Critical Review: COPD Patients' Experiences in Emergency Department

This report provides a critical review of a research article that explores the experiences of individuals with chronic obstructive pulmonary disease (COPD) who frequently visit the Emergency Department (ED) and their carers. The study employed a mixed-method design, including a descriptive qualitative phase, conducted in the Illawarra Shoalhaven Local Health District in Australia. The research identified the complex psychosocial factors, such as fear, anxiety, and self-blame, that influence patients' coping abilities and self-management of their condition, often leading to ED presentations. The review highlights the importance of an interdisciplinary approach, including nurses, to improve patient outcomes and reduce the stigma associated with COPD. The article emphasizes the need for effective interventions and community-based care to support COPD patients and reduce ED visits. The review concludes by underscoring the role of nurses in promoting healthy behaviors, providing education, and encouraging proactive self-management among COPD patients.

Running head: CRITICAL REVIEW OF RESEARCH ARTICLE
Critical review of research article
Name of the Student
Name of the University
Author note

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1. a) The aim of the article is to explore the experiences of individuals with chronic
obstructive pulmonary disease (COPD) who have high frequency of presentations to the
Emergency Department (ED) and their carers (Robinson et al., 2017).
b) A mixed method study, descriptive qualitative phase was conducted for the researchers
and conducted in Illawarra Shoalhaven Local Health District (ISLHD), located in
southern New South Wales, which is a regional area on coastline on eastern seaboard,
Australia. The individuals who attended ED three times in a single health district for
COPD in the previous year participated in semi-structured face-to-face interviews.
Around 19 individuals participated in the study, out of which 12 were males comprising
of COPD patients and carers. Through thematic analysis, it was found that there is high
complexity among the people living with the disease. There is need for understanding of
COPD related issues that are faced by the patients and carers.
c) The article contributes to the fact that COPD can be managed by self-management
and optimal community-based care that can result in less ED presentations.
2. The study design is descriptive qualitative methods. The data is collected from sequential
mixed method study for examining the COPD ED presentations in the ISLHD from July
2014 to June 2015 over the period of 12 months. The research was conducted in ISLHD,
situated in Australia’s coastline on eastern seaboard. About 70 participants who attended
ED at least more than three times were identified and around 32 were selected for the
study. Informed consent was taken and data was collected through semi-structured
interviews.
Open-ended questions were asked to the participants and their responses were
recorded and transcribed. Thematic analysis was done where every piece of information

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in the recording was analyzed through listening, reading or re-reading transcripts by
interviewers. Finally, these codes were drawn into themes that were identified and
named.
The mixed study design used for this study is appropriate as it helped to overcome
the limitations that are involved with a single research design. This research method was
useful in exploring the experiences of COPD patients through multiple ways. This
method is beneficial for the study as it helped the researchers to describe and report easily
and position the research study into a transformative research (Woodward, 2013). The
sequential exploratory method was adopted where the initial data collection is qualitative
and further analyzed by a quantitative phase of data collection and analysis (Fetters,
Curry & Creswell, 2013). This study design aligned with the research question as it
helped to explore the phenomenon or experiences faced by COPD patients. Moreover,
this design helped to develop strategies and interventions for effective management of
COPD through self-management and community services. However, this method is time
taking as the data collection was done over a period of 12 months and it is very complex.
The planning for resources and its implementation is time consuming and discrepancies
may arise during the interpretation of findings, however, the researchers were reflexive.
3. This article illustrated the psychosocial factors that are associated with chronic illness.
Individuals who arrive at the ED with COPD have complex experiences. The factors like
fear, anxiety and self-blame have an impact on their coping ability and self-management
of their condition. These factors necessitate ED presentation for resolving their
symptoms. These factors highlighted by the article can assist healthcare professionals to

