Guided Review of Qualitative Literature on COPD Exacerbations

This study focuses on the chronic-obstructive pulmonary disease (COPD) exacerbations and explores the understanding and experience of COPD patients in identifying and treating COPD’s exacerbations at home. The study used a qualitative research design and purposive sampling technique. The data was collected through semi-structured interviews and analyzed using grounded theory. The study findings suggest that COPD patients can identify exacerbations at home through visible and invisible features and use self-management strategies during exacerbations.

Research Critique
Assessment 2 Guided Review of nominated literature (QUALITATIVE)
1. Background of the study (Total: 10 marks)
a. What is the health issue that provides the focus of this study?\
This study focuses on the chronic- obstructive pulmonary disease (COPD)
exacerbations that affect one out of three UK patients requiring re-hospitalizations in 28
days of previous admission. Adequate self management techniques can reduce re-
hospitalizations and promote outcomes in COPD-patients (Linton, 2015). According to
Brown (2017), patients are the core people who can trace-out their own health-condition
alterations and hence they should understand meaning of COPD-exacerbations,
recognize deteriorating symptoms and react adequately. Therefore, Williams (2014)
explores the understanding of experience in recognizing and self-managing COPD-
exacerbations in this study.
b. Generally, what have been the results of previous studies of this issue?
The previous studies show that there is no clear definition, method of identifying and
understanding of exacerbations by COPD-patients. Some studies specify that the
COPD-patients don’t have clear understanding of the exacerbation’s meaning while
certain studies indicate that COPD-patients understand these terms. Harrison’s (2013)
meta-analyses indicate that previous qualitative researches have only investigated
about the experience of exacerbations among COPD-patient’s but not about the method
of identifying exacerbation. Patients are found to feel comfortable to self-manage
COPD-exacerbation at-home. Despite, several studies publishing about assessment of
exacerbations (Sundh, 2013), still no clear evidence is found about recognition and self-
management of exacerbations (Risor, 2013).
1

Research Critique
c. What is the significance of this study?
This study is highly significant as an appropriate self-management of COPD can reduce
the number of patients being re-hospitalized and promote patient outcomes. This
includes earliest recognition with self-management of COPD-exacerbations by patients
themselves.
2. Overview of research design (Total: 10 marks)
a. What was the aim of the research?
The objectives/aims are the specific accomplishments framed by the study-researchers
to achieve what they have indented to inquire (Polit, 2016). In this study, the
researchers have given a clear objective as ‘to explore the understanding as well as
experience of COPD-patients in identifying and treating COPD’s exacerbations at
home’. Their objective is achievable and can help them to solve their research-problem
(Iverson, 2014).
b. What research design was used?
They used qualitative research- design which is a systematic, subjective as well as
interactive approach that is utilized to explore the person’s life experiences and give
them a meaning (Yin, 2015).
c. Describe the main characteristics of the research design identified.
The characteristics of their identified qualitative design include: increased flexibility with
elasticity and capability in adjusting to the phenomenon (experience) that is learned at
the time of data collection period; merges varied strategies of data collection and also
has the tendency of holistic striving; requires intense researcher’s involvement for a
2

Research Critique
longer time and necessitates continuous data-analysis of the gathered information to
develop subsequent strategies (Yin, 2015).
d. How did the research design chosen meet the aim(s) of the study?
According to Polit (2016), qualitative design is used to describe and enhance the
understanding of human experiences as pain, comfort, disabilities, and difficulties (THS,
2015). Moreover, it explores the selected experience of an individual in an in-depth
manner by collecting a rich qualitative data (Grove, 2015). This proves that the selected
qualitative design will help them to scrutinize what they have intended to achieve based
on their objective/aim as ‘to explore the understanding and experience of COPD
patients in ruling-out and managing COPD’s exacerbations at home’.
3. Sampling (Total: 15 marks)
a. What were the characteristics of the participants in this study?
In this study, they have invited patients with variety of characteristics as age, gender,
severity of COPD (GOLD) stages: II, III & IV, duration of COPD features (years), home
oxygen use, previous attendance in lung rehabilitation programmes and living set-up
(living with spouse and/or family or living alone).
b. What were the inclusion and exclusion criteria of the sample?
Eligibility criteria designate certain characteristics to the population through which the
study-subjects are recruited for the study (Polit, 2016). According to Yin (2016),
selecting samples within inclusion criteria (attributes that the subjects should possess)
and the exclusion criteria (attributes that the samples should never possess) is highly
crucial, which is evidenced in this study. Williams (2014) has selected COPD patients
who met their eligibility criteria from the hospital’s admission registers, rehabilitation
3

