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NURS2000 Behavioural Responses To Chronic Illnes

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

Open-ended questions were asked to the participants and their responses were recorded and transcribed. Thematic analysis was done where every piece of information in the recording was analyzed through listening, reading or re-reading transcripts by interviewers. Finally, these codes were drawn into themes that were identified and named.

The mixed study design used for this study is appropriate as it helped to overcome the limitations that are involved with a single research design. This research method was useful in exploring the experiences of COPD patients through multiple ways. This method is beneficial for the study as it helped the researchers to describe and report easily and position the research study into a transformative research (Woodward, 2013). The sequential exploratory method was adopted where the initial data collection is qualitative and further analyzed by a quantitative phase of data collection and analysis (Fetters, Curry & Creswell, 2013). This study design aligned with the research question as it helped to explore the phenomenon or experiences faced by COPD patients. Moreover, this design helped to develop strategies and interventions for effective management of COPD through self-management and community services. However, this method is time taking as the data collection was done over a period of 12 months and it is very complex. The planning for resources and its implementation is time consuming and discrepancies may arise during the interpretation of findings, however, the researchers were reflexive.

This article illustrated the psychosocial factors that are associated with chronic illness. Individuals who arrive at the ED with COPD have complex experiences. The factors like fear, anxiety and self-blame have an impact on their coping ability and self-management of their condition. These factors necessitate ED presentation for resolving their symptoms. These factors highlighted by the article can assist healthcare professionals to consider the highly complex experiences of patients with COPD instead of judgmental attitudes, improve the delivery of care, and thereby, reduce the ED presentations.

The psychosocial factors illustrated in this article are fear, anxiety and self-blame that affect self-management of COPD condition. During the COPD exacerbation, patients feel anxious and as a result, it worsens the condition. Moreover, when a COPD patient experiences episode of difficulty in breathing, it triggers anxiety among them and as a result, panic sets in. Fear is also associated with COPD as a recent study revealed that this condition is often accompanied with co-morbid anxiety and fear. ED presentation because of COPD exacerbation triggers fear and panic before admission and there is a strong link between fear and symptoms worsening with poor self-management of this condition (Sayiner et al., 2012). The smoking related behaviors tend to make COPD patients blame for their exacerbating condition (Plaufcan, Wamboldt & Holm, 2012). Apart from poor self-management, lack of appropriate community-based care also social factors that contribute to ED presentations and life-threatening situations. The judgmental attitude of healthcare professionals and stigma associated with COPD, as he or she is a smoker with lack of empathy and care greatly contribute to their exacerbating condition (Korpershoek et al., 2016).

These psychosocial factors affect COPD individuals and their families or carers towards COPD management. The judgmental attitudes by healthcare providers towards COPD greatly reduce the activation of self-management in chronic illness. The COPD related stigmatization and poor quality of care results in low persuasion of patients to adopt the self-management behaviors. Moreover, the healthcare professionals are unsupportive, poor advocacy towards self-management services that inculcates fear and anxiety among the patients leading to increased ED presentations among COPD patients (Halpin et al., 2015).


Interdisciplinary approach in chronic illness management through employment of biopsychosocial framework is one of the best approaches in assisting patients to reduce symptoms and regain their normal functionality. The teams members work in collaboration with common goals, purpose, make decisions and share responsibilities and resources in effective chronic illness management. In this approach, the patients and their family members are involved in the clinical decision-making process, about their condition, prognosis and care plan. This approach helps to improve patient outcomes, increase their level of satisfaction, thereby reducing the length of hospital stays, and encourage patients to take an active part in the ongoing plan (Chouinard et al., 2013).