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consider the highly complex experiences of patients with COPD instead of judgmental
attitudes, improve the delivery of care, and thereby, reduce the ED presentations.
The psychosocial factors illustrated in this article are fear, anxiety and self-blame
that affect self-management of COPD condition. During the COPD exacerbation, patients
feel anxious and as a result, it worsens the condition. Moreover, when a COPD patient
experiences episode of difficulty in breathing, it triggers anxiety among them and as a
result, panic sets in. Fear is also associated with COPD as a recent study revealed that this
condition is often accompanied with co-morbid anxiety and fear. ED presentation
because of COPD exacerbation triggers fear and panic before admission and there is a
strong link between fear and symptoms worsening with poor self-management of this
condition (Sayiner et al., 2012). The smoking related behaviors tend to make COPD
patients blame for their exacerbating condition (Plaufcan, Wamboldt & Holm, 2012).
Apart from poor self-management, lack of appropriate community-based care also social
factors that contribute to ED presentations and life-threatening situations. The judgmental
attitude of healthcare professionals and stigma associated with COPD, as he or she is a
smoker with lack of empathy and care greatly contribute to their exacerbating condition
(Korpershoek et al., 2016).
These psychosocial factors affect COPD individuals and their families or carers
towards COPD management. The judgmental attitudes by healthcare providers towards
COPD greatly reduce the activation of self-management in chronic illness. The COPD
related stigmatization and poor quality of care results in low persuasion of patients to
adopt the self-management behaviors. Moreover, the healthcare professionals are
unsupportive, poor advocacy towards self-management services that inculcates fear and

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anxiety among the patients leading to increased ED presentations among COPD patients
(Halpin et al., 2015).
4. Interdisciplinary approach in chronic illness management through employment of
biopsychosocial framework is one of the best approaches in assisting patients to reduce
symptoms and regain their normal functionality. The teams members work in collaboration
with common goals, purpose, make decisions and share responsibilities and resources in
effective chronic illness management. In this approach, the patients and their family members
are involved in the clinical decision-making process, about their condition, prognosis and
care plan. This approach helps to improve patient outcomes, increase their level of
satisfaction, thereby reducing the length of hospital stays, and encourage patients to take an
active part in the ongoing plan (Chouinard et al., 2013).
The article is relevant to clinical practice and highlights the fact that collaborative inter-
disciplinary approach among healthcare providers help in self-management of chronic
illness. The inter-sectorial knowledge sharing can be helpful in delivering the best quality of
care that fulfills patients’ needs. Although, the paper did not explain inter-disciplinary
approach in detail, it can contribute to achievement of best practices in chronic illness
management. The role of nurses is relatively invisible in the study, however they can help to
reduce COPD exacerbations and improve their quality of life. Effective communication
between healthcare providers can help to include patients and their carers in the development
of care plan and thereby, improving the quality of care. The multi-disciplinary team of
physicians, nurses, behavioral specialists and physical therapists can help patients with
COPD to develop skills so that they can take an active part in self-management of their
chronic illness (Robinson et al., 2017).

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5. The article contributes to the fact that inter-disciplinary approach while working with
COPD patients and their families can be helpful in improving their condition and reducing
the barriers of stigma associated with the chronic disease. This article is helpful in revealing
the fact that being a student RN; one can take an active part in the implementation of
effective interventions for the COPD patients. The understanding of their experiences can be
helpful for the nurses to improve clinical process with better health outcomes. The nurses can
also help to reduce barriers of stigmatization through empathetic and compassionate care.
Through effective communication, nurses can motivate and encourage patients with chronic
illness to adopt lifestyle modifications and take an active part in self-management behaviors.
Nurses can contribute to chronic illness management and ensure continuity of care by
promoting healthy behaviors in COPD patients, giving advice and supporting them,
educating and encouraging them to manage their condition proactively (Schulman‐Green et
al., 2012).
From the above discussion, it can be concluded that COPD patients frequently present at ED
and there is lack of appropriate community-based care services for them. The article also
highlighted the fact that psychosocial factors like fear, anxiety and self-blame leads to poor
disease management. This paper also provides an insight into the perspectives of patients living
with COPD who frequently get admitted to ED. Nurses, as a part of interdisciplinary team must
increase awareness about issues in COPD presentation by implementing effective interventions
and promoting, encouraging healthy behaviors among them so that they manage their COPD
condition and avoid ED presentations.

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https://books.google.co.in/books?
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