Aim: To explore the role of coping moderators in self-management of breathlessness crises by people with advanced respiratory disease.
Design: A secondary analysis of semi-structured interview data.
Methods: Interviews with patients who had advanced respiratory disease, chronic breathlessness and at least one experience where they considered presenting to Emergency but self-managed instead (a "near miss"). Participants were recruited from New South Wales, Queensland, Victoria, South Australia or Tasmania. Eligible caregivers were those who contributed to Emergency-related decision-making. Interviews were coded inductively and then deductively against the coping moderators social support and dispositional coping style, defined by the Transactional Model of Stress and Coping.
Results: Interviews were conducted between October 2015 - April 2016 with 20 patients and three caregivers. Social networks offered emotional and practical support but also had potential for conflict with patients' 'hardy' coping style. Patient hardiness (characterized by a sense of 'commitment' and 'challenge') promoted a proactive approach to self-management but made some patients less willing to accept support. Information-seeking tendencies varied between patients and were sometimes shared with caregivers. An optimistic coping style appeared to be less equivocally beneficial.
Conclusion: This study shows that social support and coping style may influence how people self-manage through their breathlessness crises and identified ways coping moderators can facilitate or hinder effective self-management.
Impact: This study confers insights into how social-support and coping style can be supported and optimized to facilitate breathlessness self-management. Acknowledging coping moderator interactions is beneficial for developing resources and strategies that recognise patient mastery.
目的: 探讨应对调节者在晚期呼吸系统疾病患者呼吸困难危机自我管理中的作用。 设计: 半结构化访谈数据的二次分析。 方法: 采访患有晚期呼吸系统疾病、慢性呼吸困难的患者,至少有一次他们考虑过紧急情况下自我管理的经历(“相近差错”)。参与者来自新南威尔士、昆士兰、维多利亚、南澳大利亚或塔斯马尼亚。合格的护理人员是那些参与紧急相关决策的人。 访谈以应激和应对的交互模型为基础,对应对调节者的社会支持和倾向性应对方式进行归纳和演绎编码。 结果: 在2015年10月至2016年4月期间,对20名患者和3名护理人员进行了访谈。社交网络提供了情感和实际支持,但也有可能与患者的“坚强”应对方式发生冲突。患者的意志力(以“承诺”和“挑战”为特征)促进了积极主动的自我管理方法,但使一些患者不愿意接受支持。患者之间的信息寻求倾向各不相同,有时与护理人员分享。乐观的应对方式看来有明显的好处。 结论: 本研究表明,社会支持和应对方式可能影响人们如何通过呼吸困难的危机自我管理,并确定应对调解人可以促进或阻碍有效的自我管理的方式。 影响: 本研究探讨如何支持和优化社会支持和应对方式,以促进呼吸困难的自我管理。认识到应对调节者的相互作用有助于开发认识到患者掌握情况的资源和策略。.
Keywords: breathlessness; coping; dyspnea; emergency; nursing; qualitative; respiratory; self-management; social support.
© 2019 John Wiley & Sons Ltd.