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

Kelly, Carol; Lynes, Dave; O’Brien, Mary; Shaw, Benjamin A.

doi:10.1111/crj.12571

Cited by 26 publications

(21 citation statements)

References 28 publications

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“…Interestingly, a recent study on oxygen therapy in general mentions the treatment as "a wolf in sheep's clothing." 23 The study showed that subjects experienced oxygen therapy as a burden together with its advantages, which indicated feelings of resentment, dependency, invasion of privacy, and being trapped due to the technology. Although the populations in this study and in our review comprised different diagnoses, the experienced consequences of ventilation treatment were similar.…”

Section: Discussionmentioning

confidence: 99%

Users' Experiences With Home Mechanical Ventilation: A Review of Qualitative Studies

et al. 2019

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BACKGROUND: Users of home mechanical ventilation encounter major psychological and physiologic challenges. To ensure well-functioning home mechanical ventilation, users' experiences of care and treatment are important knowledge to supplement clinical perspectives. This systematic review aimed to summarize current qualitative evidence regarding experiences of home mechanical ventilation users. METHODS: By following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, 9 databases were systematically searched. Seven studies met the inclusion criteria after title and/or abstract screening and full-text assessment. These were appraised by using the Relevance, Appropriateness, Transparency, Soundness checklist. Thematic analysis guided data extraction and identification of the findings. The Confidence in the Evidence for Reviews of Qualitative Research tool was applied to assess the confidence of the findings. RESULTS: The review showed high confidence in 4 findings: an increase in quality of life, feeling forced to accept home mechanical ventilation, collaboration between home-care assistants and users of home mechanical ventilation is challenging, and information about the technology from a user's perspective. The review showed moderate confidence in 2 findings: living at home is pivotal for a normalized everyday life, and home mechanical ventilation causes a life with continued worries and uncertainty. CONCLUSIONS: According to the users, treatment by home mechanical ventilation resulted in increased well-being and facilitated a community-and home-based lifestyle compared with institutional-based treatment. However, the users also expressed difficulties in coming to terms with the necessary extensive surveillance, which gave rise to a sense of undermined autonomy and self-determinism as well as continued worries and uncertainty. The users called this situation dependent independency. As a result of the review we call for an increased focus on a patientcentered treatment and care.

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Section: Discussionmentioning

confidence: 99%

Users' Experiences With Home Mechanical Ventilation: A Review of Qualitative Studies

et al. 2019

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“…Free text responses revealed that several clinicians believe that oxygen is useful as a placebo or that it may help the patient. A previous qualitative study 26 identified that oxygen was used by clinicians as a cure-all. Like our findings, "anxiety" or its use as a placebo was commonly cited as a reason for giving oxygen.…”

Section: Discussionmentioning

confidence: 99%

<p>Understanding Clinicians’ Perceived Barriers and Facilitators to Optimal Use of Acute Oxygen Therapy in Adults</p>

Cousins¹,

Wark²,

Hiles³

et al. 2020

COPD

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Background: Supplemental oxygen is commonly administered to patients in acute care. It may cause harm when used inappropriately. Guidelines recommend prescription of acute oxygen, yet adherence is poor. We aimed to identify barriers and facilitators to practicing in accordance with the evidence-based Thoracic Society of Australia and New Zealand (TSANZ) oxygen guideline, and to determine the beliefs and attitudes relating to acute oxygen therapy. Methods: A national cross-sectional survey was conducted. The survey consisted of 3 sections: (1) introduction and participant characteristics; (2) opinion/beliefs, knowledge and actions about oxygen therapy and other drugs; and (3) barriers and facilitators to use of the TSANZ guideline. Convenience sampling was employed. A paper-based survey was distributed at the TSANZ Annual Scientific Meeting. An online survey was emailed to the TSANZ membership and to John Hunter Hospital's clinical staff. Results: Responses were received from 133 clinicians: 52.6% nurses, 30.1% doctors, and 17.3% other clinicians. Over a third (37.7%) were unaware/unsure of the oxygen guideline's existence. Most (79.8%) believe that oxygen is a drug and should be treated as one. Most (92.4%) stated they only administered it based on clinical need. For four hypothetical cases, there was only one where the majority of participants identified the optimal oxygen saturation. A number of barriers and facilitators were identified when asked about practicing in accordance with the TSANZ guideline. Lack of oxygen equipment, getting doctors to prescribe oxygen and oxygen being treated differently to other drugs were seen as barriers. The guideline itself and multiple clinician characteristics were considered facilitators. Conclusion: There is discordance between clinicians' beliefs and actions regarding the administration of oxygen therapy and knowledge gaps about optimal oxygen therapy in acute care. Identified barriers and facilitators should be considered when developing evidencebased guidelines to improve dissemination and knowledge exchange.

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“…An awareness that oxygen is only indicated in hypoxemia and not breathlessness is lacking amongst both clinicians and patients [13]. Kelly et al find a set of fixed beliefs regarding oxygen exists amongst healthcare professionals' (HCPs) and patients, including the perception that oxygen is a universal remedy [14]. They also established that HCPs use oxygen for symptom relief, and more broadly, that HCPs levels of knowledge and understanding could be substantially and significantly enhanced [15].…”

Section: Introductionmentioning

confidence: 99%

Acute oxygen therapy: a cross-sectional study of prescribing practices at an English hospital immediately before COVID-19 pandemic

Barrett

Catangui

Scott

2020

Expert Review of Respiratory Medicine

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Background: Approximately 14% of UK hospital in-patients receive supplemental oxygen therapy, only 57% have valid prescriptions. Oxygen must be optimally prescribed to ensure maximal therapeutic response whilst minimizing adverse outcomes (including fatality). This study investigates prescription compliance. Methods: All adults admitted to medical wards (18 February to 3 March 2020) were included. Analyses present proportions, descriptive statistics, and hypothesis testing. Ethical approval was unnecessary for this audit. Results: Of the 636 patients admitted, 66 (10%) were receiving oxygen therapy. Ages ranged from 34 to 100 years with 36 (54.5%) males and 30 (45.5%) females. The prescription was not documented in the oxygen section of the drug chart (n = 37, 56.1%, p = 0.389), nor did it have the physicians signature (n = 40, 60.6%, p = 0.110) nor date (n = 46, 69.7%, p = 0.002). Thirteen chronic obstructive pulmonary disease (COPD) patients (19.7%) were at risk of hypercapnic failure (p = 1.582x10 −6). Target oxygen saturation (SpO2) range had been documented for 30 (45.5%) patients. A target SpO2 range of 88-92% was documented for 9 patients (13.6%), a 94-98% range documented for 11 patients (16.7%). All patients had an invalid prescription. Conclusion: We present real-world practice in naturalistic settings, immediately before pandemiclockdown. Enhanced compliance is advocated to reduce risks of harm and mortality.

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

Abstract: Background: Despite emerging evidence and guidelines, poor prescribing and

Cited by 26 publications

References 28 publications

Users' Experiences With Home Mechanical Ventilation: A Review of Qualitative Studies

Users' Experiences With Home Mechanical Ventilation: A Review of Qualitative Studies

<p>Understanding Clinicians’ Perceived Barriers and Facilitators to Optimal Use of Acute Oxygen Therapy in Adults</p>

Acute oxygen therapy: a cross-sectional study of prescribing practices at an English hospital immediately before COVID-19 pandemic

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