Research Critique
(lung) programmes & patients attending generalized health-practice service by the
research (pulmonary) nurses. Their inclusion/eligibility criteria includes: COPD patients;
aged 40 years or above; having FEV1 (forced- expiratory pulmonary volume) for 1- s,
<80% of post bronchodilator along with expected ratio of FEV1 to FVC (forced vital-lung
capacity) with <0.70, history of smoking for 10 or more pack years, more than score-2 in
MRC dyspnea scale, registered in any general health-care practice. higher risk for
COPD-exacerbations necessitating home care and/or history of previous
hospitalizations (Jones, 2014), got referred to lung rehabilitation centres; nil history of
any other lung diseases, nil history of chronic heart failure under the classifications of
New York cardiac Association with Grade- IV (severe), ability to give consent for the
study, life-expectancy above 3-months and speaks and writes in English.
c. Why is it important to identify these criteria before recruitment starts?
Polit (2016) has given that eligibility criteria has to be framed before commencing
sample-recruitment as appropriate selection of inclusion and exclusion criteria can
promote the validity (external and internal) of the study findings, enhance the feasibility,
yields un-biased study findings and reduce the cost as well as ethical constraints of the
study (Yin, 2016). Polit (2016) has stated that such recruitments will promote the
homogeneity of the selected subjects by appropriate control of confounding variables. A
study’s construct validity is also enhanced only when the eligibility criteria and
population construct matches.
d. What sampling technique was used in this study?
The researchers have used purposive/ judgmental sampling technique which is a non-
probability sampling technique in which the subjects were recruited based on the
4

Research Critique
personal judgment of the researchers; about which one’s will be more informative
(LoBiondo-Wood, 2013).
e. How was this sample appropriate for meeting the research aim?
Williams (2014) has purposely selected samples by judging them as the typical of the
target population with specific knowledge about the study problem (LoBiondo-Wood,
2013). This purposive selection of COPD subjects can aid them to meet their research
aim because this technique has enabled the study-researchers to recruit the subjects
based on the personal judgment (voluntarily) to achieve their study’s preferences as to
explore the experiences as well as understanding of COPD-patients in identifying and
treating COPD-exacerbations at-home (Polit, 2016).
4. Data collection (Total: 20 marks)
a. How were the data collected?
Williams (2014) has gathered qualitative (narrative) data to address their research
problem through a semi-structured interview technique based on their interview guide
that focused on the topics as COPD patient’s experience, their recognition as well as
self-management of exacerbations at home by allowing the subjects to converse within
the given topic, as suggested by Grove (2015). The interview lasted for 20- 55 minutes.
b. What, specifically, did the researchers do?
The researchers have conducted an interview with the participants by questioning them
based on the selected topics. They have allowed them to ventilate their experiences
and understanding in handling COPD-exacerbations. Then have audio-recorded their
field notes soon after the interview to enhance the study’s context which could help in
5

Research Critique
the data analysis. They have transcribed it and analysed using grounded theory
method.
c. How did data collection fit the aims of this study?
The text suggests that their interview guide had set of questions that have focused on
the understanding and experience of COPD-patients in identifying and handling
exacerbations particularly at-home. This indicates that that their data collection exactly
fits the objective of this study to be explored.
d. What might have been some advantages and disadvantages of this method of data
collection?
The advantages of semi-structured interview includes: assists the researchers to
prepare the topics of interview in advance to enable their competence; enables the
subjects to express their views (experiences) openly in their terms; directs the
researcher to gather information in a sequence with topic guide; provides valid, reliable,
accurate and comparable non-numeric data; encourages 2-way communication by
allowing the participants to question the investigator; involves the advantages of both
un-structured and structured interview method by allowing the subjects to ventilate
emotions as well as structuring the interview with topic guide; enables study subjects to
tell out the answers with reasons; motivates subjects to describe emotional and
sensitive issues (Gerrish, 2015). Semi-structured interview’s disadvantages include:
requires sufficient preparation prior to interview to go as per the guide to avoid
incomplete collection of data; requires interviewing skills; necessitates sufficient
subjects to get general comparisons; requires analytical skills to avoid risk of
6

Research Critique
constructing too many data; requires much time and necessitates confidentiality from
the researchers (Grove, 2015).
e. From your understanding of the weekly readings, what if any, are some alternative
methods of data collection that these researchers could have chosen?
From my readings, I suggest using focused group interviews as an alternate to semi-
structured method to enhance the credibility of study-findings. This method involves
gathering of subjects as a group with 4 to more for a discussion by the researchers
(Polit, 2016). The interviewer should prepare a written set of question and should plan
the discussion sessions to collect rich narrative data from the subjects. The subjects
should be allowed to talk-out their views freely in an environment with similar type of
members (COPD) to get more appropriate responses as compared with other interview
methods (Yin, 2016). .
5. Data analysis/results (Total: 20 marks)
a. How was the data analyzed?
They performed data-analysis by organizing as well as interpreting the qualitative data
to explore the underlying facts (experience of COPD-patients in ruling-out and
managing exacerbations). Williams (2014) has tape-recorded the gathered data,
transcribed their verbatim and anonymised the transcripts through importation to
software (qualitative data programme- NVIVO-10) by storing, structuring and analysing
the data. They explored theoretical linkages by using grounded-theory with comparative
(constant) approach, open-method, axial-method and selective-coding method with
memo-writing, as given by Polit (2016).
7

