Faculty of Health and Wellbeing

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 Professional impact Quality of working life Professional social significance Professional social validity • Symptomatology • Quality of life/Quality of patient experience • Social significance • 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. Total Citations = 2313 Database references n = 2132 Grey literature results n = 181 Title/abstracts screened (excl duplicates) n = 1440 Rejected at title/abstract stage n = 1305 Full papers n = 135 n = 177 excluded Rejected at full paper stage n = 102 Total papers n = 33 + 4 grey literature + 3 handsearching Rejected at data extraction n = 5: 35 included papers (36 primary studies)

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 A&E 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/_assets/pdf/hsc-EmpoweringFrontlineStaffReport.pdf • Guest et al (2004) An evaluation of the impact of nurse, midwife and health visitor consultants. King’s 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@shu.ac.uk Faculty of Health and Wellbeing