Navigating complexity: nurses’ experiences in delivering holistic care to patients with chronic obstructive pulmonary disease

Abstract

Abstract Background Chronic obstructive pulmonary disease (COPD) is a complex, progressive condition associated with substantial physical, psychological, and social burden. Holistic, person-centered care is central to effective COPD management, yet its delivery in outpatient settings remains challenging. Nurses play a pivotal role in providing such care; however, their lived experiences of delivering holistic COPD care within constrained health systems are insufficiently understood. Aim To explore nurses’ experiences of delivering holistic care to patients with COPD in university-affiliated polyclinic settings, and to develop an inductively derived conceptual model of holistic COPD nursing care that may inform future research and practice development. Methods A qualitative study using an interpretive (hermeneutic) phenomenological orientation was employed. In-depth, semi-structured interviews were conducted with 20 nurses working in King Faisal University–affiliated polyclinics in Saudi Arabia. Participants had direct involvement in outpatient COPD care. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke’s six-phase framework. Methodological rigor was ensured through reflexivity, member reflection, and audit trails, in line with SRQR guidelines. Results Four interrelated themes were identified: (1) Seeing the Whole Person Behind the Breathlessness, reflecting nurses’ efforts to address psychosocial and functional dimensions beyond respiratory symptoms; (2) The Weight of Invisible Care Work, highlighting emotional labour, compassion fatigue, and family mediation; (3) Holistic Care in a Fragmented System, capturing time pressure and system gaps that constrained care delivery; and (4) Striving to Do Right by the Patient, illustrating moral tension alongside professional meaning derived from small relational successes. Conclusion Holistic COPD care in outpatient settings is a morally driven, relational practice sustained by nurses’ commitment but constrained by fragmented systems and limited time. Structural and educational support is essential to enable sustainable, holistic care and to protect nurses from moral distress and burnout. Clinical trial Not applicable.