Emme Christina, Rydahl-Hansen Susan, Ostergaard Birte, Schou Lone, Svarre Jakobsen Anna, Phanareth Klaus
Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark.
J Clin Nurs. 2014 May;23(9-10):1445-58. doi: 10.1111/jocn.12444. Epub 2013 Dec 26.
To describe what characterises chronic obstructive pulmonary disease patients' coping of physical, emotional and social problems before, during and after virtual admission, in interaction with health professionals and relatives.
Telemedicine for patients with chronic obstructive pulmonary disease is gaining ground. However, virtual admission using telemedicine in the patients' home as a replacement of hospital admission has received little attention. Furthermore, little is known about how telemedicine affects chronic obstructive pulmonary disease patients' coping.
Grounded Theory study using semi-structured interviews.
The study was a part of The Virtual Hospital study, exploring virtual admission for patients with acute exacerbation of chronic obstructive pulmonary disease. During virtual admission, patients had access to medical equipment consisting of monitoring devices, medication, nebuliser and a touch screen with built-in videoconference system. Nine participants were interviewed after virtual admission. Open coding, axial coding and selective coding, using constant comparative analysis, were conducted.
A substantive Grounded Theory was developed, containing the core category - struggling to be in control of life with chronic obstructive pulmonary disease - related to four categories: complete powerlessness, dependency, pursuit of regaining autonomy and efforts to remain in control of problems related to chronic obstructive pulmonary disease. Virtual admission supported participants' autonomy. The involvement of health professionals was reduced as participants used the medical equipment to cope with disease-related problems. Participants' coping was closely linked to the presence of the equipment, making it difficult for them to apply their experiences after discharge from virtual admission.
Virtual admission may support chronic obstructive pulmonary disease patients' coping of physical and emotional problems. However, coping experiences made during virtual admission may not be directly applicable outside a telemedical setting.
Telemedicine may result in different roles for patients, relatives and health professionals. Clinicians should consider how they can support chronic obstructive pulmonary disease patients' coping during telemedical interventions, focusing on how to ensure a sustained improvement that patients can benefit from outside the telemedical setting.
描述慢性阻塞性肺疾病患者在虚拟住院前、住院期间和住院后与医护人员及亲属互动时应对身体、情感和社会问题的特点。
慢性阻塞性肺疾病患者的远程医疗正在逐渐普及。然而，在患者家中使用远程医疗进行虚拟住院以替代住院治疗的情况却很少受到关注。此外，对于远程医疗如何影响慢性阻塞性肺疾病患者的应对方式知之甚少。
采用半结构化访谈的扎根理论研究。
该研究是虚拟医院研究的一部分，探索慢性阻塞性肺疾病急性加重患者的虚拟住院情况。在虚拟住院期间，患者可以使用由监测设备、药物、雾化器和内置视频会议系统的触摸屏组成的医疗设备。九名参与者在虚拟住院后接受了访谈。采用持续比较分析法进行开放式编码、轴心式编码和选择性编码。
形成了一个实质性的扎根理论，包含核心类别——努力掌控慢性阻塞性肺疾病患者的生活——与四个类别相关：完全无力感、依赖、追求恢复自主以及努力控制与慢性阻塞性肺疾病相关的问题。虚拟住院支持了参与者的自主性。随着参与者使用医疗设备应对与疾病相关的问题，医护人员的参与度降低。参与者的应对方式与设备的存在密切相关，这使得他们在虚拟住院出院后难以应用自己的经验。
虚拟住院可能有助于慢性阻塞性肺疾病患者应对身体和情感问题。然而，在虚拟住院期间获得的应对经验可能无法直接应用于远程医疗环境之外。
远程医疗可能会使患者、亲属和医护人员的角色发生变化。临床医生应考虑如何在远程医疗干预期间支持慢性阻塞性肺疾病患者的应对，重点关注如何确保患者在远程医疗环境之外也能持续受益于病情的改善。
