The research paper Symptom clusters in chronic obstructive pulmonary disease by Bradlee Jenkins, Ponrathi Athilingam and Rebecca Jenkins was written with the purpose of conducting a comprehensive literature review to identify symptom clusters that are common in patients suffering from the chronic obstructive pulmonary disease (COPD). COPD is fourth worldwide as a leading cause of death in human beings. The Global Initiative for Chronic Obstructive Lung Disease [GOLD] projects that COPD will be the third leading cause of death by 2020 ( Brad lee , Ponrathi & Rebecca, 2019 ) .
COPD is characterized by persistent airflow resistance due to chronic inflammatory response of the body that declines overall lung functioning. The research aims to solve a health crisis by discovering any information that could help in preventing or suppressing the various symptoms of COPD. The symptoms of the disease have been investigated and have been found not only to be physiological but also psychological ( Brad lee , Ponrathi , & Rebecca, 2019 ) . COPD is progressive and patients experience changes in both physical and cognitive competence as the condition worsens.
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The problem under investigation in the study is the identification of symptom clusters in COPD patients. The investigators have done a good job in placing the research problem in the context of existing knowledge since COPD is a condition that has been known and studied for a long time now. The study is designed to solve a problem relevant to nursing because accurate findings from the research could lead to improvement of treatment and prevention of COPD with regards to delivering clinical solutions to multiple symptoms during treatment.
The references used in the research are current and updated. The researchers referenced literature from the PubMed, Web of Science, and Embase databases which are reputable and credible sources of accurate medical information. They also identified potential articles that were published between 2005 and 2008 with trials conducted on adult humans. Out of 3956 potential articles from the database, only 1748 unique articles met the criteria of being published between 2005 and 2008 and being conducted on people above the age of nineteen ( Brad lee , Ponrathi & Rebecca, 2019 ) . The researchers were keen to make sure that articles used were of cases that happened in recent times. Search terms included symptom, symptom cluster, symptom combination, and chronic obstructive pulmonary disease. An accurate search strategy was implemented that used Boolean operators "OR" and "AND". Out of the 1748 articles, 21 articles were chosen for full-text assessment and out of the 21, 5 were included for synthesis ( Brad lee , Ponrathi & Rebecca, 2019) .
The theoretical concepts in the research are defined and have been well related to the research. COPD symptoms are clinically known and accepted. The research draws from no only nursing theory but other disciplines of medicine such as psychiatry. The authors have clearly given the theoretical framework stated in the research article which is the well-known literature of the symptoms and stages of COPD. A suitable hypothesis for this study would have been: There are distinct symptom clusters experienced by patients of COPD. The independent and dependent variables in this study are test scores measuring both physical and psychological fitness of COPD patients. The operational definitions of the variables are provided and are concrete and measurable international units. Recruitment for the study was done in hospitals and pulmonary clinics ( Brad lee , Ponrathi , & Rebecca, 2019 ) . The sampling design method used was qualitative because studies required participants to have some form of COPD-related functional impairment. Inductive reasoning was used in cluster analysis to identify relationships in symptom clusters.
The sample size had a total of 596 people. The participants ranged from 54 in number to 250. The participants had a mean age of 70.49 years. 80.7% of them were males and 19.3% were females ( Brad lee , Ponrathi , & Rebecca, 2019 ) . Some studies reported COPD severity based on spirometry test results. The researchers used a non-probabilistic approach to filter the sample size. According to GOLD, COPD is said to be present when the spirometry gives an FEV that is less than 80%. A study categorized its result as either moderate (50% < FEV < 80%) to severe airflow resistance (30% < FEV < 50%) ( Brad lee , Ponrathi , & Rebecca, 2019 ) . Two themes of symptoms emerged categorized into respiratory-related symptoms and psychological related symptoms. Under respiratory-related symptoms, breathing difficulty was a common symptom component. One of the studies examined the stability of the symptoms over time. The instruments used for cluster analysis were Becky Anxiety Inventory (BAI), Memorial Symptom Assessment Scale (MSAS), and the Bronchitis Emphysema Symptom Checklist (BESC) ( Brad lee , Ponrathi & Rebecca, 2019 ) . The measurement tools used in the study had good reliability and validity for they are international standards that have been used and accepted for a long time in the medical field.
Focusing on psychological symptoms, participants showed four symptom clusters which included general somatic distress, fear, nervousness and, respiratory-related distress. The BAI anxiety factory was used to determine the severity of the symptoms. Other psychological symptoms clusters included fatigue-related sleep, memory function decline, and emotional problems. With respect to respiratory-related problems, participants reported feelings such as chocking, indigestion, face flushed and difficulty breathing ( Brad lee , Ponrathi & Rebecca, 2019 ) . The difficulty breathing was characterized with shortness of breath, shallow breathing, and mucus congestion which coincides with current literature about COPD. Most participants identified breathing difficulty as the most distressing symptom which in turn contributed to higher levels of emotional problems such as anxiety. The researchers identified that patients would most notably switch back-and-forth between psychological symptoms and physical symptoms.
The study findings were that the majority of the patients reported an array of both physical and psychological symptoms. For example, in emotional problems, anxiety and memory function decline were reported alongside physical symptoms such as chest discomfort and pain or an unpleasant sensation. Patients would go from psychological to physical symptoms with time transition, for example, they would go from “I feel like I need air” to “I am worried about getting air” ( Brad lee , Ponrathi & Rebecca, 2019 ) . The aim of the research was to evaluate evidence of symptom clusters in COPD patients. Results found that there was a significant correlation between BAI and COPD mastery. One study identified depression in a symptom cluster. Depression was associated with low COPD mastery which then would become a hindrance to self-care management. There was also a relationship between the level of lung damage and the severity of anxiety and depression scores. Women reported higher levels of somatic and cognitive symptoms, the female gender seems to be more vulnerable to disease-specific changes that may increase anxiety of depression as compared to the male gender ( Brad lee , Ponrathi & Rebecca, 2019 ) .
The study does not show any sign of unethical research practices. Database mining and analysis tools were used to extract data and the results were presented in a tabular format along with comprehensive discussions. In my opinion, the strengths of the research were its reliance on modern database tools. Its limitations, however, were the reliability and validity of one measuring instrument which a given study had designed for their own case. This made it harder to compare with the other study results. The results can be generalized to other populations and have provided insights to the overlap of cognitive and physical symptoms in COPD patients which is invaluable information to the nursing practice
Reference
Bradlee A. Jenkins, Ponrathi Athilingam, & Rebecca A. Jenkins, (2019). Symptom clusters in chronic obstructive pulmonary disease : A systematic review. Science Direct , 23-29. Retrieved from https://www.sciencedirect.com/science/article/pii/S089718971830586X
