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

Christine Hübsch,1,2 Christian Clarenbach,2,3 Paul Chadwick,4 Matthias Peterer,5 Sonja Beckmann,1 Rahel Naef,1,6 Gabriela Schmid-Mohler1,2 1Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland; 2Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland; 3Faculty of Medicine, University of Zurich, Zurich, Switzerland; 4Centre for Behaviour Change, University College London, London, UK; 5Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland; 6Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, SwitzerlandCorrespondence: Gabriela Schmid-Mohler, Centre of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland, Tel +41 44 255 20 03, Email [email protected]: 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 whee