Physiological nursing research in dyspnea: a paradigm shift and a metaparadigm exemplar

Dyspnea, the primary activity-limiting symptom in chronic obstructive pulmonary disease, is associated with respiratory muscle mechanisms. This leads to a paradigm shift from pulmonary processes to respiratory muscle function. Within the context of an integrative metaparadigm, basic and clinical nursing science are developed: to better understand physiological processes associated with dyspnea as presented in three physiological models of dyspnea, to identify respiratory muscle mechanisms associated with current treatment strategies for dyspnea, to eventuate clinical assessments of exercise endurance, and to generate treatment strategies in the promotion of positive life processes. The basic knowledge developed within this program provides a foundation for the generation of strategies to assess patients, to promote normal functioning of life processes, and to enhance positive coping with responses to illness. Thus, this research program provides a model for the development of substantive physiological and clinical knowledge for nursing practice.