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Bearing witness to the challenges of breathlessness

02 April 2021
Volume 26 · Issue 4

Abstract

The community respiratory nurse specialist (CRNS) supports patients at different stages of lung disease, witnessing the challenge of living with chronic obstructive pulmonary disease (COPD), a progressive illness for which there is no cure. Breathlessness is the most prominent and debilitating symptom experienced; it is frightening, distressing and very difficult to manage. Little is known about the experience of CRNSs in witnessing the distress of patients, specifically those experiencing breathlessness. The nurse may have cared for such patients over many months or years. In witnessing this distress, CRNSs engage in emotional labour, which is associated with burnout and poor-quality care. This paper seeks to identify bearing witness to suffering and vulnerability as components of emotional labour in the context of the CRNS role. It highlights the need for research to explore the experience of CRNSs and insights into supporting people with long-term breathlessness. It is more likely that well-supported staff can provide sustained, supportive care to patients living with breathlessness.

When considering an affective symptom, such as breathlessness, the experience of the symptom is directly influenced by the individual's thoughts and feelings, as well as their physiology, as is also the case with pain. Therefore, providing compassionate, therapeutic care is of paramount importance to support individuals living with breathlessness. Better understanding of the components of delivering this care might provide much needed insight into supporting breathless patients.

Breathlessness is a common and distressing symptom in advanced disease, affecting almost all people living with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), as well as most people with chronic heart failure and advanced cancer (Solano et al, 2006). The community respiratory nurse specialist (CRNS) is well placed to support respiratory patients with what are often very challenging, distressing symptoms, throughout the disease process and, ultimately, to the end of life. However, the sustained witnessing of distress can cause burn out among nurses (Salyers et al, 2017), offers personal and professional challenges and affects the delivery of holistic, therapeutic care (Sawbridge, 2016). Emotional labour-a term encompassing the sacrifice nurses make of their personal thoughts and feelings to engage in therapeutic care with patients-is an under-researched role requirement within nursing (Gray, 2009). Seeking to understand CRNSs' experience of emotional labour in witnessing the distress of patients with breathlessness will address this important aspect of therapeutic care.

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