| Symptoms that occur with disease are often the most disturbing facet of an illness. Dyspnea is just such a symptom. It is associated with multiple clinical conditions and can impact on functional capability, emotional well being, and quality of life.;Traditionally, dyspnea has been defined as the state of difficult breathing. However, preliminary work by this author led to the reconceptualization of dyspnea as a perceptual-interpretive response process and the development of a model depicting this process.;In the present study, a qualitative inductive approach, including a series of dialogue-generating informant interviews with six patients hospitalized for a exacerbation of chronic obstructive pulmonary disease (COPD), was used to elaborate and refine the preliminary model and to identify preconditions, consequences, and subtypes of the process within one diagnostic category. Informants were identified using a combination of convenience and theoretical sampling and included 6 males (5 Caucasian and 1 African American, from 55--78 years of age, with moderate to end-stage COPD).;One hundred and forty dypsneic sutuations were examined. The three phases of the core dypsneic process (Sensory Detection and Discrimination, Appraisal, and Judgement Phases) undergirded each situation of difficult breathing. Additionally, informants reevaluated their breathing difficulty within the perceptual framework, as the dyspneic situation progressed over time. Three subtypes of the dypsneic process ("Everyday", "Bad Attack", and "Sudden and Unexpected" Subtypes) were identified. Preconditions (e.g. COPD, aging) and triggers (e.g. pathological, environmental, situational) that set the process in motion, as well as, consequences of the core dyspneic process, which included strategic behavioral (e.g. immediate and long term), emotional (e.g. fear, hostility, frustration) and physical (e.g. exhaustion, discomfort, weakness) responses were also delineated.;This study represents a first and necessary step towards concept refinement and theory development. The dyspneic process model may potentially lead to an explanatory model for nursing that merges the multiple aspects of breathing difficulty within an integrated theoretical framework. The notion of process represents a promising insight with potential nursing practice implications related to intervention. For example, if we as nurses can influence patient thinking, perhaps we will positively affect their responses, and ultimately patient outcomes. |
