Patients with chronic obstructive pulmonary disease experienced ongoing challenges of

preserving their personal integrity

 
(1999) Res Nurs Health 22, 67; Leidy Nk, Haase JE.. Functional status from the patient's
perspective: the challenge of preserving personal integrity.. Feb; . :. –77..

Clinical Question: How do patients with chronic obstructive pulmonary disease (COPD)
experience the changes in their ability to perform day to day activities?

Design

Phenomenology.

Setting

Pulmonary outpatient clinic in southeastern USA.

Patients

12 English speaking patients (mean age 67 y, 50% men) with moderate to severe emphysema,
chronic bronchitis, asthma with underlying chronic airways obstruction, or COPD. Patients of
varying sociodemographic backgrounds were recruited using purposive sampling.

Methods

Unstructured, tape recorded interviews that lasted 30–60 minutes each were conducted in a
private room in the clinic. Patients were asked to describe a typical day and were then
encouraged to self direct the content of the interview. Audiotapes were transcribed, checked for
accuracy, and analysed based on Colaizzi's phenomenological method and the consensus
dialogue approach to concept clarification. Theme clusters were identified and findings were
validated for credibility.

Main findings

The concept of personal integrity emerged, which related to patients' experiences of finding
purpose and meaning from daily activity. Personal integrity represented a sense of satisfying
wholeness that included intrapersonal and interpersonal characteristics. Patients felt the
challenge of preserving personal integrity as they faced increasing limitations in their ability to
perform activities. The 2 central characteristics that defined a sense of personal integrity were
effectiveness and connectedness. Effectiveness was described as a sense of “being able,” and
included 4 interrelated characteristics: physical predictability (an expectation that the body
would function consistently), energy (an ability to function with ease), variety in form of
expression (the perception that activities could be done in various ways), and expertise (the use
of experience and knowledge). In response to these challenges, patients used emotional
expression (talking about their frustrations), goal setting and “trying” (prioritising, planning, and
pacing themselves), and recollection (remembering what they “used to do”). Connectedness was
described as a sense of “being with” other people, a spiritual being, nature, or aspects of one's
inner self. Connectedness related to the patients' desires for the following: familiarity and
comfort, which seemed affected by their illness symptoms and treatments; shared experiences
with family and friends; and the understanding and trustworthiness of others. In response to
these challenges, patients enjoyed personal solitude and expressed gratitude for those people,
ideas, or things that made them feel connected.

Conclusions

Patients with chronic obstructive pulmonary disease experienced ongoing challenges in

Commentary

This study by Leidy and Haase adds strength and depth to quantitative research on the wide
range of physiological, symptomatic, and psychosocial factors that influence performance in
people with COPD. Their qualitative study explores the changes in ability to perform day to day
activities from the perspective of the patients themselves. From this study, we learn that physical
changes make daily activities more difficult and challenge personal integrity and feelings of
effectiveness and connectedness with the world. The authors provide a detailed and
comprehensive conceptual analysis of the data. The power of the patient's perspective is clear in
the results presented.

The goal of the healthcare provider is to improve and maintain day to day performance in
patients with COPD and yet, we are often at a loss for how to intervene. Although qualitative
studies such as this are not designed to evaluate the effectiveness of interventions, they can
provide direction about the types of interventions that should be designed and evaluated. This
work on personal integrity suggests that interventions should focus on individual, patient driven
needs; support emotional expression, goal setting, and recollection; and foster connectedness
with family and friends. Regular access to nursing support based upon patient driven needs may
increase a patient's belief in his ability to cope and develop a more empowering and less
conditional relationship. Further research is needed to define the intervention more specifically
and to evaluate its effectiveness in improving personal integrity and, ultimately, the patient's
quality of life.
Adults with chronic lung disease had fatigue with laboured breathing that interfered with
daily living, but coped well

 
(1999) J Adv Nurs 30, 469. Small S, Lamb M.. Fatigue in chronic illness: the experience of
individuals with chronic obstructive pulmonary disease and with asthma.. Aug;. :. –78.

