Carol Kelly

How do respiratory patients perceive oxygen therapy? A critical interpretative synthesis of the literature

Oxygen therapy is a common intervention in health care worldwide; yet, despite universal use, it is evident through poor practice that oxygen is often prescribed and administered injudiciously. It is proposed that possibly an influencing culture presides, whereby oxygen is often poorly understood and uncertainty regarding its use exists. It is unclear where the origins of this culture lie but exploring perceptions may enlighten the problem. A review of the literature was undertaken to establish what is already known about this elusive phenomenon. The paucity of any direct evidence regarding perceptions of oxygen directed the review to utilize a critical interpretative synthesis (CIS). The aim of this study was to explore how respiratory patients perceive oxygen therapy. A systematic search in Medline, Cinahl, Embase, British Nursing Index and PsychInfo yielded 1514 studies of which 42 were selected to consider the review question. The CIS allowed evidence from across studies to synthesize existing and new interpretations of data related to patients’ perceptions of oxygen therapy. Synthetic constructs then informed the synthesizing arguments, namely positive – feeling safe, enabler and comforter; negative – fear, oxygen versus self, restriction and embarrassment; and impartiality – mixed blessings. The findings are divergent, and at times contradictory. There appears uncertainty among patients regarding the purpose and benefits of oxygen therapy, though an underlying faith in health-care professionals is apparent. This faith seems to foster acceptance of a life-changing therapy, despite the impact, burden and incomplete understanding. There is a clear need for further research regarding these elusive perceptions in order to improve clinical practice in respect of oxygen.

How do health-care professionals perceive oxygen therapy? A critical interpretive synthesis of the literature

Oxygen is one of the commonest health-care interventions worldwide. This might suggest that health-care professionals (HCPs) would be knowledgeable and familiar with its uses and limitations. Yet it is apparent, through clinical audit, that oxygen is probably misunderstood by many HCPs. The aim of this critical interpretive synthesis (CIS) is to explore qualitative and quantitative literature in relation to HCPs beliefs and perceptions of oxygen therapy. A systematic search in Medline, Cinahl, Embase, British Nursing Index and PsychInfo using search terms, such as, oxygen therapy, chronic respiratory disease, HCPs and perceptions yielded 1514 studies of which 12 contained data relevant to the review question. Two reviewers independently screened the articles for eligibility against inclusion and exclusion criteria, and data were selected and synthesized with an integrative and interpretive approach using CIS. This allowed diverse empirical evidence to be synthesized to develop existing and new interpretations of data.Three synthetic constructs were interpreted from the available literature, namely, oxygen for symptom relief, levels of knowledge and understanding and oxygen as a therapy for HCPs. The literature alludes to deep-seated beliefs that exist. In order to enhance practice, these beliefs and cultures need to be challenged. Further research is needed to explore HCPs’ perceptions of oxygen therapy in order to inform the seemingly resistant adoption of evidence based practice in relation to oxygen.

Difficult decisions: An interpretative phenomenological analysis study of healthcare professionals’ perceptions of oxygen therapy in palliative care

Background: The role of oxygen therapy to palliate dyspnoea is controversial. Without a clear evidence base oxygen is commonly prescribed, sometimes to the detriment of patients. This use of oxygen appears to be an entrenched culture, the roots of which remain obscure. Aim: To explore healthcare professionals’ perceptions of oxygen therapy in palliative care. Design: Interpretative phenomenological analysis study utilising semi-structured interviews to explore beliefs and behaviours of healthcare professionals regarding palliative oxygen therapy. Data were recorded, transcribed and analysed using interpretative phenomenological analysis. Setting/participants: A total of 34 healthcare professionals, including doctors, nurses, pharmacists and paramedics in the United Kingdom, who were involved in prescribing, or administering, oxygen therapy to palliate dyspnoea. Results: Most healthcare professionals in this study were well informed about oxygen therapy; all recognised the role of oxygen in palliative care setting as important. The overarching theme of compassion identified sub-themes of ‘comfort’, ‘do anything and everything’ and ‘family benefit’. However, the use of oxygen in the palliative care setting was not without its dilemmas, as additional sub-themes of ‘controversy’, ‘doubt’ and ‘dependency’ illustrated. Conclusion: Findings suggest that oxygen therapy in palliative care poses an on-going dilemma for healthcare professionals striving to provide optimum care. It seems patients and families often expect and welcome oxygen, but the perception of oxygen as a solution to dyspnoea can conflict with healthcare professionals’ own doubt and experiences. There appears to be an emotional cost associated with this dilemma and the choices that need to be made.

