rigorous because
it was done by a team of highly qualified qualitative researchers who worked independently,
but in collaboration with the research team.
The major finding of this research was, therefore, that the patients were able to
identify the occurrence of exacerbation by relying on the visible and invisible symptoms. The
visible signs through which the patients identify exacerbation include sputum, cough, and
temperature. It was easy for the patients to notice the changes in these measurable symptoms
because they were more severe during exacerbation than the rest of the times (Beghé,
Verduri, Roca & Fabbri, 2013). Invisible signs are, on the other hand, as their name suggests
the subjective signs which cannot be seen or measured, but felt by the patients. They include
the soreness, tightness, and heaviness of the chests. These are usually felt especially during
exacerbation when they become more severe, hence making it easy for the patients to know
that they are experiencing exacerbation. These findings are useful in as far as the
management of exacerbation is concerned. Thus, they can be applied in developing a care
plan for all the exacerbation patients at the healthcare facilities or home-based settings. It can
enhance the practice of self-management by such patients.

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References
Leung, L. (2015). Validity, reliability, and generalizability in qualitative research. Journal of
family medicine and primary care, 4(3), 324.
Neuman, W. L. (2013). Social research methods: Qualitative and quantitative approaches.
New York: Pearson education.
Taylor, S. J., Bogdan, R., & DeVault, M. (2015). Introduction to qualitative research
methods: A guidebook and resource. New York: John Wiley & Sons.
Silverman, D. (Ed.). (2016). Qualitative research. New York: Sage.
Beghé, B., Verduri, A., Roca, M., & Fabbri, L. M. (2013). Exacerbation of respiratory
symptoms in COPD patients may not be exacerbations of COPD. European
Respiratory Journal, 41(4), 993-995.
Jones, S. E., Green, S. A., Clark, A. L., Dickson, M. J., Nolan, A. M., Moloney, C., ... &
Bell, D. (2014). Pulmonary rehabilitation following hospitalisation for acute
exacerbation of COPD: referrals, uptake and adherence. Thorax, 69(2), 181-182.
Nici, L. (2014). Exacerbation of COPD. American Journal of Respiratory and Critical Care
Medicine, 189(6), P11.
Williams, V., Hardinge, M., Ryan, S., & Farmer, A. (2014). Patients’ experience of
identifying and managing exacerbations in COPD: a qualitative study. NPJ primary
care respiratory medicine, 24, 14062.