Patients' and their family members' experiences of participation in care following an acute exacerbation in chronic obstructive pulmonary disease: A phenomenological-hermeneutic study

Contributing to self-care of a person with chronic obstructive pulmonary disease: A qualitative study of the experiences of family caregivers

AIM

To explore family caregivers' experiences of contributing to self-care of patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A qualitative description study.

METHODS

Individual semi-structured interviews were conducted face-to face, by telephone or video calls in a purposive sample of 17 family caregivers of patients with COPD recruited in Italy, and analysed through content analysis. The consolidated criteria for reporting qualitative studies (COREQ) checklist was used for study reporting.

RESULTS

Ten subcategories were derived from 106 codes grouped into three main categories: family caregiver contributions to maintaining disease stable and ensuring a normal life for patients; family caregiver contributions to disease monitoring; and family caregiver contributions to coping with disease exacerbations. Family caregivers provided practical and emotional support, and their contribution was essential to improve treatment adherence, to enable the patient to continue living a normal life, and to have access to the healthcare services. Family caregivers were constantly vigilant and monitored patients daily to detect worsening conditions, and they managed exacerbations especially when patients were unable to do it due to their critical conditions.

CONCLUSION

This study broadens knowledge of family caregivers' contributions to patients' self-care in COPD, describing the different ways family members provide daily care to patients and the many responsibilities they take on.

IMPACT

Family caregivers perform a variety of behaviours when supporting patients with COPD in self-care, especially when patients are more dependent and the disease more severe. Nurses should acknowledge the various contributions provided by family caregivers and develop educational interventions aiming to support them in patient care and improve patient outcomes.

PATIENT OR PUBLIC CONTRIBUTION

Researchers shared the draft study report with participants for validation and feedback. This helped to strengthen the study design and results.

Burden, coping and resilience among caregivers for patients with chronic obstructive pulmonary disease: An integrative review

AIM

This study aims to synthesise quantitative and qualitative evidence to comprehensively examine the burden of family caregivers of chronic obstructive pulmonary disease patients and to understand their coping strategies and related resilience factors.

BACKGROUND

Long-term chronic obstructive pulmonary disease care causes heavy psychological and physical burden to caregivers, which is related to the coping strategies used. Resilience is a protective factor originating within the individual and has become a concept related to illness, health and care.

DESIGN

An integrative review.

METHODS

Relevant literature was comprehensively searched from China Biology Medicine, China National Knowledge Infrastructure, Wan Fang, PubMed, Embase, Web of Science and Ovid databases from the establishment of the database till January 2023, and the quality of the selected articles was evaluated. Reporting was done according to a PRISMA checklist.

FINDINGS

The burden of family caregivers with chronic obstructive pulmonary disease includes poor health, worry and fear, anticipatory loss and uncertainty, relationship tensions and disagreements, loss of identity and social isolation, lack of supportive knowledge and financial burden. Family caregivers used problem-centred coping, emotion-centred coping, avoidance coping, social support and dyadic coping with their patients to manage their burdens. The factors chronic obstructive pulmonary disease associated with a caregiver's resilience included a higher level of knowledge, social and familial support, a close relationship with patients, a caregiver's sense of responsibility, the patient's high self-efficacy, etc. CONCLUSIONS: The findings show that caregivers of chronic obstructive pulmonary disease patients face multiple burdens, adapt through different coping styles and have different psychological consequences, while coping style and mental health status also affect the magnitude of burden.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

The findings informed health professionals about personalised chronic obstructive pulmonary disease home care interventions to reduce caregiver burden, effectively manage illness and maintain family intimacy.

NO PATIENT OR PUBLIC CONTRIBUTION

No patients, families, service providers or members of the public were involved in this study.

The Family Involvement in Care Questionnaire-An instrument measuring family involvement in inpatient care

BACKGROUND

Family involvement in care can be seen as a prerequisite for high-quality family-centered care. It has been identified to improve both patient safety and the quality of care by reducing patient complications and hospital length of stay.

OBJECTIVE

To develop and evaluate the content validity of a questionnaire measuring family involvement in inpatient care.

