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Gregersen NV, Refsgaard B, Sørensen D. Preparing safe discharge in a complex practice: A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards. Scand J Caring Sci 2024; 38:756-766. [PMID: 38622922 DOI: 10.1111/scs.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/06/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. AIM To explore the process of preparing discharge for patients with COPD in a hospital setting. METHOD Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. RESULTS We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. CONCLUSION This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.
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Affiliation(s)
| | - Birgit Refsgaard
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
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2
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Borge CR, Larsen MH, Osborne RH, Aas E, Kolle IT, Reinertsen R, Lein MP, Thörn M, Lind RM, Groth M, Strand O, Andersen MH, Moum T, Engebretsen E, Wahl AK. Impacts of a health literacy-informed intervention in people with chronic obstructive pulmonary disease (COPD) on hospitalization, health literacy, self-management, quality of life, and health costs - A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2024; 123:108220. [PMID: 38458089 DOI: 10.1016/j.pec.2024.108220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To compare the effect of motivational interviewing (MI) and tailored health literacy (HL) follow-up with usual care on hospitalization, costs, HL, self-management, Quality of life (QOL), and psychological stress in people with chronic obstructive pulmonary disease (COPD). METHODS A RCT was undertaken in Norway between March 2018-December 2020 (n = 127). The control group (CG, n = 63) received usual care. The intervention group (IG, n = 64) received tailored HL follow-up from MI-trained COPD nurses with home visits for eight weeks and phone calls for four months after hospitalization. Primary outcomes were hospitalization at eight weeks, six months, and one year from baseline. The trial was registered with ClinicalTrials.gov (NCT03216603) and analysed per protocol. RESULTS Compared with the IG, the CG had 2.8 higher odds (95% CI [1.3 to 5.8]) of hospitalization and higher hospital health costs (MD=€ -6230, 95% CI [-6510 to -5951]) and lower QALYs (MD=0.1, 95% CI [0.10 to 0.11]) that gives an ICER = - 62,300. The IG reported higher QOL, self-management, and HL (p = 0.02- to <0.01). CONCLUSION MI-trained COPD nurses using tailored HL follow-up is cost-effective, reduces hospitalization, and increases QOL, HL, and self-care in COPD. PRACTICE IMPLICATION Tailored HL follow-up is beneficial for individuals with COPD and the healthcare system.
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Affiliation(s)
- Christine R Borge
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Marie H Larsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway
| | - Richard H Osborne
- Centre of Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Norway; Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | | | | | | | - Oda Strand
- Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marit Helen Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Torbjørn Moum
- Department of Behavioral Sciences in Medicine, University of Oslo, Norway
| | - Eivind Engebretsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway
| | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway
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Wu R, de Lara E, Liaqat D, Liaqat S, Chen JL, Son T, Gershon AS. Feasibility of a wearable self-management application for patients with COPD at home: a pilot study. BMC Med Inform Decis Mak 2024; 24:66. [PMID: 38443858 PMCID: PMC10916068 DOI: 10.1186/s12911-024-02461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Among people with COPD, smartphone and wearable technology may provide an effective method to improve care at home by supporting, encouraging, and sustaining self-management. The current study was conducted to determine if patients with COPD will use a dedicated smartphone and smartwatch app to help manage their COPD and to determine the effects on their self-management. METHODS We developed a COPD self-management application for smartphones and smartwatches. Participants were provided with the app on a smartphone and a smartwatch, as well as a cellular data plan and followed for 6 months. We measured usage of the different smartphone app functions. For the primary outcome, we examined the change in self-management from baseline to the end of follow up. Secondary outcomes include changes in self-efficacy, quality of life, and COPD disease control. RESULTS Thirty-four patients were enrolled and followed. Mean age was 69.8 years, and half of the participants were women. The most used functions were recording steps through the smartwatch, entering a daily symptom questionnaire, checking oxygen saturation, and performing breathing exercises. There was no significant difference in the primary outcome of change in self-management after use of the app or in overall total scores of health-related quality of life, disease control or self-efficacy. CONCLUSION We found older patients with COPD would engage with a COPD smartphone and smartwatch application, but this did not result in improved self-management. More research is needed to determine if a smartphone and smartwatch application can improve self-management in people with COPD. TRIAL REGISTRATION ClinicalTrials.Gov NCT03857061, First Posted February 27, 2019.
