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

This qualitative study explores how COPD patients identify exacerbations and the management mechanisms employed at home. The study reveals that COPD patients identify exacerbations based on visible and invisible symptoms and employ self-management techniques. The findings highlight that the patients only accessed healthcare assistance in the event that the self-management techniques did not result in improvement in their conditions.

Running head: GUIDED REVIEW OF NOMINATED LITERATURE
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Guided Review of Nominated Literature (Qualitative)
Name:
Institutional Affiliation:

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Guided Review of Nominated Literature (Qualitative)
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; doi:10.1038/npjpcrm.2014.62
Q 1) Background of the Study (10 Marks)
a. What is the health issue that provides the focus of this study?
The central focus of the study was Chronic Obstructive Pulmonary Disease (COPD). COPD is a
chronic disease resulting from lung inflammation that causes blockage of airflow in the alveoli
and bronchi as well as related breathing problems. The associated respiratory related diseases
include chronic bronchitis, emphysema, and asthma. The disease is caused mainly by tobacco
smoking which causes the development and progression of the disease. In addition, COPD is
related to indoor and outdoor air pollutants in homes and workplaces, respiratory diseases
especially those that lead to inflammation of the lungs, and genetic factors especially deficiency
of alpha-1 antitrypsin.
Generally, what have been the results of previous studies of this issue?
Earlier research on COPD demonstrates that patients lack a precise definition of what exactly
exacerbations are or even how they are recognised by the COPD patients (Burge & Wedzicha,
2013). On the contrary, the studies show that the patients are capable of identifying the imminent
exacerbations (Kessler et al, 2016). Specifically, exacerbations are identified by the patients
based on subjective experiences (Adams et al, 2016). One of the notable shortcomings of the
previous studies is that they have focused on finding out how the COPD patients experience
exacerbations rather than their ability to identify exacerbations (Harrison et al, 2013).

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Additionally, other studies have revealed reluctance by the patients to seek health care assistance
instead opt for treating exacerbations at home (Wang, Haugen, Steihaug, & Werner, 2102).
b. What is the significance of this study?
This study is significant in that it was set out to explore how the COPD patients identify
exacerbations and the management mechanisms employed at home. Previous studies have shown
that COPD patients prefer treating exacerbations at home to consulting healthcare professionals;
it is evident that promoting self-management among the patients would effectively reduce the
number of hospital admissions. On the same note, self- management would improve the
treatment outcomes of COPD. However, the fundamental requirement for effective treatment of
exacerbations at home is the ability of the patients to successfully identify exacerbations
following the onset of symptoms.
Q2) Overview of Research Design (10 marks)
a. What was the aim of the research?
The aim of this research was to explore the current patient’s understanding and experience of
managing and identifying COPD exacerbations at home.
b. What research design was used?
This study was a qualitative research since it explored the patients understanding and experience
of COPD rather than seeking definitive conclusions. The research design that was used for this
study was grounded theory. Grounded theory involves collection and analysis of data
concurrently leading to development of theory has is rooted in the data collected (Gelling, 2015).
c. Describe the main characteristics of the research design identified
The principal characteristics of Grounded theory include constant comparison, theoretical
sampling, and continuous collection of data until the research reaches saturation (Gelling, 2015).

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Constant comparison entails interaction between sampling, collection, and analysis of data as the
research progresses. With regard to theoretical sampling, grounded theory design involves
changing the participants in the course of the research as new theory emerge. Finally, theoretical
saturation is a point at which all the theories of the research have been exhausted and no new
data can be collected.
d. How did the research design chosen meet the aims of the study?
The aim of this study was to explore the participants’ understanding and experience of managing
and identifying COPD exacerbations at home. Using grounded theory enabled the researchers to
fulfil the aim of the study since it allowed the researchers to select maximum number of
participants who would allow all the aspects of the study to be explored.
Q3) Sampling (15 marks)
a. What were the characteristics of the participants in this study?
The participants selected for this study consisted of 27 males and 17 females aged between 55
and 85 years. The mean age for the group was 71 years. Out of this group, 29 participants were
living with their spouses while the remaining 15 members were staying alone. Another notable
feature of the participants is that 33 members had previously attended pulmonary rehabilitation
programme. Moreover, the selected participants were at different severity of COPD. Specifically,
14 participants were at stage II, 21 at stage III, while 9 participants were at stage IV. Finally, 11
of the participants were currently using home oxygen.
b. What were the inclusion and exclusion criteria of the sample?
The participants to be selected for interview had to meet of conditions before they were allowed
to participate in the research. To begin with, the participant had to be above 40 years to
participate in the interview. Also, the individual had to have the ability to give informed consent,

