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Nyman F. Health care of the disadvantaged: chronic obstructive pulmonary disease in later life. Front Public Health 2023; 11:1304494. [PMID: 38026408 PMCID: PMC10666629 DOI: 10.3389/fpubh.2023.1304494] [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: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Chronic diseases have emerged as the foremost causes of death and disability worldwide. This article employs an ethnographic approach to conduct a gerontological investigation of chronic obstructive pulmonary disease (COPD), the third leading cause of global mortality, trailing only cardiovascular diseases and cancers. Methods This study is rooted in an extensive amalgamation of biomedical literature and official epidemiological data. Additionally, it offers enriched insights through an extensive ethnographic research methodology, encompassing ethnographic fieldwork, participant observation, interviews, and focus groups. Results The findings expound that individuals grappling with chronic obstructive pulmonary disease often undergo intricate cognitive and emotional experiences, necessitating holistic solutions that consider psychological processes, contextual factors, and subjective age. These challenges extend beyond the purview of a purely medical perspective. Conclusion This article concludes that the lens of gerontology is invaluable in comprehending chronic obstructive pulmonary disease, particularly due to its association with old age and increased longevity. Among older individuals, diagnosing the condition presents a formidable challenge. Breathlessness, a cardinal symptom, often overlaps with normal age-related declines in pulmonary function, rendering COPD's insidious onset misconstrued as a consequence of aging-related changes.
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Affiliation(s)
- Fredrik Nyman
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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2
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Delaney S, Cronin P, Huntley-Moore S. Conceptualisations of COPD self-management: A narrative review of the research literature. Chronic Illn 2023; 19:514-528. [PMID: 35876320 DOI: 10.1177/17423953221115441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To examine how self-management is conceptualised in the research literature on chronic obstructive pulmonary disease (COPD). METHODS A narrative review was undertaken to search the research literature on COPD self-management. Ten databases (2000-2021) were searched for published texts. Sixty-two articles met the inclusion criteria. A thematic analysis was conducted of the literature. RESULTS Three conceptualisations of COPD self-management were identified: 1) a dominant medicocentric conceptualisation which represented self-management as medical in focus; 2) a less dominant experiential conceptualisation that viewed it as arising from the experiences of people living with COPD; and 3) a smaller body of literature that attempted to integrate medicocentric and experiential conceptualisations of self-management. DISCUSSION The dominance of the medicocentric conceptualisation of self-management and the polarisation of medicocentric and experiential perspectives were striking. An integrated conceptualisation of self-management has the potential to unite these competing perspectives and promote collaborative relationships between individuals and professionals, so long as the underlying values informing it are made explicit. However, there is a dearth of literature on this approach and it would benefit from more attention. Methods such as Co-production and the Personal Outcomes Approach offer the potential to support an integrated perspective in clinical practice.
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Affiliation(s)
- Sarah Delaney
- Health Research Charities Ireland, Digital Office Centre, 12 Camden Row, Dublin, Ireland
| | - Patricia Cronin
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Sylvia Huntley-Moore
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
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3
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Tomán E, Pintér JN, Hargitai R. Preliminary study of the exploration patients' experiences of chronic respiratory experiences during the COVID-19 pandemic using interpretative phenomenological analysis. PSYCHIATRY RESEARCH COMMUNICATIONS 2023; 3:100101. [PMID: 36573131 PMCID: PMC9771840 DOI: 10.1016/j.psycom.2022.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
During the first period of coronavirus pandemic, respiratory patients may have been more vulnerable to mental health problems in addition to their physical vulnerability. The aim was to explore and deepen our understanding of the experiences of chronic respiratory patients at risk of pandemic COVID-19 using interpretative phenomenological analysis. The study involved 8 participants with asthma, COPD or cystic fibrosis. Three main themes emerged: 1. respiratory illness as a defining experience in everyday life, 2. the impact of the COVID-19 pandemic on the self and identity organisation, and 3. adaptation to experiencing vulnerability. Breathlessness as the most frightening feature of progressive lung disease, can be linked to fear and anxiety in different ways. The experience of vulnerability is a fundamental part of their lives. The potentially contagious nature of COVID-19 draws a sharp line between the endangered Self and the dangerous Other. In terms of their adaptation, we observe essentially self-defense mechanisms and emotion-focused strategies.
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Affiliation(s)
- Edina Tomán
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Corresponding author. Doctoral School of Psychology, ELTE Eötvös Loránd University, 1064, Budapest, Hungary
| | - Judit Nóra Pintér
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Rita Hargitai
- Institute of Psychology, PPKE Pázmány Péter Catholic University, Budapest, Hungary
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4
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Bueno GH, Campos CJG, Turato ER, Paschoal IA, Valladão LS, Baltieri L, Martins LC. Experiences in elderly people with chronic obstructive pulmonary disease in relation to the use of long-term home oxygen therapy: a qualitative study about feelings attributed to therapy. BMC Pulm Med 2022; 22:96. [PMID: 35305608 PMCID: PMC8933854 DOI: 10.1186/s12890-022-01891-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background Elderly people are more likely to suffer severe chronic obstructive pulmonary disease (COPD) and require long-term home oxygen therapy (LTOT) as part of their treatment. LTOT has advantages such as improvement in symptoms, but there are also disadvantages such as physical barriers, psychosocial barriers and emotional challenges. The aim of this study is to understand the experiences of elderly people with COPD using LTOT with respect to their feelings attributed to therapy. Methods Qualitative study. Seven semidirected interviews were conducted with patients with a confirmed COPD diagnosis who used LTOT and were treated at an outpatient service. The content analysis technique was applied with the support of WebQDA software 2.0. Results Three categories emerged that were associated with the use of LTOT: (1) poor self-image; (2) feelings of sadness and (3) the impact of LTOT on others such as family and friends. Conclusions LTOT in elderly people with COPD was associated with a poor self-image, feelings of sadness and impacted on others apart from the patient. When LTOT is prescribed, healthcare practitioners should proactively address these concerns to minimise the negative biopsychosocial experiences caused by LTOT.
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5
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Melhem O, Savage E, Lehane E. Symptom burden in patients with chronic obstructive pulmonary disease. Appl Nurs Res 2021; 57:151389. [PMID: 33549292 DOI: 10.1016/j.apnr.2020.151389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/15/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is now a growing body of evidence to suggest that patients with chronic disease experience their symptoms as a burden. Although symptoms are a principal focus for diagnosis and treatment of chronic obstructive pulmonary disease (COPD), there has been little research to date on symptom burden with reference to frequency, severity, and distress of symptoms. METHODS A descriptive, cross-sectional survey design was used. Symptom burden was measured using the Memorial Symptom Assessment Scale (MSAS). A sample of 214 patients with COPD, recruited from one of the major teaching hospitals in Ireland. RESULTS Patients experienced a median of 13 symptoms. Patients with 'very severe' COPD experienced the greatest number, with a median of 15 symptoms, followed by those with 'severe' COPD, with a median of 14 symptoms. Patients with 'mild' and 'moderate' COPD reported a median of 10 symptoms each. The most burdensome symptoms were shortness of breath, lack of energy, difficulty sleeping, worrying, dry mouth, feeling nervous, and feeling irritable. Total symptom burden was found to be low. Patients with 'very severe' COPD had the greatest symptom burden, followed by those with 'severe', 'moderate', and 'mild' COPD. Symptom burden was higher for psychological symptoms, with a mean score of 1.60 compared to the physical symptoms (mean = 0.87). CONCLUSION Patients with COPD experience a remarkably high number of symptoms, and significant symptom burden of both physical and psychological symptoms. There is a need for early assessment and management of both physical and psychological symptoms in all patients with COPD.
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Affiliation(s)
- Omar Melhem
- Nursing Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates.
| | - Eileen Savage
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Elaine Lehane
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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6
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Paradise RK, Dryden E, Elvin D, Fisher C, Touw S, Trumble L, Batalden M. Incorporating patient input into the design of a disease management program for COPD. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2019; 8:100363. [PMID: 31147276 DOI: 10.1016/j.hjdsi.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/22/2019] [Accepted: 05/09/2019] [Indexed: 11/15/2022]
Abstract
In the era of value-based payment contracts, there is increasing emphasis on disease management as a strategy for improving care quality and reducing costs. To design effective disease management programs, healthcare systems should understand the day-to-day experience of living with particular health conditions, and ensure that evidence-based services and interventions are adapted to align with the realities of patients' lives and their priorities. For healthcare systems operating with limited resources, there is a need for practical and small-scale approaches for collecting and using patient input as part of program design and operations. This case study describes a targeted interview process that Cambridge Health Alliance (CHA) used to gather patient input during the design of a disease management program for chronic obstructive pulmonary disease. The patient perspectives gathered through the interviews influenced several aspects of the program design. The key lessons from CHA's experience are: 1) A small-scale approach with cycles of 5-10 interviews can produce valuable insights for program design; 2) Short patient vignettes can be used to summarize patient data in a simple and compelling format; and 3) Clinicians' perspectives are critical for interpreting patient input and extracting information that is most likely to be useful for program design. CHA's approach provides an example of a systematic and practical process for gathering patient input that other healthcare systems can adapt to their local contexts.
