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Canadian Journal of Respiratory, Critical Care, and Sleep Medicine
Revue canadienne des soins respiratoires et critiques et de la médecine du sommeil
Volume 7, 2023 - Issue 1
104
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Original Research

“Not just the asthma”: Understanding the acute asthma experiences of adult women with asthma presenting to the emergency department through photovoice

ORCID Icon, , , , &
Pages 10-20 | Published online: 26 Oct 2022
 

Abstract

Rationale: Asthma is a common reason for emergency department (ED) presentation. Few studies have explored the experiences of adults during asthma exacerbation, particularly those that necessitate ED care.

Objectives: This study explored adults experiences during asthma exacerbation.

Methods: A photovoice study was conducted. ED patients presenting for asthma care between the ages of 17-55 years were eligible for the study and recruited in the ED. Participants had 3-4 weeks to take photographs and subsequently completed a one-on-one photo-elicitation interview. Interviews were audio recorded, transcribed and thematically analyzed.

Measurements and Main Results: Six patients agreed to participate; 2 were lost to follow-up. One primary theme emerged. Specifically, the role of hope and fear, including the tension between them, in their experience of their condition. Hope and fear permeated all aspects of experience, including the following subthemes: 1) participants adopting the roles of advocate and expert, 2) frustration with their health state, 3) loss of freedom and subsequent feelings of failure, 4) barriers to accessing health care, and 5) “good” and “bad” ED care. Asthma was an ever-present consideration in participants lives during times of “good asthma control” and times of exacerbation.

Conclusions: Participants’ focus on the roles of hope and fear, both in the ED and beyond, suggests that openly acknowledging and addressing these emotional aspects as a part of the ED interaction could result in a better care experience for some patients. Seeing the whole person as more than their symptoms and sharing decision-making may help clinicians to provide care that supports hopefulness.

RÉSUMÉ

Justification: L'asthme est une raison courante pour la présentation au service des urgences. Peu d'études ont exploré les expériences des adultes pendant l'exacerbation de l'asthme, en particulier celles qui nécessitent des soins du service des urgences.

Objectifs: Cette étude s'est penchée les expériences des adultes pendant l'exacerbation de l'asthme.

MÉTHODES: Une étude de photovoice a été menée. Les patients âgés de 17 à 55 ans qui se présentaient au service des urgences pour des soins reliés à l'asthme étaient admissibles à l'étude et recrutés sur place. Les participants ont eu de trois à quatre semaines pour prendre des photos et ont ensuite passé un entretien individuel de photo-élicitation. Les entrevues ont été enregistrées, transcrites et analysées de manière thématique.

Mesures et Principaux Résultats: Six patients ont accepté de participer; deux ont été perdus de vue. Un thème principal est apparu, soit le rôle de l'espoir et de la peur, y compris la tension entre eux, dans leur vécu concernant leur état. L'espoir et la peur ont imprégné tous les aspects de l'expérience, y compris les sous-thèmes suivants : 1) les participants adoptant le rôle de défenseur et d'expert, 2) la frustration face à leur état de santé, 3) la perte de liberté et les sentiments d'échec subséquents, 4) les obstacles à l'accès aux soins de santé, et 5) les « bons » et les « mauvais » soins prodigués par le service des urgences. L'asthme était une considération toujours présente dans la vie des participants pendant les périodes de « bonne maîtrise de l'asthme » et les périodes d'exacerbation.

Conclusions: L'accent mis par les participants sur le rôle de l'espoir et de la peur, à la fois au service des urgences et à l’extérieur de celui-ci, indique que le fait de reconnaitre ouvertement ces aspects et d’en tenir compte dans le cadre de l'interaction avec les services d'urgence pourrait entraîner une meilleure expérience de soins pour certains patients. Le fait de voir la personne dans son ensemble, au-delà de ses symptômes, et de partager la prise de décision peut aider les cliniciens à fournir des soins qui alimentent l'espoir.

Acknowledgments

The authors would like to thank all the study participants for sharing their stories as well as the Emergency Medicine Research Group (EMeRG) at the University of Alberta for their assistance with recruitment and screening database management. Finally, the authors would like to thank the knowledge users (B. Sevcik and R. St. James) for their support in developing the materials for this study.

Disclosure statement

The authors have no conflicts of interest to declare.

Additional information

Funding

This research was funded by the Canadian Institutes of Health Research (CIHR) Patient-oriented Research Collaboration grant, Alberta Innovates Partnership for Research and Innovation in the Health System (PRIHS) grant and the EMeRG at the University of Alberta. At the time of this study, B.H. Rowe was supported as a Tier I Canada Research Chair in Evidence-based Emergency Medicine from CIHR through the Government of Canada (Ottawa, ON). B.H. Rowe’s research is now supported by the CIHR through the Scientific Director’s Operating Grant (CIHR SOP#: 154602). S. Gupta’s research is supported by the University of Toronto Michael Locke Term Chair in Knowledge Translation and Rare Lung Disease Research. The funding partners take no responsibility for the conclusions reported.

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