Embedding nurse‐led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease

Abstract

AimTo describe a small multidisciplinary team's experience of the process of embedding nurse‐led supportive care into an existing Chronic Obstructive Pulmonary Disease outpatient service.DesignCase study methodologyMethodsData were collected from multiple sources including key documents and semi‐structured interviews with healthcare professionals (n = 6) conducted between June and July 2021. A purposive sampling strategy was used. Content analysis was applied to key documents. Interviews were transcribed verbatim and analysed using an inductive approach.ResultsSubcategories under the four‐stage process were identified from the data. Assessment: evidence of needs of patients with Chronic Obstructive Pulmonary Disease; gaps in care and evidence of other models of supportive care. Planning: setting the supportive care service structure and intention; resources and funding; leadership, specialization and respiratory/palliative care roles. Implementation: relationships and trust; embedding supportive care and communication. Evaluation: benefits and positive outcomes for staff and patients, and, improvements and future considerations for supportive care in the COPD service.ConclusionA collaboration between respiratory and palliative care services resulted in successfully embedding nurse‐led supportive care in a small outpatient service for patients with Chronic Obstructive Pulmonary Disease. Nurses are well placed to lead new models of care that aim to address unmet biopsychosocial‐spiritual needs of patients. More research is needed to evaluate nurse‐led supportive care in Chronic Obstructive Pulmonary Disease and other chronic illness settings; the effectiveness of nurse‐led supportive care from the perspective of patients and caregivers and the impact of nurse‐led supportive care on health service usage.Patient or Public ContributionThe development of the model of care is informed by ongoing discussions with patients with COPD and their caregivers.Data availability statement: Research data are not shared (due to ethical restrictions).Impact Embedding nurse‐led supportive care in an existing Chronic Obstructive Pulmonary Disease outpatient service is achievable. Nurses with clinical expertise can lead innovative models of care that address the unmet biopsychosocial‐spiritual needs of patients with conditions such as Chronic Obstructive Pulmonary Disease. Nurse‐led supportive care may have utility and relevance in other chronic disease contexts.

Partnership‐based nursing practice framework for patients with advanced chronic obstructive pulmonary disease and their families—A discursive paper

“…Interdisciplinary collaboration, nested in shared responsibility for patient‐family welfare guidance of patients for services in the healthcare and social system, is essential in partnership‐based nursing practice. The significance of the role of nurses as leaders in such collaboration in chronic care is noteworthy (Ora et al., 2023).…”

“…A synthesis of approaches is needed to maximize proper symptom management and to account for the complex and deep-seated existential, psychological and social issues that people with COPD and their families face (Iyer et al, 2019;Ora et al, 2023). Vermylen et al (2015) suggested a model, Proactive palliative care in COPD, that highlights ongoing communication with patients, incorporating advanced care planning, 'meaning-centred care' and collaboration as appropriate.…”

“…A synthesis of approaches is needed to maximize proper symptom management and to account for the complex and deep‐seated existential, psychological and social issues that people with COPD and their families face (Iyer et al., 2019; Ora et al., 2023). Vermylen et al.…”

“You don't want to know just about my lungs, you…want to know more about me”. Patients and their caregivers' evaluation of a nurse‐led COPD supportive care service

“…Between 2018 and 2020, nurse‐led supportive care was embedded in an existing nurse‐led COPD outpatient model of care through a collaboration between respiratory and palliative care services in a tertiary hospital in Sydney, Australia (Ora et al., 2023). Nurse‐led COPD supportive care was introduced into the COPD service to better address the biopsychosocial‐spiritual needs of patients with COPD and to enhance the respiratory team's primary palliative care skills.…”

“…Supportive care is therefore distinguished as an approach that may be more appropriate for patients living with COPD, than current palliative care models that tend to cater best to patients with more predicable patterns of decline and relatively short‐term care needs such as patients with advanced cancer (Luckett et al., 2014). The authors have previously published the nurse‐led model of supportive care that was embedded into an existing COPD outpatient service (Ora et al., 2023). This paper reports on an evaluation of a nurse‐led model of COPD supportive care from patient and caregiver perspectives.…”