Macrolide antibiotics for non-cystic fibrosis bronchiectasis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the impact of macrolide antibiotics in the treatment of adults and children with non-cystic fibrosis bronchiectasis.

A wolf in sheep's clothing? Patients' and healthcare professionals' perceptions of oxygen therapy: An interpretative phenomenological analysis.

Despite emerging evidence and guidelines, poor prescribing and administration of oxygen therapy persists. This study aimed to explore healthcare professionals’ (HCPs) and patients’ perceptions of oxygen.

Oxygen therapy: time to move on?

This analysis examines the roots of clinical practice regarding oxygen therapy and finds that some aspects have changed very little over the past 200 years. Oxygen is commonly prescribed and administered as a therapy across all healthcare settings, particularly for the treatment and management of respiratory conditions, both acute and chronic. Yet despite its widespread use and recent advances in understanding and guidance, poor practice and controversies regarding its use persist. This historical analysis highlights origins in practice that may suggest where the roots of these fallacies lie, highlighting potential ambiguities and myths that have permeated clinical and social contexts. It can be considered that based on clinical presumptions and speculation the prolific and injudicious use of oxygen was encouraged and the legacy for today’s practice seeded. The conjectures proposed here may enable modern day erroneous beliefs to be confronted and clinical practice to move on.

Domiciliary oxygen therapy: assessment and management.

This article examines assessment and management strategies for all categories of domiciliary oxygen therapy for adult patients. It highlights the evidence underpinning each category, and enables dissemination of good practice to colleagues, patients and carers.

Research priorities for respiratory nursing: a UK-wide Delphi study

Respiratory nurses make a significant contribution to the delivery of respiratory healthcare, but there is a dearth of nurse-led, practice-focused, published research. Using a modified three-round Delphi, this study sought to identify research priorities for respiratory nursing to inform a national research strategy. Study information and the survey link were sent electronically to members of UK professional respiratory organisations. Round 1 had 78 items across 16 topics, informed by a systematic literature review. Respondents suggested additional items which were content analysed to inform Round 2. Respondents rated all items and ranked the topics in all rounds. To ensure rigour, rounds had an explicit focus with pre-determined criteria for consensus (70%). In total, 363 responses were received across Rounds 1, 2 and 3 (n=183, 95 and 85, respectively). The top five research priorities were: 1) “Patient understanding of asthma control”; 2) “The clinical and cost-effectiveness of respiratory nurse interventions”; 3) “The impact of nurse-led clinics on patient care”; 4) “Inhaler technique”; and 5) two topics jointly scored: “Prevention of exacerbations” and “Symptom management”. With potential international significance, this is the first UK study to identify research priorities for respiratory nursing, providing direction for those planning or undertaking research. UK-wide Delphi survey identifies nursing research priorities to enhance respiratory care for patients and carers http://ow.ly/ekGt30iXYXt

Self-management for non-cystic fibrosis bronchiectasis: Cochrane Systematic Review

