Table 3 Summary of papers included in the review

(Ayerle, Makowsky and Schücking 2012) [50]

Germany, home visiting

Mixed method:

review of family records, 30 questionnaire and interviews with 14 mothers and 6 social workers

734 families whose vulnerability was scored according to factors such as conflict, drug abuse, social support, mental health, stress, teenage pregnancy, immigrant status

To examine the role of family midwives in the provision of care to vulnerable women and prevention of child neglect and abuse

The highest frequencies of care activities related to infant care and nutrition, giving advice on the mother-child relationship, and psychosocial support. The youth welfare services were significant collaborators. Mothers felt it was important to have early access to the FM and easy between-visits communication via phone calls or text messages. They appreciated the physical and psychosocial care for the infant and themselves.

(Bray et al. 2005) [51]

USA Eastern Carolina, clinics

Intervention study

160 minority African American patients in rural areas

To explore the efficacy of combining nurse-led-care management and interdisciplinary group visits for patients with diabetes mellitus

In the intervention group, 61% of patients had a reduction in HbA1c, and the percentage of patients with a HbA1c of less than 7% improved from 32% to 45% (P, 0.5).

(Chang et al. 2009) [39]

Kampala Uganda, community

Retrospective cohort study

360 urban slum dwelling HIV + people on ART of low socio-economic status in an already poor country and a significant proportion consists of displaced persons from the civil war in northern Uganda

To assess an alternative model, community-based, comprehensive antiretroviral programme staffed primarily by peer health workers and nurses

258 (72%) were active and on therapy approximately 2 years later.

(Chetty and Hoque 2013) [40]

South Africa: KwaZulu-Natal community psychiatric clinic

Quasi-experimental, non-equivalent, control group design study design

30 depressed Indian poor urban participants

To determine the effectiveness of a nurse-facilitated-cognitive-group intervention as an adjunct to antidepressant medication

At 6 weeks of the intervention, there was a decrease in the Beck Depression Inventory (BDI) scores of the intervention group and an increase in the BDI scores in the control group. At 12 weeks of the group intervention, the BDI scores for the intervention group showed a considerable reduction in their levels of depression, while the participants of the control group had a further increase in their scores—statistically significant difference between the groups, (P < 0.001)

(Coddington et al. 2011) [52]

USA Indiana, nurse-managed clinics

Non-experimental design review of child records

500 charts of patients from uninsured families or families on Medicaid

To assimilate evidence regarding quality of care received at nurse-managed clinics

Nurse-managed clinics met or exceeded national Healthcare Effectiveness and Data Information Set quality indicators as well as targets set by the Office of Medicaid Policy and Planning

(Dorney-Smith 2011) [53]

Hostel in South London, UK

Descriptive study using patient records to assess care usage and health outcomes

34 homeless males and females average age was 39 years

To assess outcomes of 1 year to reduce mortality and morbidity and secondary care usage at the hostel

34 hostel clients directly benefited from intermediate care. At the end of the year, the number of hospital admissions to the hostel had dropped 77% relative to 2008, and the number of accident and emergency (A&E) attendances had dropped 52%. Hospital “did not attends” (DNAs) were 22% lower. An economic evaluation found that the pilot project was cost neutral overall, and there is some evidence that health outcomes improved. intermediate care pilot project

(Ersser et al. 2013) [54]

Inner city metropolitan borough, England, UK GP clinics

Descriptive quantitative pretest-post-test design using health-related quality of life measures, severity measures, parental measure. Qualitative focus groups with parents

Families from high mobility, ethnic diversity and social deprivation setting

To evaluate the nurse-led Eczema Education Programme

Statistically significant impacts were observed on infant quality of life (P < 0.001), child quality of life (P = 0.027), disease severity (P < 0.001) and parental self-efficacy (P < 0.001). Improvements in child quality of life, parental efficacy and service impact were also evident from qualitative data. The cumulative total of all GP visits for selected participants post-EEP reduced by 62%.

