Effect of comprehensive nursing intervention on lung function and psychological state of patients with chronic obstructive pulmonary disease

Abstract

BACKGROUND

Symptoms caused by chronic obstructive pulmonary disease (COPD), such as dyspnea, cough, chest tightness, and limited physical activity, can easily lead to anxiety and depression in patients. Comprehensive nursing interventions, including nutritional guidance, pulmonary rehabilitation training, psychological intervention, and sleep care, are beneficial for improving pulmonary function and psychological state.

AIM

To explore the effect of comprehensive intervention on the pulmonary function and psychological state of patients with COPD.

METHODS

This retrospective study included patients with COPD who visited the Department of Respiratory and Critical Care Medicine of Suzhou Ninth People’s Hospital (Suzhou, Jiangsu Province, China). A total of 77 patients with COPD who received comprehensive nursing intervention from April to December 2023 were selected to form the observation group. According to the principle of matching (1:1) control study, 77 patients with COPD who received routine nursing intervention from April to December 2022 were selected to compose the control group. The 6-minute walking distance (6-MWD), pulmonary function indexes [forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC) value, FEV₁/FVC ratio], sleep status [assessed by Pittsburgh Sleep Quality Index (PSQI)], psychological status [assessed by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS)] and quality of life [assessed by St. George’s Respiratory Questionnaire (SGRQ)] were compared between the two groups before and after the nursing intervention cycle (i.e., continuous intervention for 2 months).

RESULTS

The were no statistically significant differences in 6-MWD, FEV₁, FVC, and FEV₁/FVC ratio, as well as PSQI, SAS, SDS, and SGRQ scores between the observation and control groups prior to nursing intervention (P > 0.05). However, at the end of the nursing intervention cycle, a follow-up examination revealed that 6-MWD of the observation group was longer than that of the control group (261.21 ± 27.76 months vs 234.85 ± 24.87 months, respectively, P < 0.001). Moreover, the pulmonary function indicators (FEV₁, FVC, FEV₁/FVC) of the observation group were higher than those of the control group (P < 0.05). Furthermore, the scores of each dimension and total score of PSQI, SAS score, SDS score, and the scores of each dimension of SGRQ in the observation group were significantly lower than those in the control group (P < 0.05).

CONCLUSION

In patients with COPD, comprehensive nursing intervention can effectively enhance exercise endurance, improve lung function and sleep quality, alleviate anxiety and depression, and ameliorate quality of life.

Key Words: Lung diseases; Chronic obstructive; Nursing; Pulmonary function; Anxiety; Depression

Core Tip: Patients with chronic obstructive pulmonary disease often experience anxiety and depression due to symptoms such as difficulty breathing, coughing, and chest tightness. This study focused on the comprehensive nursing intervention including nutritional guidance, lung rehabilitation training, and psychological and sleep care for patients. The results showed that the intervention can effectively improve lung function, while also playing a positive role in alleviating anxiety and depression.

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterized by persistent airflow limitation[1]. Long-term chronic airway inflammation causes pathological factors (e.g., lumen exudation, airway remodeling and airway stenosis), which can lead to airway resistance, increased respiratory work, increased oxygen consumption, respiratory muscle fatigue, decreased muscle strength and activity endurance. This process results in the development of dyspnea, cough, expectoration, chest tightness, limited physical activity, and other discomforts in patients[2]. These symptoms can lead to negative emotions such as anxiety and depression[3]. Therefore, patients with COPD need to bear a dual burden both physically and psychologically. As a long-term chronic disease, COPD treatment alleviates and controls symptoms, reduces the frequency of onset, and controls airway inflammation. More importantly, it strengthens respiratory function exercise and rehabilitation nursing, thereby continuously improving the quality of life of patients. However, routine care lacks personalization and comprehensiveness, and its effect is limited[4]. As a patient-centered holistic nursing model, comprehensive nursing intervention can provide patients with more comprehensive nursing services by integrating the professional knowledge and skills of multiple disciplines. Therefore, the aim of this study was to explore the impact of a comprehensive strategy including health education, nutritional support, lung rehabilitation training, sleep care, and psychological intervention on the lung function and psychological status of patients with COPD. The objective was to provide a scientific basis for strengthening nursing interventions in such patients.