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Affiliation(s)
| | - Eileen Dryden
- Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, USA
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7
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van der Meide H, Teunissen T, Visser LH, Visse M. Trapped in my lungs and fighting a losing battle. A phenomenological study of patients living with chronic obstructive and pulmonary disease. Scand J Caring Sci 2019; 34:118-127. [PMID: 31099083 PMCID: PMC7074040 DOI: 10.1111/scs.12713] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/14/2019] [Indexed: 12/01/2022]
Abstract
Chronic obstructive and pulmonary disease (COPD) has detrimental effects on individuals with the disease. COPD causes breathlessness, morbidity and associated psychosocial distress. This study was guided by the phenomenological question what is it like to have COPD and situated in Van Manen's phenomenology of practice. Experiential material was gathered through phenomenological interviews. Four themes emerged from the lived experiences of patients living with COPD: breath as a possibility; being vigilant; fighting a losing battle; and feeling isolated from others. For patients with COPD, breathing becomes ever-present and shifts from the invisible background of daily living to the central activity around which everyday life is organised. COPD patients always monitor their own breath and scrutinise the environment on possible dangers that can affect their breathing. Whenever moving or being involved in an activity, a part of their mind is preoccupied with the breathing. Although COPD patients realise that no amount of good behaviour will matter and that the decline of their lungs is inevitable, they make every effort to take good care of their body. They anticipate and avoid triggers of breathlessness isolating them from social interactions and activities. The appearance of the body as a source of social embarrassment also has an isolating effect. This study shows that breathlessness is a constant horizon that frames the experience of COPD patients. It is a limiting factor and determines their entire life. A more profound understanding of these experiences in healthcare professionals will contribute to person-centred care for COPD patients.
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Affiliation(s)
- Hanneke van der Meide
- University of Humanistic Studies, Utrecht, The Netherlands.,Tilburg University, Tilburg, Tranzo Scientific Center for Care and welfare, The Netherlands
| | | | - Leo H Visser
- University of Humanistic Studies, Utrecht, The Netherlands.,Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Merel Visse
- University of Humanistic Studies, Utrecht, The Netherlands
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8
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Penny E, Malpass A. Dear Breath: using story structure to understand the value of letter writing for those living with breathlessness - a qualitative study. Arts Health 2019; 13:20-34. [PMID: 31038423 DOI: 10.1080/17533015.2018.1555178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Despite the prevalence of dyspnoea (the pathological term for breathlessness) amongst the general population and the diagnostic importance of dyspnoea for respiratory illness, public awareness of dyspnoea is poor with an estimated two million people with undiagnosed Chronic Obstructive Pulmonary Disorder in the UK. We explore whether therapeutic letter writing is a valuable arts health approach for those living with breathlessness. Methods: Eighty (80) participants took part in 10 workshops held in community-based settings. The overall approach was qualitative. We analysed the data thematically. Results: Informed by theories of story structure, our analysis explores letters written to the breath in terms of there being a protagonist, antagonist, a process of recognition and reconciliation. Conclusions: Writing a letter to the breath facilitates new ways of relating to breathlessness. Letters create a personal narrative and workshops create a public story. Further research should explore whether therapeutic letter writing can support communication about breathlessness with clinicians.
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Affiliation(s)
| | - Alice Malpass
- Centre for Academic Primary Care, Bristol Medical School , Bristol, UK
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9
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Lippiett KA, Richardson A, Myall M, Cummings A, May CR. Patients and informal caregivers' experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research. BMJ Open 2019; 9:e020515. [PMID: 30813114 PMCID: PMC6377510 DOI: 10.1136/bmjopen-2017-020515] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify, characterise and explain common and specific features of the experience of treatment burden in relation to patients living with lung cancer or chronic obstructive pulmonary disease (COPD) and their informal caregivers. DESIGN Systematic review and interpretative synthesis of primary qualitative studies. Papers were analysed using constant comparison and directed qualitative content analysis. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science searched from January 2006 to December 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Primary qualitative studies in English where participants were patients with lung cancer or COPD and/or their informal caregivers, aged >18 years that contain descriptions of experiences of interacting with health or social care in Europe, North America and Australia. RESULTS We identified 127 articles with 1769 patients and 491 informal caregivers. Patients, informal caregivers and healthcare professionals (HCPs) acknowledged lung cancer's existential threat. Managing treatment workload was a priority in this condition, characterised by a short illness trajectory. Treatment workload was generally well supported by an immediacy of access to healthcare systems and a clear treatment pathway. Conversely, patients, informal caregivers and HCPs typically did not recognise or understand COPD. Treatment workload was balanced with the demands of everyday life throughout a characteristically long illness trajectory. Consequently, treatment workload was complicated by difficulties of access to, and navigation of, healthcare systems, and a fragmented treatment pathway. In both conditions, patients' capacity to manage workload was enhanced by the support of family and friends, peers and HCPs and diminished by illness/smoking-related stigma and social isolation. CONCLUSION This interpretative synthesis has affirmed significant differences in treatment workload between lung cancer and COPD. It has demonstrated the importance of the capacity patients have to manage their workload in both conditions. This suggests a workload which exceeds capacity may be a primary driver of treatment burden. PROSPERO REGISTRATION NUMBER CRD42016048191.
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Affiliation(s)
- Kate Alice Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
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10
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Lovell N, Etkind SN, Bajwah S, Maddocks M, Higginson IJ. Control and Context Are Central for People With Advanced Illness Experiencing Breathlessness: A Systematic Review and Thematic Synthesis. J Pain Symptom Manage 2019; 57:140-155.e2. [PMID: 30291949 DOI: 10.1016/j.jpainsymman.2018.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 12/01/2022]
Abstract
CONTEXT Breathlessness is common and distressing in advanced illness. It is a challenge to assess, with few effective treatment options. To evaluate new treatments, appropriate outcome measures that reflect the concerns of people experiencing breathlessness are needed. OBJECTIVES The objective of this study was to systematically review and synthesize the main concerns of people with advanced illness experiencing breathlessness to guide comprehensive clinical assessment and inform future outcome measurement in clinical practice and research. METHODS This is a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. MEDLINE (1946-2017), PsycINFO (1806-2017), and EMBASE (1974-2017), as well as key journals, gray literature, reference lists, and citation searches, identified qualitative studies exploring the concerns of people living with breathlessness. Included studies were quality-assessed using the Critical Appraisal Skills Program checklist and analyzed using thematic synthesis. RESULTS We included 38 studies with 672 participants. Concerns were identified across six domains of "total" breathlessness: physical, emotional, spiritual, social, control, and context (chronic and episodic breathlessness). Four of these have been previously identified in the concept of "total dyspnea." Control and context have been newly identified as important, particularly in their influence on coping and help-seeking behavior. The importance of social participation, impact on relationships, and loss of perceived role within social and spiritual domains also emerged as being significant to individuals. CONCLUSION People with advanced illness living with breathlessness have concerns in multiple domains, supporting a concept of "total breathlessness." This adapted model can help to guide comprehensive clinical assessment and inform future outcome measurement in clinical practice and research.
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Affiliation(s)
- Natasha Lovell
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.
| | - Simon N Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
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11
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Oxley R, Harrison SL, Rose A, Macnaughton J. The meaning of the name of 'pulmonary rehabilitation' and its influence on engagement with individuals with chronic lung disease. Chron Respir Dis 2019; 16:1479973119847659. [PMID: 31137961 PMCID: PMC6539565 DOI: 10.1177/1479973119847659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/24/2019] [Indexed: 01/23/2023] Open
Abstract
Pulmonary rehabilitation (PR) is recommended for all individuals living with a lung condition and chronic breathlessness. This article considers how adopting an interdisciplinary, medical humanities approach to the term 'pulmonary rehabilitation' might unpack some of the misconceptions, misrepresentations or negative connotations surrounding it, which have been largely overlooked in explanations of the low uptake of this programme. Taking key insights from Wellcome Trust-funded Life of Breath project, including ethnographic research in community fitness groups in North East England and the 'Breath Lab' special interest group, this article outlines how the whole-body approach of PR is not easily understood by those with lung conditions; how experience can inform breath perception through the pacing of everyday life; and how stigma can impact rehabilitation. This article highlights the value of medical humanities in working through communicative challenges evident in the translation of PR between patient and clinical contexts and sets out two arts-based approaches (Singing for Lung Health and dance movement) as potential options that could be included in the PR referral. Finally, the article outlines the need for collaborative research exploring the communication and meaning of healthcare strategies and experiences at the interface of the arts, humanities and medical practice.