(Frankenberg et al. 2009) [41]

Indonesia 13 of 26 provinces at village level

Secondary analysis of Indonesia Family Life Survey dataset (1993,1997, 2000) using logistic modelling

7224 households including the poor with low education in rural areas

To investigate the impact of scale up of midwives in access to midwifery services on women’s use of antenatal care and delivery assistance

Regardless of a woman’s educational level, the placement of village midwives in communities is associated with significant increases in women’s receipt of iron tablets and in their choices about care during delivery—changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy.

(Gill et al. 2008) [42]

Rural KwaZulu-Natal in South Africa outreach clinics

Quasi-experimental study using clinical records and

284 rural poor with diabetes

To evaluate a nurse-led diabetes protocol and education-based system

A total of 284 patients were enrolled, with 197 followed for 18 months (13 died and 26% lapsed during the period). HbA1c was 11.6 ± 4.5% (sd) at baseline, 8.7 ± 2.3% at 6 months and 7.7 ± 2.0% at 18 months. There was a small associated increase in weight but no increase in hypoglycaemia. Subgroup analysis showed that education alone, without drug type or dose changes, also improved control (HbA1c 10.6 ± 4.2% baseline and 7.6 ± 2.3% at 18 months). The service was very popular with patients, families and other health workers.

(Goodman et al. 2005) [55]

England shire and inner London in homes and in care facilities

Focus groups and survey conducted in two settings with staff

74 community-based nurses and care home managers and staff providing care to older people in care homes and in their own home

To examine partnership of district nurses and care home staff providing care for older people

Nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working.

(Griffiths et al. 2009) [56]

Australia: Western Sydney, community

Cross-sectional survey design, administered at two time points

327 women in a socially and economically disadvantaged community

To measure the effect of a community capacity-building programme implemented by Women’s Health Nurses

There was a significant improvement in mental health indicators and fewer women believed their physical or emotional problems imposed a considerable burden on their daily activities. They also believed people from other cultures were more likely to be accepted by neighbours and reported increased involvement in community activities as a direct result of the Villawood Icebreakers Project.

(Gross et al. 2010) [43]

Kenya

Secondary analysis of dataset from the Kenya Health Workforce Informatics System using logistic modelling

Nurses employed in Kenya’s public sector in rural and underserved areas

To analyse the effect of Kenya’s Emergency Hiring Plan for nurses on their inequitable distribution in rural and underserved areas

Of the 18 181 nurses employed in Kenya’s public sector in 2009, 1836 (10%) had been recruited since 2005 through the Emergency Hiring Plan. Nursing staff increased by 7% in hospitals, 13% in health centres and 15% in dispensaries. North Eastern province, which includes some of the most remote areas, benefited most: the number of nurses per 100 000 population increased by 37%. The next greatest increase was in Nyanza province, which has the highest prevalence of HIV infection in Kenya. Emergency Hiring Plan nurses enabled the number of functioning public health facilities to increase by 29%. By February 2010, 94% of the nurses hired under pre-recruitment absorption agreements had entered the civil service.

(Hesselink and Harting 2011) [57]

Netherlands in parent-child centres

Mixed methods: multiple case study field notes, observations and recordings of group classes, attendance logs, semi-structured individual interviews, a focus group interview, and structured questionnaires

119 first- and second-generation pregnant ethnic Turkish women with low education and minimal knowledge of Dutch

To evaluate a multiple risk factor perinatal programme ethnic Turkish community health workers in collaboration with midwives and physiotherapists

Most participants (82%) were first-generation ethnic Turkish, 47% had a low educational level, 43% were pregnant with their first child and 34% had a minimal knowledge of the Dutch language. The community health workers’ Turkish background was vital in overcoming cultural and language barriers and creating a confidential atmosphere. Participants, midwives and health workers were positive about the programme. Midwives also observed improvements of knowledge and self-confidence among the participants. The integration of the community health workers into midwifery practices was crucial for a successful programme implementation.