MATERIALS AND METHODS

Research subjects

This retrospective study included patients with COPD who visited the Department of Respiratory and Critical Care Medicine at the Suzhou Ninth People’s Hospital (Suzhou, Jiangsu Province, China). The implementation of comprehensive nursing interventions for patients with COPD in our hospital was initiated in April 2023. Therefore, 77 patients with COPD who received comprehensive nursing intervention from April to December 2023 were selected to form the observation group. According to the principle of matching (1:1) control study, 77 patients with COPD who received routine nursing interventions from April to December 2022 were selected to compose the control group.

The inclusion criteria were: (1) Age ≥ 18 years; (2) Meeting the diagnostic criteria for COPD[5], with the disease being in a stable phase; (3) Having normal communication skills; and (4) Ability to take care of oneself, with reading comprehension, communication skills, and normal cognitive function, able to cooperate with clinical interventions and assessments.

The exclusion criteria were: (1) COPD combined with disease in other important organs/systems; (2) Previous history or family history of mental illness; (3) History of alcohol or drug dependence; (4) Presence of pneumoconiosis, tuberculosis, bronchial asthma, lung cancer and other respiratory diseases; (5) COPD combined with other diseases that affect sleep quality; and (6) Presence of severe mental symptoms and a risk of self-injury prior to intervention.

Intervention methods

Patients in the control group received routine nursing care, mainly by nurses who carried out routine health education for patients, reminded patients to take their medication on time, and asked them to quit smoking (if applicable). During hospitalization, the patients were mainly instructed to perform appropriate abdominal breathing, voice breathing, and other lung function training once a day for 30 minutes. At the same time, psychological counseling was provided to patients in an appropriate way of chat. After discharge, patients were reminded to perform lung function training by telephone follow-up.

The observation group received comprehensive nursing intervention. First, through unified and standardized training of the nursing team, the training included unified intervention content, operational procedures, and communication methods to ensure consistency among different implementers.

The specific nursing operation contents were as follows: (1) Health education: According to the education level and cognitive understanding ability of the patient and their families, oral expression and a health knowledge manual were used to introduce the causes, clinical manifestations, treatment and intervention methods, clinical outcomes, and other information regarding COPD to help them understand the disease. In addition, for patients with severe resting hypoxemia who met the clinical indications for long-term oxygen therapy (i.e., resting arterial partial pressure of oxygen ≤ 55 mmHg or oxygen saturation ≤ 88%, consistent with the clinical guidelines for long-term home oxygen therapy for COPD), it was recommended that patients strictly follow medical advice and adhere to low flow oxygen therapy for at least 15 hours per day[6], to ensure sufficient oxygen supply to organs and tissues. During the intervention, a health knowledge symposium was organized to invite patients and their families to participate, encourage patients to share rehabilitation experience, and patiently answer questions posed by patients and correct misperceptions; (2) Psychological care: Through in-depth communication, psychologists from the hospital encouraged the patients to express their demands, and provided emotional support by listening to their concerns, worries, and confusions. Moreover, emotional counseling included playing videos, music, etc., to divert their attention. Additionally, successful medical records were shared with patients to provide encouragement, support, and care, helping them build confidence in their recovery; (3) Sleep guidance: Specialized nurses introduced the factors and hazards affecting sleep quality to patients and their families, as well as the usage, dosage, pharmacological effects, and hazards of various commonly used hypnotic drugs. Patients were encouraged to avoid using hypnotic drugs as much as possible. A sleep schedule was discussed and developed with the patient to avoid staying up late, sleeping for too long, and sleeping excessively during the day. At the same time, the patient was guided to change their poor sleeping posture. The patients were advised not to have dinner too late or eat excessively, avoid eating foods rich in water or drinking a lot of water 4 hours before bedtime, and avoid drinking coffee, strong tea, etc. before bedtime; (4) Nutritional guidance: The patients were assisted to establish correct eating habits and were informed to consume more fresh vegetables and fruits, choose soft and easily digestible foods as much as possible, and pay attention to balanced nutrition. At the same time, nutritionists from the hospital provided guidance to patients, developed personalized meal plans based on scientific meal tables, and made appropriate adjustments according to the daily eating habits, condition, and daily activities of the patients. The calorie intake was controlled between 104.6 kJ/(kg·day) and 125.6 kJ/(kg·day). The nutritional status of the patients was regularly assessed and timely intravenous nutrition support, such as glucose, fat emulsion, and compound amino acids, was provided for severely malnourished individuals; and (5) Cardiopulmonary rehabilitation and exercise training: During hospitalization, the rehabilitation therapist demonstrated breathing techniques on site, and the patient imitated and practiced these techniques until they could perform them correctly. Initially, pursed lip breathing and abdominal breathing were performed, followed by respiratory muscle endurance training. During training, a ball breathing trainer was used. After taking 2-3 calm breaths, patients inhaled fully through the nose, held the mouthpiece, and exhaled slowly and deeply through the mouth to raise the ball. Next, the mouthpiece was removed and patients exhaled slowly through the nose or mouth, completing one cycle (5-10 minutes in total). Family members were invited to participate in joint learning. After respiratory training, endurance and resistance exercises (20-30 minutes) included: Warm-up (aerobic stepping, shoulder and chest stretching for 3-5 minutes); upper limb resistance (elastic band or water bottle lift, 8-10 times per group, 3-5 minutes); lower limb resistance (micro squatting, heel lifting: 8-10 times/group, 3-5 minutes); aerobic stepping (3-5 minutes); and organized activities (2-5 minutes). Personalized exercise plans were developed based on the lung function and exercise ability of the patients, with on-site guidance and correction of incorrect movements by rehabilitation therapists to ensure training effectiveness.