Background The aims of therapeutic management for non-cystic fibrosis (non-CF) bronchiectasis are: preservation of lung function, reduction of symptoms and exacerbations and to improve quality of life. Self-management interventions are beneficial in the management of other airway diseases and are a research priority for bronchiectasis. Objectives To assess the efficacy, cost-effectiveness and adverse effects of self-management interventions for adults and children with non-CF bronchiectasis. Methods Cochrane Airways Group’s Specialised Register, ClinicalTrials.gov and the World Health Organisation trials portal were searched. We included all parallel and cluster-randomised controlled trials which included adults and children with non-CF bronchiectasis and assessed self-management interventions delivered in any form (e.g., mobile device, face-to-face) compared with usual care or alternate form of self-management. Two reviewers independently assessed studies for eligibility and quality, and extracted data. Results We identified 53 records and included 2 studies: one RCT of early rehabilitation in adults in two centres in England and one proof-of-concept RCT of an expert patient programme in adults in a single regional respiratory centre in Northern Ireland. A total of 84 adult patients with bronchiectasis were randomised. Data aggregation was not possible. For primary outcomes, health-related quality of life was reported in both studies but showed no significant benefit. One study reported more deaths in the intervention group compared to the control group, (Intervention: 4 of 8, Control: 2 of 12), although small numbers limit interpretation. Neither study reported data on exacerbations requiring antibiotic therapy. For secondary outcomes, frequency of hospital admissions was reported in one study but was not significantly different between groups. Both studies reported lung function in terms of FEV1 and there were no significant differences between groups. One study reported data on self-efficacy and showed evidence of benefit. Neither study reported data on respiratory symptoms, economic costs or adverse events. Using GRADE guidelines, the outcomes included were judged as very low quality. Conclusions There is insufficient evidence to determine whether self-management has benefits in adults and children with non-CF bronchiectasis. Future studies should more clearly define self-management interventions, control for sources of variability, be adequately powered, measure clinically important outcomes, and include children.

M12 A uk survey on the experiences and views of respiratory nurses (rns) on their role in delivering cognitive behavioural therapy (cbt) for patients with chronic obstructive pulmonary disease (copd)

Background COPD is a progressive, irreversible condition. Anxiety and depression are two common, yet least treated co-morbidities, in COPD. RNs frequently encounter patients with distressing symptoms hence are ideally placed to address these. CBT delivered by RNs reduces symptoms of anxiety, depression, improves quality of life and is cost -effective.1 A UK-wide Delphi survey conducted with RNs in 2016–2017 identified that the topic of psychological interventions, including CBT, was ranked in the top five areas of care for future research.2 Aim To explore views of RNs on the importance of screening/providing integrated psychological treatment into routine care and the feasibility of undertaking education and training in CBT. Method A UK-wide electronic survey was conducted to gather respiratory nurses views on the importance of addressing psychological well-being, current practice, feasibility of education and training in CBT from a personal and organisational perspective. The Results were collated and analysed. Results Ninety-six responses were received. The majority (58%) of respondents had ≥10 years’ experience in respiratory care and represented a diverse spread of regions across the UK. The Results are presented in Table 1. Conclusions There is a clear recognition from RNs of the importance of screening respiratory patients for symptoms of anxiety/depression and undertake further education to deliver psychological treatment such as CBT. RNs with skills to address both physical and psychological symptoms of COPD may be more beneficial and acceptable to patients. References . Heslop-Marshall K, Stenton C, Newton J, Carrick-Sen D, Baker C, Burns G, De Soyza A. A RCT of CBT delivered by respiratory nurses to reduce anxiety in COPD. ERJ2016;48:OA289. doi:10.1183/13993003.congress-2016.OA289 . Kelly C, Knighting K, Kirkcaldy A, Pilkington M. A delphi study to identify research priorities for respiratory nursing. Report for the Association of Respiratory Nurse Specialists (ARNS). Edge Hill University2017. Abstract M12 Table 1 Survey results 92% of RNs stated they should screen for symptoms of anxiety and depression. 78% of RNs stated they should help manage symptoms of anxiety and depression. 70% of RNs surveyed currently screen for symptoms of anxiety and depression. 51% of those who screen refer to psychological services. 91% of RNs felt that they should be trained to identify psychological difficulties. 77% of RNs agreed they should be trained in CBT. 63% of RNs felt that support from management would be given to access training 65% of RNs felt support to deliver CBT would be provided. 55% of RNs felt they would have capacity to deliver this service and 23% were unsure.