HLST261 Adult Nursing

Introduction:

The assignment focuses on the evidence based practice in nursing and the purpose of the paper is to critique a selected original research paper.

One of the most common causes of hospitalization and death in the world is Chronic Obstructive Pulmonary Diseases or COPD (López?Campos, Tan and Soriano 2016). The adverse effect of the disease has become a huge threat to the health status of the population and increases the burden of the health care industry in the population (Rice, et al. 2014). It has been found that the prevalence of COPD in UK is 1.5% (Adeloye et al. 2015). Thus, it is important to provide adequate focus on the acute management of COPD in an effective manner in order to reduce the rate of hospitalization in the population, provide safety to the patient and improve the quality of life (Naik et al. 2014). In this regards the domain 2 of National Health Service or NHS provides effective guidelines in order to develop the quality of life (Department of health 2018). This paper will analyse a relevant article and relate the evidence with the domain 2 of NHS. The chosen article for the paper is Avoiding hospital admission in COPD: impact of a specialist nursing team (Cox et al. 2017).

Discussion:

Evidence-based practice:

The evidence-based practice in nursing is considered as the interdisciplinary approach to the nursing practice that has been introduced in the year 1992 (Hall and Roussel 2016). The evidence-based practice refers to the use of most recent best practice recommendations in order to take decision related to the patient care (Baker and Tickle-Degnen 2014). The evidence-based practice includes three basic principles. The first principle is identify the best available evidence based on research regarding the treatment process in order to make decision whether the treatment process is relevant for the patient or not. Clinical examination in order to identify health condition, risk factors and benefits of the treatment for individual is the second principle. The third principle indicates considering the preference and values of the patient regarding the treatment process (Babcock and Thonus 2018).  The process is not only for supporting the decision making but also for using knowledge, skills and experience of health professional in order to provide effective service to the patient considering the social support and financial condition as well (Hamer and Collinson 2014). Such evidence-based practice is important in order to provide effective care service that aims to develop the health condition of the patient, improve the quality of life and achieve expected outcomes (Liamputtong 2013). Such process helps the patient to access most effective treatment that is based on evidence (Melnyk et al. 2014). The evidence-based practice helps to promote the attitude of inquiry in nursing practice (DiCenso, Guyatt and Ciliska 2014). Such process helps the health professionals to ensure that the treatment process used by them is informed by the most recent evidence. The use of evidence-based practice helps to use the health resources in an effective manner (Schmidt and Brown 2014). Hence, evidence based practice play an important role in order to provide patient centred care and ensure patient safety.

Rationale for choosing NHS domain 2:

The NHS domain 2 provides guidelines for enhancing the quality of life for the patient that are affected with the long term disease conditions. The domain provides one over reaching indicator, two guidelines related to health for improving the quality of life for the people that are suffering from long term health conditions and six areas of improvement. The domain provides effective improvement areas for the condition of unplanned hospital admission in case of chronic ambulatory care, diabetes, asthma and epilepsy. The indicators in the NHS framework reflect the changes that are needed in order to enhance the quality of life. The domain also indicates that implementation of principle of equality is also important in order to provide appropriate benefits to all suffering from long term conditions. Recent trends, current practice related to the long term condition and areas of improvement are also mentioned in the domain. Such explanation is helpful in case of managing COPD patients as it is also a long term health condition (Rycroft et al. 2012). The areas of improvement provided by the domain would help the health professionals in understanding the way to improve the acute assessment process in order to reduce the rate of hospitalization due to COPD (Department of health 2018). Thus, it can be said that the chosen domain of NHS outcomes framework is relevant to the field of clinical practice.

Rationale of choosing the article:

Cox et al. (2017) has provided relevant information related to the use of acute assessment in order to reduce the hospital admission due to COPD. The research has focused to the evaluation of the safety factor and effectiveness of acute respiratory assessment by specialist nurse in order to reduce the unnecessary hospitalization of COPD patients. According to the study the most common cause of COPD is smoking. Among the population of 724000, the percentage of smokers is estimated as 19.1%. Thus, increase in the rate of hospitalization due to COPD has been found. Most of the health care organization use the guidelines provided by the British Thoracic Society that includes admission avoidance rules (brit-thoracic.org.uk 2018). However, it has been found that the guideline is not effective, thus the implementation of ARAS has been recommended thus. The study has effectively obtained that the skills of respiratory nurse specialist has been contributed effectively in acute assessment of COPD patients by using survey and collecting data from the case notes of the patient. The use of effective CBG assessment and idea of initiating emergency oxygen has become effective in order to achieve patient satisfaction. It has been found that the use of ARAS has helped to reduce the incident of unnecessary hospitalization (Cox et al. 2017). In this manner the study has helped to understand effective ways for acute assessment and identify effective scheme to manage hospital admission.  The study has provided effective way to improve the quality of life of the patients with COPD. The areas of improvement are also mentioned in the study. Such recommendations would help to manage the patient with long term condition (Miravitlles et al. 2016). Thus, it can be said that the study has maintained the NHS framework in an effective manner.