Following discharge from the hospital, the same rehabilitation therapist guided the home rehabilitation training through online video teaching, with a fixed schedule of once a week, 20-30 minutes. The video guidance content included review of breathing training and exercise training movements, correction of common incorrect movements in home training, adjustment of individualized training intensity, and guidance on coping with exercise discomfort symptoms. One day before each video guidance session, the patient and their family were notified via WeChat or telephone. During the guidance, real-time answers to questions were provided, and the training completion status and adverse reactions were recorded to ensure the standardization and safety of the home training, thereby reducing poor training effects caused by incorrect movements. Both groups received continuous intervention for 2 months, and the evaluation of effectiveness was conducted at the end of the intervention.

Observation indicators

Walking test: On the day prior to intervention and at the end of the intervention period, we assessed the exercise endurance of the patients using a 6-minute walking distance (6-MWD) measurement evaluation method. During the test, the patient walked at the fastest speed for 6 minutes in a 30-m corridor, and the researchers timed and marked the endpoint position to measure the total distance traveled. In this test, longer distances denote greater exercise endurance.

Pulmonary function: On the day before intervention and at the end of the intervention period, a pulmonary function meter was used to measure the forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC) of the patients. A higher FEV₁/FVC ratio indicates better lung function.

Sleep condition: On the day prior to intervention and at the end of the intervention period, the Pittsburgh Sleep Quality Index (PSQI) scale was utilized to assess the sleep condition of the patients. This scale consists of seven dimensions, namely sleep onset time, sleep duration, hypnotic drugs, daytime function, sleep disorders, sleep efficiency, and sleep quality. Each dimension is scored from 0 to 3, with the total score ranging from 0-21. A higher score indicates poorer sleep quality[7].

Psychological condition: On the day before intervention and at the end of the intervention period, the Self-rating Anxiety Scale (SAS) and the Self Rating Depression Scale (SDS) were used to assess the psychological condition of the patients. Both scales consist of 20 items each, and all items are scored using the Likert 4-point (1-4 points) scoring method. The sum of the scores for each item represents the total gross score, and the standard score is equal to the gross score multiplied by 1.25 times and taken as an integer. SAS score ≥ 50 denotes anxiety, with higher scores indicating more severe anxiety[8]; SDS score ≥ 53 denotes depression, with higher scores indicating more severe depression[9].

Quality of life: On the day prior to intervention and at the end of the intervention period, the St. George’s Respiratory Questionnaire (SGRQ) was employed to assess the impact of COPD symptoms on the quality of life of patients. This questionnaire includes three dimensions, namely symptoms (frequency and severity), activity ability (physical activity limited by breathing difficulties), and life impact (the comprehensive impact of the disease on daily life and psychosocial function). The score range for each dimension is from 0 to 100 points. Higher scores indicate worse health-related quality of life[10].

