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) - PowerPoint PPT Presentation

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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)

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Title: 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)


1
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
2
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

3
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)

4
  • 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

5
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

6
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

7
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

8
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

9
(No Transcript)
10
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

11
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

12
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

13
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

14
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

15
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.

16
Any questions?k.gerrish_at_shu.ac.uk
Faculty of Health and Wellbeing
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