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adequately understand written and verbal English, and have a life expectancy of more than 3
months. Additionally, for an individual to have been selected for interview a smoking pack of
greater than 10 pack years was a requirement. Similarly, the individual must have had an MRC
dyspnoea scale of 2 or more. Finally, individuals included for the interview must have been
registered with a general practice for hospital admission or pulmonary rehabilitation. On the
other hand, individuals with lung disease and chronic heart failure as defined by the New York
Heart were effectively excluded from participation in the interview.
c. Why is it important to identify these criteria before recruitment starts?
The identification of the inclusion criteria was important in ensuring that the measurement error
was effectively minimised during the research by reducing selection bias (Merriam & Tisdell,
2016).
d. What sampling technique was used in this study?
The sampling technique used in this study was theoretical sampling. In this study, participants
were recruited from hospital admission records as the research progressed and new aspects of the
study emerged.
e. How was this sample appropriate for meeting the research aim?
Theoretical sample was appropriate for this study in that it presented the researches with
maximum number of participants who would provide all the information and conditions related
to CPOD exacerbations as recommended by Strauss & Corbin (2015). Additionally, theoretical
sample facilitated assessment of relevant data before investing much time and money into the
research. Finally, theoretical sample included participants who had experienced COPD
exacerbations and would provide critical insights to the study (Gelling, 2015).

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Q4) Data Collection (20 marks)
a. How were the data collected?
Data was collected by means of interviews
b. What specifically, did the researchers do?
In-depth interviews were used to gather information from participants at their respective homes.
During the interview sessions, topic guides with questions focused on the patients’ experience,
identification, and management of exacerbations at home were used. In the process, the
researchers took audio recordings of the interviews along with filed notes to be used for further
analysis of the data collected.
c. How did data collection fit the aim of this study?
Interviews were appropriate method for collection of data in this study because they allow
collection and exploration of data with the research participants. In addition, interviews are the
most appropriate method of data collection that are related to the knowledge and experience of
participants (Gelling, 2015).
d. What might have been some advantages and disadvantages of this method of data
collection?
The main advantages of interviews as a method of data collection is that they permit researchers
to further explore the experience of the participants by conducting follow-up studies with
facilitate acquisition of in-depth data. On the other hand, interviews are time consuming during
planning, conduction, and analysis of data. In addition, the use of interviews could lead to
collection of biased data if not properly planned (Gelling, 2015).

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e. From you understanding of the weekly reading, what if any, are some alternative
methods of data collection that these researches could have chosen?
Focus groups would have been more suited at the start and latter stages of the study. At the start
of this study, focus groups would have been more appropriate for identification of key issues
which would then be considered more deeply using interviews. Similarly, focus groups would
have been used during the latter stages to contribute interpretation of findings as proposed by
Gelling (2015).
Q5) Data Analysis/ Result (20 marks)
a. How was the data analysed?
The method of data analysis used in line with Glaser’s (2015) proposals. In this case, the data
from the audio-recorded interviews and field notes were transcribed verbatim. In addition, the
transcripts which were anonymous were stored, organised, and analysed using NVIVO 10
software programme. The data analysis methods used included comparative analysis, memo-
writing, and coding such as axial, open, and selective methods as proposed by Rabinovich &
Kacen (2014).
b. Why is it important to select applicable methods of data analysis in qualitative
research?
Qualitative research is usually criticized for subjective interpretation of the data collected. As a
result, the method of data analysis must be selected to ensure that the results obtained are
objective and free from conflicts with related studies (Curtis & Drennan, 2013).
c. What did the researchers say about the rigour of their analysis?
The rigour on data analysis was recorded as high. The high level was achieved in two ways.
Firstly, the coding of the interviews was carried out by a qualitative researcher who was not a

