Christensen Helle M, Titlestad Ingrid L, Huniche Lotte
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
SAGE Open Med. 2017 Nov 10;5:2050312117739785. doi: 10.1177/2050312117739785. eCollection 2017.
Non-invasive ventilation treatment for patients with acute exacerbation of chronic obstructive pulmonary disease is well documented. Communication with patients during treatment is inhibited because of the mask, the noise from the machine and patient distress. Assessing life expectancy and identifying end-stage chronic obstructive pulmonary disease posed difficulties and caused doubts concerning initiation and continuation of non-invasive ventilation as life-sustaining treatment. Health professionals expressed a need for knowledge of patients' perspectives and attitude towards non-invasive ventilation.
The study adheres to principles of Critical psychological practice research. Data on patients' and health professionals' perspectives were obtained from observations from the ward and semi-structured interviews with 16 patients. A group of health professionals was set up to form a co-researcher group. The co-researcher group described and analysed treatment practice at the department, drawing on research literature, results from observations and patients' interviews.
Interviews revealed that 15 patients evaluated treatment with non-invasive ventilation positively, although 13 had experienced fear and 14 discomfort during treatment. The co-researcher group described health professionals' perspectives and analysed treatment practice based on data from patients' perspectives developing new management strategies in clinical practice with non-invasive ventilation.
The participatory approach enabled continuous and complementary development of knowledge and treatment practice. The investigation of patient perspectives was particularly productive in qualifying cooperation among health professionals. The study resulted in preparing, and implementing, new clinical strategies.
慢性阻塞性肺疾病急性加重患者的无创通气治疗已有充分记录。治疗期间,由于面罩、机器噪音和患者痛苦,与患者的沟通受到阻碍。评估预期寿命和识别终末期慢性阻塞性肺疾病存在困难,并引发了关于启动和继续无创通气作为维持生命治疗的疑问。卫生专业人员表示需要了解患者对无创通气的看法和态度。
该研究遵循批判性心理实践研究原则。关于患者和卫生专业人员观点的数据来自病房观察以及对16名患者的半结构化访谈。成立了一组卫生专业人员组成共同研究小组。共同研究小组利用研究文献、观察结果和患者访谈结果,描述并分析了该科室的治疗实践。
访谈显示,15名患者对无创通气治疗给予积极评价,尽管13名患者在治疗期间经历过恐惧,14名患者感到不适。共同研究小组描述了卫生专业人员的观点,并根据患者观点的数据分析治疗实践,在无创通气的临床实践中制定新的管理策略。
参与式方法促进了知识和治疗实践的持续和互补发展。对患者观点的调查在促进卫生专业人员之间的合作方面特别有成效。该研究促成了新临床策略的制定和实施。