Where breath meets care: nurses' perspectives on enabling COPD self-management in polyclinic settings

Effective self-management is central to living well with chronic obstructive pulmonary disease (COPD), yet its success depends heavily on how nurses translate guidelines into everyday encounters with patients and families. Evidence from primary care and polyclinic settings, particularly in Middle Eastern contexts, remains limited.

To explore nurses' perspectives on how they enable COPD self-management in polyclinic settings, and to illuminate the relational, organizational, and cultural factors that shape this work.

A qualitative interview study using reflexive thematic analysis, informed by attention to nurses' lived experiences of providing COPD self-management support.

Semi-structured, in-depth interviews were conducted with nurses providing care for adults with COPD in university-affiliated polyclinics. Participants were purposively sampled to capture variation in experience, role, and clinic type. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Rigour was enhanced through iterative coding, team discussions, reflexive journaling, and member reflections with a subset of participants.

Eighteen nurses described COPD self-management support as an ongoing negotiation "where breath meets care." Four interrelated themes were identified: (1) Teaching patients to breathe again-using simple language, demonstrations, and repetition to make complex regimens manageable; (2) Between protocols and people-working around time pressure, fragmented pathways, and limited resources while trying to individualize care; (3) Culture, family, and the silent burden-navigating family gatekeeping, stigma, and culturally embedded health outcomes are predetermined about lung disease; and (4) Building trust, breathing hope-developing long-term, relationship-based care in which small clinical gains (e.g. fewer exacerbations, better inhaler use) signalled meaningful progress.

Nurses' efforts to enable COPD self-management extend far beyond technical education, encompassing relational work, advocacy, and adaptation to cultural and system constraints.

Findings highlight the need for protected time, continuity of care, and context-sensitive training that strengthens nurses' skills in collaborative teaching, family engagement, and navigating structural barriers in COPD self-management support.

Not applicable.