Evaluation of the impact of nurse consultant roles in the United Kingdom: a mixed method systematic literature review Kate Gerrish, Ann McDonnell, Fiona Kennedy (funded by the Burdett Trust for Nursing)

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Evaluation of the impact of nurse consultant
roles in the United Kingdom a mixed method
systematic literature review Kate Gerrish, Ann
McDonnell, Fiona Kennedy(funded by the Burdett
Trust for Nursing)
Faculty of Health and Wellbeing
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Introduction

• Nurse consultants (NC) introduced into the NHS in
  England in 2000
• Early work in UK showed some evidence of NC
  impact in developing services providing
  leadership for frontline staff (Guest et al.
  2004)
• Previous reviews have been methodologically
  limited growing interest prompts the need to
  assess current state of evidence

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Framework for capturing impact

• Empowering frontline staff to deliver evidence
  based care the contribution of nurses in APN
  roles (Gerrish et al 2007)
• Framework of clinical professional significance
• Extended from work by Schultz et al (2002)

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• Clinical significance

• Professional significance

• Symptomatology
• Quality of life/Quality of patient experience
• Social significance
• Social validity

• Professional impact
• Quality of working life
• Professional social significance
• Professional social validity

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Aims of review

• To explore the impact of nurse consultants on
  patient and professional outcomes within adult
  healthcare settings
• To identify the extent to which existing studies
  have used quantitative outcome measures or
  qualitative dimensions of impact
• Further refine the proposed framework for
  capturing the impact of NC roles
• Preliminary stage of larger study on impact of NC
  roles

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Methods

• Broad search strategy
• Databases MEDLINE, PsycINFO, Pubmed, CINAHL,
  British Nursing Index, Cochrane Library, Scopus,
  Web of Knowledge
• Grey literature incremental searching plus
  contact with known experts
• Quantitative and qualitative studies included
• All citations double reviewed against a priori
  inclusion criteria

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Methods cont.

• No minimum quality threshold
• All included studies double reviewed using
  established tools/checklists
• Quantitative studies were appraised using Thomas
  et al (2003)
• Qualitative studies appraised using the CASP
  framework (2006)
• Rees et al (2010) checklist was used for
  descriptive surveys

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Methods cont.

• Data extraction on customised forms for each
  study design
• Dimensions of impact mapped on to the proposed
  framework for assessing impact
• Overarching synthesis use of matrices to explore
  how the evidence from the qualitative studies
  added to, challenged or identified gaps in the
  evidence from the quantitative studies and vice
  versa

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Findings

• 36 primary studies - 12 quantitative with a
  comparison group, 9 descriptive surveys (no
  comparison) and 15 qualitative studies
• Heterogeneity in terms of clinical setting,
  nature of clinical services and outcomes assessed
• Overall, study quality was weak
• In quantitative studies, study design
  compromised by lack of adequate comparators
• In qualitative studies focus was often on
  processes rather than outcomes of care

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Clinical significance

• Symptomatology
• Qual - e.g. resolving patient problems/controlling
  symptoms
• Quant - e.g. reduced anxiety
• QoL/quality of patient experience
• Qual - e.g. patient satisfaction with care
• Quant - e.g. patient satisfied with explanation
  of tests
• Social significance
• Qual - e.g. reduced waiting times/seen quicker
• Quant - e.g. reduced length of stay or AE
  attendance
• Social validity
• Qual Quant evidence of acceptance/preference of
  NC by patients

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Professional significance

• Professional impact
• Qual - e.g. helping others to develop their
  practice/expertise
• Quant - very little evidence - e.g. increased
  accuracy of recordings/ observations
• Quality of working life
• Qual - e.g. enhanced team/staff morale
• Quant - almost no evidence - only e.g. staff
  reported feeling supported
• Professional social significance
• Qual - e.g. implications for workload/remit of
  others
• Quant - almost no evidence - only e.g. single
  item alluding to impact on medical colleagues
  roles
• Professional social validity
• Qual Quant evidence of value of NC role to staff

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Discussion - where to now?

• Although study quality is poor, evidence suggests
  a largely positive impact review suggests range
  of areas that NCs potentially influence
• Further robust research is required
• Quantitative evidence on professional outcomes
• Quantitative/qualitative involving patients
• Proposed framework could help NC (APNs?) in
  practice assess their impact guide future
  research

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Watch this space

• Development of toolkit/guidance to help NC
  capture evidence of their impact
• including reflective activities, tips to address
  challenges, and possible tools for capturing
  evidence
• Has been developed through in-depth case studies
  with several NCs in larger study exploring NC
  impact

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References

• Full paper on this work is currently under review
  in JAN
• Gerrish et al (2007). Empowering frontline staff
  to deliver evidence based care the contribution
  of nurses in APN roles. http//www.shu.ac.uk/_asse
  ts/pdf/hsc-EmpoweringFrontlineStaffReport.pdf
• Guest et al (2004) An evaluation of the impact of
  nurse, midwife and health visitor consultants.
  Kings College London, London.
• Schultz et al (2002) Dementia caregiver
  intervention research in search of clinical
  significance. BMJ 42(5), 589.

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Any questions?k.gerrish_at_shu.ac.uk
Faculty of Health and Wellbeing