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Affiliation(s)
- Robert Wu
- University Health Network, Toronto, Canada.
- University of Toronto, Toronto, Canada.
| | | | | | | | | | - Tanya Son
- University Health Network, Toronto, Canada
| | - Andrea S Gershon
- University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Center, Toronto, Canada
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4
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Nóbrega VMD, Viera CS, Lorenzini E, Neves ET, Reichert APDS, Vaz EMC, Collet N. Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study. J Child Health Care 2023:13674935231159827. [PMID: 36853118 DOI: 10.1177/13674935231159827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.
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Affiliation(s)
| | - Claudia Silveira Viera
- Nursing Collegiate and the Graduate Program in Bioscience and Health at Western State University of Parana - Unioeste, Cascavel, Brazil
| | - Elisiane Lorenzini
- Department of Nursing and the Graduate Program in Nursing, 28117Universidade Federal de Santa Catarina - Campus Florianópolis, Florianopolis, Brazil
| | - Eliane Tatsch Neves
- Department of Nursing and the Graduate Program in Nursing, 28118Universidade Federal de Santa Maria, Santa Maria, Brazil
| | | | - Elenice Maria Cecchetti Vaz
- Department of Public Health and the Graduate Program in Nursing, 28097Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Neusa Collet
- Department of Public Health and the Graduate Program in Nursing, 28097Universidade Federal da Paraíba, João Pessoa, Brazil
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Schmid-Mohler G, Hübsch C, Steurer-Stey C, Greco N, Schuurmans MM, Beckmann S, Chadwick P, Clarenbach C. Supporting Behavior Change After AECOPD - Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel. Int J Chron Obstruct Pulmon Dis 2022; 17:1651-1669. [PMID: 35923357 PMCID: PMC9339665 DOI: 10.2147/copd.s358426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Abstract
After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study's aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients' key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence - including but not limited to patients' perspective - and health professionals' perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated.
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Affiliation(s)
- Gabriela Schmid-Mohler
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Christine Hübsch
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Claudia Steurer-Stey
- Epidemiology, Biostatistics and Prevention Institute, University Zurich, Zurich, Switzerland
- mediX Group Practice Zurich, Zurich, Switzerland
| | - Nico Greco
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Sonja Beckmann
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Paul Chadwick
- Centre for Behavior Change, University College London, London, UK
| | - Christian Clarenbach
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Schmid-Mohler G, Clarenbach C, Brenner G, Kohler M, Horvath E, Spielmanns M, Petry H. Advanced nursing practice in COPD exacerbations: the solution for a gap in Switzerland? ERJ Open Res 2020; 6:00354-2019. [PMID: 32577416 PMCID: PMC7293988 DOI: 10.1183/23120541.00354-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
AIM This study aimed to address the need for adaptation of the current model of chronic obstructive pulmonary disease (COPD) care in Switzerland, particularly in regard to acute exacerbations, and how far an integrated approach involving advanced nursing practice can meet those needs. METHODS A state analysis guided by the PEPPA framework was initiated by the Pulmonology Clinic of University Hospital Zürich. Literature describing the current provision of COPD care regarding exacerbations in Switzerland and international qualitative studies describing the patient perspective were systematically searched and summarised. The health providers' perspective was investigated in three focus-group interviews. RESULTS A lack of systematic and state-of-the-art support for patient self-management in Switzerland was described in literature and confirmed by the health providers interviewed. While care was assessed as being comprehensive and of good quality in each individual sector, such as inpatient, outpatient, rehabilitation and home settings, it was identified as being highly fragmented across sectors. The interview participants described day-to-day examples in which a lack of support in COPD self-management and fragmentation of care negatively affected the patients' disease management. CONCLUSION The necessity of coordinating the transition between healthcare sectors and self-management support and that these organisational boundaries should be addressed by a multi-professional team were identified. Initial evaluation indicates that advanced practice nurses potentially have the skill set to coordinate the team and address patients' self-management needs in complex patient situations. However, the legal foundation and a reimbursement system to ensure long-term implementation is not yet available.
