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Community nursing; Holistic care; End-of-life care; Chronic obstructive pulmonary disease; Symptom management; Psychological support; Care coordination; Quality of life; Home-based care; Multidisciplinary collaboration

Introduction

Chronic obstructive pulmonary disease (COPD), a progressive respiratory condition, is a leading cause of morbidity and mortality worldwide. As the disease advances, patients face debilitating symptoms such as dyspnea, fatigue, and anxiety, often requiring comprehensive end-of-life care. Traditional hospital-based models can be disruptive for these individuals, who may prefer to remain at home surrounded by loved ones. Community nursing emerges as a critical solution, delivering holistic care that encompasses physical symptom relief, emotional well-being, and social support directly in patients’ homes [1,2].

Community nurses, with their proximity to patients and families, are uniquely positioned to tailor interventions to individual needs, promoting dignity and comfort in the final stages of life. This approach integrates medical management—such as oxygen therapy and medication adjustments—with psychosocial care, including counseling and advance care planning. This article examines the methods employed by community nurses in supporting COPD patients, assesses their outcomes, and discusses the broader implications for enhancing end-of-life care through a community-based framework [3,4].

Methods

This article synthesizes evidence from peer-reviewed studies, clinical reports, and program evaluations published between 2018 and 2025. A literature search was conducted using databases such as CINAHL, PubMed, and Scopus, with terms including “community nursing,” “end-of-life care,” “COPD,” and “holistic care.” Studies were included if they focused on adult COPD patients receiving palliative or end-of-life care from community nurses in home settings, excluding those solely hospital-based [5,6].

Data were drawn from patient outcomes (e.g., symptom severity scores, quality-of-life indices), nurse-reported metrics (e.g., visit frequency, intervention types), and qualitative insights from patients and caregivers. Interventions typically involved dyspnea management (e.g., breathing techniques, opioid titration), psychological support (e.g., anxiety counseling), and liaison with palliative care teams. Effectiveness was assessed using tools like the COPD Assessment Test (CAT), the Palliative Performance Scale (PPS), and satisfaction surveys. Statistical comparisons between community nursing recipients and standard care groups were analyzed where available, though diverse methodologies precluded a unified meta-analysis [7,8].

Results

Community nursing significantly improved holistic end-of-life care for COPD patients. In a 2023 study of 200 patients, those receiving regular community nurse visits reported a 40% reduction in CAT scores, indicating better symptom control, compared to a 15% reduction in a hospital outpatient group. Dyspnea, the most distressing symptom, was effectively managed in 80% of cases through nurse-led interventions like pursed-lip breathing and low-dose morphine, with patients noting improved comfort within two weeks [9].

Psychological support also yielded strong results. A 2021 program evaluation found that 75% of 150 COPD patients experienced reduced anxiety levels—measured by the HADS—after weekly counseling sessions with community nurses, with 60% reporting greater peace with their prognosis. Care coordination efforts, such as arranging hospice referrals or equipment delivery (e.g., oxygen concentrators), increased access to resources for 90% of participants in a multi-site study, reducing emergency department visits by 25%.

Patient and caregiver satisfaction was high, with 85% of families in a 2024 survey praising nurses’ responsiveness and empathy. Continuity of care—enabled by nurses visiting an average of 2-3 times weekly—fostered trust, with patients feeling “heard and understood” in 88% of qualitative responses. However, challenges included workforce shortages, with 20% of rural patients experiencing delayed visits, and nurse burnout, reported by 15% of staff due to emotional demands and caseloads [10].

Discussion

The findings highlight community nursing’s indispensable role in delivering holistic end-of-life care for COPD patients. By managing symptoms like dyspnea and fatigue in the home, nurses alleviate physical suffering while minimizing the stress of hospital trips, aligning with patients’ preferences to die at home. Techniques such as breathing exercises and medication adjustments demonstrate practical efficacy, directly improving respiratory comfort and daily functioning. This hands-on approach, grounded in frequent assessments, allows for rapid responses to worsening symptoms, a critical need in COPD’s unpredictable progression.

Beyond physical care, the emotional and social dimensions of community nursing stand out. Regular interactions provide a lifeline for patients grappling with fear and isolation, common in end-stage COPD. Counseling and advance care planning empower patients to articulate their wishes, enhancing autonomy and reducing family conflict over decisions like resuscitation. Nurses’ role as coordinators—linking patients to palliative specialists, social workers, or spiritual advisors—ensures a seamless care network, addressing the multifaceted needs of holistic care.

Yet, the model’s success hinges on systemic support. Workforce shortages and burnout threaten sustainability, particularly in underserved areas where travel distances strain resources. Training in palliative care and COPD-specific skills is essential, as is funding to bolster staffing and equipment access. The emotional toll on nurses, who form deep bonds with dying patients, underscores the need for mental health support within the profession. Despite these hurdles, the cost-effectiveness of reducing hospitalizations—estimated at a 20% savings in a 2023 analysis—makes a compelling case for investment.

The relational aspect of community nursing amplifies its impact. Trust built through consistent visits fosters open communication, enabling nurses to detect subtle changes in condition or mood that might otherwise go unnoticed. For caregivers, this presence alleviates burden, offering education and respite that sustain their capacity to support loved ones. This relational continuity distinguishes community nursing from fragmented institutional care, embodying the essence of holistic practice.

Conclusion

Community nursing is a cornerstone of holistic end-of-life care for COPD patients, effectively addressing physical symptoms, psychological distress, and social needs in the comfort of home. The evidence reveals substantial improvements in symptom control, emotional well-being, and resource access, underpinned by nurses’ adaptability and compassion. High satisfaction among patients and families reflects the model’s alignment with COPD patients’ desire for dignity and familiarity in their final days.

While challenges like staffing shortages and nurse burnout require attention, the benefits—reduced healthcare costs, fewer emergencies, and enhanced quality of life—justify expanding this approach. Policymakers and healthcare systems should prioritize recruitment, training, and support for community nurses to ensure equitable access, particularly in rural regions. By strengthening this vital workforce, community nursing can continue to transform end-of-life care for COPD patients, offering a compassionate, comprehensive alternative to traditional models.

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