Statistical analysis

SPSS version 27.0 (IBM Corp., Armonk, NY, United States) statistical software was used for data analysis. It was initially confirmed that the measurement data conformed to normal distribution by the Shapiro-Wilk method, and these data were expressed as the mean ± SD. The two groups were compared using the independent sample t-test. Count data adoption rate and composition ratio are presented as n (%); the two groups were compared using the χ² test. P values < 0.05 indicate statistically significant differences.

RESULTS

Baseline data

Comparison between two groups in terms of age, sex, marital status, smoking history, education level, living conditions, medical payment methods, comorbidities of other underlying diseases, and COPD course did not reveal statistically significant differences (P > 0.05; Table 1).

Table 1 Comparison of baseline data between two groups, mean ± SD/n (%).

Baseline data	Control group (n = 77)	Observation group (n = 77)	t/χ2 value	P value
Age (years)	58.93 ± 6.41	59.57 ± 7.35	0.576	0.566
Gender			0.244	0.621
Male	45 (58.44)	48 (62.34)
Female	32 (41.56)	29 (37.66)
Marital status			0.559	0.455
Have spouse	60 (77.92)	56 (72.73)
No spouse	17 (22.08)	21 (27.27)
Smoking history			0.107	0.744
Have	46 (59.74)	44 (57.14)
No	31 (40.26)	33 (42.86)
Standard of culture			0.199	0.905
Junior high school and below	39 (50.65)	40 (51.94)
High school/vocational school	25 (32.47)	26 (33.77)
College degree or above	13 (16.88)	11 (14.29)
Living			0.116	0.733
Living alone	27 (35.06)	25 (32.47)
Not living alone	50 (64.94)	52 (67.53)
Medical payment method			0.145	0.703
Medical insurance/commercial insurance	58 (75.32)	60 (77.92)
At his own expense	19 (24.68)	17 (22.08)
Merge other underlying diseases			0.247	0.619
Yes	46 (59.74)	49 (63.64)
No	31 (40.26)	28 (36.36)
Course of COPD (years)	6.45 ± 1.76	6.79 ± 1.81	1.182	0.239

COPD: Chronic obstructive pulmonary disease.

6-MWD

Prior to intervention, there was no statistically significant difference in the 6-MWD index between the two groups (P > 0.05). After 2 months of intervention, the 6-MWD of the observation group was significantly longer than that of the control group (261.21 ± 27.76 months vs 234.85 ± 24.87 months, respectively, P < 0.001; Table 2).

Table 2 Comparison of 6-minute walking distance between two groups (mean ± SD).

Indicator	Phase	Control group (n = 77)	Observation group (n = 77)	t value	P value
6-MWD (m)	Before intervention	219.86 ± 21.19	216.94 ± 20.05	0.878	0.381
	Postintervention	234.85 ± 24.87a	261.21 ± 27.76a	4.247	< 0.001

^aP < 0.05 vs before intra group intervention.

6-MWD: 6-minute walking distance.

Lung function indicators

Prior to the intervention, there was no statistically significant difference in FEV₁, FVC, and FEV₁/FVC indicators between the two groups (P > 0.05). After 2 months of intervention, the values of these indexes in the observation group were higher than those in the control group, and the differences were statistically significant (P < 0.05; Table 3).

Table 3 Comparison of two groups of lung function indicators (mean ± SD).

Pulmonary function indicators	Phase	Control group (n = 77)	Observation group (n = 77)	t value	P value
FEV1 (L)	Before intervention	1.24 ± 0.19	1.21 ± 0.22	0.906	0.367
	Postintervention	1.62 ± 0.27a	1.98 ± 0.39a	6.660	< 0.001
FVC (L)	Before intervention	1.93 ± 0.31	1.91 ± 0.34	0.381	0.703
	Postintervention	2.41 ± 0.39a	2.86 ± 0.45a	6.631	< 0.001
FEV1/FVC (%)	Before intervention	64.52 ± 4.56	63.35 ± 5.32	1.460	0.146
	Postintervention	67.22 ± 4.26a	69.23 ± 6.05a	2.384	0.018

^aP < 0.05 vs before intra group intervention.

