scholarly journals Advanced nursing practice in COPD exacerbations: the solution for a gap in Switzerland?

2020 ◽  
Vol 6 (2) ◽  
pp. 00354-2019
Author(s):  
Gabriela Schmid-Mohler ◽  
Christian Clarenbach ◽  
Gabi Brenner ◽  
Malcolm Kohler ◽  
Eva Horvath ◽  
...  
Keyword(s):  
Nursing Practice ◽  
Current Model ◽  
Integrated Approach ◽  
University Hospital ◽  
Self Management ◽  
Outpatient Rehabilitation ◽  
Chronic Obstructive ◽  
Management Support ◽  
Health Providers ◽  
Advanced Nursing Practice

AimThis study aimed to address the need for adaptation of the current model of chronic obstructive pulmonary disease (COPD) care in Switzerland, particularly in regard to acute exacerbations, and how far an integrated approach involving advanced nursing practice can meet those needs.MethodsA state analysis guided by the PEPPA framework was initiated by the Pulmonology Clinic of University Hospital Zürich. Literature describing the current provision of COPD care regarding exacerbations in Switzerland and international qualitative studies describing the patient perspective were systematically searched and summarised. The health providers' perspective was investigated in three focus-group interviews.ResultsA lack of systematic and state-of-the-art support for patient self-management in Switzerland was described in literature and confirmed by the health providers interviewed. While care was assessed as being comprehensive and of good quality in each individual sector, such as inpatient, outpatient, rehabilitation and home settings, it was identified as being highly fragmented across sectors. The interview participants described day-to-day examples in which a lack of support in COPD self-management and fragmentation of care negatively affected the patients' disease management.ConclusionThe necessity of coordinating the transition between healthcare sectors and self-management support and that these organisational boundaries should be addressed by a multi-professional team were identified. Initial evaluation indicates that advanced practice nurses potentially have the skill set to coordinate the team and address patients' self-management needs in complex patient situations. However, the legal foundation and a reimbursement system to ensure long-term implementation is not yet available.

scholarly journals Self-management challenges following hospital discharge for patients with multimorbidity: a longitudinal qualitative study of a motivational interviewing intervention

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046896
Author(s):  
Carina Brandberg ◽  
Mirjam Ekstedt ◽  
Maria Flink
Keyword(s):  
Qualitative Study ◽  
Motivational Interviewing ◽  
Hospital Discharge ◽  
Controlled Trial ◽  
Intervention Group ◽  
University Hospital ◽  
Self Management ◽  
Chronic Obstructive ◽  
Management Support ◽  
Post Discharge

ObjectivesThe aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period.DesignThis is a longitudinal qualitative study using data from a randomised controlled trial (RCT) of motivational interviewing (MI) sessions.SettingThe RCT was conducted at six wards in two hospitals—one university hospital and one general hospital in Stockholm, Sweden, during 2016–2018.ParticipantsSixteen participants from the intervention group, diagnosed with heart failure or chronic obstructive pulmonary disease and at least one other chronic condition, were purposively selected for this study.InterventionsEach participant had four or five post-discharge MI sessions with a trained social worker during a period of approximately 4 weeks. The sessions were recorded digitally and analysed using content analysis. Altogether, 70 recorded sessions were analysed.ResultsSelf-management after hospital discharge was a dynamic process with several shifting features that evolved gradually over time. Patients with multimorbidity experienced two major challenges with self-management in the first 4 weeks following hospital discharge: ‘Managing a system-centred care’ and ‘Handling the burden of living with multiple illnesses at home post-discharge’.ConclusionsSelf-management for patients with multimorbidity in the first post-discharge period does not equate to a fixed set of tasks, but varies over the post-discharge period. Self-management challenges include not only the burden of the disease itself, but also that of navigating and understanding the healthcare system. Hence, self-management support post-discharge involves both aiding patients with care coordination and meeting their gradually shifting disease-related needs.Trial registration numberNCT02823795.

Self-management support preferences of people with asthma or chronic obstructive pulmonary disease: A systematic review and meta-synthesis of qualitative studies

2019 ◽  
pp. 174239531986944 ◽  
Author(s):  
Selena O’Connell ◽  
Vera JC McCarthy ◽  
Eileen Savage
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Healthcare Professionals ◽  
Qualitative Studies ◽  
Self Management ◽  
Chronic Obstructive ◽  
Management Support ◽  
Obstructive Pulmonary Disease ◽  
The Individual ◽  
Behavioural Sciences

