Table 1 Moving from empirical data to preliminary themes

“The nurse (Inf. 2) tells me (the observer) that she notices that the patient (Pt. 3) had breathlessness, but that she was still able to do a lot of talking. Her breathing stabilised quickly, indicating to the nurse that the patient could handle the breathlessness in that situation. The nurse furthermore explains that the patient paused several times during their conversation, which told her that the patient was in control of her breathing”

Managing dyspnoea

“The nurse (Inf. 1) is explaining her actions in a situation where the patient (Pt. 5) wanted more water even though she had a glass already. “It’s like this –if I tell the patient: “Now, look, you already have a glass of water – that’s enough, you don’t need another one.” That would agitate her, making her breathlessness even worse. So in that situation, I do the same as in any other breathlessness situation – I try to support her in creating order out of chaos, because it allays her concerns and gives tranquillity. Bringing her the extra glass of water helps achieve that.”

“The pulse oximeter is a very important tool for us because COPD patients, they really can cheat you. The patient will be sitting, eating breakfast and thinking he is doing really well, and then, when you put on the pulse oximeter, the saturation is only 76 %. So you could say that it’s the last part of an overall picture of the patient.” (Inf. 1)

Collecting information about dyspnoea

The nurse (Inf. 2) enters the patient’s room (Pt. 1) with a pulse oximeter. She places the instrument on the patient’s finger, saying: “93.94 % – now, that’s good, I’ll decrease the oxygen level to half a litre.”

“There was a situation during a night watch where I experienced I didn’t have the time to stay with a COPD patient while she was breathless. I gave the patient a face mask with medicine and then had to leave her. When I came back, the patient’s breathlessness was even worse and beyond her control. Helping her calm down again was really tough. It was unpleasant, both for the patient, but also for me.” (Inf. 2)

Framework, structure and time

“She (Pt. 1) quickly gets exertional dyspnoea. As I see it, she is extremely discouraged by it, to the point where she stays in bed most of the time.” (Inf. 2)

Types of dyspnoea

“Actually, I noticed immediately as I entered the room that she (Pt. 4) was gasping for her breath, and I thought this is a good sign, because it [her breathlessness] must have been from walking to the toilet and back, and I thought to myself, she needs an inhalation, quickly.” (Inf. 1)

“You sometimes have a patient with a dyspnoea that has completely taken over, so that they cannot find head or tail of anything. They have red flushing cheeks, they are sweating, hot … and their breathlessness has left them completely out of control. They get anxious, become powerless and have no idea what to do. That’s really uncomfortable to watch, I think.” (Inf. 2)