Searching for "transformative moments": A qualitative study of nurses' work during home visits to COPD patients and their caregivers in Norway.
Gunvor Aasbø, Ellen Kristvik, Kari Nyheim Solbrække and 1 others
PMID 30918681WHAT IT FOUND
Nurses in COPD home visits used the patient-caregiver relationship to surface conflicts, clarify oxygen and activity needs, and talk through adjustment.
Spouses could both block and reveal problems, so nurses worked to recognise both parties.
Key findings
01The nurses' interactions during home visits showed two patterns: adjustment to an altered life situation and reconciliation to a deteriorating illness.
02Caregivers could be both a resource and a challenge, and spouses sometimes acted as a brake on the patient's honesty.
03Home visits often addressed practical COPD management, including medication adherence, external support, respite, nutrition, physical activity, and action plans for acute exacerbations.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is qualitative and small: 20 home visits were observed, but only two are described in detail. The nurses interviewed described their interactions with little specificity, so the in-depth understanding relied heavily on limited observations. Patients and caregivers were not interviewed, so their own experience of the nurses' support is unknown. The study did not measure whether the home visits improved patient symptoms, admissions, quality of life, or caregiver strain. The services were nurse-led ambulatory services near Oslo for severe or very severe COPD, most patients using home oxygen, so the findings may not transfer to other settings. The analysis focused on two interaction patterns and did not specifically examine how nurses approached mental health issues in patients or caregivers.
Declared interests
The authors declare no conflicts of interest. The supplied text does not report a funding source.
The easy way to misread this
Do not conclude that these home visits improved COPD outcomes or reduced admissions. The study described nurses' interactions during home visits and did not measure patient or caregiver outcomes.