Barriers and facilitators to nurses addressing social needs and associated outcomes in the ambulatory setting in adult patients: Systematic review

Abstract

Review Methods: Cochrane Handbook of Systematic Reviews; Risk of Bias-CASP and the JBI checklist; Certainty of evidence-GRADE-CERQual assessment.Results: After duplicates were removed, 1331 titles and abstracts were screened, and a full-text review was performed on 189 studies. Twenty-two studies met inclusion criteria. The most frequently cited barriers to addressing social needs were lack of resources, workload burden, and lack of education in social needs. The most cited facilitators were engaging the person and family in decision-making, a well-integrated standardized data tracking and referral documentation system, clear communication within the clinic and with community partners, and specialized education and training. Seven studies measured the nurse's impact of screening for and addressing social needs, and outcomes improved in most of these studies. Conclusion:Barriers and facilitators specific to nurses in the ambulatory setting and associated outcomes were synthesized. Limited evidence suggests that screening for social needs by nurses may impact outcomes by decreasing hospitalizations, decreasing emergency department utilization, and improving self-efficacy towards medical and social services navigation.Impact: These findings inform practice and facilitate changes within nursing towards care that accounts for a person's individual social needs in ambulatory care settings and are most directly applicable to nurses and administrators in the United States.Reporting Method: PRISMA guidelines, supplemented by the ENTREQ and SWiM guidelines.

Learning in real world practice: Identifying implementation strategies to integrate health-related social needs screening within a large health system

“…Integrating the screening tool into the patient portal increases patient engagement with implementation, but there remains a demonstrated need to improve clinician motivation to screen and capacity to act on HRSNs identified. Clinicians have previously reported both a lack of training on HRSNs and lack of resources to address HRSNs as key barriers to screening [34,[40][41][42], with some arguing that screening for HRSNs without linking patients to resources is ineffective and unethical [43]. In addition to clinicians, patients have also expressed the importance of clarifying the purpose of the HRSN screen, especially if to connect patients to social services [38,42].…”

Nurse-Led, Telephone-Based Primary Palliative Care Intervention for Patients With Lung Cancer

“…Intervention activities that fell under the provision of physical, psychological, and social domains included nurses routinely assessing physical and psychological symptoms commonly associated with lung cancer, including dyspnea, pain, cough, fatigue, gastrointestinal disturbances, anxiety, and depression, using validated questionnaires. Nurses play a major role in addressing patients' social aspects of care provision, 25 which in a large integrated health care system, is often complex for patients to navigate. For example, the nurses assessed basic needs such as transportation for medical appointments and adequate food supply.…”