Guided Review: Patients' Experience Managing COPD Exacerbations

This assignment provides a detailed analysis of a qualitative research study focused on patients' experiences in identifying and managing Chronic Obstructive Pulmonary Disease (COPD) exacerbations at home. The analysis covers various aspects of the study, including the background, research design, sampling methods, data collection techniques, and key findings. The study aimed to explore patients' understanding and experiences through interview-based qualitative research, recruiting 44 participants with moderate to very severe COPD. The analysis highlights the importance of understanding patients' perspectives on recognizing and managing COPD exacerbations, emphasizing the use of both visible and invisible symptoms in identifying these events. The review also discusses the strengths and limitations of the chosen research methods, ethical considerations, and the potential transferability of the findings to other chronic conditions. The assignment concludes by underscoring the significance of the study's findings in improving patient care and self-management strategies for COPD.

Bachelor Nursing Assignment
1

Background of the study:
a. What is the health issue that provides the focus of this study?
Chronic obstructive pulmonary disease (COPD) was the main focus of this research study.
b. Generally, what have been the results of previous studies of this issue?
In previous studies, it has been established that it was difficult for the patient to understand
the term COPD. Patients used clinical markers for the identification of exacerbations of
COPD. Patietns followed COPD symptoms for contacting the healthcare providers. Patients
exhibited deficiency of knowledge about the visible and invisible symptoms for the
understanding and recognisation of COPD exacerbatiosn. Few of the patients considered
COPD exacerbations as the bad day (Polastri, Pisani, Dell'Amore et al., 2017; Brien et al.,
2018). After completion of this study it was evident that patients were able to distinguish
between bad day and COPD exacerbations.
c. What is the significance of this study?
Patient’s knowledge and understanding of the COPD exacerbations were being assessed in
this intervention. Knoeledge about the COPD exacerbations among patietns can be helpful in
early identification of the disease. It can be helpful in implementing early intervention for
prevention, treatment and management of COPD. Patients were able to verbalise both
subjective and objective symptoms of COPD.
Overview of research design :
a. What was the aim of the research?
Main aim of this study is to explore patients’ current understanding and experience in
managing and identifying COPD exacerbations at home.
2

b. What research design was used?
Research design implemented in this study was interview based qualitative study.
d. Describe the main characteristics of the research design identified.
Main characteristics of the interview based qualitative study design was sampling of the
participants. Main focus of interview based qualitative study design should be participats
because its outcome is significantly based on the expression of participants. Participants
should express and verbalise their knowledge, opinion and experiences about the issue.
Interview questions design is very important aspect in this study design because outcome of
this study completely depends on interview questions. In this study design, semi-structured
interviews were carried out (Morris, 2015; Bell, 2014).
e. How did the research design chosen meet the aim(s) of the study?
Aim of this study was to identify understanding and knowledge of patient’s about
recognisation of the COPD exacerbations, patient’s experiences and patient’s self-
management strategy by the patietns. Interview questions incorporated in this study also
addressed all these aspects. Hence, it reflects this research design can be helpful to meet aim
of the study.
Sampling :
a. What were the characteristics of the participants in this study ?
In this qualitative study, 27 male and 17 female participants were recruited. These patients
were with average age of 71 years with range between 55 – 85 years. According to GOLD,
COPD can be calssified into different classes based on severity of COPD. Number of patietns
recruited with varied severity of COPD were : GOLD stage II, GOLD stage III and GOD
stage IV with 14, 21 and 9 patients respectively. Recruited patients were associated with
3