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Affiliation(s)
- Rebecca Oxley
- The Centre for Medical Humanities, Caedmon Building, Durham
University, Durham, UK
| | - Samantha L. Harrison
- School of Health and Social Care, Centuria Building, Teesside
University, Middlesbrough, Tees Valley, UK
| | - Arthur Rose
- The Centre for Medical Humanities, Caedmon Building, Durham
University, Durham, UK
| | - Jane Macnaughton
- The Centre for Medical Humanities, Caedmon Building, Durham
University, Durham, UK
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12
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Ek K, Ternestedt BM, Andershed B, Sahlberg-Blom E. Shifting Life Rhythms: Couples’ Stories about Living Together When One Spouse Has Advanced Chronic Obstructive Pulmonary Disease. J Palliat Care 2018. [DOI: 10.1177/082585971102700302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aim: This study examines couples’ experiences of living together when one partner has advanced chronic obstructive pulmonary disease (COPD). Method: Repeated qualitative interviews with four couples over an eight-month period, where one spouse in each couple suffered from advanced COPD. The final dataset comprised 19 interviews. A phenomeno-logical-hermeneutical method was used to interpret the interview text. Findings: One main theme, “living with the disease and one's spouse in a new and changeable life rhythm”, emerged from three subthemes: “living with uncertainty”, “living in a changed intimate relationship”, and “finding new ways of living together”. A mutual sense of companionship between the spouses facilitated their chances of reshaping their relationship and adapting it to the new life rhythm required by everyday life with the disease. Conclusion: The healthy spouse had major responsibility for the health of their sick spouse. Awareness of the couple's own conceptions and knowledge of health and illness is central to person-focused care, as is awareness of what values are important to them when restructuring their everyday life.
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Affiliation(s)
- Kristina Ek
- K Ek (corresponding author) School of Health and Medical Sciences, Örebro University, Fakultetsgatan 1, S-701 82, Örebro, Sweden
| | - Britt-Marie Ternestedt
- Department of Palliative Care Research, Ersta Sköndal University College, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and StockholmsSjukhem Foundation, Research and Development Department, Stockholm, Sweden
| | - Birgitta Andershed
- Department of Nursing, Gjøvik University College, Gjøvik, Norway, Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, and School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Eva Sahlberg-Blom
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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13
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Exploring medicines management by COPD patients and their social networks after hospital discharge. Int J Clin Pharm 2018; 40:1019-1029. [PMID: 30056568 PMCID: PMC6208597 DOI: 10.1007/s11096-018-0688-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/05/2018] [Indexed: 12/17/2022]
Abstract
Background Unplanned hospital admissions (UHAs) for chronic obstructive pulmonary disease (COPD) are a major burden on health services. Effective medicines management is crucial to avoid such admissions but little is known about the role of social networks in supporting medicines-taking. Objective To examine the activities and strategies recently discharged COPD patients and their social network members (SNMs) utilise to manage their medicines. Setting COPD patients recently discharged from an acute NHS Trust in Northwest England. Methods Semi-structured, face-to-face interviews; audio-recorded and transcribed with consent, NVivo v11 facilitated qualitative thematic analysis. NHS ethical approved. Main outcome measure Interview topic guide and analysis informed by Cheraghi-Sohi et al.’s conceptual framework for ‘medication work’ exploring medication–articulation, informational, emotional and surveillance work. Results Twelve interviews were conducted during March–August 2016. Participants’ social networks were small (n < 5) and restricted to family members and healthcare professionals. Participants social network members performed similar medication–articulation and surveillance work to coronary heart disease, arthritis and diabetes patients. When participants social network members resolved issues identified by surveillance work, this medication work was conceptualised as surveillance–articulation work. The social network members performed little emotional work and were infrequently involved in informational work despite some participants describing informational needs. After discharge, participants reverted to pre-admission routines/habits/strategies for obtaining medication supplies, organising medicines, keeping track of supplies, ensuring adherence within daily regimens, and monitoring symptoms, which could cause issues. Conclusion This study applied Cheraghi-Sohi’s framework for medication work to COPD patients and described the role of the social network members. Pharmacists could proactively explore medication infrastructures and work with patients and their close social network members to support medication work.
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14
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Monaro S, West S, Pinkova J, Gullick J. The chaos of hospitalisation for patients with critical limb ischaemia approaching major amputation. J Clin Nurs 2018; 27:3530-3543. [PMID: 29776002 DOI: 10.1111/jocn.14536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 04/10/2018] [Accepted: 05/08/2018] [Indexed: 01/23/2023]
Abstract
AIMS AND OBJECTIVES To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). BACKGROUND CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia. While a wealth of clinical outcome data on CLI and amputation exists internationally, little is known about the patient/family-centred experience of hospitalisation to inform preservation of personhood and patient-centred care planning. DESIGN Longitudinal qualitative study using Heideggerian phenomenology. METHODS Fourteen patients and 13 family carers provided a semistructured interview after advice for major amputation. Where amputation followed, a second interview (6 months postprocedure) was provided by eight patients and seven family carers. Forty-two semistructured interviews were audio-recorded and transcribed verbatim. Hermeneutic phenomenological analysis followed. RESULTS Hospitalisation for CLI, with or without amputation, created a sense of chaos, characterised by being fragile and needing more time for care (fragile body and fragile mind, nurse busyness and carer hypervigilance), being adrift within uncontrollable spaces (noise, unreliable space, precarious accommodation and unpredictable scheduling) and being confused by missed and mixed messages (multiple stakeholders, information overload and cultural/linguistic diversity). CONCLUSIONS Patients and families need a range of strategies to assist mindful decision-making in preparation for amputation in what for them is a chaotic process occurring within a chaotic environment. Cognitive deficits increase the care complexity and burden of family advocacy. RELEVANCE TO CLINICAL PRACTICE A coordinated, interprofessional response should improve systems for communication, family engagement, operation scheduling and discharge planning to support preparation, adjustment and allow a sense of safety to develop. Formal peer support for patients and caregivers should be actively facilitated.
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Affiliation(s)
- Susan Monaro
- Concord Repatriation General Hospital, Concord, NSW, Australia.,University of Sydney, Susan Wakil School of Nursing & Midwifery, NSW, Australia
| | - Sandra West
- University of Sydney, Susan Wakil School of Nursing & Midwifery, NSW, Australia
| | - Jana Pinkova
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Janice Gullick
- University of Sydney, Susan Wakil School of Nursing & Midwifery, NSW, Australia
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15
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Shaw RL, Smith LJ, Hiles DR. Exploring the felt sense of chronic ill-health: dialoguing between IPA, lifeworld theory and narrative inquiry to make sense of feelings and affect. QUALITATIVE RESEARCH IN PSYCHOLOGY 2018. [DOI: 10.1080/14780887.2018.1499839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rachel L. Shaw
- Aston University, School of Life & Health Sciences, Birmingham, UK
| | - Laura J. Smith
- Aston University, School of Life & Health Sciences, Birmingham, UK
| | - David R. Hiles
- Centre for Counselling & Psychotherapy Education (CCPE), London, UK
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16
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Halding AG, Aarsheim EI, Dolmen NM, Jensen AJ, Stavøstrand S, Grov EK. COPD transitions in health and self-management: service users' experiences from everyday life. Int J Chron Obstruct Pulmon Dis 2018; 13:2075-2088. [PMID: 30013335 PMCID: PMC6037402 DOI: 10.2147/copd.s158058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To explore how persons living with COPD experience transitions related to health, self-management, and follow-up from the healthcare services. Patients and methods This study is part of a participatory research project. Six males and five females living with COPD, with a COPD assessment test score of 21–29, participated; all the participants were living at home. Data were collected in qualitative research interviews and analyzed using qualitative content analysis highlighting the participants’ experiences. Results The findings showed two main themes: “The struggle to keep going” and “The need for continuity and competent facilitation”. The participants reported complex health transitions, with changes in roles and function, demanding exacerbations and critical events, and challenges with learning needed self-management. They expressed a great need for and had great benefit from, education, rehabilitation, and follow-up in their management of everyday life. Not all received offers in line with current guidelines. Conclusion In-depth knowledge of patients’ experienced COPD transitions offers clinicians guidance for the timing and quality of follow-up services. Life with COPD entails challenging transitions in health and self-management. Good rehabilitation and follow-up from the healthcare services are needed throughout the disease trajectory. Participation in self-management education and rehabilitation that include psychosocial aspects may facilitate health-enhancing transitions and improve self-management skills. Experienced lack of competence and flexibility among healthcare providers hinders trust and collaboration. Access to stable and competent follow-up in the primary health services may facilitate cohesive services and collaborative self-management.