The article is relevant to clinical practice and highlights the fact that collaborative inter-disciplinary approach among healthcare providers help in self-management of chronic illness. The inter-sectorial knowledge sharing can be helpful in delivering the best quality of care that fulfills patients’ needs. Although, the paper did not explain inter-disciplinary approach in detail, it can contribute to achievement of best practices in chronic illness management. The role of nurses is relatively invisible in the study, however they can help to reduce COPD exacerbations and improve their quality of life. Effective communication between healthcare providers can help to include patients and their carers in the development of care plan and thereby, improving the quality of care. The multi-disciplinary team of physicians, nurses, behavioral specialists and physical therapists can help patients with COPD to develop skills so that they can take an active part in self-management of their chronic illness (Robinson et al., 2017).

The article contributes to the fact that inter-disciplinary approach while working with COPD patients and their families can be helpful in improving their condition and reducing the barriers of stigma associated with the chronic disease. This article is helpful in revealing the fact that being a student RN; one can take an active part in the implementation of effective interventions for the COPD patients. The understanding of their experiences can be helpful for the nurses to improve clinical process with better health outcomes. The nurses can also help to reduce barriers of stigmatization through empathetic and compassionate care. Through effective communication, nurses can motivate and encourage patients with chronic illness to adopt lifestyle modifications and take an active part in self-management behaviors. Nurses can contribute to chronic illness management and ensure continuity of care by promoting healthy behaviors in COPD patients, giving advice and supporting them, educating and encouraging them to manage their condition proactively (Schulman?Greenet al., 2012).

From the above discussion, it can be concluded that COPD patients frequently present at ED and there is lack of appropriate community-based care services for them. The article also highlighted the fact that psychosocial factors like fear, anxiety and self-blame leads to poor disease management. This paper also provides an insight into the perspectives of patients living with COPD who frequently get admitted to ED. Nurses, as a part of interdisciplinary team must increase awareness about issues in COPD presentation by implementing effective interventions and promoting, encouraging healthy behaviors among them so that they manage their COPD condition and avoid ED presentations.



Chouinard, M. C., Hudon, C., Dubois, M. F., Roberge, P., Loignon, C., Tchouaket, É., ... & Sasseville, M. (2013). Case management and self-management support for frequent users with chronic disease in primary care: a pragmatic randomized controlled trial. BMC health services research, 13(1), 49. Doi:

Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs—principles and practices. Health services research, 48(6pt2), 2134-2156. Doi: 10.1111/1475-6773.12117

Halpin, D., Hyland, M., Blake, S., Seamark, C., Pinnuck, M., Ward, D., ... & Seamark, D. (2015). Understanding fear and anxiety in patients at the time of an exacerbation of chronic obstructive pulmonary disease: a qualitative study. JRSM open, 6(12), 2054270415614543. Doi: 10.1177/2054270415614543

Korpershoek, Y. J. G., Vervoort, S. C. J. M., Nijssen, L. I. T., Trappenburg, J. C. A., & Schuurmans, M. J. (2016). Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study. International journal of chronic obstructive pulmonary disease, 11, 2977. Doi:

Plaufcan, M. R., Wamboldt, F. S., & Holm, K. E. (2012). Behavioral and characterological self-blame in chronic obstructive pulmonary disease. Journal of psychosomatic research, 72(1), 78-83. Doi: 10.1016/j.jpsychores.2011.10.004

Robinson, K., Lucas, E., van den Dolder, P., & Halcomb, E. (2017). Living with chronic obstructive pulmonary disease: The stories of frequent attenders to the emergency department, Journal of Clinical Nursing, 27, 48-56.Doi: 

Sayiner, A., Alzaabi, A., Obeidat, N. M., Nejjari, C., Beji, M., Uzaslan, E., ... & Rashid, N. (2012). Attitudes and beliefs about COPD: data from the BREATHE study. Respiratory medicine, 106, S60-S74. Doi:

Schulman?Green, D., Jaser, S., Martin, F., Alonzo, A., Grey, M., McCorkle, R., ... & Whittemore, R. (2012). Processes of self?management in chronic illness. Journal of Nursing Scholarship, 44(2), 136-144. Doi: 10.1111/j.1547-5069.2012.01444.x

Woodward, M. (2013). Epidemiology: study design and data analysis. CRC press.

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