COPD patietns since 1 – 25 years. 15 and 29 patients were living alone and living with their
spouses or other family mmebrs respectively.
b. What were the inclusion and exclusion criteria of the sample ?
Inclusion and exclusion criteria for the recruitment of the participants were as follows : Age
40 years. A forced expiratory volume in 1s (FEV1) post-bronchodilator ˂80% and predicted
ratio of FEV1 to forced vital capacity (FVC) ˂0.70. Smoking history 10 pack years. MRC
dyspnoea scale ⩾2. Registered with a general practice and with an exacerbation of COPD
requiring home treatment or hospital admission in the previous year or referred for
pulmonary rehabilitation. Absence of other significant lung disease. Absence of chronic heart
failure defined by the New York Heart Association classification system as severe (Grade
IV). Able to give informed consent. Life expectancy of 43 months. Able to adequately
understand written and verbal English.
c. Why is it important to identify these criteria before recruitment starts ?
Inclusion and exclusion should be incorporated in the sample selection because it can define
sample universe. Deciosn making in sample selection can be improved and patient
characteristics can be identified by incorporating inclusion and exclusion criteria. In COPD
patients severity of disease, potential risk factors and co-morbid conditions are important
factors. All these factors can be identified by incorporating inclusion and exclusion criteria. It
can also be helpful in obtaining robust and valid output and reducing variability in the
outcome (Isaacs, 2014; Braun et al., 2014).
d. What sampling technique was used in this study?
Purposive sampling is a popular method of sampling in which samples are being selected
according to the preselected criteria with respect to aims of the study. In this study, samples
4

with history of COPD were selected which meet aim of the study; hence, this sampling
method can be considered as purposive sampling method (Morris, 2015; Fisher, 2011).
e. How was this sample appropriate for meeting the research aim?
Aim of this study was to understand patient’s knowledge about COPD. In this study COPD
patients were recruited. Hence, patient’s undersranding and information about COPD can be
collcted from the recruited patients. As recruited patients can provide information required to
meet aim of the study, it can be concluded that this sample was appropriate for meeting
research aim.
Data collection:
a. How were the data collected?
Data was collected by conductiong in-depth interview at patient’s home.
b. What, specifically, did the researchers do?
Experienced and trained researchers need to be involved in the data collection and in this
study also experienced and trained researchers were recruited. These researchers designed
semi-structured type of questions and these questions were specific to the aim of the study.
These questions addressed patient’s experience, knowledge, ability to recognise and manage
COPD. These researchers conducted interviews for each of the participant between 20 to 55
minutes and this interview process was audio-recorded. These audio-records were useful in
getting details of interview, correct analysis and monitoring of the interview process. Few of
the patients were not able to express their knowledge about COPD; hence family members of
six members were involved in the interview process (Levickis et al., 2013).
c. How did data collection fit the aims of this study?
5

Aim of this study was to understand the knowdge of patients about COPD. Collected data
provided information about the patient’s experience and knowdge about COPD. Hence, it
indicate data collection fit the aim of the study. Research can be considered as evidence based
research, if collcted data fulfil requirement to achieve aim of the study.
d. What might have been some advantages and disadvantages of this method of data
collection?
Advantages of the interview-based data collection include:
Accurate data can be collcted in the interview based data collection because during interview
process patients can not provide incorrect data about age and gender. In this type of data
collection, extent of knowledge and ease of expression can be easily accessed because both
verbal and non-verbal ques can be obtained. Accurate data can be obtained, if there is no
distraction during the interview process. In interview based data collection, distractions can
be effectively avoided. In interview based data collection assessment and recording of
emotions and behaviour are possible.
Following are the disadvantages of interview-based data collection:
High cost can be considered as the significant limitation for the home-based interviews
because it is necessary for interviewer to visit each patient’s home for conducting interview.
Less number of participants should be recruited. As more number of participants would
require recruitment of more number of researchers for conductiing interviews (Morris, 2015;
Erlingsson & Brysiewicz, 2013).
d. From your understanding of the weekly readings, what if any, are some alternative
methods of data collection that these researchers could have chosen?
6

In qualitative research, interview-based data collection is the most acceptable and accurate
method of data collection. However, other methods of data collection like observations and
textual or visual analysis (eg from books or videos) could have been implemented in the data
collection. These types of data collection would have been given more insight of emotional
and behavioural aspects of patients (Morris, 2015; Dean et al., 2016).
Data analysis/results:
a. How was the data analysed?
Multiple steps were involved in the data analysis. In the initial steps, collected data was
stored and organised in easily accessible manner. Audio-recorded data were transcribed into
the verbatim and anonymised transcripts were imported into the NVIVO 10 (qualitative
software data programme). Grounded theory approach and constant comparative method
were implemented in the data analysis. Bias was eliminated from the outcome obtained by
implementing open, axial and selective coding.
b. Why is it important to select applicable methods of data analysis in qualitative
research?
In this study, grounded theory approach was used for the analysis of data because in this
analysis human actions and interactions can be studied. In this study, also patient’s
interaction with the COPD was being evaluated (Morris, 2015; Fisher, 2011).
c. What did the researchers say about the rigour of their analysis?
Coding system can be implemented for improving rigour and validity of the outcome of the
study. Expereinced researcher performed coding who was not involved in the study. It helped
in reducing biasness. Coding and elimination of the biasness helped in improving
transparency of the study. Memo-writing was implemented in the data analysis which helped
7