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Affiliation(s)
- Anne-Grethe Halding
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway,
| | | | | | | | | | - Ellen Karine Grov
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway,
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17
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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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18
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Clari M, Ivziku D, Casciaro R, Matarese M. The Unmet Needs of People with Chronic Obstructive Pulmonary Disease: A Systematic Review of Qualitative Findings. COPD 2018; 15:79-88. [PMID: 29308932 DOI: 10.1080/15412555.2017.1417373] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The complexity of chronic obstructive pulmonary disease (COPD) can negatively impact the lives of people with the condition and compromise their capacity to take care of their needs. Unmet needs can then lead to significant morbidity, unpleasant emotional experiences and a poor quality of life; thus this systematic review aimed to identify, evaluate and synthesise the qualitative literature on the unmet needs of people with COPD. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. A systematic search of five databases was conducted, searching for articles published from January 1995 to May 2017. Eight papers were identified. Two researchers extracted the data and independently assessed their quality. The total sample of people with COPD included was 108. Nine categories were derived from 49 findings, and aggregated into three synthesised findings: (1) people with COPD have unmet needs regarding information about the disease; (2) people with COPD have unmet physical, emotional and social needs, due to the disease symptoms and treatments; and (3) people with COPD have unmet care needs. This review showed qualitative evidence regarding the dimensions in which people with COPD express their unmet needs. The needs that are mainly unsatisfied include physical, psychosocial, informational and practical aspects, as well as the need for healthcare professional care. A global approach, which includes the areas identified by our findings, could lead to an improvement in the care of people with COPD and could improve the self-care management of those individuals who do not correctly identify their needs.
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Affiliation(s)
- Marco Clari
- a Department of Biomedicine and Prevention , University of Rome 'Tor Vergata', Rome , Italy
| | - Dhurata Ivziku
- a Department of Biomedicine and Prevention , University of Rome 'Tor Vergata', Rome , Italy
| | | | - Maria Matarese
- c Research Unit of Nursing Science , Campus Bio-Medico University of Rome , Rome , Italy
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19
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Andersen IC, Thomsen TG, Bruun P, Bødtger U, Hounsgaard L. The experience of being a participant in one's own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary disease: a longitudinal study. Int J Qual Stud Health Well-being 2017; 12:1371994. [PMID: 28875771 PMCID: PMC5613917 DOI: 10.1080/17482631.2017.1371994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 01/11/2023] Open
Abstract
PURPOSE In healthcare related to hospital discharge and follow-up, it is acknowledged that patient participation can strengthen self-management in patients with chronic obstructive pulmonary disease. However, the meaning of participation in care following a severe acute exacerbation is less described. Therefore, the aim of this part of a larger study was to explore patients' experiences of participating in their care around discharge and in their subsequent day-to-day care at home. METHOD The study was designed as a qualitative, longitudinal study. Data were collected by repeated participant observations and in-depth interviews with 15 patients within a period of 18 months post-discharge. A phenomenological-hermeneutic approach was used to interpret the data. RESULTS Before discharge, the patients struggled to regain a sense of control in their efforts to build up strength, and acquire sufficient clarity and confidence to face self-management at home. At home, the patients strived to comply with advice and encouragement in a struggle to stay motivated and confident, and to ask for help. CONCLUSIONS With more knowledge about patients' participation in care, healthcare professionals can encounter patients in ways that are sensitive to their specific care and support needs and, thereby, contribute to the promotion of patients' health and well-being.
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Affiliation(s)
- Ingrid Charlotte Andersen
- Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Slagelse Hospital, Slagelse, Denmark
| | - Thora Grothe Thomsen
- Zealand University Hospital, Roskilde and Koege, Denmark and Institute of Regional Health Research, University of Southern Denmark, OdenseDenmark
| | - Poul Bruun
- Health Sciences Research Center, University College Lillebaelt, Denmark
| | - Uffe Bødtger
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark and Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lise Hounsgaard
- Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Center, University College Lillebaelt, Denmark
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20
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How Lived Body and Lived Space Intersect to Influence the Experience of Chronic Obstructive Pulmonary Disease. TOPICS IN GERIATRIC REHABILITATION 2017. [DOI: 10.1097/tgr.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Halding AG, Grov EK. Self-rated health aspects among persons living with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017; 12:1163-1172. [PMID: 28442902 PMCID: PMC5396837 DOI: 10.2147/copd.s129325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a cohort of chronic obstructive pulmonary disease (COPD) patients and perform a within-group comparison regarding self-management activation, social provision, and health status. Patients and methods A cross-sectional survey including 116 persons. Results The sample comprised 65 men and 38 women, mean age 69 years. Fourteen percent reported very high impact of COPD on their health; 19% had received pulmonary rehabilitation offers, 39% had been offered self-management education, and 64% had acute hospital admissions due to COPD complications in the past year. Persons with COPD Assessment Test (CAT) scores ≥30 reported significantly poorer self-management activation and significantly lower social provision than those reporting CAT scores <30. Number of COPD years had no significant influence on COPD health care consultations or self-management activation. Conclusion Persons with COPD reported decreasing social provision with increasing COPD years and poorer health status. Although COPD is a progressive disease, health status and self-management activation did not vary with number of COPD years. Those living with a very high COPD impact on health reported significantly lower self-management activation but fewer acute hospital admissions. Practice implications COPD patients’ need for pulmonary rehabilitation, self-management support, and social support should be assessed and appropriate services offered throughout the disease trajectory.
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Affiliation(s)
- Anne-Grethe Halding
- Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway
| | - Ellen Karine Grov
- Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway
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22
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Fotokian Z, Mohammadi Shahboulaghi F, Fallahi-Khoshknab M, Pourhabib A. The empowerment of elderly patients with chronic obstructive pulmonary disease: Managing life with the disease. PLoS One 2017; 12:e0174028. [PMID: 28369069 PMCID: PMC5378379 DOI: 10.1371/journal.pone.0174028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/02/2017] [Indexed: 02/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a serious health problem that has significant effects on the life status of elderly persons. Use of the empowerment approach is necessary for health promotion in older people with COPD, but little attention has so far been paid to all the dimensions of empowerment in the management of COPD, which would provide useful knowledge regarding elders with COPD. This article reports on a study exploring people's experiences of the empowerment of older people with COPD. This study adopted an exploratory qualitative design and was carried out using grounded theory methodology. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems that they encounter. We collected data by conducting in-depth semi-structured interviews and taking field notes. Twenty-four participants were selected through purposive sampling. The results showed that in encountering the complexity of disease and in response to difficulties induced by COPD, three strategies were applied. Elderly persons with COPD, their family caregivers, and professional team members engaged in "managing life with COPD," "striving to keep abreast of life," "preparing for battle with disease," and "helping to stabilize the elder's life." The outcome of these strategies was "co-existence with disease." The potential of "managing life with COPD" was influenced by the following factors: "co-existence with ageing," "personal potential," "a challenged health system," and "weak social support." "Managing life with COPD" enables the elder to feel in control and live optimally. This is a fragile balance, however, and the unpredictability of COPD can tip the elder into "self-efficacy." Understanding the experiences of the empowerment process of older people with COPD can help health professionals provide more focused elderly care.
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Affiliation(s)
- Zahra Fotokian
- Department of Nursing, Ramsar Nursing Care Research Center, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Mazandaran, Iran
| | - Farahnaz Mohammadi Shahboulaghi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Masoud Fallahi-Khoshknab
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Ali Pourhabib
- Department of Nursing, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Mazandaran, Iran
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23
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Gullick J, Monaro S, Stewart G. Compartmentalising time and space: a phenomenological interpretation of the temporal experience of commencing haemodialysis. J Clin Nurs 2017; 26:3382-3395. [PMID: 28001331 DOI: 10.1111/jocn.13697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To interpret the spatio-temporal experience of people with end-stage kidney disease and their families in the first months of haemodialysis. BACKGROUND While dialysis is the mainstay of end-stage kidney disease management, the actual initiation of treatment is often unexpected by people and families. Poor biopsychosocial preparation means haemodialysis commencement is experienced as a crisis. While previous phenomenological studies suggest that over time, a habitual incorporation of dialysis into one's self-concept is possible, the spatio-temporal experience of people new to haemodialysis is not well understood. DESIGN A phenomenological study. METHODS Following purposive sampling, 18 participants were recruited either during an inpatient admission or while attending a public hospital-based haemodialysis unit in Sydney, Australia. Eleven people who had commenced haemodialysis within the previous three months and five close family members were separately engaged in semistructured interviews. Hermeneutic interpretation within a Heideggerian framework occurred through a backward-and-forward analysis between the early haemodialysis experience and its relationship to Being. RESULTS Themes that related to a temporal and spatial understanding of Being-in-the-world as a new haemodialysis patient or carer included the following: 'compartmentalising life into dialysis and non-dialysis days' (lost time, clock time and lived time); 'compartmentalising before, now and future' (normalising the 'before', dealing with the 'now' and the 'foreverness' of dialysis); and finally, 'compartmentalising space'. CONCLUSIONS In the months after dialysis commencement, patients and family carers compartmentalise time and space with a loss of continuity of meaningful, lived time that had framed people's past sense of normal. RELEVANCE TO CLINICAL PRACTICE Resource enhancement activities should focus on social connectivity and provision of personnel and/or infrastructure to reduce boredom, to facilitate engagement with meaningful tasks and, where appropriate, to support the continuation of work activities during the dialysis period.
