Identification And Management Of COPD Exacerbations: A Grounded Theory Essay.

1. Background of the study

a. What is the health issue that provides the focus of this study?

b. Generally, what have been the result of previous studies of this issue?

c. What is the significance of this study?

2. overview of research design

a. What was the aim of the research?
b. What research design was used?
c. Describe the main characteristics of the research design identified?
d. How did the research design chosen meet the aims of the study?

3. samplinga.

a. What were the characteristics of the participants in this study?
b. What were the inclusion and exclusion criteria of the sample?
c. Why is it important to identify these criteria before recruitment starts ?
d. What sampling technique was used in this study?
e. How was this sample appropriate for meeting the research aim?

4. data collection

a. How were the data collected?
b. What , specifically, did the researchers do?
c. How did data collection fit the aim of this study ?
d. What might have been some advantages and disadvantages of this method of data collection?
e. From you understanding of the weekly reading, what if any , are some alternative methods of data collection that these researches could have chosen?

5. data analysis/ result

a. How was the data analysed?
b. Why is it important to select applicable methods of data analysis in qualitative research?
c. What did the researchers say about the rigour of their analysis?
d. What were the study finding?
e.Into which other setting can these findings be transferred?

1.a. Chronic Obstructive Pulmonary Disease (COPD) is responsible for a significant high number of patient admissions in hospitals. In particular, patients with COPD are readmitted for exacerbations within 28 days of hospital admission in the United Kingdom (Healthcare Commission Clearing the Air, 2016). This trend has caused the initiation of research to find out how best COPD patients can carry out effective self-management so that the number of hospital admissions is effectively reduced. The strategies that have been proposed include self, timely detection, and treatment of the exacerbations by the COPD patients away from hospitals (Taylor et al, 2015). More importantly, COPD patients are the first to experience exacerbations and are therefore better placed to react appropriately if they understand the constitution and recognition of exacerbation symptoms (Bischoff et al, 2012).

b. Previous studies have shown that patients lack a precise definition of what exactly exacerbations are or even how they are recognised by the COPD patients (Burge & Wedzicha, 2013). On the contrary, the studies show that the patients are capable of identifying the imminent exacerbations (Kessler et al, 2016). Specifically, exacerbations are identified by the patients based on subjective experiences (Adams et al, 2016). One of the notable shortcomings of the previous studies is that they have focused on finding out how the COPD patients experience exacerbations rather than their ability to identify exacerbations (Harrison et al, 2013). Additionally, other studies have revealed reluctance by the patients to seek health care assistance instead opt for treating exacerbations at home (Wang, Haugen, Steihaug, & Werner, 2102).

c. Since previous studies have shown that COPD patients prefer treating exacerbations at home to consulting healthcare professionals, it is evident that promoting self-management among the patients would effectively reduce the number of hospital admissions. On the same note, self- management would improve the treatment outcomes of COPD. However, the fundamental requirement for effective treatment of exacerbations at home relies on the ability of the patients to successfully identify exacerbations following the onset of symptoms. This study is therefore significant in that it sets out to ascertain how the COPD patients identify exacerbations and the management mechanisms employed at home.

2.a. The aim of the research was to explore the current patient’s understanding and experience of managing and identifying COPD exacerbations at home.

b. The research design that was used for this study was grounded theory research. Grounded theory is a type of research design in which a hypothesis is generated based on the results of the findings as opposed to preconceived concepts. As such the research relies exclusively on the results collected as opposed to previous literature reviews or hypotheses. In this case, the researches formulate research question and then carry out research to answer the formulated question.

