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Systematic Review Unveils Gaps in District Nursing Care for Older Adults

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Understanding the quality of care delivered by district nurses is crucial for enhancing patient outcomes. Despite the importance, there is a notable absence of a comprehensive overview of the interventions executed by district nurses, the evidence supporting their effectiveness, or the nurse-sensitive outcomes that should be measured for these interventions. This study aims to bridge this gap by systematically reviewing the existing literature on district nursing care interventions for community-living older people and evaluating the evidence for their effectiveness.

Study Objectives and Methodology

The primary objectives of the study were to provide an exhaustive list of interventions for older adults evaluated in district nursing care and to appraise the evidence supporting these interventions. Additionally, the study aimed to identify nurse-sensitive outcomes used to measure the effectiveness of these interventions, the methods employed for their measurement, and the patient groups they were applied to.

To achieve these objectives, a systematic review of the literature was conducted, focusing on experimental studies that evaluated district nursing care interventions. Data were sourced from MEDLINE, CINAHL, PsycInfo, and EMBASE. A custom data extraction form was used to gather study characteristics and assess the interventions and outcomes. The methodological quality of the included studies was appraised using a 13-item critical appraisal tool developed by the Joanna Briggs Institute.

Results and Findings

The review included 22 studies, with methodological quality scores ranging from 6 to 11 on a 13-point scale. The interventions identified were highly diverse in terms of components, delivery methods, and target populations. A total of 44 outcomes were categorized following the Nursing Outcome Classification and were measured in various ways and at different times.

The results revealed significant heterogeneity in the interventions and the outcomes used to evaluate them. This variability underscores the need for a standardized approach to measure the effectiveness of district nursing care interventions.

Concrete Insights for Nursing Practice

– Standardization of interventions and outcomes is critical for assessing the quality of district nursing care.
– There is a need for high-quality, methodologically robust research to identify effective nursing interventions.
– Diverse intervention components and delivery methods suggest tailored approaches may be necessary for different patient groups.
– The Nursing Outcome Classification can serve as a valuable tool for categorizing and standardizing outcomes in nursing studies.

This study is the first systematic review summarizing the evidence for the effectiveness of nurse-led interventions conducted by district nurses for community-living older people. However, the review highlights the uncertainty surrounding which interventions are most effective and what outcomes should be measured to substantiate the effectiveness of district nursing care. Given that only experimental studies were included, the findings may present an incomplete picture of the effectiveness of these interventions. Therefore, methodologically strong research programs focusing on district nursing care are highly necessary.

Original Article: Int J Nurs Stud Adv. 2021 Nov 23;3:100053. doi: 10.1016/j.ijnsa.2021.100053. eCollection 2021 Nov.

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