Analysis of the article using CASP tool:

The study has provided a clear statement of aims which is evaluation of the safety and effectiveness of the acute respiratory assessment by specialist nurse for the patient diagnosed with COPD in order to reduce the rate of unnecessary hospitalization.

The researchers have justified the method that is the review of the patient case notes and conducting survey among the patient with COPD and the rationale for choosing such method was to analyse the condition of the patient and understand the patient satisfaction with ARAS, hence it can be said that the researchers have used appropriate methodology.

The recruitment strategy was appropriate as the researchers have aimed to evaluate the effectiveness of acute respiratory assessment and recruited patient with COPD and analysed the satisfaction level of the patients.

The researchers have collected the data from survey and patient case notes. Questions that are asked in the survey have been mentioned in the research paper that were relevant for addressing the research question. However, the researchers did not document the condition of the patients before or after the treatment.  

The relationship between the researchers and the participants has been considered as the researchers have effectively examined their role. Additionally the researchers have identified the limitation of their study and respond effectively to bring possible changes for addressing the limitations.

The study did not disclose the information about the participants and did not forced anyone to participate in the study that means the study has maintained the ethical factors such as confidentiality. However, there is no declaration about the approval of the study from ethics committee, which has indicated lack of ethical consideration.

The researchers have kept the surveys anonymous thus, failed to analyze the patient profiles, which indicate that more effective qualitative research might be introduced in the study. Description of the data analysis process has been mentioned but due to lack of randomization and blinding the researchers have failed to control the bias in the study.

Clear statement of findings is present in the study and it has indicated that community specialist nurse-led admission-avoidance service would be effective for the patient with COPD, experienced and skilled nursing professionals are required to perform the ARAS and adequate pharmacological treatment along with CBG assessment would facilitate the health professionals to undertake effective care process for such patients. However, the details related to the severity of COPD and the previous health history of the patient has not been addressed in the study.

Nevertheless, the study has provided adequate information regarding the effective the acute assessment in order to diminish the threat of COPD and rate of hospitalization, hence it can be said that the study is valuable  and the findings could be utilised in the clinical practice as the researchers have supported their findings with adequate evidence (Casp-uk.net 2018).

Justification for the findings of the article:

The article has provided adequate information regarding the use of acute assessment in order to manage COPD patients in the health care organization in the discussion part. The article has indicated that acute assessment carried out by a specialist nurse helps to avoid unnecessary admission in the hospital and it is safe and cost effective as well. The importance of providing appropriate pharmacological support to the patient has been mentioned by the researchers. The study has mentioned the important skills that are needed in order to assess the acute assessment in an effective manner.  The ability of the specialist health professionals to provide education to the community nurses and the patient in order to promote self-management is also discussed by the study. The effectiveness of capillary blood gas assessment in order to manage the COPD patients has been mentioned in the study. The study also informed about the satisfaction of the patients regarding the acute assessment by the specialist nurse. The ARAS scheme and its effectiveness have been mentioned in the study. Such information helps the nursing practitioners in order to understand the effective ways of managing patients with COPD. The implementation of the strategy provided by the study would help to reduce the rate of unnecessary hospital admission of the patients with COPD. The process used in the study is useful in improving the quality of the patients that are suffering from long term COPD condition and the areas of improvement is also considerable in practical application of the process in order to reduce the incident of hospitalization (Cox et al. 2017). Thus, it can be said that the study has justified its role in order to provide effective evidence that could be introduced in the health care organization in order to bring change and the practice has supported the domain 2 of NHS that provides guidelines for enhancing the quality of life of the patient with long term condition.

Reflection:

The evidence provided by the study is helpful in order develop knowledge regarding the acute assessment for the patient with COPD. The information about the process such as oxygen therapy and gas capillary assessment has helped me to understand effective process that need to be learn in order to perform the acute assessment in an effective manner. The idea of make available a specialist nurse in the weekend by call in order to assist the practitioners is appreciable. The information regarding proper pharmacological support is helpful in order to provide effective service. The discussion related to the ARAS scheme has helped me to understand the way of managing hospital admission. Such findings provided by the study has encouraged me to improve my skills and met the requirements of the patients in an effective manner. Hence, I could develop my professional practice through the utilisation of such knowledge regarding the care process, assessment and management of patient with COPD. I have decided to use the strategies provided by the study in order to perform acute assessment of COPD patient in my session of nursing practice. It is expected that the implementation of such strategy would help me to reduce the unnecessary hospitalization due to COPD and improve the quality of life of the patients. Such actions would help me to establish myself as a successful nurse in future (Cox et al. 2017).

