Abstract
BackgroundThere appears to be divergence between nurses’ and patients’ perceptions of dyspnoea onset and on how help should be given. This may affect how nurses understand and assess their patients’ anxiety and the severity of dyspnoea, potentially diminishing their chances of relieving patients’ dyspnoea. The aim of this study was to explore nurse–patient interaction in situations where patients with chronic obstructive pulmonary disease are experiencing acute or worsened dyspnoea in a hospital setting.MethodsAn ethnographic study using participant observation of two nurses’ interactions with six patients, followed by qualitative in-depth interviews with the nurses. Data were analysed in three steps. First, they were coded for identification of preliminary themes. Second, data were regrouped into preliminary themes for focused analysis which led to formulation of themes and subthemes. Third, hermeneutical principles were used as all data were interpreted from the viewpoint of each theme.ResultsThree themes were identified: Manoeuvring along the edge; Dyspnoea within the pattern; and Dyspnoea outside the pattern. They were encompassed by the main finding: Manoeuvring along the edge of breathlessness. The nurses attempted to navigate between implicit and explicit care approaches and to create a sphere for relieving or avoiding further worsening of dyspnoea. Depending on the identified pattern for a particular dyspnoeic episode, nurses attributed different significance to the dyspnoea.ConclusionsInteracting in dyspnoeic situations places nurses in a dilemma: an implicit approach risk, deriving from exclusion of patients and performing hesitantly; or an explicit negotiation risk, where patients are exhausted and removed from focusing and breathing. The dilemma weakens nurses’ opportunities to relieve or avoid a worsening of the dyspnoea. Likewise, the divergence between nurses’ and patients’ assessment of dyspnoea as within or outside the pattern appears to jeopardize the efficiency of care. Our findings contribute to a deeper understanding of the challenges of respiratory nursing care in general, and the challenges of relieving in-patients’ dyspnoea in particular.
Highlights
There appears to be divergence between nurses’ and patients’ perceptions of dyspnoea onset and on how help should be given
The aim was further illustrated by the research question: “How does the interaction between the nurse and the patient with chronic obstructive pulmonary disease (COPD) hospitalized with exacerbation affect the dyspnoeic situation and the ability for the nurse to help relieve patient’s dyspnoea?”
While our study provides no answers to how this problem should be handled, it appears to weaken the opportunities for the nurses to relieve or avoid a worsening of the dyspnoea experienced by their dyspnoeic patients with exacerbated COPD
Summary
There appears to be divergence between nurses’ and patients’ perceptions of dyspnoea onset and on how help should be given. This may affect how nurses understand and assess their patients’ anxiety and the severity of dyspnoea, potentially diminishing their chances of relieving patients’ dyspnoea. The aim of this study was to explore nurse–patient interaction in situations where patients with chronic obstructive pulmonary disease are experiencing acute or worsened dyspnoea in a hospital setting. This study focuses on nurses’ interaction with hospitalized patients suffering from chronic obstructive pulmonary disease (COPD). We aimed to explore situations in which patients experience acute or worsened dyspnoea. Defined as the subjective sensation of difficult breathing [7], dyspnoea becomes the most prominent symptom [8, 9] with the progress of the disease, increasing the risk of acute exacerbation leading to hospitalization [10]
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