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Affiliation(s)
- Janice Gullick
- Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Concord West, NSW, Australia
| | - Susan Monaro
- Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia.,Concord Repatriation General Hospital, Concord West, NSW, Australia
| | - Glenn Stewart
- Concord Repatriation General Hospital, Concord West, NSW, Australia
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24
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Wainwright M. Sensing the Airs: The Cultural Context for Breathing and Breathlessness in Uruguay. Med Anthropol 2017; 36:332-347. [DOI: 10.1080/01459740.2017.1287180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Megan Wainwright
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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25
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Lindenmeyer A, Greenfield SM, Greenfield C, Jolly K. How Do People With COPD Value Different Activities? An Adapted Meta-Ethnography of Qualitative Research. QUALITATIVE HEALTH RESEARCH 2017; 27:37-50. [PMID: 27117959 DOI: 10.1177/1049732316644430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition where activities of daily living (ADLs) may be very restricted; people with COPD need to prioritize what is important to them. We conducted a meta-ethnography to understand which ADLs are valued and why, systematically searching for articles including experiences of ADLs and organizing themes from the articles into five linked concepts: (a) caring for the body, (b) caring for the personal environment, (c) moving between spaces, (d) interacting with others, and (e) selfhood across time. In addition, we identified three key aspects of personal integrity: effectiveness, connectedness, and control. We found that ADLs were valued if they increased integrity; however, this process was also informed by gendered roles and social values. People whose sense of control depended on effectiveness often found accepting help very difficult to bear; therefore, redefining control as situational and relational may help enjoyment of activities that are possible.
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Affiliation(s)
| | | | | | - Kate Jolly
- University of Birmingham, Birmingham, United Kingdom
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26
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Brice L, Gilroy N, Dyer G, Kabir M, Greenwood M, Larsen S, Moore J, Kwan J, Hertzberg M, Brown L, Hogg M, Huang G, Tan J, Ward C, Gottlieb D, Kerridge I. Haematopoietic stem cell transplantation survivorship and quality of life: is it a small world after all? Support Care Cancer 2016; 25:421-427. [PMID: 27699502 DOI: 10.1007/s00520-016-3418-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/19/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this qualitative study was to gain a rich understanding of the impact that haematopoietic stem cell transplantation (HSCT) has on long-term survivor's quality of life (QoL). METHOD Participants included 441 survivors who had undergone HSCT for a malignant or non-malignant disease. Data were obtained by a questionnaire positing a single open-ended question asking respondents to list the three issues of greatest importance to their QoL in survivorship. Responses were analysed and organised into QoL themes and subthemes. RESULTS Major themes identified included the following: the failing body and diminished physical effectiveness, the changed mind, the loss of social connectedness, the loss of the functional self and the patient for life. Each of these themes manifests different ways in which HSCT survivor's world and opportunities had diminished compared to the unhindered and expansive life that they enjoyed prior to the onset of disease and subsequent HSCT. CONCLUSIONS HSCT has a profound and pervasive impact on the life of survivors-reducing their horizons and shrinking various parts of their worlds. While HSCT survivors can describe the ways in which their life has changed, many of their fears, anxieties, regrets and concerns are existential in nature and are ill-defined-making it exceeding unlikely that they would be adequately captured by standard psychometric measures of QoL post HSCT.
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Affiliation(s)
- Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Gemma Dyer
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Stephen Larsen
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - John Kwan
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Louisa Brown
- Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Jeff Tan
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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27
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Oxley R, Macnaughton J. Inspiring change: humanities and social science insights into the experience and management of breathlessness. Curr Opin Support Palliat Care 2016; 10:256-61. [PMID: 27490147 PMCID: PMC4974063 DOI: 10.1097/spc.0000000000000221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Breathlessness can be debilitating for those with chronic conditions, requiring continual management. Yet, the meaning of breathlessness for those who live with it is poorly understood in respect of its subjective, cultural, and experiential significance. This article discusses a number of current issues in understanding the experience of breathlessness. RECENT FINDINGS Effective communication concerning the experience of breathlessness is crucial for diagnosis, to identify appropriate treatment, and to provide patients with the capacity to self-manage their condition. However, there is an evident disconnect between the way breathlessness is understood between clinical and lay perspectives, in terms of awareness of breathlessness, the way symptoms are expressed, and acknowledgement of how it affects the daily lives of patients. SUMMARY The review highlights the need for integrated multidisciplinary work on breathlessness, and suggests that effective understanding and management of breathlessness considers its wider subjective and social significance.
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Affiliation(s)
- Rebecca Oxley
- Department of Anthropology, Centre for Medical Humanities
| | - Jane Macnaughton
- Centre for Medical Humanities, School of Medicine, Pharmacy and Health, Durham University, Durham, England, UK
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28
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Kawada T. Approaches to daily body condition management in patients with stable chronic obstructive pulmonary disease. J Clin Nurs 2016; 25:3279-3290. [PMID: 27545279 DOI: 10.1111/jocn.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 11/30/2022]
Abstract
AIM AND OBJECTIVE To clarify the characteristics of sub-groups of patients with stable chronic obstructive pulmonary disease having similar approaches to daily body condition management. BACKGROUND Prior literature has shed light on the experience of patients with chronic obstructive pulmonary disease and revealed that these patients engage in many activities and try different things in their daily lives to regulate and manage their body condition. The research so far has all been qualitative, comprising mostly interviews, and no quantitative studies have been performed. In this study, cluster analysis was used to show that subgroups of patients with similar characteristics undertake similar approaches to body condition management. DESIGN Descriptive, correlational study. METHODS Invitations to participate in the survey were extended to patients with stable chronic obstructive pulmonary disease. Cluster analysis was performed on the basis of questionnaire scores relating to nine different categories of daily body condition management actions. The characteristics of the body condition management approaches, in each subgroup, were investigated using analysis of variance and multiple comparisons. RESULTS The cluster analysis produced six subgroups, each defined by the effort expended as part of their body condition management. The subgroups also differed depending on patient age and disease severity. CONCLUSION Body condition management approaches taken by patients with stable chronic obstructive pulmonary disease are overall, comprehensive approaches. RELEVANCE TO CLINICAL PRACTICE Patients with chronic obstructive pulmonary disease were subgrouped based on their engagement in body conditioning. Relationships between the subgroups and the engagement in body conditioning, age and shortness of breath severity were observed. The care of patient support should be comprehensive and depend on their age and the duration of the disease. In addition, it should be long term and recognise that the patients are living their own respective lives. Such considerations and focused perspectives are what we think will lead to an improvement in patients' quality of life and prevent their condition from worsening.
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Affiliation(s)
- Terue Kawada
- School of Nursing, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan.
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29
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30
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Jensen LBS, Brinkjær U, Larsen K, Konradsen H. Exploring the Unmet Needs of the Patients in the Outpatient Respiratory Medical Clinic: Patients versus Clinicians Perspectives. Int J Chronic Dis 2015; 2015:749369. [PMID: 26783555 PMCID: PMC4689906 DOI: 10.1155/2015/749369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/10/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022] Open
Abstract
Aim. Developing a theoretical framework explaining patients' behaviour and actions related to unmet needs during interactions with health care professionals in hospital-based outpatient respiratory medical clinics. Background. The outpatient respiratory medical clinic plays a prominent role in many patients' lives regarding treatment and counselling increasing the need for a better understanding of patients' perspective to the counselling of the health care professionals. Design. The study is exploratory and based on Charmaz's interpretation of grounded theory. Methods. The study included 65 field observations with a sample of 43 patients, 11 doctors, and 11 nurses, as well as 30 interviews with patients, conducted through theoretical sampling from three outpatient respiratory medical clinics in Denmark. Findings. The patients' efforts to share their significant stories triggered predominantly an adaptation or resistance behaviour, conceptualized as "fitting in" and "fighting back" behaviour, explaining the patients' counterreactions to unrecognized needs during the medical encounter. Conclusion. Firstly this study allows for a better understanding of patients' counterreactions in the time-pressured and, simultaneously, tight structured guidance program in the outpatient clinic. Secondly the study offers practical and ethical implications as to how health care professionals' attitudes towards patients can increase their ability to support emotional suffering and increase patient participation and responsiveness to guidance in the lifestyle changes.