(Homer et al. 2012) [58]

Australia: Sydney in women’s homes, community health centre

Mixed methods: a focus group discussion and review of patient records

353 Aboriginal and Torres Strait Islander women who gave birth in 2007 and 2008

To examine the perspectives of women accessed the service

353 women gave birth through the Malabar service during 2007 and 2008. Over 40% of the babies born were identified as Aboriginal and Torres Strait Islander. Almost all the women had their first antenatal visit before 20 weeks of pregnancy. The service was successful in reducing the number of women smoking cigarettes during pregnancy. Women felt the service provided ease of access, continuity of care and caregiver, trust and trusting relationships.

(Hurley et al. 2013) [59]

Police custody suites in Tayside Scotland, UK

Qualitative study using focus groups and interviews underpinned by realistic evaluation method

28 nurses and nurse manager, police and security personnel caring for 4953 offenders

To explore the impact of nurses assuming leadership roles in delivering primary health care to detainees

The quality of clinical care for detainees improved, policing concerns for detainee safety were mitigated and forensic medical examiners were able to expand their specialist roles. Key supporting mechanisms in achieving these outcomes included generating collaborative practices, enacting clinical leadership and providing a forensic nursing educational programme to empower nurses to generate service provision and grow professional autonomy.

(Jackson et al. 2009) [60]

UK: North England, community health

Mixed methods: 21 survey and 9 focus group discussions at baseline, 6 and 12 months post-implementation

Individuals holding strategic posts in the Public Health and Nursing Directorates, health visitors, school nurses, voluntary sector staff delivering interventions to address health inequalities

To evaluate the community health team working in a defined geographical or topic area

Six themes emerged from the focus group data that illustrated key issues for the implementation of the CHT: “agreeing the focus”, “strong leadership”, “the challenge of communication”, “managing workloads and new ways of working”, “success of the CHT” and “outside influences”. Communication and heavy workloads were identified as key barriers to the success of the CHT in the questionnaire data.

(Labhardt et al. 2011) [44]

Primary health care clinics in rural districts in Central Cameroon

Open-label, three-arm, cluster-randomized trial in nurse-led facilities

221 poor, rural patients with hypertension and diabetes

To compare the effects of low-level facility-based interventions on patient retention rates for cardiovascular (CV) disease in an environment of task shifting and nurse-led care in

A total of 33 centres and 221 patients were included. After 1 year, 109 patients (49.3%) remained in the programme. Retention rates in groups 2 and 3 were 60% and 65%, respectively, against 29% in the control group. The differences between the intervention groups and the control group were significant (P < 0.001), but differences between the two intervention groups were not (P = 0.719). There were no significant differences in BP or fasting plasma glucose trends between retained patients in the study groups. Average monthly cost to patients for antihypertensive medication was €1.1 ± 0.9 and for diabetics €1.2 ± 1.1. Transport costs to the centres were on average €1.1 ± 1.0 for hypertensive patients and €1.1 ± 1.6 for patients with diabetes.

(Lamers et al. 2010) [61]

General practices, Limburg, the Netherlands

Randomized controlled trial

187 elderly patients with chronic obstructive pulmonary disease and symptoms of depression

To evaluate the effectiveness of a nurse-led minimal psychological intervention (MPI) in reducing depression and anxiety and improving disease-specific quality of life

Patients receiving the MPI had significantly fewer depressive symptoms (mean BDI difference 2.92, P = 0.04) and fewer symptoms of anxiety (mean SCL difference 3.69, P = 0.003) at 9 months than patients receiving usual care. Further, mean SGRQ scores were significantly more favourable in the intervention group than in the control group after nine months (mean SGRQ difference 7.94, P = 0.004).

