Evidence-Based Practice in Health Care: Reinforcing Safe Practice

Introduction
The essay will present a critical examination that how evidence-based practice reinforces safe
practice in health care. It will also differentiate between different types of evidence that are
used in nursing practice. The chosen research topic is benefits to people diagnosed with
Chronic Obstructive Pulmonary Disease (COPD) by the specialist nurses. The research topic
is based on the second Domain of the NHS Framework which is “Enhancing quality of life
for people with long-term conditions”. In 2011, around 1.2 million people have been
diagnosed with COPD according to Department of Health. This makes COPD the second
most common lung disease in the UK, second to asthma. The magnitude of the disease
demands its active and efficient management and therefore, this topic is chosen for this
assignment. Management of long-term disorders such as COPD is challenging for the
healthcare professionals. Chief causes of development of COPD in a person includes
smoking, second-hand smoking, pollution or genetic factors. Specialist nurse have proven
useful to the healthcare facilities by implementing innovative ways of working (RCN, 2010).
In the past, specialist nurses have provided holistic care and timely interventions which
helped in reducing patient morbidity and also prevented expensive care episodes like
unintended hospital admissions (Baxter & Leary, 2011). When people diagnosed with COPD
are directly referred to COPD specialist nurses, a reduction in unrequired hospital admissions
is observed (Knolle, et al., 2011). The essay will provide evidence for association between
specialist nurses and health outcome of COPD patients through a range of evidences found in
the literature. 5 articles have been chosen for that purpose. A research question based on the
issue is formulated using PICO framework. Data is extracted from the five studies using
Timmins and McCabe (2005) framework. These studies are then critically appraised using
CASP framework. Further a discussion of the themes that emerged through critical appraisal
is done. Lastly, based on the discussion, recommendations are provided on the research
problem.
Background
Current models of health care delivery for people with long term diseases are unsustainable
and those people need support in manage their conditions (Department of Health, 2011), and
subsequently avoid hospital admission. One of these prevalent long-term diseases is COPD,
which is characterised by advancing deterioration of lung capacity, recurrent hospital

admissions, disability, and depression (McLean, et al., 2012). COPD is a degenerative
disorder which demonstrates chronic airflow obstruction because bronchitis, emphysema, or
both (Yawn & Thomashow, 2011). People diagnosed with COPD experience acute
exacerbations and their quality of life is impaired which is frequently the cause of their
hospital presentation, admission and stay (Heaney, et al., 2009). Hospital admission are
effective in providing relief in of the acute exacerbations but it fails to adequately address the
issues of long-term issues of fatigue, poor exercise tolerance, and depression are often not
appropriately managed (Brill & Wedzicha, 2014). Moreover, prognosis for people with
COPD who are above 50 years age and need hospitalisation is unfavourable (Fried, et al.,
2012), and the number of deaths due to COPD has remained constant for last three decades.
Therefore, to manage the situation, various alternatives to hospital admissions are found such
as nursing care through home-based programmes, respiratory rehabilitation, etc. Support after
discharge through nurse visits is seen as a substitute to hospital admission which is cost
effective and safe option (Escarrabill, 2009). Support to patient in the form of nurse visits at
patient’s home or through telephone after discharge has decreased hospital admissions later
(Steventon, et al., 2012).
In the past, it was believed that long-term conditions can be controlled by the health
professional (Anderson & Funnell, 2005). But, it is found that the daily responsibilities
regarding the care of a long term condition also lies with the patient and their families (Korff,
et al., 2002). The White Paper “Equity and Excellence: Liberating the NHS” published by
NHS also established this need. This placed a prospect that shared decision making must be
set as standard with the idea of ‘no decision about me without me’ (Department of Health,
2010b). particularly, in chronic diseases such as COPD, it is vital that the patient participates
in management of his condition and modifies his/her behaviour and lifestyle to the outcomes
of their disease (Babiker, et al., 2014). To make this a possibility, healthcare facilities must
acknowledge the role of patients in their own care for long-term conditions (Entwistle, et al.,
2018). So, it can be established that specialist nursing care has been proven beneficial in
management of COPD. (Vahdat, et al., 2014). This research will focus on a particular aspect
of management of COPD, that is hospital admissions. The purpose of this study will be to
investigate the effect of specialist nursing care on the rate of hospital admission among
people diagnosed with COPD. It is hypothesised that there will be an inverse association
between specialist nursing care and hospital admission which will eventually lead to
enhancement in quality of life of people with COPD.

Formulation of a research question
Research question for the chosen topic was formed by using the PICO framework as shown
in Table 1
Table 1 PICO framework to develop research question
Population (P) Patient diagnosed with COPD
Intervention (I) Specialist Nursing Care
Comparison (C) No Specialist Nurse
Outcome (O) Prevention of recurrent hospital admission
Research question
Does intervention from specialist nurses helps to prevent hospital admissions of patient
with COPD?
As indicated above, previous studies have found that if patients of COPD are given specialist
nursing care, their health outcome is likely to be better than when they receive non-specialist
nursing care. Improved health outcomes for the patients will result in reducing patient
morbidity and mortality and thereby improving their quality of life. It is essential that people
who have to live with long-term condition must have improved quality of life so that they can
live with the disease which is focus of the Domain 2 of the NHS Outcomes Framework
(2017/18). It is essential to answer the formulated research question as it can guide the
pathway of interventions for people with COPD. Findings from this review can establish the
usefulness of the specialist nursing `-term conditions such COPD which may lead to build
specialist interventions by training the nurses in required domains.
Methodology
Literature search strategy
A review of the literature was conducted in order to answer the research question. Suitable
original articles pertaining to the research topic were found by searching the databases,
MEDLINE, CINAHIL and PubMed. Articles published within last 20 years in English

language were selected. Articles which focused on the specialist nursing care and found the
association between specialist nursing care and hospital admission rate were considered.
Keywords used for primary search were “COPD”, “specialist nurse”, “recurrent”, “hospital
admission” and “chronic obstructive pulmonary disease”. Boolean operators (AND, OR)
were used to make the search more productive and focused. Search was continued further
through medical subheading (MeSH). Google scholar was also used for the search. A manual
review of the reference list of all the retrieved articles were done. When results of the same
cohort were presented at more than one studies, only single most direct article was chosen to
avoid duplication. When the articles were selected, the titles and abstract were screened to
determine their relevancy. Then articles were filtered through full-text format eligibility. The
article inclusion flow chart can be found in Table 2.
Inclusion criteria
 English language for understanding issues
 Published within last 20 years to make the research current
 Full-format text availability to find out the relevant information from each chosen
article.
Exclusion criteria
 Non-English language for understanding issues
 Irrelevancy to the research topic