FEV₁: Forced expiratory volume in 1 second; FVC: Forced vital capacity.

Sleep status scores

Before intervention, there was no statistically significant difference in the scores of various dimensions (i.e., bedtime, sleep time, hypnotic drugs, daytime function, sleep disorders, sleep efficiency, sleep quality) and the total PSQI score between the two groups (P > 0.05). After 2 months of intervention, the scores of all dimensions and PSQI total score in the observation group were lower than those in the control group, and the differences were statistically significant (P < 0.05; Table 4).

Table 4 Comparison of sleep status scores between two groups (score, mean ± SD).

Indicator	Phase	Control group (n = 77)	Observation group (n = 77)	t value	P value
Bedtime	Before intervention	1.74 ± 0.35	1.79 ± 0.37	0.862	0.390
	Postintervention	1.35 ± 0.31a	0.87 ± 0.24a	10.740	< 0.001
Sleep time	Before intervention	1.42 ± 0.25	1.48 ± 0.29	1.375	0.171
	Postintervention	1.15 ± 0.23a	0.95 ± 0.21a	5.635	< 0.001
Hypnotic drugs	Before intervention	1.37 ± 0.30	1.44 ± 0.37	1.290	0.199
	Postintervention	1.12 ± 0.25a	0.96 ± 0.21a	4.301	< 0.001
Daytime function	Before intervention	1.43 ± 0.29	1.46 ± 0.32	0.609	0.543
	Postintervention	0.85 ± 0.22a	0.63 ± 0.17a	6.943	< 0.001
Sleep disorders	Before intervention	1.67 ± 0.38	1.72 ± 0.40	0.795	0.428
	Postintervention	1.28 ± 0.29a	1.08 ± 0.27a	4.429	< 0.001
Sleep efficiency	Before intervention	1.74 ± 0.40	1.79 ± 0.43	0.747	0.456
	Postintervention	1.28 ± 0.36a	0.92 ± 0.39a	5.952	< 0.001
Sleep quality	Before intervention	1.39 ± 0.33	1.41 ± 0.35	0.365	0.716
	Postintervention	1.08 ± 0.25a	0.92 ± 0.23a	4.133	< 0.001
PSQI total score	Before intervention	10.76 ± 2.53	11.09 ± 2.86	0.758	0.449
	Postintervention	8.11 ± 1.73a	6.33 ± 1.36a	7.098	< 0.001

^aP < 0.05 vs before intra group intervention.

PSQI: Pittsburgh Sleep Quality Index.

Psychological conditions

Prior to intervention, there was no statistically significant difference in SAS and SDS scores between the two groups (P > 0.05). After 2 months of intervention, these scores were significantly lower in the observation group compared with the control group, and the differences were statistically significant (P < 0.05; Table 5).

Table 5 Comparison of psychological conditions between two groups (mean ± SD).

Psychological state	Phase	Control group (n = 77)	Observation group (n = 77)	t value	P value
SAS score (points)	Before intervention	57.74 ± 6.65	58.85 ± 7.04	1.006	0.316
	Postintervention	54.85 ± 4.82a	48.73 ± 3.97a	8.601	< 0.001
SDS score (points)	Before intervention	54.54 ± 5.87	55.18 ± 5.92	0.674	0.502
	Postintervention	50.75 ± 4.31a	46.92 ± 3.58a	5.998	< 0.001

^aP < 0.05 vs before intra group intervention.

SAS: Self-rating Anxiety Scale; SDS: Self-rating Depression Scale.

SGRQ scores

Before intervention, there was no statistically significant difference in the scores of each dimension of SGRQ between the two groups (P > 0.05). After 2 months of intervention, the SGRQ scores of the observation group were significantly lower than those of the control group in all dimensions, and the differences were statistically significant (P < 0.05; Table 6).

Table 6 Comparison of St. George’s Respiratory Questionnaire scores between two groups (mean ± SD).

