Effectiveness of registered nurses on patient outcomes in primary care: a systematic review

Abstract

Background Globally, registered nurses (RNs) are increasingly working in primary care interdisciplinary teams. Although existing literature provides some information about the contributions of RNs towards outcomes of care, further evidence on RN workforce contributions, specifically towards patient-level outcomes, is needed. This study synthesized evidence regarding the effectiveness of RNs on patient outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. A comprehensive search of databases (CINAHL, MEDLINE Complete, PsycINFO, Embase) was performed using applicable subject headings and keywords. Additional literature was identified through grey literature searches (ProQuest Dissertations and Theses, MedNar, Google Scholar, websites, reference lists of included articles). Quantitative studies measuring the effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN) that reported related outcomes were included. Articles were screened independently by two researchers and assessed for bias using the Integrated Quality Criteria for Review of Multiple Study Designs tool. A narrative synthesis was undertaken due to the heterogeneity in study designs, RN-led interventions, and outcome measures across included studies. Results Forty-six patient outcomes were identified across 23 studies. Outcomes were categorized in accordance with the PaRIS Conceptual Framework (patient-reported experience measures, patient-reported outcome measures, health behaviours) and an additional category added by the research team (biomarkers). Primary care RN-led interventions resulted in improvements within each outcome category, specifically with respect to weight loss, pelvic floor muscle strength and endurance, blood pressure and glycemic control, exercise self-efficacy, social activity, improved diet and physical activity levels, and reduced tobacco use. Patients reported high levels of satisfaction with RN-led care. Conclusions This review provides evidence regarding the effectiveness of RNs on patient outcomes in primary care, specifically with respect to satisfaction, enablement, quality of life, self-efficacy, and improvements in health behaviours. Ongoing evaluation that accounts for primary care RNs’ unique scope of practice and emphasizes the patient experience is necessary to optimize the delivery of patient-centered primary care. Protocol registration ID PROSPERO: International Prospective Register of Systematic Reviews. 2018. ID=CRD42 018090767.

Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review

“…While it is possible that quantitative measurements alone are insufficient to capture the holistic impact of system navigation, it is also conceivable that interventions focused primarily on linking patients to existing community-based health and social services may be insufficient to influence significant changes in patient-related health and health behaviour outcomes. For example, evidence from a recent systematic review demonstrates that chronic disease/case management and disease prevention initiatives led by registered nurses in primary care settings are effective for improving health outcomes and health-related behaviours such as weight loss, smoking cessation, diet and physical activity, self-efficacy, and social activity [ 63 ]. Thus, while team-based system navigation may be effective for improving health service utilization by supporting patients to access the most appropriate services to meet their needs, the lack of clinical care provision within system navigation programs, when compared to primary care-based chronic disease and/or case management interventions [ 27 ], may limit the possible impact of system navigation alone on health-related outcomes.…”

Effectiveness of System Navigation Programs Linking Primary Care with Community-Based Health and Social Services: A Systematic Review

“…While it is possible that quantitative measurements alone are insu cient to capture the holistic impact of system navigation, it is also conceivable that interventions focused primarily on linking patients to existing community-based health and social services may be insu cient to in uence signi cant changes in patientrelated health and health behaviour outcomes. For example, evidence from a recent systematic review demonstrates that chronic disease/case management and disease prevention initiatives led by registered nurses in primary care settings are effective for improving health outcomes and health-related behaviours such as weight loss, smoking cessation, diet and physical activity, self-e cacy, and social activity (57). Thus, while team-based system navigation may be effective for improving health service utilization by supporting patients to access the most appropriate services to meet their needs, the lack of clinical care provision within system navigation programs, when compared to primary care-based chronic disease and/or case management interventions (27), may limit the possible impact of system navigation alone on health-related outcomes.…”

Integration of primary care education into undergraduate nursing programs: a scoping review protocol

“…RNs practicing in PC settings function as generalists who provide a broad range of services, including chronic disease management; episodic care; assessment, screening, and preventative care; health education; and therapeutic interventions 4 . Recent systematic reviews indicate that RNs in PC are associated with positive outcomes, including better patient satisfaction, lower rates of hospitalization, increased health promotion/education, and better chronic disease management 5,6 . Furthermore, health care professionals working in PC teams that include RNs report satisfaction and joy in their work 7 …”