Objectives To synthesise findings from qualitative studies on the preferences of people with asthma or chronic obstructive pulmonary disease (COPD) for self-management support. Methods A thematic synthesis of literature was carried out. Six databases (ASSIA, CINAHL, MEDLINE, PsycINFO, Psychology and the Behavioural Sciences and SSCI) were used to search for qualitative studies eliciting perspectives of adults with asthma and/or COPD on self-management support, published between May 2008 and April 2018. Results A total of 968 articles were retrieved across databases, with 15 articles included in the synthesis. Three themes were identified: Types of Support described the range of supports valued by participants in the studies, particularly education provided by competent healthcare professionals; The Support Relationship highlighted the importance of a collaborative relationship with one’s healthcare professional which was characterised by communication, trust and continuity over time and Accessibility identified the considerations of participants relating to physically accessible, prompt support which is provided in a format preferred by the individual. Discussion Increased understanding of patients’ preferences may provide insight which can be used to enhance engagement with self-management support. Further research needs to examine self-management support preferences outside the context of evaluating interventions for people with asthma/COPD and needs to address the optimal means of enhancing accessibility.

scholarly journals Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence

2019 ◽  
Vol 6 (1) ◽  
pp. e000379 ◽  
Author(s):  
Raquel Farias ◽  
Maria Sedeno ◽  
Danielle Beaucage ◽  
Isabelle Drouin ◽  
Isabelle Ouellet ◽  
...  
Keyword(s):  
Large Scale ◽  
Action Plan ◽  
Real Life ◽  
Healthcare Utilisation ◽  
Administrative Databases ◽  
Self Management ◽  
Chronic Obstructive ◽  
Management Support ◽  
Copd Exacerbations ◽  
Management Interventions

IntroductionSelf-management interventions with Written Action Plans and case management support have been shown to improve outcomes in patients with chronic obstructive pulmonary disease (COPD). Novel telehealth technologies may improve self-management interventions. The objectives of this study were to determine whether the use of an interactive phone telesystem increases Action Plan adherence, improves exacerbation recovery and reduces healthcare use in a real-life practice of a COPD clinic.MethodsInitially, 40 patients were followed by a COPD telesystem for 1 year. Detailed data from patients’ behaviours during exacerbations was recorded. The telesystem use was then extended to 256 patients from a real-life COPD clinic. Healthcare utilisation for the year before and after telesystem enrolment was then assessed through hospital administrative databases.ResultsThirty-three of the 40 patients completed the initial 1-year study. Eighty-one exacerbations were reported in the 1-year follow-up. Action Plan adherence was observed for 72% of the exacerbations and those who were adherent had a significantly faster exacerbation recovery time. The large-scale implementation of the telesystem resulted in a significant decrease in the proportion of patients with ≥1 respiratory-related emergency room (ER) visits (120 before vs 110 after enrolment, p<0.001) and with ≥1 COPD-related hospitalisations (75 before vs 65 after enrolment, p<0.001).DiscussionCOPD Written Action Plan adherence was further enhanced with the use of telehealth technologies in a specialised clinic with experience in COPD self-management. Patients followed by the telesystem recovered faster from exacerbations and had a further decrease in COPD-related ER visits and hospitalisations.Trial registration numberNCT02275078.

scholarly journals Patients’ and healthcare professionals’ perceptions of self-management support interactions: Systematic review and qualitative synthesis

2017 ◽  
Vol 14 (2) ◽  
pp. 79-103 ◽  
Author(s):  
Marika Franklin ◽  
Sophie Lewis ◽  
Karen Willis ◽  
Helen Bourke-Taylor ◽  
Lorraine Smith
Keyword(s):  
Systematic Review ◽  
Healthcare Professionals ◽  
Care Delivery ◽  
Individual Responsibility ◽  
Self Management ◽  
Chronic Obstructive ◽  
Traditional Model ◽  
Management Support ◽  
Model Of Care ◽  
Qualitative Synthesis

Objective To review studies examining the experience of self-management support in patient–provider interactions and the shaping of goals through interactions. Methods We undertook a systematic review and thematic synthesis of the qualitative literature. We searched six databases (2004–2015) for published studies on the provision of self-management support in one-to-one, face-to-face, patient–provider interactions for obesity, type 2 diabetes mellitus and chronic obstructive pulmonary disease, with 14 articles meeting inclusion criteria. Results Themes identified from studies were (1) dominance of a traditional model of care, encompassing the provision of generic information, exclusion of the psychosocial and temporal nature of interactions and (2) a context of individual responsibility and accountability, encompassing self-management as patients’ responsibility and adherence, accountability and the attribution of blame. Interactions were constrained by consultation times, patient self-blame and guilt, desire for autonomy and beliefs about what constitutes ‘effective’ self-management. Discussion Encounters were oriented towards a traditional model of care delivery and this limited opportunity for collaboration. These findings suggest that healthcare professionals remain in a position of authority, limiting opportunities for control to be shared with patients and shared understandings of social context to be developed.

scholarly journals Participants’ experiences of and perceived value regarding different support types for long-term condition self-management programmes

