Here at Nursology.net, we support students and early career scholars who are conducting nursing-theory guided research. Today, we are happy to announce a study in need of our support titled, “Tertiary Nursing Care for People with Pulmonary Sequelae of COVID-19: An Interpretive Description Study,” by masters of nursing student Cameron Albright BScN, RN from Athabasca University. Cameron will be using the Neuman Systems Model concept of ‘created environment’ as a conceptual extension of the reciprocal-interaction paradigm for their research framework.
The following special-edition blog introduces Cameron’s study, including how you, our reader can support the recruitment for his important work:
The challenges I’ve faced working as a nurse/nursologist during the COVID-19 pandemic has propelled me to grow and change both as a professional and human being. The patient with COVID-19 will always hold a special place in my heart because of these experiences. Throughout the years of the pandemic, I began to notice that many people were living with debilitating sequelae of COVID-19. I then began to notice that there was significant heterogeneity in clinical presentations of COVID-19 sequelae (or long-COVID), yet many of the patients I was caring for had significant dysfunction of the pulmonary system. While knowledge was advancing in a quantitative and precision-medicine fashion toward understanding the pathophysiological mechanisms, biomarkers, and treatment perspectives of pulmonary sequelae as a distinct phenotype (or subtype) of COVID-19 sequelae (Vianello et al., 2021; Yong & Liu, 2022; Reese et al., 2023), there was little knowledge development from qualitative research to complement the various patterns of knowing that are critical for holistic nursing practice.
My supervisors and I undertook a literature review as part of my thesis research (in press) from a precision-health lens. Following a systematized methodology, we found 4 qualitative studies with 6 pooled participants’ interview data that contained subjective reporting of terms such as “lung damage”, “fibrosis”, “lung scarring”, “oxygen therapy”, or “CT/Xray changes” consistent with Beauchamp et al.’s (2021) criteria for pulmonary rehabilitation post-COVID-19. While this review illuminated important implications for clinical practice, it became evident that qualitative research of COVID-19 sequelae was needed from a precision health framework to understand the phenomena of the various subtypes of COVID-19 sequelae more clearly and this set the path for this study for pulmonary sequelae, given my observations in practice and the paucity of qualitative research found within the literature. The following three points summarize my observations in practice and the literature that characterize the clinical/research problem:
- Lung damage and chronic lung impairment secondary to COVID-19 represent an emerging stressor within the internal environment of human beings (i.e., unpleasant symptoms and morbidity).
- Elements of the external environment (i.e., lack of healthcare access, continuity of care, and treatments) acted as stressors that influence complex health-illness transitions and permeate into the internal environment to create uncertainty.
- These deductions are derived from practice and what is available in the literature. Knowledge of pulmonary sequelae of COVID-19 is rapidly evolving in quantitative paradigms which will help to inform the more empirical knowledge needs of nurses/nursologists in practice. However, there is a paucity of primary qualitative research that studies the experience of people with pulmonary sequelae as a distinct subtype of COVID-19 sequelae. Therefore, a critical area of nursing/nursology knowledge (subjective human responses) of this population is missing. This is creating a gap in understanding the phenomenon of pulmonary sequelae holistically which will be needed to inform therapeutic care planning now and in the future. Nurses/nursologists will assume great responsibility in the care of people living with various subtypes of COVID-19 sequelae (Maxwell & Radford, 2021). Therefore, the advancement of qualitative knowledge of COVID-19 sequelae from a precision health framework is essential to support these caring practices now and in the future of pandemic recovery.
This study, titled, “Tertiary Nursing Care for People with Pulmonary Sequelae of COVID-19: An Interpretive Description Study,” is guided by a critical case purposive sampling method that is helpful in qualitative research of an exploratory nature or when a small number of participants might provide a resounding account of the phenomena of interest (Etikan et al., 2016; Rai & Thapa, 2015). Patient-reported outcomes (PROs), which are a “direct subjective assessment by the patient of elements of their health” (Rothman et al., 2007) are used to inform inclusion and exclusion criteria. Specifically, Beauchamp et al.’s (2021) criteria for pulmonary rehabilitation post-COVID provide specific measures to determine if one if living with chronic lung impairment from COVID-19 as opposed to other subtypes of sequelae. In this study, official diagnoses or clinical documentation is not considered in the recruitment of participants. Rather, PROs as inclusion criteria that are consistent (within the participants own words) with Beauchamp et al.’s (2021) criteria, then it can be reasonably assured that participants are living with this subtype of COVID-19 sequelae while balancing the axiological dimensions of qualitative research that values the subjective experiences of persons. In this context, requiring clinical “proof” would be counterintuitive to the very nature of qualitative inquiry, yet PROs within the framework of inclusion and exclusion criteria can help enhance precision in participant recruitment that is consistent with a critical case purposive sample.
The Sequelae of COVID-19 is an emerging health concern and nurses/nursologists will assume responsibility for the ongoing care needs of this population for years to come. As COVID-19 sequelae move toward precision health in quantitative paradigms, it will be essential to complement this knowledge with qualitative evidence derived from a similar precision health lens to more holistically inform patterns of knowing that influence care planning. The Neuman Systems Model concept of ‘created environment’ as a conceptual extension of the reciprocal-interaction paradigm, provides a promising framework to situate this study. Interpretive description as methodology endeavors to ensure that subjective human responses are illuminated in this context and to also ensure the study’s procedures are responsive to the needs of practice that it will inform.
Do you know anyone experiencing long-COVID who would be interested in participating in my master’s thesis research? I am recruiting people with pulmonary sequelae secondary to COVID-19 who would be willing to join a one-hour virtual, telephone, or text-based interview. The purpose of this interpretive description study is to illuminate the subjective experiences of people living with pulmonary sequelae as a distinct subtype of COVID-19 sequelae to inform the development of tertiary nursing care strategies for this population. If you can help me with recruitment, please use this recruitment poster within your professional or personal networks.
About Cameron Albright (he/him)
I am a registered nurse/nursologist (RN) residing and practicing in Nova Scotia, Canada. I completed my Bachelor of Science in Nursing (BScN) at Dalhousie University and graduated in 2018. Since that time, I have worked in a variety of clinical settings including acute medical and surgical, progressive (intermediate care), community, and hospice care. Early in my undergraduate studies, I saw the significance of nursing/nursology discipline-specific knowledge, and I was fortunate to attend a university where all knowledge and clinical reasoning was filtered through a nursing/nursology lens. Since then, the classic works of renowned theorists from Watson, Rogers, and Parse have inspired my practice, and I have spent a considerable amount of time throughout my MN studying these concepts in detail. I am eternally grateful to the brilliant intellectuals who have devoted their careers to advancing this corpus of knowledge for the welfare of humanity.
Direct patient care is where my heart and soul as a nurse/nursologist will always rest. I currently work in direct care at our local hospital and maintaining a position in clinical practice will be of considerable importance in my career alongside work in academia. My passion for research and nursing/nursology discipline-specific knowledge directly extends from experiencing first-hand the therapeutic benefit of practicing within various conceptual and theoretical foundations of the discipline. This lead me, in 2019, to begin my Master of Nursing (MN) degree with Athabasca University. In 2020, I obtained CNA (Canadian Nurses Association) certification in Medical-Surgical Nursing (CMSN(C)). I have also served on our local Clinical Ethics Consult Team, undertook contractual positions as a research and teaching assistant with Dalhousie University, and as guest lecturer for undergraduate nursing students on nursing theory, professional transformation, and ethical/legal issues in nursing/nursology.