Evaluating the nursing, midwifery and health visiting contribution to chronic disease management: An integration of three reviews

Abstract for ‘Health in Transition’, Conference in Australia, August 2009 Evaluating the nursing, midwifery and health visiting contribution to chronic disease management: An integration of three reviews
ObjectivesThis review integrated evidence from three related, but independent, reviews commissioned by the NIHR SDO (UK) in recognition of the growing prevalence of people with chronic diseases and the associated costs to them, their families, the health and social care services and the economy. The review aimed to synthesise the findings of the three reviews, highlight the types of NMHV activity and the contextual settings that have the strongest evidence base for practice, identify evidence gaps about effectiveness and appropriateness of NMHV interventions/models of care, methodological challenges and areas for future research.

MethodsThe three reviews investigated the roles of nurses, midwives and health visitors (NMHV) in chronic disease management (CDM) and explored transitions relating to NMHV interventions and evaluation across all levels of care. They employed different conceptual frameworks, methodologies and disease categories but using an iterative, consensus based approach, we developed an overarching protocol and a framework driven by current models of CDM.

Thematic findings were mapped on to the key NMHV contribution concepts identified in this framework, which included nursing roles, their impact on outcomes of care, cost effectiveness, patient perspectives, barriers and facilitators of nursing contribution to CDM

ResultsCollectively the reviews examined 477 research papers and 78 non research items. There is considerable heterogeneity in types of nursing roles, interventions and the level of nursing contribution to CDM. Whilst evidence indicated that nurses can provide safe and effective care and may have benefits in terms of quality of care, such as patient satisfaction, care experience and continuous support, the quality of evidence was poor (reflecting a low investment in nursing research). The methodological challenges of integrating reviews that differed in their conceptual frameworks, focus and theoretical approaches will be discussed.

ConclusionsThe implications for policy, organisation and delivery are that whilst nurses make a positive contribution to CDM, key issues to address include appropriate training, levels of autonomy for nurses, standardised nursing roles and functions recognising that different disorders and care contexts have different requirements for generic and specialist roles. Recommendations for research include the evaluations of specific nursing interventions (components of complex interventions) in relation to patient centred outcomes, standardising core components for case management in different care contexts, efficiency and patient experience of different assessment systems and user involvement in developing interventions and tools for measuring patient reported outcomes.