“Patch them up and send them home”: perceptions of nurses and physiotherapists in their role with end-stage COPD

Background: People with severe Chronic Obstructive Pulmonary Disease (COPD) have a high symptom burden and experience repeated hospital admissions as their disease progresses. End of life is typically difficult to predict, and although palliative care initiatives are developing within COPD, active treatment often continues up to death. There is a lack of literature in the field concerning the impact this has on staff delivering care, and their role in decision-making within this patient group.
Aims: To explore the role of staff in caring and treatment decision-making for those with acute severe COPD and the multi-disciplinary team relationships influencing care.
Methods: This exploratory, qualitative study consisted of 4 interviews and 1 focus group with nurses and physiotherapists who care for patients with severe COPD in the acute hospital setting. A grounded theory approach to analysis was aided by the software NVivo.
Results: Advocacy and support to patients and families were cited as important aspects of their role, but effectiveness is hampered by pressure on beds and the general approach of “patch them up and send them home”. Advocacy was described in terms of information-giving and communication, and staff opinions were consulted in some treatment decisions, but that this depended on the hierarchy of the medical team: “…it comes down to which consultant is in charge that day”. Levels of decision-making involvement and advocacy were related to knowing the patient and professional experience, but were significantly limited by time and other pressures.
Conclusions: Participants described frustration regarding the lack of palliative care decision-making in end-stage COPD, but nurses and physiotherapists are developing their roles in advocacy for this patient group. A second phase of data collection is investigating the nature of advocacy in this group further.