Conclusion:          

From the above discussion it can be concluded that, one of the most common causes of hospitalization is COPD. The increasing incidents of COPD and death caused by the disease has created burden for the health professionals. However, it has been found that the implementation of effective assessment could reduce the risk of COPD thus help to reduce the rate of unnecessary hospitalization in an effective manner. In this regards, the domain 2 of NHS provides effective guidelines for developing the quality of life of the patients with long term condition and provides information about the areas of improvement. The article Avoiding hospital admission in COPD: impact of a specialist nursing team has provided important information about the acute assessment process. Evidence-based practice such as oxygen therapy and gas capillary assessment has been provided by the article. It is important to implement such process in order to perform effectively in the acute assessment and meet the requirements of the patients.

Further research need to be done in order to done in order to gather more relevant information that could help to reduce the risk of COPD and research could be done based on different non-pharmacological treatment to reduce the prevalence of hospitalization due to COPD. It could be recommended that the nursing professionals need to promote the findings of the research and educate people about vaccination for preventing infectious respiratory disease which could lead to development of COPD. Additionally, research could focus on pulmonary rehabilitation for the patient with severe COPD to avoid risk of readmission.

Reference:

Adeloye, D., Chua, S., Lee, C., Basquill, C., Papana, A., Theodoratou, E., Nair, H., Gasevic, D., Sridhar, D., Campbell, H. and Chan, K.Y., 2015. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. Journal of global health, 5(2).

Babcock, R.D. and Thonus, T., 2018. Researching the writing center: Towards an evidence-based practice. Peter Lang International Academic Publishers.

Baker, N. and Tickle-Degnen, L., 2014. Evidence-based practice. Willard and Spackman’s occupational therapy, 12th edn. Lippincott, Philadelphia, pp.398-412.

brit-thoracic.org.uk. 2018. Home | British Thoracic Society | Better lung health for all. [online] Brit-thoracic.org.uk. Available at: https://www.brit-thoracic.org.uk/ [Accessed 14 Oct. 2018].

Casp-uk.net. 2018. [online] Available at: https://casp-uk.net/wp-content/uploads/2018/03/CASP-Qualitative-Checklist-Download.pdf [Accessed 4 Jul. 2018].

Cox, K., Macleod, S.C., Sim, C.J., Jones, A.W. and Trueman, J., 2017. Avoiding hospital admission in COPD: impact of a specialist nursing team. British Journal of Nursing, 26(3), pp.152-158.

Department of health 2018. Setting Levels of Ambition for the NHS Outcomes Framework. [online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/212805/Chapter-4-Enhancing-quality-of-life-for-people-with-long-term-conditions.pdf [Accessed 4 Jul. 2018].

DiCenso, A., Guyatt, G. and Ciliska, D., 2014. Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.

Hall, H.R. and Roussel, L.A., 2016. Evidence-based practice. Jones & Bartlett Publishers.

Hamer, S. and Collinson, G., 2014. Achieving Evidence-Based Practice E-Book: A Handbook for Practitioners. Elsevier Health Sciences.

Liamputtong, P., 2013. Research methods in health: foundations for evidence-based practice.

López?Campos, J.L., Tan, W. and Soriano, J.B., 2016. Global burden of COPD. Respirology, 21(1), pp.14-23.

Melnyk, B.M., Gallagher?Ford, L., Long, L.E. and Fineout?Overholt, E., 2014. The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), pp.5-15.

Miravitlles, M., Vogelmeier, C., Roche, N., Halpin, D., Cardoso, J., Chuchalin, A.G., Kankaanranta, H., Sandström, T., ?liwi?ski, P., Zatloukal, J. and Blasi, F., 2016. A review of national guidelines for management of COPD in Europe. European Respiratory Journal, 47(2), pp.625-637.

Naik, D., Joshi, A., Paul, T.V. and Thomas, N., 2014. Chronic obstructive pulmonary disease and the metabolic syndrome: Consequences of a dual threat. Indian journal of endocrinology and metabolism, 18(5), p.608.

Rice, M.B., Thurston, G.D., Balmes, J.R. and Pinkerton, K.E., 2014. Climate change. A global threat to cardiopulmonary health. American journal of respiratory and critical care medicine, 189(5), pp.512-519.

Rycroft, C.E., Heyes, A., Lanza, L. and Becker, K., 2012. Epidemiology of chronic obstructive pulmonary disease: a literature review. International journal of chronic obstructive pulmonary disease, 7, p.457.

Schmidt, N.A. and Brown, J.M., 2014. Evidence-based practice for nurses. Jones & Bartlett Publishers.

Bibliography:

LoBiondo-Wood, G., Haber, J., Berry, C. and Yost, J., 2013. Study Guide for Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

Puhan, M.A., Gimeno?Santos, E., Cates, C.J. and Troosters, T., 2016. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. The Cochrane Library.

Yuan, L., Dai, X., Yang, M., Cai, Q. and Shao, N., 2016. Potential treatment benefits and safety of roflumilast in COPD: a systematic review and meta-analysis. International journal of chronic obstructive pulmonary disease, 11, p.1477.