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Affiliation(s)
- Lone Birgitte Skov Jensen
- Department of Education, University of Aarhus, 2400 Copenhagen, Denmark
- Respiratory Department, Gentofte University Hospital, 2900 Gentofte, Denmark
| | - Ulf Brinkjær
- Department of Education, University of Aarhus, 2400 Copenhagen, Denmark
| | - Kristian Larsen
- Department of Education, Learning and Philosophy, University of Aalborg, 2450 Copenhagen, Denmark
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Monjazebi F, Dalvandi A, Ebadi A, Khankeh HR, Rahgozar M, Richter J. Functional Status Assessment of COPD Based on Ability to Perform Daily Living Activities: A Systematic Review of Paper and Pencil Instruments. Glob J Health Sci 2015; 8:210-23. [PMID: 26493419 PMCID: PMC4803967 DOI: 10.5539/gjhs.v8n3p210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/05/2015] [Indexed: 11/12/2022] Open
Abstract
Context: Activity of daily living (ADL) is an important predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Increasing ADL is important in patients with COPD and assessment of ADL is one of the best ways to evaluate the status of COPD patients. Objectives: The objective of this systematic review was to provide an overview of the psychometric properties of paper and pencil instruments measuring ADL in patients with COPD. Data Sources: English papers published from 1980 to 2014 regarding ADL in patients with COPD were searched in Web of Science, MEDLINE, Google Scholar, Cochrane, PubMed, ProQuest, and CINAHL databases using the following keywords: “COPD”, “ADL”, “activities of daily living”, “daily activities”, “instrument”, “questionnaire”, “paper-and-pencil instruments”, and “measure”. Following the Internet search, manual search was also done to find article references. Study Selection: A total of 186 articles were found. Of those, 31 met the inclusion criteria. Full texts of articles meeting the inclusion criteria were studied. Consensus-based standards for the selection of health measurement instruments”(COSMIN) were used to assess the quality of the studies. Data Extraction: Data extraction form based on research aims developed by researchers and psychometric experts, with 17 questions was used. Results: In these articles, 14 pen and paper instruments were identified for examining ADL in patients with COPD; of which, 4 dealt directly with ADL while 9 assessed other criteria i.e. dyspnea as ADL indicator. The majority of instruments only dealt with two main dimensions of ADL: Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL), and did not consider Advanced Activities of Daily Living (AADL), which is influenced by cultural and motivational factors. Conclusion: Despite several ADL instruments identified, complete psychometric processes have only been done in a few of them. Selection of the appropriate instrument should focus on the aim of the study and the target construct.
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Affiliation(s)
- Fateme Monjazebi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Disler RT, Green A, Luckett T, Newton PJ, Inglis S, Currow DC, Davidson PM. Experience of advanced chronic obstructive pulmonary disease: metasynthesis of qualitative research. J Pain Symptom Manage 2014; 48:1182-99. [PMID: 24780181 DOI: 10.1016/j.jpainsymman.2014.03.009] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/13/2014] [Accepted: 04/02/2014] [Indexed: 11/16/2022]
Abstract
CONTEXT Chronic obstructive pulmonary disease (COPD) is a life-limiting illness. Despite best available treatments, individuals continue to experience symptom burden and have high health care utilization. OBJECTIVES To increase understanding of the experience and ongoing needs of individuals living with COPD. METHODS Medline, PsycINFO, CINAHL, and Sociological Abstracts were searched for articles published between January 1990 and June 2013. Metasynthesis of qualitative data followed the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Metasyntheses are increasingly used to gain understandings of complex research questions through synthesizing data from individual qualitative studies. Descriptive and analytical themes were developed through thematic synthesis and expert panel discussion of extracted primary quotes, not the primary data themselves. RESULTS Twenty-two studies were included. Four hundred twenty-two free codes were condensed into seven descriptive themes: better understanding of condition, breathlessness, fatigue, frailty, anxiety, social isolation, and loss of hope and maintaining meaning. These seven themes were condensed further into three analytical themes that described the experience and ongoing needs of individuals with COPD: the need for better understanding of condition, sustained symptom burden, and the unrelenting psychological impact of living with COPD. CONCLUSION Combining discrete qualitative studies provided a useful perspective of the experience of living with COPD over the past two decades. Further studies into the ongoing needs of individuals with COPD are unlikely to add to this well-established picture. Future research should focus on solutions through the development of interventions that address patients' ongoing needs.
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Affiliation(s)
- Rebecca T Disler
- University of Technology Sydney, Ultimo, New South Wales, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
| | - Anna Green
- University of Technology Sydney, Ultimo, New South Wales, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; ImPaCCT (Improving Palliative Care through Clinical Trials), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Tim Luckett
- University of Technology Sydney, Ultimo, New South Wales, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; ImPaCCT (Improving Palliative Care through Clinical Trials), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Phillip J Newton
- University of Technology Sydney, Ultimo, New South Wales, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Sally Inglis
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David C Currow
- Discipline, Palliative, and Supportive Services, Flinders Centre for Clinical Change, Flinders University, Adelaide, South Australia, Australia
| | - Patricia M Davidson
- ImPaCCT (Improving Palliative Care through Clinical Trials), South Western Sydney Clinical School, Liverpool, New South Wales, Australia; Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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"The unpredictable death"-The last year of life for patients with advanced COPD: Relatives' stories. Palliat Support Care 2014; 13:1213-22. [PMID: 25315360 DOI: 10.1017/s1478951514001151] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged, and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or a recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognosticate the progress and time of death. Patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with a focus on death and dying from the perspective of relatives. METHOD Interviews were conducted with the relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by means of content analysis. RESULT All relatives described the patients as having had a peaceful death that did not correspond with the worry expressed earlier by both the patients and themselves. During the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable. SIGNIFICANCE OF RESULTS The patients and their relatives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was available. It is essential for the nurse to create relationships with patients and relatives that enable them to talk about dying and death on their own terms.
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Dignani L, Toccaceli A, Guarinoni MG, Petrucci C, Lancia L. Quality of Life in Chronic Obstructive Pulmonary Disease: An Evolutionary Concept Analysis. Nurs Forum 2014; 50:201-13. [PMID: 25155165 DOI: 10.1111/nuf.12110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore the concept of quality of life (QoL) of people with chronic obstructive pulmonary disease (COPD) in the nursing context. BACKGROUND The issue of QoL takes on a leading role in the COPD field because it is an incurable pathology. Despite its relevance, this concept is quite ambiguous, and there is no consensus of opinion in the literature regarding its definition. DESIGN AND METHODS Rodgers' method of evolutionary concept analysis was employed to delineate and clarify the concept of QoL in COPD. An electronic review was made on scientific databases from 2008 to 2013. The 75 selected articles were analyzed in order to highlight the main themes related to QoL concept. RESULTS The QoL appears as a dynamic and multidimensional concept that evolves with the progression of the pathology and the impairment of health status. It has both subjective and objective characteristics, intrinsic and extrinsic elements. CONCLUSIONS This analysis provides an overview of the QoL concept related to COPD patients that is useful as a guide to research into nursing care and for clinical practice.
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Affiliation(s)
| | - Andrea Toccaceli
- Department of Health, Life and Environmental Sciences, Nursing Science Doctorate School, University of L'Aquila, L'Aquila, Italy
| | | | - Cristina Petrucci
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Loreto Lancia
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Klinke ME, Jónsdóttir H. Smoking addiction in chronic obstructive pulmonary disease: Integrating neurobiology and phenomenology through a review of the literature. Chron Respir Dis 2014; 11:229-36. [PMID: 25150186 DOI: 10.1177/1479972314546764] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this review is to extend professional understanding of the various mechanisms that make smoking cessation difficult for patients with chronic obstructive pulmonary disease (COPD). Smoking in people with COPD is a major challenge for health care today. In spite of significant advances in knowledge about the processes of nicotine addiction, current interventions to support smoking cessation in patients with COPD are less successful than hoped for. A wealth of literature has confirmed that nicotine addiction is a powerful force and that smoking is not simply an unhealthy lifestyle or destructive behavior. However, research based on this realization is still in its infancy. To increase understanding and to develop ways of enhancing smoking cessation in patients with COPD, we review and synthesize knowledge found in neurobiology and phenomenology. We use neurobiology to explain the neurochemical changes that take place in addiction in order to substantiate phenomenological perspectives of smoking in patients with COPD. We relate the smoking experience to the concept of "affordances"-in this context "smoking affordances"-to analyze how smoking affects action possibilities in individuals with COPD. Combining these perspectives helps to illuminate the manifold and unique issues related to smoking addiction in patients with COPD.
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Affiliation(s)
- Marianne E Klinke
- Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Reykjavik, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Reykjavik, Iceland
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Monaro S, Stewart G, Gullick J. A ‘lost life’: coming to terms with haemodialysis. J Clin Nurs 2014; 23:3262-73. [PMID: 24810661 DOI: 10.1111/jocn.12577] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Susan Monaro
- Sydney Nursing School; University of Sydney; Sydney NSW Australia
- Level 3 West Cardiovascular Service; Concord Repatriation General Hospital; Concord NSW Australia
| | - Glenn Stewart
- Level 4 North Renal Medicine; Concord Repatriation General Hospital; Concord NSW Australia
| | - Janice Gullick
- Master of Emergency Nursing; Master of Intensive Care Nursing; Sydney Nursing School; University of Sydney; Sydney NSW Australia
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Apps LD, Harrison SL, Williams JEA, Hudson N, Steiner M, Morgan MD, Singh SJ. How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study. Int J Chron Obstruct Pulmon Dis 2014; 9:257-63. [PMID: 24600218 PMCID: PMC3942113 DOI: 10.2147/copd.s52691] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors. Methods Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention. Thematic analysis was supported by NVivo software (version 8, QSR International, Melbourne, Australia). Results Three main themes are described, ie, experiencing and understanding symptoms of COPD, current self-care activities, and the importance of family perceptions in managing COPD. Conclusion Self-care activities evolved spontaneously as participants experienced symptoms of COPD. However, there was a lack of awareness about whether these strategies would impact upon symptoms. Perceptions of COPD by family members posed a challenge to self-care for some participants. Health care professionals should elicit patients’ prior disease experiences and utilize spontaneous attempts at disease management in future self-management. These findings have implications for promoting self-management and enhancing quality of life.
