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

摘要：

目的 探讨老年慢性阻塞性肺疾病患者居家肺康复实施的相关困境，为提高患者居家肺康复的依从性提供参考。 方法 应用描述性现象学研究方法，采用目的抽样法，于2025年10月—2026年1月选取上海市某三级综合性医院确诊并进行治疗或随访的慢性阻塞性肺疾病的患者作为研究对象，运用Colaizzi 7步内容分析法对访谈资料进行归类与分析。 结果 共提炼出4个主题、8个亚主题：肺康复知识理解与实践转化困难（专业指导内容抽象，患者难以理解和转化；主观症状体验难以转化为有效的沟通与指导依据）；疾病认知偏差与症状负担降低肺康复动力（对疾病及肺康复价值认识不足或存在偏差；症状负担、检查结果困惑及负性情绪影响坚持肺康复）；家庭与同伴的双重影响增加实施肺康复的阻力（家庭过度关注与保护限制肺康复自主性；病友比较带来心理压力并削弱参与意愿）；肺康复中出现消极应对与行为退缩（选择性执行肺康复计划；以遗忘和回避减轻肺康复负担）。 结论 老年慢性阻塞性肺疾病患者居家肺康复实施困境涉及认知、沟通、社会支持及行为应对等多个方面，护士应加强可理解、可操作的个体化康复指导，重视患者主观症状表达和心理体验，联合家庭照护者构建支持性康复环境，以促进居家肺康复的长期依从和实施。

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