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Affiliation(s)
- Gabriela Schmid-Mohler
- Centre of Clinical Nursing Science, University Hospital Zürich, Zürich, Switzerland
- Division of Pulmonology, University Hospital Zürich, Zürich, Switzerland
- Medical Dept Heart–Vascular–Thorax, University Hospital Zürich, Zürich, Switzerland
| | - Christian Clarenbach
- Division of Pulmonology, University Hospital Zürich, Zürich, Switzerland
- Medical Dept Heart–Vascular–Thorax, University Hospital Zürich, Zürich, Switzerland
| | - Gabi Brenner
- Directorate of Nursing and Allied Health Professionals, University Hospital Zürich, Zürich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital Zürich, Zürich, Switzerland
- Medical Dept Heart–Vascular–Thorax, University Hospital Zürich, Zürich, Switzerland
| | - Eva Horvath
- Medical Dept Heart–Vascular–Thorax, University Hospital Zürich, Zürich, Switzerland
| | - Marc Spielmanns
- Pulmonary Medicine, Zürcher RehaZentren Klinik Wald, Zürich, Switzerland
- Dept of Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zürich, Zürich, Switzerland
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7
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Hegelund A, Andersen IC, Andersen MN, Bodtger U. The impact of a personalised action plan delivered at discharge to patients with COPD on readmissions: a pilot study. Scand J Caring Sci 2019; 34:909-918. [PMID: 31865631 PMCID: PMC7754430 DOI: 10.1111/scs.12798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/31/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022]
Abstract
Background Self‐management interventions in COPD, including action plans, have the potential to increase quality of life and to reduce respiratory‐related hospitalisations. However, knowledge is still sparse of the effectiveness of a personally tailored action plan introduced at or right after discharge from hospital. Aim This pilot study aimed to test whether a personalised, stepwise action plan supported with a short instruction provided at or postdischarge after an acute exacerbation in chronic obstructive pulmonary disease admission as an addition to usual care reduces readmissions and symptom burden, including anxiety and depression levels at 3‐month follow‐up. Methods The study was carried out in a randomised controlled design with follow‐up after 3 months. In all, 75 participants were randomly assigned to either an intervention group that received an action plan, including the COPD Assessment Test (CAT), or to a control group that received usual care. The incidence of COPD‐related readmissions was measured as the primary outcome. Results Compared to the control group, the action plan group significantly reduced the incidence of readmissions. The action plan group showed a trend towards a significant decrease in HADS‐depression, but none in HADS‐anxiety. Significant improvements in CAT scores were observed for the participants in the intervention group. Only inferior minor differences were found in use of inhalation therapy. Conclusions A personally tailored action plan introduced at or postdischarge combined with follow‐up support is an effective self‐management tool to support recovery and to reduce unnecessary readmissions. In future follow‐up care, the healthcare professional must initiate the action plan at discharge and immediately after having the opportunity to follow the patient at home. This might require healthcare professionals working across healthcare sectors, who support patients until they have the needed confidence and competence in using the plan.
