A systematic review of the effectiveness of clinical nurse specialist interventions in patients with chronic obstructive pulmonary disease (COPD)
, and | Aug 14, 2018
About this article
Article Category: Original Article
Published Online: Aug 14, 2018
Page range: 147 - 156
Received: Sep 03, 2017
Accepted: Nov 25, 2017
DOI: https://doi.org/10.2478/fon-2018-0019
Keywords
© 2018 Hua Yin, Ling Yang, Qiao Ye, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
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Figure 2
Alternative keywords and search strategy.
| Population | Interventions | Outcome |
|---|---|---|
| 1. Chronic respiratory disease | 5. Nurse specialist | 15. Safe* |
| 2. Discharged | 6. Clinical nurse specialist | 16. Effective |
| 3. Chronic obstructive pulmonary disease | 7. Advance practice nurse | 17. Effectiveness |
| 4. COPD | 8. Special nurse-led | 18. Exercise tolerance |
| 9. Specialist-led | 19. Pulmonary function | |
| 10. RNS-led | 20. Mortality | |
| 11. RNS | 21. Satisfaction | |
| 12. CNS-led | 22. The quality of life | |
| 13. Home-based | 23. Low cost | |
| 14. Outreach nursing | 24. Economic | |
| 25. Cost effectiveness | ||
| 26. Combination of 1–4 using “OR” | 27. Combination of 5–14 using “OR” | 28. Combination of 15–25 using “OR” |
| The last step is to combine 26+27+28 using “AND” |
Characteristics of included studies.
| Author (date published) | Journal | Setting | Sample | Intervention group | Control group | Outcomes | Duration of the study | Notes |
|---|---|---|---|---|---|---|---|---|
| Smith et al. (1999) | Australian and New Zealand Journal of Medicine | Adelaide, Australia | Patients with principal diagnosis of COPD attending The Queen Elizabeth Hospital ( | Patients received home-based nursing interventions including condition monitor, education, and early identification of exacerbations after leaving the hospital | Patients received usual care and education from outpatient clinics and GP services | Hospital admission Length of stay Emergency and outpatient department attendances Mortality rate FEV1 Health-related guality of life HRQL for patient caregivers | 12 months | Health-related guality of life was improved |
| Cotton et al. (2000) | Thorax | Glasgow, UK | Patients with diagnosis of exacerbation of COPD attending the Royal College of Physicians of London ( | The patients in the intervention group were sent home within 3 days after admitted. These patients were visited by a specialized nurse | Patients received the care of the medical unit and discharge with usual admission duration | Readmission Additional hospital days Mortality within 60 days | 14 months | Patients with acute exacerbations of COPD can be discharged home earlier than the current practice |
| Davies et al. (2000) | BMJ | Liverpool, UK | Patients with diagnosis of COPD based on standard criteria ( | Patients were visited morning and evening by nurses for three days after discharge | Patients received inpatient admission as usual | Readmission rates at 2 weeks and 3 months Changes in FEV1 Mortality Health status of patients Health-related guality of life | 18 months | No difference was found in mortality and FEV1 |
| Griffiths et al. (2000) | The Lancet | Wales, UK | Local hospital and local GP referring ( | The treatment group received a multidisciplinary treatment, including two sessions: a general education session and an individualized physical training session | Patients continued with their usual outpatient or primary care followup for 1 year | Health service use Walking tolerance Health status including St. George’s Respiratory Questionnaire | 12 months | Walking ability and health status were improved |
| Skwarska et al, (2000) | Thorax | Edinburgh, UK | Patients with exacerbation of COPD admitted to the Royal Infirmary of Edinburgh ( | Patients in the supported discharged group were discharged home with an appropriate treatment package and visited at home by a specialist nurse at the following day | Patients received treatment by the hospital team and discharge as usual | Health status (FEV1, etc.) Patients satisfaction Quality of life (Chronic Respiratory Questionnaire) Mean health service cost Rate of readmission for 8 weeks | 18 months | No difference in readmission and health status, satisfaction was good, and the average cost was much lower |
| Hernandez et al. (2003) | European Respiratory Journal | Barcelona, Spain | Patients in the ER of two hospitals in the Barcelona area ( | Patients in the intervention group supported by a skilled specialist nurse called patients regularly and provide consultation service, All of these calls and service were free within eight weeks after discharge. | Patients were evaluated by the attending physician. At discharge, the patient was usually supervised by the primary care physician | Mortality Hospital readmissions Rate of ER visit Quality of life (St. George’s Respiratory Questionnaire) Knowledge of the disease Patients’ satisfaction Health condition Overall direct cost per patient Days of inpatient hospitalization | 12 months | Comprehensive home care is cost effective |
| Vrijhoef et al. (2007) | Chronic Illness | Alkmaar, the Netherlands | Patients from the respiratory outpatient clinic of general and teaching hospital ( | Patients in the intervention group were transferred to respiratory nurses instead of respiratory physicians | Patients assigned to the usual care group received routine respiratory outpatient care provided by the respiratory care physician and follow-up consultations from their respiratory care physician at the outpatient clinic | Clinical parameters (caregivers’ registries) Health status (COOP/WONCA chart, St George’s Respiratory Questionnaire) Self-care behavior (including knowledge, Dutch instrument) Patient satisfaction Consultation with the main care providers | 16 months | Respiratory nurse reported more consultations, worsening in FV2008C, improvements in subjective knowledge, self-assessed rate for coping with COPD, and overall satisfaction |
| Efraimsson et al. (2008) | Scandinavian Journal of Caring Sciences | Sweden | Patients with COPD from a Swedish primary care setting ( | Patients received an education that laid emphasis on self-care ability and supported them according to their specific needs and ability to deal with the disease | The control group received a conventional care, including a first visit to the nurse, spirometry, and a follow-up visit to a physician | Knowledge of COPD and smoking habits (questionnaire specially developed for this study) Quality of life (St. George’s Respiratory Questionnaire) | 10 months | The program can improve patients’ quality of life and have effect on smoking habits |
| Sridhar et al. (2008) | Thorax | West London, UK | Patients with acute exacerbation of COPD admitted to a hospital in London ( | Patients received a care package incorporating initial pulmonary rehabilitation and self-management education and other support by a specialist nurse | Usual treatment from their primary care physician, secondary care physician, and/or the respiratory nursing service as appropriate | Hospital readmission rate Unscheduled primary care consultations Quality of life (Chronic Respiratory Questionnaire) | 24 months | Self-management of patients was improved |