关键词: 肺疾病，慢性阻塞性, 肺康复, 困境, 质性研究, 慢性病护理

Abstract:

Objective To explore the challenges related to home pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease（COPD），providing a reference for improving long-term adherence to home-based pulmonary rehabilitation in clinical practice. Methods A descriptive phenomenological study was conducted using purposive sampling from October 2025 to January 2026，selecting patients diagnosed with COPD at A tertiary comprehensive hospital in Shanghai as research subjects. Colaizzi’s seven-step content analysis method was employed to categorize and analyze the interview data. Results A total of 4 themes and 8 sub-themes were identified. ①Difficulty in understanding and practicing pulmonary rehabilitation knowledge（abstract professional guidance content makes it hard for patients to comprehend and apply；subjective symptom experiences fail to translate into effective communication and guidance foundations）. ②Disease cognition bias and symptom burden reduce motivation for pulmonary rehabilitation（insufficient or biased understanding of the disease and the value of pulmonary rehabilitation；symptom burden，test result confusion，and negative emotions hinder adherence to pulmonary rehabilitation）. ③Dual influence of family and peer support increases resistance to pulmonary rehabilitation implementation（excessive family focus and protective behaviors limit rehabilitation autonomy；peer comparisons create psychological stress and weaken participation willingness）. ④Negative coping and behavioral regression in long-term pulmonary rehabilitation（selective execution of rehabilitation plans，using forgetting and avoidance to reduce the burden of pulmonary rehabilitation）. Conclusion For elderly patients with COPD undergoing home-based pulmonary rehabilitation，the implementation challenges involve multiple aspects，including cognition，communication，social support，and behavioral coping. Nurses should strengthen comprehensible and operable individualized rehabilitation guidance，pay attention to patients’ subjective symptom expression and psychological experience，and collaborate with family caregivers to build a supportive rehabilitation environment，so as to promote long-term adherence and implementation of home-based pulmonary rehabilitation.

Key words: Pulmonary Disease，Chronic Obstructive, Pulmonary Rehabilitation, Challenges, Qualitative Research, Chronic Disease Nursing