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Affiliation(s)
- Lindsay D Apps
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, UK
| | - Samantha L Harrison
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, UK
| | - Johanna E A Williams
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, UK
| | - Nicky Hudson
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Michael Steiner
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, UK
| | - Mike D Morgan
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, UK
| | - Sally J Singh
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, UK ; Applied Research Centre Health & Lifestyle Interventions, Coventry University, Coventry, UK
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Pooler C. Living With Chronic Lower Pulmonary Disease: Disruptions of the Embodied Phenomenological Self. Glob Qual Nurs Res 2014; 1:2333393614548762. [PMID: 28462289 PMCID: PMC5342278 DOI: 10.1177/2333393614548762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022] Open
Abstract
In this article, I present a phenomenological study of individuals' experiences of living with moderate to very severe chronic lower pulmonary disease (chronic obstructive pulmonary disease, asthma, or both). Phenomenology is a philosophy, distinct from descriptive or thematic research, which is useful as a foundation for scientific inquiry. In this study, I used the lens of Merleau-Ponty to understand and interpret participants' experiences of living with pulmonary disease, and the approach of van Manen for analysis. I conclude that in chronic pulmonary disease, awareness of breathing and the body is experienced in the sounds, sensations, and signals of breathing and the body, and in the experiences of the body-in-the-world. Central themes of being-in-the-world from the study describe the disruption of the embodied phenomenological self: Participants experienced slowing down, doing less, and having to stop due to shortness of breath. Both chronic and acute dyspnea were prevalent and the taken-for-granted aspects of daily activities were disrupted. Findings of this study have implications for public and patient education, and opportunities for integration of experiential aspects within nursing education and practice.
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Hayle C, Coventry PA, Gomm S, Caress AL. Understanding the experience of patients with chronic obstructive pulmonary disease who access specialist palliative care: a qualitative study. Palliat Med 2013; 27:861-8. [PMID: 23681494 DOI: 10.1177/0269216313486719] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care for people with life-limiting non-malignant disease is increasingly prioritised. People with end-stage chronic obstructive pulmonary disease are among a key group of non-cancer patients likely to benefit from specialist palliative care, but it remains uncertain whether the needs of this group are met by existing services. AIM To evaluate the experiences of patients with chronic obstructive pulmonary disease who accessed specialist palliative care. DESIGN Data from semi-structured interviews were analysed using a hermeneutic phenomenological approach. SETTING/PARTICIPANTS Eight patients accessing specialist palliative care within one city in North West England. RESULTS Perceived benefits of specialist palliative care included reduced frequency of hospital admission, improved physical and psychological symptoms, reduced social isolation and a broadened physical environment. Participants were mainly aware of their poor prognosis, but discussion of referral to palliative care sometimes caused distress owing to the historical associations between dying and hospice care. Following engagement with services, participants' perceptions changed: palliative care was associated with social inclusion and opportunities to engage in reciprocal and altruistic social action. Negative associations were replaced by uncertainty and anxiety about the prospect of discharge. CONCLUSIONS Much within existing services works well for people with chronic obstructive pulmonary disease, but opportunities to enhance palliative care for this underserved group remain. Future research might focus on prospectively evaluating the impact of key components of palliative care on core patient-centred outcomes. Additionally, work must be done to raise awareness of the benefits of specialist palliative care for non-cancer patients, as negative associations can form a barrier to access.
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Affiliation(s)
- Catherine Hayle
- Hospital Specialist Palliative Care Team, Salford Royal Foundation Trust, Salford, UK
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Macdonald MT, Lang A, Storch J, Stevenson L, Barber T, Iaboni K, Donaldson S. Examining markers of safety in homecare using the international classification for patient safety. BMC Health Serv Res 2013; 13:191. [PMID: 23705841 PMCID: PMC3669614 DOI: 10.1186/1472-6963-13-191] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homecare is a growth enterprise. The nature of the care provided in the home is growing in complexity. This growth has necessitated both examination and generation of evidence around patient safety in homecare. The purpose of this paper is to examine the findings of a recent scoping review of the homecare literature 2004-2011 using the World Health Organization International Classification for Patient Safety (ICPS), which was developed for use across all care settings, and discuss the utility of the ICPS in the home setting. The scoping review focused on Chronic Obstructive Pulmonary Disease (COPD), and Congestive Heart Failure (CHF); two chronic illnesses commonly managed at home and that represent frequent hospital readmissions. The scoping review identified seven safety markers for homecare: Medication mania; Home alone; A fixed agenda in a foreign language; Strangers in the home; The butcher, the baker, the candlestick maker; Out of pocket: the cost of caring at home; and My health for yours: declining caregiver health. METHODS The safety markers from the scoping review were mapped to the 10 ICPS high-level classes that comprise 48 concepts and address the continuum of health care: Incident Type, Patient Outcomes, Patient Characteristics, Incident Characteristics, Contributing Factors/Hazards, Organizational Outcomes, Detection, Mitigating Factors, Ameliorating Actions, and Actions Taken to Reduce Risk. RESULTS Safety markers identified in the scoping review of the homecare literature mapped to three of the ten ICPS classes: Incident Characteristics, Contributing Factors, and Patient Outcomes. CONCLUSION The ICPS does have applicability to the homecare setting, however there were aspects of safety that were overlooked. A notable example is that the health of the caregiver is inextricably linked to the wellbeing of the patient within the homecare setting. The current concepts within the ICPS classes do not capture this, nor do they capture how care responsibilities are shared among patients, caregivers, and providers.
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Affiliation(s)
- Marilyn T Macdonald
- School of Nursing, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, PO Box, 15000, Halifax, Nova Scotia B3H 4R2, Canada.
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Al-Gamal E, Yorke J. Perceived breathlessness and psychological distress among patients with chronic obstructive pulmonary disease and their spouses. Nurs Health Sci 2013; 16:103-11. [PMID: 23692348 DOI: 10.1111/nhs.12073] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 04/14/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to describe the impact of breathlessness on Jordanian patients with chronic obstructive pulmonary disease (COPD) and their spouses' perception of the patients' breathlessness. A cross-sectional, descriptive, correlational design was used with a sample of 67 Jordanian patients with COPD related breathlessness and their spouses. The Dyspnoea 12 Scale (D-12) and Hospital Anxiety and Depression Scale (HADS) were administered to both patients and spouses. There was a significant positive correlation between total patients' D-12 scores and total HADS scores. Spouses who perceived the patients to have more severe breathlessness affect (D-12 affect subscale) were more likely to experience a higher level of psychological distress (HADS total). Both patients and spouses reported clinically significant levels of anxiety and depression. There was no statistical difference in total D-12 and HADS scores between COPD patients and their spouses. The finding of this study indicates the importance of healthcare providers in supporting both patients with breathlessness and their spouses and the need to develop family-centred services.
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Low G, Ross C, Stickland M, Wilson D, Wong E. Perspectives of Aging Among Persons Living With Chronic Obstructive Pulmonary Disease. West J Nurs Res 2013; 35:884-904. [DOI: 10.1177/0193945913478844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Among pulmonary rehabilitation attendees, we explored their tendency to downplay versus acknowledge physical and psychosocial health limitations, and the subsequent impact either strategy had on how they perceive their own aging process. Participants ( N = 87) were 44 to 82 years of age, and diagnosed with chronic obstructive pulmonary disease (COPD). The St. George’s Respiratory Questionnaire measured their health limitations. The Attitudes to Aging Questionnaire captured their perspectives of aging. Participants downplayed their symptoms and psychosocial impact, and remained most positive about psychosocial loss and carefully reserved about psychological growth. Acknowledged activity impairment had negative consequences, however, for their perspectives of physical change. These findings signify a balanced identity and perspective of aging that supports the Identity Process Theory. We encourage nurses and other practitioners, and researchers in pulmonary rehabilitation setting, to use this theory to better understand how people with COPD adapt to aging.