SGRQ dimension	Phase	Control group (n = 77)	Observation group (n = 77)	t value	P value
Disease symptoms	Before intervention	66.74 ± 6.23	67.32 ± 6.79	0.552	0.581
	Postintervention	52.83 ± 5.58a	47.83 ± 4.98a	5.866	< 0.001
Activity capacity	Before intervention	60.61 ± 5.95	61.29 ± 6.02	0.705	0.482
	Postintervention	55.75 ± 5.04a	49.85 ± 4.85a	7.402	< 0.001
Life impact	Before intervention	50.61 ± 7.28	51.09 ± 7.56	0.401	0.689
	Postintervention	37.09 ± 5.33a	29.25 ± 4.73a	9.654	< 0.001

^aP < 0.05 vs before intra group intervention.

SGRQ: St. George’s Respiratory Questionnaire.

DISCUSSION

Patients with COPD often exhibit symptoms such as shortness of breath, coughing, and chest tightness. In severe cases, they may experience breathing difficulties or even shock, which affect the quality of life and may be life-threatening. The American Thoracic Society and the European Respiratory Society have stated that conducting individualized and comprehensive nursing interventions for patients with symptomatic chronic lung damage can stabilize or even reverse the disease symptoms, promote pulmonary rehabilitation, and optimize their individual functional status[11]. However, at present, there is no systematic and unified nursing model for COPD in China. Nevertheless, as an important and effective non-pharmacological intervention measure, conducting comprehensive nursing interventions including health education, nutritional guidance, functional training, sleep guidance, and psychological intervention holds significant importance.

In clinical practice, it is widely recognized that providing appropriate pulmonary rehabilitation training for patients with COPD can improve their respiratory symptoms and quality of life. Barlow et al[12] also showed that 7 weeks of rehabilitation training in patients with COPD effectively improved respiratory distress symptoms, enhanced exercise endurance and 6-MWD, and improved quality of life. Therefore, in the routine care for patients with COPD, the emphasis is on lung function training. However, it is often overlooked that those patients suffer from the disease for a long time and generally have varying degrees of anxiety or depression. Anxiety increases the psychological burden on patients, while depression causes them to lose confidence in life.

In addition, negative emotions (i.e., anxiety and depression) can lead to an increase in the activity of substances such as plasma norepinephrine, which are excitants for the sympathetic nervous system. This further enhances the activities of the body and affects the sleep structure and heart-lung functions[13]. In turn, poor sleep negatively impacts the psychology of the patient, thereby aggravating their negative mental state and resulting in low adherence to their medication schedule and rehabilitation training[14]. Therefore, when emphasizing pulmonary rehabilitation training for patients with COPD, it is also necessary to pay attention to their emotional changes and sleep quality. In this study, we attempted to adopt a comprehensive nursing intervention strategy consisting of health education, psychological care, sleep guidance, nutrition guidance, and functional training in the observation group, and compared it with conventional care provided to patients in the control group. The results showed that end of the intervention period (continuous intervention for 2 months), the 6-MWD of the observation group was longer than that of the control group. Additionally, the pulmonary function indicators (FEV₁, FVC, FEV₁/FVC) of the observation group were higher than those of the control group.

Moreover, the scores of each dimension of the PSQI for sleep and the total score of PSQI, the SAS and SDS scores, and each dimension of SGRQ of the observation group were significantly lower than those of the control group. This evidence indicates that the comprehensive nursing intervention strategy offers a significant advantage compared with conventional care. The possible reasons are that in the routine care of the control group, health education, sleep guidance, psychological intervention and nutrition guidance were not set as the nursing goals, and there was a lack of targeted nursing intervention methods. The comprehensive nursing intervention in the observation group included health education, psychological care, and sleep guidance content. For instance, in health education, relevant information regarding COPD (such as causes, clinical manifestations, treatment and intervention methods, and clinical outcomes) is explained to patients, helping them to understand the disease[15].

Poureslami et al[16] also showed that providing health education to patients with COPD enhances their knowledge regarding COPD and reduces the levels of depression and anxiety. In terms of psychological care, it involves in-depth communication between the psychologist and the patient. We found that patients with COPD had higher SAS and SDS scores prior to intervention, mainly due to long-term respiratory distress and concerns regarding prognosis, leading to a higher incidence and severity of anxiety and depression. Therefore, in terms of psychological care for the observation group, we organized in-depth communication between psychologists and patients by listening to the demands, concerns, and doubts of the patients to provide emotional support. At the same time, cases of successful recovery were presented to the patient to offer encouragement and help them build confidence in recovery.