METHODS

The study followed a systematic approach in building a rigorous questionnaire: identification of domain, item generation, and assessment of content validity. The content validity index was calculated based on ratings of item relevance by an expert group consisting of seven senior nurses. Subsequently, 19 online cognitive interviews using the Think-aloud method were conducted with family members of former patients who had undergone open-heart surgery.

RESULTS

Five aspects of family involvement were identified, and the initial pool of items were selected from two preexisting questionnaires. The experts' ratings resulted in item content validity of 0.71-1.00, and the scale content validity/averaging was 0.90, leading to rewording, exclusion, and addition of items. The pretesting of items through two rounds of cognitive interviews with family members resulted in the identification of three main problem areas: defining family involvement, misinterpretation of different terms, and underuse of the not relevant response option. The problems were adjusted in the final version of the questionnaire, which consists of 16 items with a four-point Likert scale and two open-ended items.

CONCLUSIONS

The Family Involvement in Care Questionnaire has demonstrated potential in evaluating family involvement in inpatient care. Further psychometric properties regarding reliability and validity need to be established.

Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study

BACKGROUND

Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement.

AIM

To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities.

METHOD

Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research.

FINDINGS

Our analysis revealed one overall theme - "The complexity of involvement" - based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act.

CONCLUSION

The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.

Qualitative longitudinal research in health research: a method study

Background

Qualitative longitudinal research (QLR) comprises qualitative studies, with repeated data collection, that focus on the temporality (e.g., time and change) of a phenomenon. The use of QLR is increasing in health research since many topics within health involve change (e.g., progressive illness, rehabilitation). A method study can provide an insightful understanding of the use, trends and variations within this approach. The aim of this study was to map how QLR articles within the existing health research literature are designed to capture aspects of time and/or change.

Methods

This method study used an adapted scoping review design. Articles were eligible if they were written in English, published between 2017 and 2019, and reported results from qualitative data collected at different time points/time waves with the same sample or in the same setting. Articles were identified using EBSCOhost. Two independent reviewers performed the screening, selection and charting.

Results

A total of 299 articles were included. There was great variation among the articles in the use of methodological traditions, type of data, length of data collection, and components of longitudinal data collection. However, the majority of articles represented large studies and were based on individual interview data. Approximately half of the articles self-identified as QLR studies or as following a QLR design, although slightly less than 20% of them included QLR method literature in their method sections.

Conclusions

QLR is often used in large complex studies. Some articles were thoroughly designed to capture time/change throughout the methodology, aim and data collection, while other articles included few elements of QLR. Longitudinal data collection includes several components, such as what entities are followed across time, the tempo of data collection, and to what extent the data collection is preplanned or adapted across time. Therefore, there are several practices and possibilities researchers should consider before starting a QLR project.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01732-4.

Stakeholder involvement in care transition planning for older adults and the factors guiding their decision-making: a scoping review

OBJECTIVE

To synthesise the existing literature on care transition planning from the perspectives of older adults, caregivers and health professionals and to identify the factors that may influence these stakeholders' transition decision-making processes.

DESIGN

A scoping review guided by Arksey and O'Malley's six-step framework. A comprehensive search strategy was conducted on 7 January 2021 to identify articles in five databases (MEDLINE, Embase, CINAHL Plus, PsycINFO and AgeLine). Records were included when they described care transition planning in an institutional setting from the perspectives of the care triad (older adults, caregivers and health professionals). No date or study design restrictions were imposed.

SETTING

This review explored care transitions involving older adults from an institutional care setting to any other institutional or non-institutional care setting. Institutional care settings include communal facilities where individuals dwell for short or extended periods of time and have access to healthcare services.

PARTICIPANTS

Older adults (aged 65 or older), caregivers and health professionals.

RESULTS

39 records were included. Stakeholder involvement in transition planning varied across the studies. Transition decisions were largely made by health professionals, with limited or unclear involvement from older adults and caregivers. Seven factors appeared to guide transition planning across the stakeholder groups: (a) institutional priorities and requirements; (b) resources; (c) knowledge; (d) risk; (e) group structure and dynamic; (f) health and support needs; and (g) personality preferences and beliefs. Factors were described at microlevels, mesolevels and macrolevels.

