A systematic review of the effectiveness and roles of advanced practice nursing in older people

Abstract

Objectives

To identify, assess and summarize available scientific evidence about the effect of interventions deployed by advanced practice nurses when providing care to older people in different care settings, and to describe the roles and components of the interventions developed by these professionals.

Background

In older people, evidence of advanced practice roles remains dispersed along different contexts, approaches and settings; there is little synthesis of evidence, and it is not easy to visualize the different practice models, their components, and their impact.

Design

Systematic review.

Data sources

Sixteen electronic databases were consulted (1990–2014). The research also included screening of original studies in reviews and reports from Centers of Health Services Research and Health Technology Agencies.

Review methods

Studies were assessed by two reviewers with the Cochrane risk of bias tool. They were classified depending on the type of follow-up (long and short-term care) and the scope of the service (advanced practice nurses interventions focused on multimorbid patients, or focused on a specific disease).

Results

Fifteen studies were included. In long-term settings, integrative, multi-component and continuous advanced practice nursing care, reduced readmissions, and increased patients’ and caregivers’ satisfaction. Advanced practice nurses were integrated within multidisciplinary teams and the main interventions deployed were patient education, multidimensional assessments and coordination of multiple providers.

Conclusion

Positive results have been found in older people in long-term care settings, although it is difficult to discern the specific effect attributable to them because they are inserted in multidisciplinary teams. Further investigations are needed to evaluate the cost-effectiveness of the two modalities detected and to compare internationally the interventions developed by advanced practice nurses.

Introduction

The Association des Infirmières et Infirmiers du Canada (AIIC) (2008), defines advanced practice nursing (APN), as “an advanced level of nursing practice that maximizes the use of specialized skills and nursing knowledge in order to respond to the customers’ needs in the health sphere”. In the United States, the introduction of these nursing roles with a high level of autonomy, dates back to the mid-1960s, whereas in Canada, those roles were introduced in the 1970s (Martin-Misener et al., 2010), but in many other countries they are irregularly developed. Many of these initiatives were launched to fulfill gaps in services traditionally carried out by physicians (DiCenso et al., 2010), in order to improve access to care, particularly in under-served areas (Delamaire and Lafortune, 2010), and as a consequence to the reduction of physicians workforce internationally (Dowling et al., 2013, Olson and Chioffi, 2005, Por, 2008). Despite this expansion, advanced practice roles are still difficult to define precisely because the term encloses a heterogeneous variety of practices, usually associated to local circumstances belonging to the setting where they are developed (Gardner et al., 2007).