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member of the research team. In addition, the members of research team engaged in regular
meetings to review and discuss the analysed data as well as the interpretation. As a consequence,
the credibility and transparency of the data was aided. As articulated by Florczak (2017) rigor
should be ensured in documentation, study procedures, and ethical considerations.
d. What were the study findings?
The research findings revealed that COPD patients identify exacerbations based on visible and
invisible symptoms. The visible symptoms were identified as those which are based on clinical
parameters while invisible symptoms are based on experience. As regards the management of the
exacerbations, the study showed that the patients employed self-management techniques. These
techniques include breathing and pacing techniques and self-administration of steroids and
antibiotics. Finally, the findings highlighted that the patients only accessed healthcare assistance
in the event that the self-management techniques did not result in improvement in their
conditions. In addition, the seeking healthcare professionals was not effective since the patients
waited until their conditions had reached crisis point and therefore have to be admitted into
hospitals.
e. Into which other setting can these findings be transferred?
These findings would find relevance in other clinical settings such as the management of
Borderline Personality Disorder. Just like COPD, BPD is a condition that can effectively be
identified and managed at home based on the experience and clinical symptoms. Families of
newly diagnosed patients could be educated on identification of BPD symptoms in which the
experience of the families and care givers would be as vital as clinical symptoms of the disorder.

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References
Adams, R., Chavanmes, N., Jones, K., Ostergaard, M., & Price, D. (2016). Exacerbations of
Chronic Obstructive Pulmonary Disease : A patient’s Perspectives. Journal of
Respiratory Primary Care, 15: 102-109.
Burge, S., & Wedzicha, J. (2013). COPD Exacerbations: Definitions and Classifications.
European Respiration Journal Supplement, 41: 46s-53s.
Curtis, E.A., & Drennan, J. (Eds.). (2013). Quantitative health research: Issues and methods.
Maidenhead, UK: Open University Press.
Florczak, K.L. (2017). Adding the truth of the matter: The case of qualitative research. Nursing
Science Quarterly, 30(4), 296-299.
Gelling, L. (2015). Qualitative Research. Nursing Standards, 29(30), 43-47.
Glaser, B. (2012). Basics of Grounded Theory Analysis. Mill Valley, CA: Sociology Press.
Harrison, S., Apps, L., Singh, S., Steiner, M., Morgan, M., & Robertson, N. (2013). Consumed
by breathing: A critical interpretive meta-synthesis of the qualitative literature. Chronic
Illness, 10: 31-49.
Kessler, R., Stahl, E., Vogelmeler, C., Haughney, J., Trudeau , E., et al. (2016). Patient
understanding, detection, and experience of COPD exacerbations: An observational,
interview-based study. Chest, 130: 133-142.
Merriam, S.B., & Tisdell, E.J. (2016). Qualitative research: A guide to design and
implementation (4th ed.). San Francisco, CA: Jossey-Bass.

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Rabinovich, M., & Kacen, L. (2014). Advanced relationship between categories analysis as a
qualitative research tool. Journal of Clinical Psychology, 66(7), 698-708.
Strauss, A., & Corbin, J. (2013). Basics of Qualitative Research: Grounded Theory Procedures
and Techniques (3rd ed.). Newbury Park, CA: Sage.
Wang, Y., Haugen, T., Steihaug, S., & Werner, A. (2012). Patients with Acute Exacerbation of
Chronic Obstructive Pulmonary Disease Feel Safe when Treated at Home: A Qualitative
Study. BMC Pulmonary Medication, 12: 45.