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Affiliation(s)
- Annette Hegelund
- Competence Center for Pulmonary Disease, Department of Medicine, Naestved and Slagelse Hospitals, Naestved, Denmark
| | - Ingrid Charlotte Andersen
- Department of Medicine, Naestved and Slagelse Hospitals, Odense, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marianne N Andersen
- Competence Center for Pulmonary Disease, Department of Medicine, Naestved and Slagelse Hospitals, Naestved, Denmark
| | - Uffe Bodtger
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Naestved Hospital, Odense, Denmark
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8
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Schmid-Mohler G, Caress AL, Spirig R, Yorke J. Introducing a model for emotional distress in respiratory disease: A systematic review and synthesis of symptom management models. J Adv Nurs 2019; 75:1854-1867. [PMID: 30734366 DOI: 10.1111/jan.13968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 12/31/2022]
Abstract
AIM To undertake a theoretical systematic review to develop a conceptual model of illness-related emotional distress in the context of symptom management in chronic respiratory disease. DESIGN We performed a systematic search to identify conceptual models. DATA SOURCES Electronic databases MEDLINE, CINAHL, EMBASE and PsycINFO were searched and papers included from inception of the search term until June 2017. REVIEW METHODS The review was conducted following Pound and Campbell's and Turner's theory synthesis. Conceptual models were appraised using Kaplan's criteria. Models were excluded if they referred to a specific condition and/or lacked clarity. RESULTS This synthesis, which includes five models and additional evidence, yielded a new conceptual model describing the processes of regulation and symptom self-management in chronic respiratory disease. Identified sources of illness-related emotional distress are new or increased symptoms, additional treatment, new restrictions in performance of daily life roles and increased unpredictability. People goals and self-efficacy were identified as further drivers of symptom self-management. The regulation process is embedded in contextual factors. CONCLUSION Theory synthesis provided transparent guidance in developing a model to understand of the factors driving self-management decisions. Therefore, the model has the potential to guide development of interventions that support symptom self-management in chronic respiratory disease. IMPACT This newly presented conceptual model of illness-related emotional distress provides an understanding of the factors that drive self-management decisions when peoples experience new or increased symptoms. Such understanding is critical for nursing practice to developing appropriate interventions, especially in support of people decision-making.
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Affiliation(s)
| | - Ann-Louise Caress
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Rebecca Spirig
- Directorate of Nursing and Allied Health Professionals, University Hospital Zurich, Zurich, Switzerland
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Simonÿ C, Andersen IC, Bodtger U, Birkelund R. Accommodating to a troubled life - chronic obstructive pulmonary disease patients' experiences and perceptions of self-image during the course of rehabilitation. Disabil Rehabil 2019; 42:2510-2518. [PMID: 30763522 DOI: 10.1080/09638288.2018.1563641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: To tailor future rehabilitation programmes for patients with chronic pulmonary obstructive disease, there is a need for more in-depth knowledge about what is essential to these patients and how they perceive their self-image while participating in rehabilitation. Therefore, this study aims to explore patients' experiences and perception of self-image during pulmonary rehabilitation.Methods: Twenty-one patients were followed by participant observations during standard rehabilitation complicity supplemented with final individual interviews. Phenomenological-hermeneutic analysis and interpretation were applied.Results: Through a rewarding peer fellowship, patients became engaged in rehabilitation and improved their capacity to embrace and manage their illness. Through a humorous interplay, encouragement to live with the life-threating disease developed. While understanding themselves in a wider perspective, patients enhanced enablement to shape life according to personal satisfaction. Although participating in the group-based programme was mostly invigorating, it was, however, sometimes perceived as a stressful overload. More individualized support from healthcare professionals was warrented.Conclusions: Group-based pulmonary rehabilitation can support chronic pulmonary obstructive disease patients towards significant change in self-image and health behaviour, leading to improved illness management. Enlarged opportunities to benefit from peer-fellowship and enhanced focus on what is essential to the participants might expand the rehabilitation yields.