Research Critique
b. Why is it important to select applicable methods of data analysis in qualitative
research?
Applicable data analysis methods has to be selected as it involves organizing qualitative
data, structuring data, eliciting meaning from gathered data to frame themes, and
frameworks (THS, 2015). Additionally, qualitative data-analysis is a labor-intensity
process that requires hard-work and creativity (Polit, 2016). Varied challenges has to be
tackled in qualitative data-analysis as absence of appropriate analytical-rules,
requirement of enormous work-effort and reducing qualitative data for reporting
purposes to balance richness and conciseness and hence, more applicable data-
analytical methods have to be selected.
c. What did the researchers say about the rigour of their analysis?
Williams (2014) said that they ensured rigour of their analysis by performing double
coding (10%) of transcripts by one among the co-authors with experience in qualitative
analysis (not a member in study team) which hasn’t produced conflicting results.
Additionally, all the research team-members had met periodically to review their data
analysis and interpretation. Both these processes maintained transparency and
credibility of study-findings (Grove, 2015).
d. What were the study findings?
The findings show that the COPD-patients can identify COPD-exacerbations at-home
by visible & invisible features. Visible/objective features include physical features as
cough with sputum production and temperature with physical- limitations and
invisible/subjective features as chest sensations (chest-soreness, tightness, heaviness
& dyspnea) with bodily-knowledge (knowing & lack of energy). The study proves that
8

Research Critique
majority of the COPD-patients have recognized exacerbations through these
approaches. They suggested that self-management strategies were used by the
patients during exacerbations which involve self-medication intake (antibiotics/steroids)
and monitoring the recovery and have consulted medical professionals when they were
unable to manage themselves.
e. Into which other settings can these findings be transferred
The study-findings can be transferred into settings with newly diagnosed COPD-patients
by educating them about visible & invisible symptoms to protect them from acute-
exacerbations (Williams, 2014). Researches has to be proposed to quantify the
experiences of COPD-patients by clarifying the existing definition of COPD-
exacerbations as well as inform clinical measures to promote early identification and
treatment of COPD-exacerbation, particularly in tele-monitoring services.
9

Research Critique
Reference
Brown, D., Edwards, H. & Seaton, L. (2017). Lewis’s Medical Surgical Nursing:
Assessment and Management of Clinical Problems. Retrieved from
https://books.google.co.in/books?isbn= 0729583937
Gerrish, K., & Lathlean, J. (2015). The research process in nursing (7th ed.). Malden,
MA: John Wiley & Sons.
Grove, S. K., Grey, J. R., & Burns, N. (2015). Understanding nursing research: Building
an evidence-based practice (6th ed.). London, United Kingdom: Elsevier
Harrison, S.L. (2013). Consumed by breathing—A critical interpretive meta-synthesis of
the qualitative literature. Chronic Illn. 10, 31–49.
Iverson, K.M. (2014). Women veterans’ preferences for intimate partner violence
screening and response procedures within the Veterans Health Administration.
Research in Nursing and Health, 37, 302-311
Jones, P.W., Nadeau, G., Small, M & Adamek, L. (2014). Characteristics of a COPD
population categorized using the GOLD framework by health status and
exacerbations. Respir Med, 108(1), 129-35. doi: 10.1016/j.rmed.2013.08.015.
Epub 2013 Aug 30.
Linton, A. D. (2015). Introduction to Medical-Surgical Nursing - E-Book. Retrieved from
https://books.google.co.in/books?isbn=0323295339
LoBiondo-Wood, G & Haber, J. (2013). Nursing Research: Methods and Critical
Appraisal for Evidence-Based. Retrieved from https://books.google.co.in/books?
isbn=0323100864
10

Research Critique
Polit, D.F & Beck, C.T. (2016). Nursing Research: Generating and assessing evidence
for nursing practice. Lippincott Williams & Wilkins: New Delhi.
Risor, M.B. (2013). The complexity of managing COPD exacerbations: a grounded
theory study of European general practice. BMJ Open, 3, e003861\
Sundh, J. (2013). Management of COPD exacerbations in primary care: a clinical cohort
study. Prim Care Respir J, 22, 393–399.
THS. (2015). Epidemiology- Glossary of Epidemiological and Statistical Terminology.
Tropical Health Solutions. Retrieved from
http://www.tropicalhealthsolutions.com/statsglossary
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
Yin, R.K. (2016). Qualitative Research from Start to Finish. Retrieved from
https://books.google.co.in/books?isbn=1462521347
11