Abstract:
Persistent breathlessness is a complex, debilitating, devastating experience shared by all sufferers of chronic lung disease. Respiratory nursing has, as a core clinical concern, the alleviation of distress and suffering associated with respiratory disease. This research describes the ways in which experienced New Zealand respiratory nurses understand, assess, manage and support patients suffering from chronic breathlessness, reviews the professional context in which these nurses practice and examines the experiences and beliefs that have lead them too and maintain them in this area of practice. Expert nursing knowledge, gained through and embedded in practice, is often arduous to access, difficult to explicate and hard to validate. Nursing expertise and nursing wisdom develops through interplay of formal learning, reflection and experience. This study has been stimulated by the realisation that the skills, understandings and practice wisdom exhibited by experienced Respiratory Nurses is poorly described in the published research literature. There is a growing recognition that this expertise, embedded in nursing practice, brings significant benefits to patients. This qualitative, grounded theory research is based upon data gathered from in-depth interviews with six experienced New Zealand respiratory nurses. Acknowledging that the principal researcher is also an experienced respiratory nurse, a constructivist research position is adopted which accepts that, during the interview and analysis processes, the meanings and interpretations are co-constructed. Analysis of these interviews revealed distinct phases of developing respiratory nurse practice including preparing and entering respiratory nursing practice, comprehension of the phenomena of chronic breathlessness and the effect upon the patient and the seeking of possibilities which may alleviate and modify the debilitating effects of chronic breathlessness. Consistent values and beliefs are identified which are captured in the concepts of professional caring and the movement towards developing expertise in practice. The unifying concept of journeying is employed to draw together these conceptual elements and develop a substantive model describing the work of experienced respiratory nurses with patients with chronic breathlessness. Implications for practice and the health system and suggestions for further research are discussed.