(Larson et al. 2010) [62]

Rural general practices, Western Australia

Prospective cohort with before-after measures

83 patients from rural areas with asthma

Trialled the outcome for asthma patients of a brief, nurse-led, patient-education session with general practice review of an asthma action plan

Mean asthma control score decreased but did not reach statistical significance (P = 0.124). Quality of life improved for adults (Wilcoxon rank signed test for two related samples P < 0.001). The proportion of patients who had one or more unscheduled visits to their general practitioner over 12 months decreased from 23% to 13% (P = 0.178), and emergency department presentations decreased from 9% to 4% (P = 0.102).

(Leipert et al. 2011) [63]

Nurse practitioner services, rural southwest Ontario, Canada

Qualitative in-depth, face-to-face interviews using interpretive description methodology

9 rural women, aged 18–80 using nurse practitioner services

To explore rural women’s experiences with primary health care nurse practitioners

The participants in the study particularly appreciated the nursing knowledge of the NP, the time the NPs spent with them, and the thoroughness of the care provided by NPs. These foundational elements of the participants’ experiences with rural NPs created a sense of trust and respect, which lead to a collaborative partnership between the NP and the rural women.

(Markle-Reid, Browne and Gafni 2013) [64]

Home visiting Southern Ontario, Canada

3 randomized controlled trials using (HRQOL) (SF-36) and Health and Social Services Utilization Inventory from baseline to the end of the intervention

498 frail older adults with chronic health conditions and depression

To explore the main lessons learned from three trials to inform the design of best practice models for nurse-led health promotion interventions

Nurse-led HPDP interventions led to greater improvements in HRQOL compared with usual home care services. The cost analysis showed that even when the costs of the HPDP interventions were included in the total cost, there was no difference in the total per-person cost of health services between the HPDP intervention and usual home care.

(Markle-Reid et al. 2014) [65]

Home visiting Ontario, Canada

Prospective one-group pre-test/post-test study design. CES-D score, GAD-7, HRQOL (SF-12v2) and HSSUI. Thematic analysis of RN and PSW focus groups, content analysis of clients’ responses to the open questions

142 elderly home care clients

To examine the feasibility and acceptability of a new 6-month interprofessional nurse-led mental health promotion intervention and to explore its effects on reducing depressive symptoms

Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQOL at 6-month follow-up, with small additional improvements 6 months after the intervention. The intervention also reduced anxiety at 1 year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services and emergency room visits over the study period.

(Mills 2014) [66]

HM Prison Risley, in the north west of England, UK

A retrospective audit of health records

27 male prisoners

To examine whether providing a nurse-led specialist diabetes service within the prison setting can improve the management of diabetes by reducing HbA1c

The results showed that hospital admission rates reduced, with only two admissions in 12 months. One was due to hypoglycaemia (overdose) and one due to infection. There were no admissions for diabetic ketoacidosis. Baseline HbA1c was 74 mmol/mol (8.9%); range 39–108 mmol/mol (5.7–12.0%). At 1-year follow-up, HbA1c had decreased to 58 mmol/mol (7.5%); range 56–119 mmol/mol (7.3–13.0%). The number of episodes of severe hypoglycaemia in the preceding 12 months was greatly reduced from 17 to 1 (P < 0.001).

(Neff, Kinion and Cardina 2007) [67]

USA: north-eastern Ohio

Quantitative descriptive review of patient records

334 Native American patients

To describe the nursing interventions provided at an urban nurse-managed centre to urban Native Americans.

The majority were over 40 years of age, were female, were single, completed high school and were poor and uninsured, and many were unemployed. The most frequent health problems were related to pain, cardiovascular symptoms, dentition problems and respiratory illnesses. The most frequent nursing interventions were for surveillance of physical signs and symptoms.

(Oliver et al. 2014) [68]

USA

Quantitative from multiple data sets

Medicare: national social insurance programme serves a large population of elderly and disabled individuals. Medicaid: social health care programme for families and individuals with low income and limited resources

Examine for a statistically significant relationship between the level of APRN practice allowed and recent nationwide, state-level analyses of Medicare or Medicare-Medicaid beneficiaries

States with full practice of nurse practitioners have lower hospitalization rates in all examined groups and improved health outcomes in their communities.

