COPD-intuition or template: Nurses' stories of acute exacerbations of chronic obstructive pulmonary disease

Abstract

Study rational. A number of nurse-researchers have examined the experience of dyspnoea reduction during non-acute phases of the chronic obstructive pulmonary disease (COPD). However, nurses working on in-patient hospital units are frequently required to care for individuals suffering from acute exacerbations of their disease (AECOPD). These critically ill individuals present at health care institutions incapacitated by severe shortness of breath/dyspnoea that is frequently refractory to treatment. To date, little is known about the nurses' understanding of the care they provide for individuals hospitalized because of these acute episodes of their chronic illness. Study objectives. The research project was undertaken, in part, to develop an understanding of nurses' experience of caregiving for individuals hospitalized for in-patient care during an AECOPD. Methodological design. This focused ethnographic narrative examined the caregiving stories of 10 nurse caregivers. The 10 nurse caregivers were interviewed while caring for a patient and their family during an experience of an AECOPD characterized by incapacitating breathlessness. Results. The nurse caregivers told a number of caregiving stories that illustrated a common care template that appears to be based on intuition or pattern recognition focusing on anxiety sometimes to the exclusion of dyspnoea. Conclusions. Analysis of these stories emphasized the need to facilitate nurses individualization of standard templates. More importantly, this analysis illustrated the critical need to develop strategies to facilitate the reshaping of inaccurate templates in the presence of new knowledge.