Patients’ Experience Of Identifying And Managing Exacerbations In COPD: A Qualitative Study

Background of the Study

Discuss “Patients’ Experience of identifying and managing Exacerbations in COPD.

“Patients’ Experience of identifying and managing Exacerbations in COPD: A Qualitative Study”is an article that was written by Andrew Farmer, Maxine Hardinge, Veronika Williams, and Sara Ryan and published in 2014 by the Primary Care Respiratory Society UK/Macmillan Publishers Limited. The research was aims at studying about the management of exacerbations in the COPD patients. Exacerbation refers to a situation in which COPD symptoms like phlegm quantity and breath shortness suddenly worsens.  According to the study conducted by these researchers, the management of exacerbations has been posing great challenge to the patients and even the medics (Williams, Hardinge, Ryan & Farmer, 2014). The patients have been facing difficulties in identifying and managing the condition on their own because they do not have a deeper understanding about its signs and symptoms.

The researchers, therefore, aimed at studying the ways through which the patients can identify and self-manage exacerbations even without the support of the healthcare providers. Research has established that effective self-management is a core component of the eradication of COPD. It can help in minimizing the cases of hospital admission. Research has also found out that the COPD patients have not been properly managing their exacerbation conditions because they lack understanding and do not know much about how to do it. At the same time, there are patients who are still reluctant to consult the medics to help in providing them with the necessary skills to use in the management of their exacerbation conditions (Williams, Hardinge, Ryan & Farmer, 2014). Based on this background study, the researchers committed themselves to carrying out a further research to fill the missing gap in knowledge. This means that the research is important because its findings will be relied upon to empower the patients to understand and adopt self-management as far as exacerbation is concerned.

The aim of the research was to study the level of understanding of the patients on the identification and management of exacerbation at home. According to these scholars, COPD always poses a great challenge especially to the home-based COPD patients because the disease is associated with exacerbation conditions that might appear at any time (Jones, Green, Clark, Dickson, Nolan, Moloney & Bell, 2014). However, most patients cannot cope up with it because they lack knowledge on how to identify these exacerbation symptoms. At the same time, they do not how to manage the condition. This, according to the researchers, might be disastrous because the patients who are at home need to have self-management skills since most of the time; they are without a healthcare provider.

Aim of the Research

In order to respond to the research question and accomplish their aim, the researchers sought to use a qualitative research method. It is a research design which mainly uses non-numerical data to gain an understanding, describe and interpret it (Williams, Hardinge, Ryan & Farmer, 2014). It is an exploratory type of study that is geared towards creating an understanding on the motivations, reasons, and opinions of people towards certain phenomenon. Its features are, therefore, that it is descriptive, detailed, non-numerical, subjective, and involves the use of objects, pictures or words to present the results. Qualitative research is subjective because it involves the researchers who oversee the collection and analysis of data (Neuman, 2013).  The use of qualitative design was appropriate for this study because it enabled the researchers to meet the aims of the study which was, of course, to explore the home-based patients’ understanding on the management of COPD exacerbations. It gave the scholars an ample opportunity to collect a detailed and comprehensive data that adequately responded to the research question.    

The research was based on a human population. Its target was the patients who had been admitted to a healthcare facility in Oxford. Since it was not possible to include everyone in study, the researchers chose to take only a small sample size to represent the entire population. So, the researchers sought to use a purposeful sampling technique. This is a sampling strategy which is non-probability in nature. Its use enabled the researchers to get a sample of 44 people to participate in the study. It was made up of males, females, patients of the required age and must have been admitted into the healthcare facilities for COPD-related illnesses (Williams, Hardinge, Ryan & Farmer, 2014). This number was appropriate because it proportionately represented the entire population without any bias since all participants were given equal changes of selection. The use of such a proportional sample also helped in eliminating any cases of biasness that might have been experienced because they might interfere with the reliability and validity of the data.

However, for anyone to be selected to participate in the study, he or she had to meet the inclusion and exclusion criteria. The inclusion criteria were determined by the patient’s age, severity of illness, duration of symptoms, marital status, and ability to speak and understand English. Only those who meet these criteria were allowed to participate in the research. Meaning, those who fail to meet the criteria had to be excluded because they were undesirable (Taylor, Bogdan & DeVault, 2015). The use of inclusion and exclusion criteria was appropriate for this research. It enabled the researchers to use only those whose participation would bring an impact on the research and help in responding to the research question, aims and objectives. That is why the inclusion and exclusion criteria had to be set before the actual study began. 

Qualitative Research Method

The data was collected using in-depth interviews. The researchers settled on the interview because it is the best instrument for the collection of data that was required. Data-collection process was done in an organized manner. Once the participants were selected, the researchers contacted them and scheduled for interviews. The researchers honoured the appointment and went to the participants’ homes where a short interview lasting for between 20 and 55 minutes was administered. During the interviews, the researcher asked a combination of short and long questions on the research topic (Silverman, 2016).

The benefit of the interview is that it produces accurate and comprehensive data that can be relied upon to respond to the research question. The direct involvement of the researcher was crucial because it gave them an opportunity to collect first-hand information and be able to ask further questions to get all the clarifications that were needed (Nici, 2014). At the same time, interviews were appropriate because they were conducted in a favourable environment in which the participants were free to respond to the questions asked. All these justified why the researchers were right for opting for interviews as the only instrument for the collection of data.

However, the disadvantage of this instrument is that it was quite cumbersome and money and time-consuming since the researchers had to create time to personally conduct the interview in each of the patient’s homes. At the same time, the presence of the researchers might have altered the responses because it might have influenced the way the participants answered the questions. This might have resulted into the collection of biased and invalid data (Williams, Hardinge, Ryan & Farmer, 2014). Therefore, if there were other opportunities, the researchers would have used questionnaire. It is the best alternative because it can help in overcoming the drawbacks of the interviews. If the researchers used the questionnaires, they would save time and other travelling costs as well as collect accurate data given by the participants without the influence of the researchers.  

Data analysis was done by using software called NVIVO. The analysis was conducted following a successful transcription and coding of the audio-recoded interviews which had been conducted. The analysis process was based on the grounded theory approach. The theoretical link of the data was identified through memo-writing, axial selective coding, and constant comparative procedures (Williams, Hardinge, Ryan & Farmer, 2014). The data analysis tool was appropriate for the type of research because it has been found to be effective in the facilitation of the synthesis, organization, and storage of qualitative data (Leung, 2015). The suitability of the analysis was enhanced by the rigorous way in which the whole coding process was performed. According to the article, coding was rigorous because it was done by a team of highly qualified qualitative researchers who worked independently, but in collaboration with the research team.

The major finding of this research was, therefore, that the patients were able to identify the occurrence of exacerbation by relying on the visible and invisible symptoms. The visible signs through which the patients identify exacerbation include sputum, cough, and temperature. It was easy for the patients to notice the changes in these measurable symptoms because they were more severe during exacerbation than the rest of the times (Beghé, Verduri, Roca & Fabbri, 2013). Invisible signs are, on the other hand, as their name suggests the subjective signs which cannot be seen or measured, but felt by the patients. They include the soreness, tightness, and heaviness of the chests. These are usually felt especially during exacerbation when they become more severe, hence making it easy for the patients to know that they are experiencing exacerbation. These findings are useful in as far as the management of exacerbation is concerned. Thus, they can be applied in developing a care plan for all the exacerbation patients at the healthcare facilities or home-based settings. It can enhance the practice of self-management by such patients.

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