Effects of specialized community nursing care in patients with chronic obstructive pulmonary disease.

Objective: To investigate the effects of specialized respiratory home nursing care after discharge from a pulmonary rehabilitation center.

Design: Pretest-posttest control group design. Patients in the experimental group were visited by a nurse who specializes in respiratory care, whereas the control group received care from nurses who did not specialize in respiratory care.

Setting: Data were collected on admission, at program discharge, and 4 months and 9 months after discharge from a pulmonary rehabilitation center.

Patients: One hundred fifteen patients were included in the study and observed for 1 year.

Outcome Measures: Health-related quality of life (HRQL), coping strategies, compliance, hospitalization, and satisfaction with the care provided.

Results: Complete data sets were obtained from 78 patients with severe airflow obstruction (FEV1 = 41%; predicted +/- SD = 15). Corrections were made for the selective nonresponse, but did not lead to adjustments in outcome scores. In both groups, HRQL scores improved between admission and discharge, but deteriorated 4 months and 9 months after discharge. The only statistically significant short-term effect was found on the "activities" component of HRQL in favor of the control group. No differences were found between groups regarding coping, compliance, and hospitalization. Patients in the experimental group, however, were more satisfied with the care provided by the specialized community nurses.

Conclusions: The treatment intervention of specialized respiratory home nursing might not have been specific or intensive enough to result in outcome benefits. Secondly, the initial benefits from baseline pulmonary rehabilitation alone may have led to positive outcomes in both patient groups.