Factors involved in access and utilization of adult hearing healthcare: A systematic review.

OBJECTIVE/HYPOTHESIS: Hearing loss is a public health concern, yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare. DATA SOURCES: Pubmed, PsychINFO, CINAHL, and Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990 to 2015. METHODS: Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study. RESULTS: Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilitation process. CONCLUSION: Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation toward improved access of care, a deeper understanding of motivators, barriers, and compliance factors can aid in delivery of effective and efficient hearing healthcare. Laryngoscope, 127:1187-1194, 2017.

Perceptions of adults with hearing impairment regarding the promotion of trust in hearing healthcare service delivery.

OBJECTIVE: This paper describes how trust is promoted in adults with hearing impairment within the context of hearing healthcare (HHC) service delivery. DESIGN: Data were analysed from a previously published descriptive qualitative study that explored perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. STUDY SAMPLE: Interview transcripts from 29 adults from four countries with different levels of hearing impairment and different experience with the HHC system were analysed thematically. RESULTS: Patients enter into the HHC system with service expectations resulting in a preconceived level of trust that can vary from low to high. Relational competence, technical competence, commercialized approach, and clinical environment (relevant to both the clinician and the clinic) influence a patient's resulting level of trust. CONCLUSIONS: Trust is evolving rather than static in HHC: Both clinicians and clinics can promote trust. The characteristics of HHC that engender trust are: practicing good communication, supporting shared decision making, displaying technical competence, offering comprehensive hearing rehabilitation, promoting self-management, avoiding a focus on hearing-aid sales, and offering a professional clinic setting.

An overview of assessment and management in COPD.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease, which has a huge impact on both families and individual patients lives. Even though COPD is largely a preventable disease, it is increasing worldwide. Therefore, healthcare professionals working within primary care are likely to come into daily contact with patients with this condition. However, statistics tell us that there are many more patients that are undiagnosed. The aim of this article is to provide an overview of this condition and to identify the various drug therapies that are available to ensure patients are receiving optimal treatment to control their symptoms of COPD.

Management of end-stage chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a potentially fatal, slowly progressive condition of the airways. It is a chronic disease which, although preventable, is not curable. COPD is one of the chronic conditions projected to increase over the next decade, and as a consequence causing increased morbidity and mortality. As the disease progresses the symptoms become more severe and, frequently, regular medication alone becomes less effective. It is essential that healthcare professionals are able to recognize, which is not always easy, when patients have reached this stage of the illness, to ensure appropriate care and management. This article provides an outline for healthcare professionals of clinical markers to help distinguish end-stage disease and pharmacological and non-pharmacological interventions that may assist in achieving optimal symptom control and provide some quality to the patient's final stage of their life.

Nursing management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality, which imposes a major burden on both society and the health service. It is a common condition that is on the increase and predominantly caused by smoking. Progressive damage to the lung tissue renders the patient increasingly breathless resulting in a frightening existence causing varying degrees of disability and handicap. It is therefore essential that healthcare professionals understand how this condition affects patients not only from a physical perspective, but also from a psychological and social perspective to provide effective nursing management. Nursing management of patients suffering from this disease is aimed at helping to control individual patient's symptoms and improve their quality of life.

Chronic obstructive pulmonary disease: a phenomenological study of patients' experiences.

AIM: The purpose of this study is to explore the experience of living with chronic obstructive pulmonary disease by investigating the subjective phenomenon as described by the patient. BACKGROUND: Chronic obstructive pulmonary disease is now recognized as one of the most common chronic respiratory diseases in the United Kingdom, with a high prevalence of morbidity and mortality. As the disease progresses, symptoms increase which gradually influence all aspects of the lives of those affected by it. METHOD: A phenomenological approach was identified as the most appropriate method to gain an understanding of living with chronic obstructive pulmonary disease. The data were obtained from 10 participants using unstructured interviews to capture detailed experiences verbatim. Analysis, based on the framework of Diekelmann et al. (The NLN Criteria for Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis, NLN Press, New York, 1989), was employed to interpret the data and determine shared themes that evolved during the course of the research. RESULTS: The data revealed valuable insights, from a patient's perspective, into the impact chronic obstructive pulmonary disease had on their daily lives. The accounts obtained from participants, many of who had severe chronic obstructive pulmonary disease, illustrate the detrimental effects of this debilitating disease. Breathlessness was identified as the most troublesome symptom leading to anxiety, panic and fear. Participants also described feeling frustrated and tired because of their breathlessness, which led to loss of social activity. This also resulted in a loss of their role within the family including loss of intimacy in personal relationships. Despite this, half of the participants felt they had a fairly good quality of life. CONCLUSION: The use of phenomenology as a research methodology fulfilled the aim of gaining a greater understanding of the experiences of living with chronic obstructive pulmonary disease. It provided valuable insights into how patients view the overall impact and their subsequent degree of coping with chronic obstructive pulmonary disease from day to day. RELEVANCE TO CLINICAL PRACTICE: Whilst there is no cure for chronic obstructive pulmonary disease and medical interventions have limited effect, health professionals can do much to improve patient's symptoms and experiences of living with chronic obstructive pulmonary disease by listening to how their symptoms affect them and adapting coping strategies. It is hoped that the themes revealed in this study generate additional understanding and insight for future innovative practice.

Caring for a patient with COPD: a reflective account.

Reflective practice has been a familiar topic in nursing journals and the term is regularly used in professional nursing practice. However, it was not until I used Johns' (1994) model to analyse and explore my feelings and actions in daily practice that I fully understood the concept of reflective practice and discovered how it can enhance professional development. This article describes a reflective experience related to caring for a patient with chronic obstructive pulmonary disease in the community. The professional implications of this experience are explored through reflection. This exploration raised two main issues: the development of a therapeutic nurse-patient relationship and the feelings of guilt experienced when reflecting on whether I had let the patient down when most needed, in the final stages of her life.

Supported discharge for patients with COPD.

This article describes how an existing chronic obstructive pulmonary disease outreach service, which manages patients at home and attempts to avoid inappropriate hospital admission, could be improved by implementing an early supported discharge scheme as a collaborative effort between primary and secondary care. Consideration is given to the practicalities of successfully implementing this development using a model devised by Post (1989a, 1989b) as a framework on which to build a systematic approach. It is hypothesised that implementing such a change would provide patient-centred care and increased patient choice, as well as relieving pressures in the acute hospital sector.

A nurse-led community scheme for managing patients with COPD.

This paper describes the development of a community-based scheme for patients with chronic obstructive pulmonary disease. The nurse-led scheme, which involves making regular visits to patients to help them manage their condition at home and to provide support and education, has resulted in early detection of problems and a reduction in hospital admissions.