Acceptability, Appropriateness and Feasibility of a Nurse-Led Integrated Care Intervention for Patients with Severe Exacerbation of COPD from the Healthcare Professional’s Perspective – A Mixed Method Study

Abstract

Purpose

To improve inpatient care and self-management in patients with severe acute exacerbations of COPD, we implemented a nurse-led behavioral intervention. This study aimed to assess implementation outcomes from the perspective of the healthcare professionals (HCP) who delivered it.

Methods

Using an explanatory sequential mixed method approach, we conducted an online questionnaire and two small group interviews. We applied descriptive statistics for quantitative data, a framework analysis for qualitative data, and a mixed methods matrix to integrate the results.

Results

A total of 19 of 27 invited participants answered the online questionnaire; 9 of 19 participated in the group interviews. The intervention’s overall acceptability, appropriateness, and feasibility was rated high to very high (median 5/5; 4/5 and 4/5). Enablers to implementation included general recognition of the need for specialized care, sufficient knowledge of the intervention by HCP, and strong interprofessional collaboration. Main barriers included the lack of resident physician’s resources and difficulties in adaptability.

Conclusion

While the acceptance of the intervention was very high, the perceived appropriateness and feasibility were affected by its complexity. The availability of a knowledgeable interprofessional core team is a strategy that supports the implementation of complex interventions.

Keywords:

• COPD
• self-management
• complex intervention
• implementation outcomes
• program evaluation
• behaviour change wheel

Acknowledgments

We thank the hospital-internal and -external participants who completed the online questionnaire and group interviews for their valuable contributions. We also thank their respective superiors for enabling their participation.

We are also grateful our involved colleagues from the APN and Physiotherapy teams, Mieke Koletsos-Lamers, Adina Wehrle, Nicola Greco and Céline Aregger, for their support with recruitment and data collection.

From UH Zurich we owe many thanks to Annina Baltes-Wieser, Head of Nursing Division C, to Heidi Petry (PhD, RN), Head of the Centre of Clinical Nursing Science, to Malcolm Kohler (MD), Medical Co-Director of Primary Area 1 and Director of the Department of Pulmonology, to Gabi Brenner, Director of Nursing, to Christine Meier, Head of Physiotherapy/Occupational Therapy, and to Monika Anderegg, Head of the Pulmonology Ward, for their consistent, ongoing and energetic support of this project.

We thank Barbara Schwaninger for her transcription of the interviews and Chris Shultis for editing support.

Disclosure

Christian Clarenbach: received advisory fees from Roche, Novartis, Boehringer, GSK, Astra Zeneca, Sanofi, Vifor, OM Pharma, Grifols, Daiichi Sankyo and Mundipharma. Paul Chadwick: received speakers honoraria for talks delivered to Roche. The authors report no other conflicts of interest in this work.

Additional information

Funding

This work was supported by a research grant from LUNGE ZUERICH, Switzerland.