(Price et al. 2011) [45]

Hlabisa District, in northern KwaZulu-Natal, South Africa

Single-centre, observational cohort study.

80 type 2 diabetic patients in rural Africa

To determine the long-term (4 years) glycaemic outcome of a structured nurse-led intervention programme

Patients were of mean plus or minus SD, age 56 plus or minus 11 years, 70% were female, BMI 31.5 plus or minus 7.2 kg/m super(2) and HbA sub(1)c 10.8 plus or minus 4.2%. HbA sub(1)c fell significantly to 8.1 plus or minus 2.2% at 6 months and 7.5 plus or minus 2.0% at 18 months. By 24 months, it had risen (8.4 plus or minus 2.3%), and at 4 years post-intervention, it was 9.7 plus or minus 4.0% (still significantly lower than baseline, P = 0.015). BMI rose significantly at 6 and 18 months but by 48 months was not significantly different from baseline.

(Riley and Crawford 2010) [69]

General practice setting, Hawkes Bay, New Zealand

Audit of health facility records

265 consultations carried out over an 18-month period. 75% with Maori/Pacific Island and NZDep96 quintile groups 4 and 5 children and their whanau/families

To describe the implementation of a nurse-led, child-specific clinic to improve health outcomes for high needs

An outcome audit after 18 months demonstrated a significant (>30%) reduction in eczema severity, daily irritability and daily occurrence of pain. Post-intervention, fewer children were hospitalized and there was a 50% reduction in antibiotic use.

(Sears et al. 2008) [70]

Washington State, USA

Natural experiment was evaluated using descriptive techniques and a pre-post design

Rural workers 18–70 years of age who were injured in Washington and filed an accepted State Fund workers’ compensation claim between July 1, 2003, and June 30, 2005

(1) Describe the contribution by NPs to Washington’s workers’ compensation provider workforce, (2) evaluate change in provider availability attributable to SHB 1691 and (3) evaluate the effect of SHB 1691 on timely accident report filing.

NPs served injured workers with characteristics similar to those served by PCPs, but 22.0% of NPs were rural, compared with 17.3% of PCPs. Of claimants with NPs as their attending provider, 53.3% were injured in a rural county, compared with 24.7% for those with PCP attending providers. The number of NPs participating in the workers’ compensation system rose after SHB 1691 implementation, more so in rural areas. SHB 1691 implementation was associated with a 16-percentage-point improvement in timely accident report filing by NPs in both rural and urban areas.

(Schnippel et al. 2015) [49]

Van-based mobile clinic in two rural districts in South Africa

Service cost analysis

PHC to 2370 poor rural women who might access the service over a 12-month period

To evaluate the cost of service delivery

Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts); the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost.

(Shumbusho et al. 2009) [47]

Three rural primary health centres in Rwanda

Review of medical records from September 2005 to March 2008

1076 rural patients enrolled in HIV care and treatment services

To evaluate a nurse-centred antiretroviral treatment programme

Of the 435 patients who initiated ART, the vast majority had adherence and side effects assessed at each clinic visit (89% and 84%, respectively). By March 2008, 390 (90%) patients were alive on ART, 29 (7%) had died, one (1%) was lost to follow-up and none had stopped treatment. Patient retention was about 92% by 12 months and 91% by 24 months. Depending on the initial stage of the disease, mean CD4 cell count increased between 97 and 128 cells/ml in the first 6 months after treatment initiation and between 79 and 129 cells/ml from 6 to 24 months of treatment. Mean weight increased significantly in the first 6 months, between 1.8 and 4.3 kg, with no significant increases from 6 to 24 months.