in improving theoretical links and concepts from the collected data. Extensive discussion was
being carried out among researchers for effective analysis and interpretation of the collected
data. Recruitement of experienced researchers and discussion among themselves helped in
improving credibility of the outcome (Bloomer et al., 2013).
d. What were the study findings?
After the completion of the study, patients were able to idnentify COPD excerbations through
visible and invisible symptoms associated with clinical parametres and experimental
knowledge respectively. Patients with past history of COPD exacerbations, identified signs
and symptoms of COPD exacerbations, were able to recognise time of COPD exacerbations.
Patients acquired and understood self-management techniques like breathing techniques.
Patients recognised importance of antibiotic and steroid administration. Patients agreed that
they can identify and recognise COPD exacerbations and seek assistance from care providers
for management of COPD exacerbations. This timely intervention can be helpful in reducing
deterioration of the patient. Findings of this intervention were in accordance to the aim of the
study because findings demonstrated that patients can recognise and identify COPD
exacerbations.
e. Into which other settings can these findings be transferred
These findings can be implemented in the long duration care facilities like diabetes and
obesity because identification of these disesase are based on the visible and invisible
symptoms (Harreveld et al., 2016).
8

References:
Bell, E. (2014). Rethinking quality in qualitative research. Australian Journal of Rural Health,
22(3), 90-1.
Bloomer, M.J., Doman, M., and Endacott, R. (2013). How the observed create ethical
dilemmas for the observers: experiences from studies conducted in clinical settings in
the UK and Australia. Nursing & Health Sciences, 15(4), 410-4.
Braun, K.L., Browne, C.V., Ka'opua, L.S., Kim, B.J., and Mokuau, N. (2014). Research on
indigenous elders: from positivistic to decolonizing methodologies. Gerontologist,
54(1), 117-26.
Dickens, A.P, Kendrick, T., Jordan, R.E., Adab, P., and Thomas, M. (2018). Independent
determinants of disease-related quality of life in COPD - scope for nonpharmacologic
interventions? International Journal of Chronic Obstructive Pulmonary Disease, 13,
247-256.
Dean, W., Sophie, D., & Isabel, H. (2016). Common qualitative methods. In Z. Schneider, D.
Whitehead, G. LoBiondo-Wood & J. Haber (Eds.), Nursing and midwifery research:
Methods and appraisal for evidence based practice (5th ed., pp. 93 - 109).
Chastwood : Elsevier Australia.
Erlingsson, C., & Brysiewicz, P. (2013). Orientation among multiple truths : An introduction
to qualitative research. African Journal of Emergency Medicine, 3(2), 92 – 99.
Fisher, K. (2011). The qualitative interview and challenges for clinicians undertaking
research: a personal reflection. Australian Journal of Primary Health, 17(1), 102-6.
Harreveld, B., Danaher, M., Celeste, L., Knight, BA., and Busch, G. (2016). Constructing
Methodology for Qualitative Research: Researching Education and Social Practice.
Springer.
Isaacs, A. (2014). An overview of qualitative research methodology for public health
researchers. International Journal of Medicine and Public Health, 4(4), 318.
Levickis, P., Naughton, G., Gerner, B., and Gibbons, K. (2013). Why families choose not to
participate in research: feedback from non-responders. Journal of Paediatrics and
Child Health, 49(1), 57-62.
Morris, A. (2015). A Practical Introduction to In-depth Interviewing. SAGE.
Polastri, M., Pisani, L., Dell'Amore, A., and Nava, S. (2017). Revolving door respiratory
patients: A rehabilitative perspective. Monaldi Archives for Chest Disease, 87(3):857.
9