Overview of research design

c. Grounded theory has five fundamental characteristics (Taber, 2012). Firstly, the research does not rely on literature review or previous hypotheses. Instead, the research hypothesis is generated form the research question. In addition, grounded theory is also characterised by collection of qualitative data as opposed to quantitative data. As opposed to other research designs such as case study and experimentation, grounded theory is a qualitative research based on theoretical sampling of data. Another feature of grounded theory is flexible and responsive sampling. That is, sampling proceeds until saturation is achieved. Further, grounded theory employs iterative approach of analysis. This means that grounded theory involves constant comparison of the data collected in the course of the study. Finally, grounded theory is characterised by open timeline. That is, the study proceeds until sufficient data is collected to address all the research questions formulated.

d. Grounded theory enabled the researches to select participants who would maximise the potential to discover the current understanding and the management of COPD exacerbations. As well, the research design would allow the researches to gather information about other conditions that are related to COPD. In this view, grounded theory was the best design for this study.

3.a. The participants selected for this study consisted of 27 males and 17 females aged between 55 and 85 years. The mean age for the group was 71 years. Out of this group, 29 participants were living with their spouses while the remaining 15 members were staying alone. Another notable feature of the participants is that 33 members had previously attended pulmonary rehabilitation programme. Moreover, the selected participants were at different severity of COPD. Specifically, 14 participants were at stage II, 21 at stage III, while 9 participants were at stage IV. Finally, 11 of the participants were currently using home oxygen. 

b. The participants to be selected for interview had to meet of conditions before they were allowed to participate in the research. To begin with, the participant had to be above 4o years to participate in the interview. Also, the individual had to have the ability to give informed consent, adequately understand written and verbal English, and have a life expectancy of more than 3 months. Additionally, for an individual to have been selected for interview a smoking pack of greater than 10 pack years was a requirement. Similarly, the individual must have had an MRC dyspnoea scale of 2 or more. Finally, individuals included for the interview must have been registered with a general practice for hospital admission or pulmonary rehabilitation. On the other hand, individuals with lung disease and chronic heart failure as defined by the New York Heart were effectively excluded from participation in the interview.

Sampling

c. The identification of the inclusion criteria was important in ensuring that the measurement error was effectively minimised during the research.

d. The sampling technique used in this study was theoretical sampling. In this techniques participants were recruited form hospital admission records with the assumption that they will be available for interview.

e. Theoretical sampling was appropriate for this study in that it allowed the researches to select maximum number of participants who would provide all the information and conditions related to CPOD exacerbations as recommended by Strauss & Corbin (2015). Additionally, theoretical sampling facilitates assessment of relevant data before investing much time and money into the research.

4.a. The method of data collection employed in this study was interviewing.

b. In this method of data collection, the participants were subjected to in-depth interviews at their respective homes. During the interview sessions, topic guides with questions focused on the patients’ experience, identification, and management of exacerbations at home were used. In the process, the researchers took audio recordings of the interviews along with filed notes to be used for further analysis of the data collected.

c. Interview method of data collection fitted this study since it allowed the researchers to collect sufficient information related to experience, identification, and management of COPD exacerbations by the patients. As well, in the course of interview, the researchers could seek clarification from the participants and thus gather additional information on conditions related to COPD. Finally, interviews allows for collection of unbiased data compared to other methods of data collection such as use of questionnaires.

d. The advantages of interviews as a method of data collection include allowing for verification of data collected, cost-effectiveness, and collection of a range of data. On the other hand, interviews are time consuming especially in cases of voluminous research questions.

e. The alternative methods that the researchers would have used for data collection include observations, use of focus groups, group feedback analysis, and use of informal conversations. As presented by Dick (2015), these methods of data collections are appropriate for use with grounded theory research design.

5.a. The method of data analysis used in line with Glaser’s (2015) proposals. In this case, the data from the audio-recorded interviews and field notes were transcribed verbatim. In addition, the transcripts which were anonymous were stored, organised, and analysed using NVIVO 10 software programme. The data analysis methods used included comparative analysis, memo-writing, and coding such as axial, open, and selective methods.