Chen et al[17] reported that compared with conventional care, increasing psychological nursing interventions for patients with COPD can effectively improve their negative emotions such as anxiety and depression. This observation is consistent with our research findings. Sleep disorders in patients with stable COPD are often driven by nighttime symptoms and psychological distress, and do not represent completely irreversible structural damage. In this investigation, we introduced the factors and hazards affecting sleep quality to patients and their families through specialized nurses, and discussed the development of sleep schedules with patients. Ultimately, this approach significantly improved the sleep quality of patients, with a particularly significant improvement in sleep onset time. This result is mainly attributed to the multimodal comprehensive nursing intervention adopted in this study, including targeted sleep guidance, respiratory training, and psychological counseling. By alleviating nighttime breathing difficulties, reducing anxiety, and stabilizing breathing patterns, the quality of sleep for patients can be improved. When the sleep quality of patients improves during nursing interventions, the use of hypnotic drugs is usually systematically reduced. Bouloukaki et al[18] showed that sleep disorders are associated with poorer physical and mental health conditions in patients with COPD. Therefore, by consistently evaluating the sleep of patients and adopting targeted sleep guidance strategies, it is possible to improve sleep quality and further enhance their physical and mental health. Patients with COPD experience increased nutrient consumption due to increased respiratory work. However, prolonged and recurrent illness can affect appetite or nutrient absorption, leading to malnutrition. This process subsequently affects respiratory and diaphragmatic function, resulting in decreased lung function[19]. Therefore, it is crucial to provide scientific nutritional guidance for patients with COPD. Nutritional guidance can reduce the risk of malnutrition in patients, help maintain normal physiological function of organ tissues, reduce respiratory load, improve lung respiratory function, enhance respiratory muscle endurance and strength, and delay lung function decline[20]. However, there is a lack of nutritional guidance in routine care. Effective functional training is the core of pulmonary rehabilitation for patients with COPD. It plays a positive role in alleviating symptoms such as fatigue and breathing difficulties, and improving exercise capacity. This may also partly explain the higher functional indicators in the observation group compared with the control group. Howcroft et al[21] found that functional training for developing action plans can improve the SGRQ score in patients with COPD. However, traditional rehabilitation guidance mostly relies on one-way information transmission through verbal explanations, which patients often find difficult to fully understand and grasp. In addition, routine nursing interventions are mainly dominated by nurse-led unified intensity breathing training, lacking individualized stratification. Numerous patients do not complete the interventions due to goal rigidity, resulting in poor training effectiveness. Rayce et al[22] found that, by providing online health training guidance, the training outcomes for patients with COPD can be guaranteed. In our comprehensive nursing intervention, rehabilitation therapists provide on-site demonstrations of breathing techniques, and patients practice until they master these techniques. Moreover, personalized functional training plans are formulated based on the lung function and exercise capacity of patients with COPD. For example, during the hospitalization period, we guide the patients in breathing training, and conduct endurance and resistance exercise training to significantly enhance their lung rehabilitation training skills and improve their physical fitness. In the implementation stage after discharge, using online video teaching guidance can reduce incorrect movements in the home-based lung rehabilitation training and greatly improve effectiveness.

This study has several limitations. This study was a single-center retrospective analysis with a small sample size and limited representativeness. Therefore, in the future, the sample size will be expanded and multicenter prospective studies will be conducted to further support the benefits of comprehensive nursing interventions on the lung function and psychological status of patients with COPD. Additionally, due to limitations in research funding, this study included an immediate effectiveness evaluation after a continuous intervention of 2 months, lacking long-term follow-up of patients. Given the chronic disease characteristics of COPD, future research should include long-term follow-up to further explore the sustainability of comprehensive nursing interventions in benefiting patients with COPD.

CONCLUSION

Comprehensive nursing interventions can effectively improve the exercise endurance, lung function, and sleep quality of patients with COPD, alleviate their anxiety and depression, and reduce the impact of respiratory symptoms on their daily lives.