CONCLUSIONS

This review explored stakeholder involvement in transition planning and identified seven factors that appear to influence transition decision-making. These factors may be useful in advancing the delivery of person and family-centred care by determining how individual-level, group-level and system-level values guide decision-making. Further research is needed to understand how various stakeholder groups balance these factors during transition planning in different health contexts.

Patients' and healthcare providers' perceptions and experiences of telehealth use and online health information use in chronic disease management for older patients with chronic obstructive pulmonary disease: a qualitative study

BACKGROUND

Telehealth and online health information provide patients with increased access to healthcare services and health information in chronic disease management of older patients with chronic diseases, addressing the challenge of inadequate health resources and promoting active and informed participation of older patients in chronic disease management. There are few qualitative studies on the application of telehealth and online health information to chronic disease management in older patients. Chronic obstructive pulmonary disease is one of the most common chronic diseases in older adults. Telehealth is widely used in the management of chronic obstructive pulmonary disease. The purpose of this study was to explore the perceptions and experiences of older patients and healthcare providers in the application of telehealth and online health information to chronic disease management of chronic obstructive pulmonary disease.

METHODS

A qualitative descriptive study with data generated from 52 individual semi-structured interviews with 29 patients [Law of the People's Republic of China on the protection of the rights and interests of older people (2018 Revised Version) = >60 years old] with chronic obstructive pulmonary disease and 23 healthcare providers. The inductive thematic analysis method was used for data analysis.

RESULTS

Four themes and 16 sub-themes were identified in this study. Four themes included: faced with a vast amount of online health information, essential competencies and personality traits ensuring older patients' participation and sustained use, user experience with the use of technology, being in a complex social context.

CONCLUSION

The ability of patients to understand health information should be fully considered while facilitating access to online health information for older patients. The role of health responsibility and user experience in older patients' participation and sustained use of telehealth and online health information needs to be emphasised. In addition, the complex social context is a determining factor to be considered, particularly the complex impact of a reliance on offspring and social prejudice on the behaviour of older adults using telehealth and online health information.

Caring for patients at home after acute exacerbation of chronic obstructive pulmonary disease: A phenomenological study of family caregivers' experiences

AIMS AND OBJECTIVES

To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation.

BACKGROUND

The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful.

DESIGN

Phenomenology.

METHODS

This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist.

RESULTS

Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals.

CONCLUSIONS

Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face.

Patient and family members' perceptions of family participation in care on acute care wards

BACKGROUND

Hospital leaders, policymakers and healthcare professionals are realising the benefits of delivering care that promotes family participation because it is known to enhance the quality of care, and improve patient satisfaction.

AIM

The aim of this study was to explore, from the perspective of patients and family members within an adult acute care ward: (a) their beliefs and attitudes towards family participation in patient care and (b) staff behaviours that support or hinder family participation in patient care.

DESIGN AND METHODS

A naturalistic approach with an exploratory sequential design was used in a medical assessment and planning unit of a regional referral hospital in Australia. Purposeful maximum variation sampling was used to recruit patients and family members who differed in age, ethnicity, relationship to patient and gender. Observer-as-participant observation data and semi-structured interviews were undertaken. Following separate inductive content analysis, data were triangulated.

RESULTS

Thirty-two patients and 26 family members were recruited. Thirty hours of observational data were gathered. Eighteen patients and 15 family members were interviewed. Analysis uncovered two contrasting categories: (a) disconnected communication and (b) family influence quality.

CONCLUSION

The findings of our study demonstrated that most patients and families perceived staff communication as disconnected and inadequate, which constrained them from engaging in care processes or decision-making. However, when family felt empowered and participated in patient care, the quality of health care was enhanced. Healthcare professionals can use these findings to make informed evidence-based changes to the way they practice and communicate to ensure family participation in patient care is optimised in the acute care setting.

Qualitative systematic review of barriers and facilitators to self-management of chronic obstructive pulmonary disease: views of patients and healthcare professionals

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.