Data collection

b. Qualitative research is usually criticized for subjective interpretation of the data collected. As a result, the method of data analysis must be selected to ensure that the results obtained are objective and free from conflicts with related studies.What did the researchers say about the rigour of their analysis?

c. The rigour on data analysis was recorded as high. The high level was achieved in two ways. Firstly, the coding of the interviews was carried out by a qualitative researcher who was not a member of the research team. In addition, the members of research team engaged in regular meetings to review and discuss the analysed data as well as the interpretation. As a consequence, the credibility and transparency of the data was aided.

d. The research findings revealed that COPD patients identify exacerbations based on visible and invisible symptoms. The visible symptoms were identified as those which are based on clinical parameters while invisible symptoms are based on experience. As regards the management of the exacerbations, the study showed that the patients employed self-management techniques. These techniques include breathing and pacing techniques and self-administration of steroids and antibiotics. Finally, the findings highlighted that the patients only accessed healthcare assistance in the event that the self-management techniques did not result in improvement in their conditions. In addition, the seeking healthcare professionals was not effective since the patients waited until their conditions had reached crisis point and therefore have to be admitted into hospitals.

e. The results of this finding could be transferred to the management of Borderline Personality Disorder. Just like COPD, BPD is a condition that can effectively be identified and managed at home based on the experience and clinical symptoms. Families on newly diagnosed patients could be educated on identification of BPD symptoms in which the experience of the families and care givers would be as vital as clinical symptoms of the disorder.

References

Adams, R., Chavanmes, N., Jones, K., Ostergaard, M., & Price, D. (2016). Exacerbations of Chronic Obstructive Pulmonary Disease : A patient’s Perspectives. Journal of Respiratory Primary Care, 15: 102-109.

Bischoff, E., Hamd, D., Sedeno, M., Benedeti, A., Schemer, T., Bernard, S., et al. (2012). Effects of written action plan adherence on COPD exacerbations recovery. Thorax, 66: 26-31.

Burge, S., & Wedzicha, J. (2013). COPD Exacerbations: Definitions and Classifications. European Respiration Journal Supplement, 41: 46s-53s.

Dick, B. (2015). Grounded Theory: A Thumbnail Sketch. Retrieved from htpp://www.scu.edu.au/schools/gcm/ar/arp/grounded.html

Glaser, B. (2012). Basics of Grounded Theory Analysis. Mill Valley, CA: Sociology Press.

Harrison, S., Apps, L., Singh, S., Steiner, M., Morgan, M., & Robertson, N. (2013). Consumed by breathing: A critical interpretive meta-synthesis of the qualitative literature. Chronic Illness, 10: 31-49.

Healthcare Commission Clearing the Air. (2016). A National Study of Chronic Obstructive Pulmonary Disease. London: Commission for Healthcare Audit and Inspection.

Strauss, A., & Corbin, J. (2013). Basics of Qualitative Research: Grounded Theory Procedures and Techniques (3^rd ed.). Newbury Park, CA: Sage.

Kessler, R., Stahl, E., Vogelmeler, C., Haughney, J., Trudeau , E., et al. (2016). Patient understanding, detection, and experience of COPD exacerbations: An observational, interview-based study. Chest, 130: 133-142.

Taber, K, S. (2012). Building Theory from Data: Grounded Theory (Wilson ed.). School-based Research: A guide for Education Students. London: Sage.

Talylor, S., Candy, B., Bryar, R., Ramsay, J., Vrijhoef, H. et al. (2015). Effectiveness of Innovations in Nurse Led Chronic Disease Management for Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review of Evidence. Biomedical Journal 331: 485.

Wang, Y., Haugen, T., Steihaug, S., & Werner, A. (2012). Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Feel Safe when Treated at Home: A Qualitative Study. BMC Pulmonary Medication, 12: 45.

Williams, V., Hardinge, M., Ryan, S., & Farmer, A. (2014). Patients’ experience of identifying and managing exacerbations in COPD: a qualitative study. NPJ primary care respiratory medicine, 24, 14062.