2019 ◽  
pp. 174239531986943 ◽  
Author(s):  
Stephen Hughes ◽  
Sophie Lewis ◽  
Karen Willis ◽  
Anne Rogers ◽  
Sally Wyke ◽  
...  
Keyword(s):  
Lived Experience ◽  
Professional Training ◽  
Self Management ◽  
Chronic Obstructive ◽  
Management Support ◽  
Structured Interviews ◽  
Obstructive Pulmonary Disease ◽  
Term Condition ◽  
Group Programme

Objectives Health professional-led group programmes are a common form of long-term condition self-management support. Much research has focused on clinical outcomes of group participation, yet there is limited research on how group participants perceive and experience the support they receive. We aim to identify the different types of support that participants receive from both facilitators and other participants, and how they value this support. Methods Semi-structured interviews were conducted with 20 participants taking part in a self-management group programme for a long-term condition (obesity, type 2 diabetes or chronic obstructive pulmonary disease). Data pertaining to support types were deductively identified through a social support framework prior to interpretive thematic analysis. Results Participants identified information and emotional support from both facilitators and other participants as complementary yet distinct. Facilitators’ support came from professional training and other participants’ support reflected the contextual, lived experience. Professional interactions were prioritised, constraining opportunities for participant–participant support to be received and exchanged. Discussion We identified a key gap in how self-management support is enacted in groups. Engaging participants to share experiential knowledge will make group support more relevant and mutually beneficial to participants living with a long-term condition.

Factors Influencing Self-Management of Chronic Obstructive Pulmonary Disease by Community-Dwelling Adults

2019 ◽  
Vol 42 (6) ◽  
pp. 423-430 ◽  
Author(s):  
Wendy S. Bauer ◽  
Rachel F. Schiffman
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Pulmonary Disease ◽  
Community Dwelling ◽  
Self Management ◽  
Chronic Obstructive ◽  
Management Support ◽  
Obstructive Pulmonary Disease ◽  
Factors Influencing ◽  
Care Costs

Individuals with chronic obstructive pulmonary disease (COPD) struggle with effective self-management, contributing to poor health outcomes and costly health care. More research is needed to understand the factors influencing COPD self-management better in order to improve outcomes and reduce health care costs for those living with this prevalent chronic illness. The purpose of this article is to describe factors influencing community-dwelling adults’ COPD self-management. In-depth interviews were conducted with 28 people living with COPD. Braun and Clarke’s thematic analysis approach was used to analyze interview data, and it resulted in the identification of themes providing insight into COPD self-management as described by those living with the disease. Specifically, factors impacting engagement in treatment recommendations are described. These findings have implications for informing evidence-based recommendations for self-management support and improving the quality of care provided to those with COPD.

scholarly journals Implementing an integrated approach to self-management support in an acute major trauma therapy team: an improvement project

2019 ◽  
Vol 8 (3) ◽  
pp. e000415 ◽  
Author(s):  
Lucinda Hollinshead ◽  
Fiona Jones ◽  
Lucy Silvester ◽  
Paul Marshall-Taylor
Keyword(s):  
Educational Intervention ◽  
Major Trauma ◽  
Integrated Approach ◽  
Trauma Centre ◽  
Self Management ◽  
Management Support ◽  
Allied Health Professionals ◽  
Improvement Project ◽  
Major Trauma Centre ◽  
The Impact

More patients now survive multiple trauma injuries, but the level of long-term unmet needs is high. Evidence shows self-management support can improve patients ’ confidence to manage these needs but traditionally this support starts post-hospital. Starting self-management support early could prepare patients and families for successful transitions from hospital. The skills and commitment of clinicians have been shown to contribute to the success or failure of self-management approaches. The aim of this project was to explore the feasibility of integrating self-management support in an acute major trauma setting by evaluating the impact of an educational intervention on clinicians’ knowledge, attitudes and behaviours regarding self-management support and identifying any barriers and facilitators to integrating self-management into daily practice. Two improvement cycles were carried out over a 1-year period involving 18 allied health professionals (AHPs) in an acute major trauma centre in London, UK. An educational intervention, ‘Bridges Self-Management Programme’ was modified for the setting. The impact was evaluated using (1) a clinician questionnaire to evaluate knowledge and attitudes; (2) case reflection forms and (3) peer review to observe interactions to integrate self-management support. Questionnaire data were summarised and pre-training and post-training scores compared; the qualitative data from written case reflections, verbal and written feedback from training and group discussions was described and analysed thematically. The result of two improvement cycles has shown it was feasible to improve AHP’s knowledge, attitudes and change behaviours regarding self-management support in the acute trauma setting, but difficult to sustain change beyond 6 months. Key barriers such as the pressure to discharge patients and support within the wider multidisciplinary team (MDT) were identified. Facilitators included the introduction of a new key-worker, to enable shared team approaches and paperwork to involve patients and families in goal setting and treatment planning. The main learning was to ensure sustainability mechanisms from the outset, engage the wider MDT in training, and integrate self-management language and principles into team processes.

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