(Small et al. 2008) [71]

Canada

Qualitative descriptive semi-structured qualitative interviews

50 individuals recruited from a cohort of Safe Injecting Facility (SIF) users

To investigate IDU perspectives regarding the impact of SIF on access to care and treatment of injection-related infections

Narratives indicate the availability of on-site nursing attention at the SIF-facilitated uptake of health services. IDU reported that the facility provided assessment and care of injection-related infections, as well as enhanced access to off-site medical services. The presence of professional nursing personnel within a sanctioned drug consumption setting serves to address social and structural barriers that often impede IDU access to health care.

(van Griensven et al. 2008) [48]

Two government-run health centres in Kigali, Rwanda

Programme treatment and outcome data from 2 facilities. Interviews with staff and MSF programme records were reviewed to describe the organization of the programme

315 children with HIV

To describe the nurse-centred paediatric ARV programme implemented in two government health centres with details of its psychosocial aspects and treatment outcomes

A total of 315 children (<15 years) were started on ARVs, at a median age of 7.2 years (range: 0.7–14.9). Sixty percent were in WHO clinical stage I/II, with a median CD 4% of 14%. Eighty-nine percent (n = 281) started a stavudine-containing regimen, mainly using the adult fixed-dose combination. The median follow-up time after ARV initiation was 2 years (interquartile range 1.2–2.6). Eighty-four percent (n = 265) of children were still on treatment in the programme. Thirty (9.5%) were transferred out, eight (2.6%) died and 12 (3.8%) were lost to follow-up. An important feature of the study was that viral loads were done at a median time period of 18 months after starting ARVs and were available for 87% of the children. Of the 174 samples, VL was <400 copies/ml in 82.8% (n = 144). Two children were started on second-line ARVs. Treatment was changed due to toxicity for 26 children (8.3%), mainly related to nevirapine.

(Welch et al. 2011) [72]

Urban community health centre, USA

Randomized controlled trial

46 poor Hispanic patients with type 2 diabetes

To evaluate the clinical usefulness of a nurse-led comprehensive diabetes care programme

Patients receiving the intervention (IC) had a significant improvement in A1C from baseline to 12-month follow-up compared with the control (AC) (−1.6 ± 1.4% versus −0.6 ± 1.1%; P = .01). The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c (IC = 45%; AC =28%), systolic blood pressure (IC = 55%; AC = 28%), eye screening (IC = 91%; AC = 78%) and foot screening, (IC = 86%; AC = 72%). Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC (P = .05 and P = .06, respectively), with no differences for depression.

(Wetta-Hall 2007) [73]

USA: Sedgwick County Kansas

Cross-sectional study health records review and survey

492 low-income uninsured programme participants population

To assess the impact of a collaborative community case management programme on a low-income uninsured population

A statistically significant (48%) reduction in total ED visits resulted in an estimated charge avoidance of US$ 1 446 280. Physical health status improved significantly; however, mental health status and health locus of control scores showed minimal change.

(Wray, Walker and Fell 2008) [74]

UK: Hull

Quantitative descriptive design using a survey

160 nursing and midwifery university students

To examine student attitudes prior to and on completion of a module on social inclusion/exclusion

The data demonstrated that the majority of students surveyed held views that were generally positive and inclusive. Yet, a small group of respondents held stereotypical views potentially compromising their ability to provide health care.

(Yates et al. 2010) [49]

Snake Park clinic in Meserani, Tanzania

Prospective study of health facility data between April 2007 and the end of 2009, received treatment for snakebite envenomation

85 patients rural poor patients

To examine the management of snakebites by the staff of a rural clinic:

The 85 snakebite cases had a mean age of 23 years and a male:female ratio of 1.4. In some cases, the seeking of treatment from traditional healers delayed treatment at the clinic. After being bitten, the snakebite cases travelled a mean of 82 km (range = 2–550 km) to reach the clinic. Thirty-two (37%) cases were unable to identify the snake that had bit them. Forty-two of the snakebite cases received antivenom. Only one patient (1%), a 12-year-old girl, died as the result of a snakebite, but another six (7%) each required a skin graft or the amputation of a limb or digit.