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Affiliation(s)
- Gail Low
- University of Alberta, Edmonton, Canada
| | | | | | | | - Eric Wong
- University of Alberta, Edmonton, Canada
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Simon ST, Bausewein C, Schildmann E, Higginson IJ, Magnussen H, Scheve C, Ramsenthaler C. Episodic breathlessness in patients with advanced disease: a systematic review. J Pain Symptom Manage 2013; 45:561-78. [PMID: 22921180 DOI: 10.1016/j.jpainsymman.2012.02.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 01/04/2023]
Abstract
CONTEXT Although episodic breathlessness (EB) is reported to be highly prevalent in advanced disease, our understanding about it is limited. OBJECTIVES The aim of this study was to systematically review and synthesize the evidence on EB regarding definition, characteristics, and patients' experiences. METHODS Systematic review using searches in six databases, hand search, and personal contacts with authors in the field. Search terms included the combination of "episodic" and "breathlessness" (and synonyms) with five different diseases. Selection criteria included patients with advanced disease and information about EB based on original research. All retrieved studies were reviewed by two independent investigators. RESULTS Twenty-seven studies (of 7584) were included in this review. Only eight studies explored EB as a primary outcome. EB is poorly defined. It is characterized by high prevalence (81%-85%), high frequency (daily), short duration (often less than 10 minutes), and severe peak intensity. EB either develops without any known trigger or is triggered by physical exertion, emotions, or environmental influences. CONCLUSION EB is a common symptom in patients with advanced disease, but information about characteristics and experiences is limited. As there is no common terminology, an agreed definition is needed to foster research to develop effective treatments for EB.
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Jensen AL, Vedelø TW, Lomborg K. A patient-centred approach to assisted personal body care for patients hospitalised with chronic obstructive pulmonary disease. J Clin Nurs 2013; 22:1005-15. [PMID: 23331341 DOI: 10.1111/jocn.12050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the patients' experiences of receiving patient-centred personal body care and to document changes compared to the patients' experiences in previous hospital stays. BACKGROUND Patients with severe chronic obstructive pulmonary disease suffer from breathlessness. Personal body care is therefore often a major challenge, and during exacerbation these patients may need comprehensive assistance. The quality of assisted personal body care depends largely on the patients' and the nurses' symptom recognition, disease management and ability to achieve therapeutic clarity in the nurse-patient interaction. We developed, implemented and evaluated a patient-centred approach to assisted personal body care in which these characteristics were sought. DESIGN The study is a qualitative outcome analysis with an interpretive description methodology. METHODS Nine female and two male hospitalised patients with severe chronic obstructive pulmonary disease were selected for patient-centred care. Specially trained nurses and nursing assistants performed the patient-centred personal body care. Data material was obtained through participant observation of body care sessions with the patients, followed by individual in-depth interviews. The transcribed interviews were analysed and an interpretive description of the patients' experiences was established. RESULTS All patients experienced the patient-centred care to be different from what they had previously experienced. The most fundamental change was the experience of being an active part of a shared project. This experience encompassed three dimensions: clear signs of acknowledgement, attentive time and security. CONCLUSION Patient-centred assistance enables patients to take an active part in their personal body care activity. The intervention may be a method for nursing staff to secure patients-centred care. RELEVANCE TO CLINICAL PRACTICE Effective communication, tools for the assessment of breathlessness, clear and straight forward organisation of body care sessions, awareness of pauses and personal acknowledgment are important for the patients' ability to take part in personal body care activities.
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Affiliation(s)
- Annesofie L Jensen
- Department of Public Health, Section for Nursing Science, Faculty of Health Science, Aarhus University, Aarhus, Denmark.
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Jácome C, Marques A, Gabriel R, Figueiredo D. Chronic obstructive pulmonary disease and functioning: implications for rehabilitation based on the ICF framework. Disabil Rehabil 2013; 35:1534-45. [DOI: 10.3109/09638288.2012.745625] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cooney A, Mee L, Casey D, Murphy K, Kirwan C, Burke E, Conway Y, Healy D, Mooney B, Murphy J. Life with chronic obstructive pulmonary disease: striving for 'controlled co-existence'. J Clin Nurs 2013; 22:986-95. [PMID: 23279604 DOI: 10.1111/j.1365-2702.2012.04285.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2012] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To understand the meaning of chronic obstructive pulmonary disease (COPD) for people and their response to this disease. BACKGROUND COPD is a major cause of disability and death. The symptoms of COPD have the potential to impact on every aspect of a person's day-to-day life. To date most published qualitative studies have focused on the 'experience' of breathlessness and its impact on the person. Few studies have sought to 'understand' the meaning of COPD to people and their response to this disease. This study aimed to address this gap. DESIGN Straussian grounded theory guided study design. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems they encounter. METHODS Data were collected through semi-structured interviews with 26 people with COPD. Study participants were recruited from general practices on the western seaboard of Ireland. RESULTS Two interrelated categories were identified as contributing to 'co-existing with COPD': 'hiding' and 'battling'. 'Co-existing with COPD' was conceptualised as the core category. The potential to 'co-exist' with COPD was influenced by mediating factors. CONCLUSION The Theory of Co-existing with COPD was generated from the data. This theory explains the delicate balance people with COPD maintain to 'co-exist with COPD'. 'Controlled co-existence' enables the person to feel in control and live life to the optimum. This is a fragile balance however and the unpredictability of COPD can tip the person into 'strained co-existence' or 'uncontrolled co-existence'. RELEVANCE TO CLINICAL PRACTICE Understanding the experience of living with COPD and the balances involved in 'co-existing with COPD' can help health professionals provide more focused and empowered client care. Enabling people to achieve 'controlled co-existence' with COPD challenges health professionals to educate people with COPD on how to effectively manage their disease.
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Affiliation(s)
- Adeline Cooney
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.
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Boeckxstaens P, Deregt M, Vandesype P, Willems S, Brusselle G, De Sutter A. Chronic obstructive pulmonary disease and comorbidities through the eyes of the patient. Chron Respir Dis 2012; 9:183-91. [PMID: 22848068 DOI: 10.1177/1479972312452436] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patient's attitudes and illness beliefs have shown to be of great importance in chronic obstructive pulmonary disease (COPD). As former qualitative research has mainly focused on patients with end-stage COPD, who are recruited within hospital or pulmonary rehabilitation settings, and excluding patients with disabling comorbidities, this study specifically aims to explore the perspectives of patients with COPD and comorbidities in primary care. This study was designed as a qualitative, explorative study using open patient interviews. The study was conducted at three primary care practices, East Flanders, Belgium. A total number of seven patients, diagnosed with COPD and given a minimum score of 2 on the Charlson Comorbidity Index were included. In-depth interviews were recorded and transcribed verbatim. Thematic analysis was deductive using NVivo software. Researchers' triangulation was performed. Participants show high adaptation capabilities and report quite positively about their functional status, with an emphasis on social participation and partnership. Knowledge of the causes and consequences of COPD appears rather limited, and participants predominantly show an external locus of control in relation to the reported factors influencing the disease and strategies for self-management. Patients with COPD with comorbidity integrate their illness and symptoms into their lives. However, a lack of knowledge and education may leave them more anxious and more dependent on health care than necessary. Our results indicate that health care workers should adopt a positive approach toward patient's functioning and empower and inform their patients. We believe that chronic care for patients with COPD should provide personalized rehabilitation taking into account individual patient characteristics and self-management and coping attitudes. We believe that there is a generic core to be identified, which can tackle both COPD and comorbidities. Further research is mandatory to develop these generic programs focusing on patients with complicated needs. Primary care can provide the setting for exploration.
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Affiliation(s)
- Pauline Boeckxstaens
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
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Ellison L, Gask L, Bakerly ND, Roberts J. Meeting the mental health needs of people with chronic obstructive pulmonary disease: a qualitative study. Chronic Illn 2012; 8:308-20. [PMID: 22659349 DOI: 10.1177/1742395312449754] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to understand the mental health needs of people living with chronic obstructive pulmonary disease: what they were experiencing, what they wanted (or did not want) which might be described as 'felt need', what they had accessed or received ('expressed need') and how, from their perspective, their emotional needs might be more effectively met by health care services. METHODS Qualitative study with 14 patients with a confirmed diagnosis of chronic obstructive pulmonary disease, where a member of the clinical team had recognised that the patient was suffering from associated emotional distress. RESULTS Three themes emerged: a sense of assuming a different identity as the disease challenged abilities, the experience of social isolation with fear of dependence and barriers the participants encountered acting as obstacles to coping, adapting and accessing treatments. There were mixed feelings about the value of talking about problems, with both psychological and physical barriers strongly militating against both expression of need and utilization of care offered. CONCLUSIONS Innovative research and clinical care should be aimed towards development of skills, strategies and systems required to engage sensitively and negotiate needs for care, in a patient-centred manner, with people who do not necessarily see the need to ask for emotional support.
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Affiliation(s)
- Louise Ellison
- Health Sciences: Primary Care, University of Manchester, UK
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Akyil RÇ, Ergüney S. Roy's adaptation model-guided education for adaptation to chronic obstructive pulmonary disease. J Adv Nurs 2012; 69:1063-75. [DOI: 10.1111/j.1365-2648.2012.06093.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Rahşan Çevik Akyil
- Internal Nursing Department; Atatürk University Faculty of Health Sciences; Erzurum; Turkey
| | - Seher Ergüney
- Internal Nursing Department; Atatürk University Faculty of Health Sciences; Erzurum; Turkey
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50
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Gullick J, West S. Uncovering the common ground in qualitative inquiry. Int J Health Care Qual Assur 2012; 25:532-48. [DOI: 10.1108/09526861211246485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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