Lucy Speakman

Thesis title: An exploration of the experiences of community respiratory nurses supporting patients who are breathless

Start year: 2017

Supervisor(s): Dr Sue Schutz

Lucy Speakman


I graduated from Nottingham University in 1994 with BNurs. I worked in Nottingham at the Queens Medical Centre for a couple of years before moving to work at the John Radcliffe in Oxford in acute medicine.

Following a year abroad travelling I returned to the UK and worked in Oxford as a community nurse in a city practice. From this job I moved to study full time at Oxford Brookes for the District Nursing Cert (BA). This enabled me to become a District Nursing sister in a rural practice where I worked for 2 years. 

Following the birth of my first daughter I worked for a short period at Didcot Community Hospital. From here I moved to my current role in the Community Respiratory Nursing Team in Oxford. This is an expanding service supporting people predominantly with COPD and asthma in the community. I have a caseload of patients that I support in their own homes. 

My special interest is in end-of-life care; holistically supporting patients and their families facing challenging symptoms like refractory breathlessness. We also support anyone requiring home oxygen and offer Pulmonary Rehabilitation to the county. Our service has recently extended to supporting patients with Long Covid in specialised community clinics.



Living with unrelenting breathlessness can cause individuals significant physical, emotional, social and economic negative impact to their lives. Often, patients are supported by their life partners or family members who help manage complex medication and oxygen regimens. Increasing breathlessness can cause fear and anxiety for both patient and caregiver, calling upon the Community Respiratory Nurse Specialist (CRNS) to offer practical and emotional support and guidance, in their role of supporting people with respiratory disease. However, supporting patients who have distressing and difficult to treat symptoms impacts the nurses caring for them too. Repeated exposure to the distress of others, is associated with increased stress and burnout on the nurse.

Coping with the distress of others requires “emotional labour”: a recognised consequence of caring that can be experienced by the individual nurse. This has been particularly apparent during the COVID-19 pandemic where nurses have witnessed grief and loss both personally and professionally. Engaging with the distress of others however can also build trust and enable a closer relationship between the nurse and patient, ensuring the patient receives best supportive care. It is therefore an important, yet challenging component in patient care and might impact the care delivered by the nurse. 

To witness breathlessness, something so life sustaining and fundamental to our survival as human beings, is to witness distress. When exposed to the distress of others, there is likely to be a personal emotional cost to the CRNS which may then influence the care they give their patients. It might, because of their own feelings, influence the care they give their patients.

Project aim

This is an unexplored area of research in respiratory nursing. The aim of this project is to reveal new understanding of the lived experience of CRNS’s supporting patients with breathlessness, how they make sense of these experiences and how they impact them personally, examining the consequence for patient care. This will seek to advance understanding in the impact of emotional labour on effective nursing care.  

This is a Hermeneutic phenomenological study using video interviews with 12 CRNS seeking to explore the lived experience of supporting patients with breathlessness. Hermeneutic phenomenological methodology was used to unconceal taken for granted understanding using Crafted Stories, and using the philosophy of Heidegger, interpretive analysis explored the data to reveal new understanding.  

Applying the study in practice

The interpretations generated from the data will be used to provide guidance for core standards of support and education for CRNS. This will contribute to an underexplored area of research and will directly benefit patients who have breathlessness, by enabling well supported CRNS’s to address the holistic needs of their patients. At a time of likely increased demand for respiratory services, ensuring nurses are well supported in their care of people with breathlessness might avoid inevitable escalating costs and reduced quality of life.

This research will hopefully contribute to the way we understand the challenge for all nurses witnessing distress, bringing new understanding of this unexplored area of knowledge. Although this research is focused on Respiratory Specialist Nurses, this is a bigger issue and has relevance to all nurses. I would like the opportunity to develop this within Oxford Health.


I have done previous courses at OBU (District Nurse cert, Advanced Certificate of Palliative Care) During the last course, I co-authored a paper with Dr Helen Walthall (previous DNurse Lead) for publication. This resulted from completion of an assignment for a module focusing on symptom management where I examined breathlessness. She encouraged me to pursue my interest in breathlessness by joining the doctorate program with a view to carrying out my own research.

Professional Doctorate in Nursing

Experience on the programme

I like the idea of engaging research in clinical practice. So often in nursing there is a divide between research and practice, but this programme provides an opportunity to bring pertinent issues in clinical practice to research. The doctorate programme has provided excellent teaching and support for the first 2 years (the MPhil part of the programme) to equip me to carry out my own research in practice in years 3,4 and 5. 

I have enjoyed returning to education after many years in clinical practice. I appreciate my ability to take a critical view when exploring concepts of nursing, aware of my own professional knowledge and experience. I feel this opportunity has enhanced the clinical care I give to patients because I am more reflective and considered when approaching my role.

It has been challenging to balance work, studying and a family life but my enjoyment of the programme has given me the impetus to keep going. The first 2 years of the taught programme has given me the research skills to undertake doctorate research. This time in the classroom has also cemented supportive relationships within the peer group where we provide ongoing encouragement to each other, especially at this challenging time of a global pandemic. 

I struggled to settle into the role of a DNURs student due to a definite feeling of imposter syndrome! My awareness of the senior roles and expertise of my peers made me question my place on the course but as we have learnt together, I have grown in confidence. I can see that we all come to the programme with different hopes, experiences and expectations and that translates into our research projects. I feel the professional doctorate suits my current role in transferring the challenges arising in clinical practice into the research arena.