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Affiliation(s)
- Charlotte Simonÿ
- Institute of Regional Health University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Denmark
| | | | - Uffe Bodtger
- Institute of Regional Health University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
| | - Regner Birkelund
- Institute of Regional Health University of Southern Denmark, Odense, Denmark.,Department of Health Research, Vejle Sygehus, Vejle, Denmark
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10
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Simonÿ C, Specht K, Andersen IC, Johansen KK, Nielsen C, Agerskov H. A Ricoeur-Inspired Approach to Interpret Participant Observations and Interviews. Glob Qual Nurs Res 2018; 5:2333393618807395. [PMID: 30397637 PMCID: PMC6207962 DOI: 10.1177/2333393618807395] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/17/2023] Open
Abstract
In-depth knowledge of what it means to patients to receive health care services is crucial to the development of adequate protocols for nursing. Qualitative research allows us to gain important insight into what is experienced by and meaningful to patients. The French philosopher Paul Ricoeur's thoughts have inspired qualitative researchers to conduct various forms of analysis and interpretation that increase our knowledge of ways of being-in-the-world. This article describes and discusses how a specific approach to derive in-depth knowledge of patients' lived experiences can be taken. A combination of participant observations and interviews was used to generate data. Field notes and transcribed interviews were gathered as one collective text and analyzed and interpreted with inspiration from Ricoeur's thoughts on narratives and interpretation. This approach is argued to be a significant way of developing in-depth knowledge of patients' lived experiences. Such knowledge is important within nursing science.
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Affiliation(s)
- Charlotte Simonÿ
- Institute of Regional Health University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Region Zealand, Denmark.,Extern Lecturer at Institute of Health, Section of Nursing Sience, Aarhus University, Denmark
| | - Kirsten Specht
- Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Kirsten Kjær Johansen
- Research Unit, Mental Health Service Esbjerg, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Odense Denmark
| | - Charlotte Nielsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark
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11
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Russell S, Ogunbayo OJ, Newham JJ, Heslop-Marshall K, Netts P, Hanratty B, Beyer F, Kaner E. Qualitative systematic review of barriers and facilitators to self-management of chronic obstructive pulmonary disease: views of patients and healthcare professionals. NPJ Prim Care Respir Med 2018; 28:2. [PMID: 29343739 PMCID: PMC5772437 DOI: 10.1038/s41533-017-0069-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023] Open
Abstract
Self-management interventions for chronic obstructive pulmonary disease (COPD) can improve quality of life, reduce hospital admissions, and improve symptoms. However, many factors impede engagement for patients and practitioners. Qualitative research, with its focus on subjective experience, can provide invaluable insights into such factors. Therefore, a systematic review and synthesis of qualitative evidence on COPD self-management from the perspective of patients, carers, and practitioners was conducted. Following a systematic search and screening, 31 studies were appraised and data extracted for analysis. This review found that patients can adapt to COPD; however, learning to self-manage is often a protracted process. Emotional needs are considerable; frustration, depression, and anxiety are common. In addition, patients can face an assortment of losses and limitations on their lifestyle and social interaction. Over time, COPD can consume their existence, reducing motivation. Support from family can prove vital, yet tinged with ambivalence and burden. Practitioners may not have sufficient time, resources, or appropriate skills or confidence to provide effective self-management support, particularly in regard to patients' psychosocial needs. This can compound patients' capability to engage in self-management. For COPD self-management to be effective, patients' psychosocial needs must be prioritised alongside medication and exacerbation management. In addition, patients' personal beliefs regarding COPD and its management should be reviewed periodically to avoid problematic behaviours and enhance positive adaptions to the disease. Patients with COPD are not a homogenous group and no one intervention will prove effective for all. Finally, practitioners require greater education, training, and support to successfully assist patients.
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Affiliation(s)
- Siân Russell
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA.
| | - Oladapo J Ogunbayo
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
| | - James J Newham
- Department of Primary Care & Public Health Sciences, King's College London, London, UK
| | - Karen Heslop-Marshall
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
| | - Paul Netts
- NHS Newcastle Gateshead Clinical Commissioning Group, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
| | - Fiona Beyer
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
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