How nurses address psychosocial needs in patients with advanced heart or lung failure: a qualitative interview study

Abstract

BACKGROUND: Patients with advanced heart failure or lung failure often experience significant changes in psychosocial needs, which may affect their quality of life, emotional wellbeing, and daily functioning. Although nurses are well-positioned to address these needs, there is limited understanding of their perspective on these conversations. Therefore, this study aimed to explore how nurses approach and experience addressing changes in psychosocial needs of patients with advanced heart failure (NYHA stage III or IV) or lung failure (GOLD 3 or 4). METHODS: A qualitative study consisting of semi-structured interviews with hospital and home care nurses. Data were collected from February to April 2025. Based on a case presented by participating nurses and on the Spider Web model for Positive Health, we inquired about perceptions, approaches and challenges to discussing psychosocial needs with patients. Interviews were recorded, transcribed, and analyzed inductively following the principles of thematic analysis. RESULTS: We interviewed six hospital and six home care nurses (total n = 12). Nurses generally experienced conversations about psychosocial needs as meaningful and part of their professional role. They used an intuitive and organic style, attuning to the needs and boundaries of patients. In practice, their approach was challenged by competing priorities and a lack of time, especially in hospital settings. Nurses found conversations about psychosocial needs easier when they had a click and trusting relationship with patients. Some were hesitant to address sensitive topics such as sexuality and financial concerns due to discomfort, perceiving it as a lower priority, or as outside their responsibility. CONCLUSIONS: We identified a discrepancy between nurses' perceived importance of discussing psychosocial issues, and the extent and thoroughness with which they do this in practice. Approaches were shaped by nurses' professional intuition and attunement to patients' needs and boundaries. Topics that nurses considered sensitive, such as sexuality and financial concerns, emerged as challenging.