Striving for habitual well-being in noninvasive ventilation: a grounded theory study of chronic obstructive pulmonary disease patients with acute respiratory failure

Aims and objectives
To present a theoretical account of the pattern of behaviour in patients with acute respiratory failure due to chronic obstructive pulmonary disease while undergoing noninvasive ventilation in a hospital setting.
Background
Strong evidence supports a positive effect of noninvasive ventilation, but successful treatment remains a challenge. Little attention has been given to patient intolerance to noninvasive ventilation as a cause of treatment failure. A better understanding of the patients' patterns of behaviour during noninvasive ventilation may improve treatment success.
Design
A constant comparative classic grounded theory study was performed.
Methods
Data collection consisted of participant observation during the treatment of 21 patients undergoing noninvasive ventilation, followed by interviews with 11 of the patients after treatment completion. Data were collected from December 2009–January 2012.
Results
A substantive theory of striving for habitual well-being was developed. The theory included three phases: initiation, transition and determination. Each phase contained a set of subcategories to indicate the dimensions of and variations in the participants' behaviour.
Conclusions
The substantive theory revealed that the patients' behaviour was related to their breathlessness, sensation of being restrained by the mask and head gear, and the side effects of noninvasive ventilation.
Relevance to clinical practice
This inter-relationship should be addressed in the use of noninvasive ventilation for the treatment of patients with chronic obstructive pulmonary disease to achieve treatment success.