CLINICAL QUESTION: What are the experiences of fatigue in adults with chronic obstructive
pulmonary disease (COPD) and asthma?

Design

Qualitative description using content analysis of semistructured interview data.

Setting

Specialist clinic and not for profit association in St John's, Newfoundland, Canada.

Participants

36 participants between 28 and 81 years of age (mean age 58 y, 69% women), 17 with COPD
(chronic bronchitis, emphysema, or both) and 19 with asthma, were recruited through a
respiratory specialist clinic and a local lung association using purposive sampling.

Methods

Data were gathered from face to face interviews that lasted about 1 hour each. Interviews were
guided by the “fatigue schedule”, a semistructured questionnaire to prompt discussion on
characteristics of fatigue, causative and precipitating factors, associated physical and emotional
feelings, the effect on relationships and everyday activities, and coping strategies and resources;
however, participants were encouraged to speak freely about their experience of fatigue.
Interviews were audiotaped, transcribed verbatim, and content analysed.

Main findings

Participants with COPD or asthma shared similar experiences of fatigue. Fatigue was described
as a feeling of general tiredness and “sapped” energy that occurred daily, sometimes
persistently, or with exacerbation of the disease. Fatigue was associated with laboured breathing
and an inability to obtain sufficient oxygen. Participants identified 3 types of precipitants of
fatigue: those that caused a flare up of the condition (eg, common cold or flu), those that caused
laboured breathing (eg, physical exertion, environmental tobacco smoke, strong odours, or the
weather), and those that affected their level of fatigue directly (eg, interrupted sleep). Fatigue
contributed to a gradual decline in the ability to perform activities of daily living. Most
participants felt that their fatigue did not interfere with their relationships with family and
friends. Although fatigue caused irritability, frustration, and depression, participants felt that they
coped well with it. Coping strategies were problem focused, which included energy conservation,
utilisation, and restoration, and emotion focused, which included being positive, accepting
physical limitations, distracting from limitations, and behaving normally (ie, not focusing on the
illness but trying to maintain a normal life within the limitations).

Conclusions

Adults with chronic obstructive pulmonary disease or asthma described fatigue as an unrelenting
feeling of tiredness that was associated with laboured breathing and that limited their ability to
perform meaningful daily activities. Coping strategies included those that managed the physical
symptoms and those that managed the emotional responses.

Commentary

The findings of this study by Small et al support the current literature on fatigue in chronically ill
patients and extend the understanding to patients with COPD and asthma. The coping strategies
described in this study are consistent with those recently drawn from developing models of
fatigue in chronic illness.1

This study shows that an aspect of the fatigue experience in this population with chronic
respiratory illness is laboured breathing. Many of the fatigue management strategies described in
this study have also been described in studies of dyspnoea in similar populations.2 However, this
study attempts to distinguish between the experiences of people with COPD and those with
asthma: an interesting finding was that fatigue with asthma was an episodic experience that
occurred during exacerbation, whereas fatigue with COPD was experienced daily. Further study
is needed to more clearly identify appropriate adaptations of fatigue management strategies for
those people with asthma compared with those with COPD.

The authors state that most participants coped well in spite of the adverse impact of fatigue on
their functioning. This conclusion must be interpreted with caution as the research was not
designed to evaluate the effectiveness of coping. Rather, one of the most noteworthy findings is
the participants' description of the impact of fatigue as affecting more than just physical aspects.
This broad conceptualisation of fatigue emphasises the need to manage the emotional and social
impact of fatigue as well. Participants who described family and friends who were understanding
of their condition felt supported, whereas those who had difficulty coping hesitated to reveal
their fatigue to others. This suggests that nurses might help their patients by fostering a shared
understanding of the experience of fatigue and support for the ill person and those around them.

This study examined fatigue as it relates to physical, emotional, and social outcomes. It adds to
the evidence that directs nursing practice in fatigue management and identifies further areas for
evaluation of these types of interventions.
 Far Eastern University
Institute of Nursing

Evidence-
Based Nursing
(Chronic Obstructive Pulmonary Disease)

Submitted by:

Russiel Mae Cuaresma

Bsn 138- Group 149