Essentials of Nursing Care in Randomized Controlled Trials of Nurse-Led Interventions in Somatic Care: A Systematic Review

Abstract

Background: Nursing practice has to contribute to evidence pointing out why there is a need for more nurse-designed randomized control trials (RCTs) focusing on evidence-based practice (EBP). How far this EBP has progressed in different health aspects is usually established by systematic reviews of RCTs. Nurse-led RCTs exist but no study has addressed the essentials of nursing care. Aim: The aim was therefore to determine the essentials of nurses' interventions by means of nurse-led RCTs in somatic care focusing on the stated context, goals, content, strategies as well as the nurse's role related to effectiveness. Methods: A systematic review was realized according to Cochrane review assumptions to identify, appraise and synthesize all empirical evidence meeting pre-specified eligibility criteria. The PRISMA statement guided the data extraction process (n = 55) from PubMed and CINAHL. Results: Of the RCTs in somatic care, 71% showed a positive effectiveness of nurse-led interventions, of which the nurse had a significant role with regard to being the main responsible in 67% of the studies. Also, 47% of the RCTs presented a theoretical standpoint related to the nurse-led interventions and most prominent were international evidence-based guidelines. Goals were found to have either a patient-centered or a professional-centered ambition. Strategies were based on patient-directed initiatives, nurse-patient-directed initiatives or nurse-directed initiatives, while contents were built upon either a patient-nurse interaction or a nursing management plan. Conclusions: This review underlines the necessity of a holistic view of a person, as nurse-led RCTs comprising a patient-centered ambition, patient-directed initiative and patient-nurse interaction plan showed beneficial nursing care effectiveness, particularly if * Corresponding author. B. Fridlund et al. 182 theory-based. In a nurse-led RCT, a basic theoretical perspective is advantageous as well as to elucidate the role of the nurse in relation to the estimated effects.

Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial

“…Theoretically-based education is considered superior to its non-theory based counterpart [34][35][36]. The majority of previous interventions that targeted knowledge, attitudes and beliefs about ACS were underpinned by a theoretical framework [7,8,[16][17][18]20].…”

Nurse-led interventions in the concept of randomized controlled trials – critical perspectives on how to handle social contexts

“…The interest in conducting this study emerged from a systematic literature review conducted in 2011 involving RCT-designed interventions in somatic adult healthcare contexts (Fridlund et al 2014). It became notable that the included RCT studies in general did not consider the contextual influences.…”

“…We found it interesting to explore this further, by focusing more explicit on if any considerations were taken to contextual influences. The present study is re-analysing the data of the former literature review of Fridlund et al (2014). Our literature review analysis uses the same data/studies as Fridlund et a.l (2014), but we have different aims, and we explore if and how the studies are handling questions concerned with contextual influences in nurse-led RCT interventions.…”

“…The literature search was carried out with a primary criterion of including studies with a focus on nurse led interventions concerning adults in somatic healthcare (Fridlund et al 2014). Specific inclusion criteria were: nurse-led RCTs concerning caring actions in adult patients in somatic healthcare; evaluating caring actions and articles not older than five years (2006)(2007)(2008)(2009)(2010).…”

“…Therefore, this paper focuses on the randomised clinical trial (RCT) as a research method in nursing interventions and problematises its methodological ability and delimitations considering the extensive use of this method in the healthcare system. The aim of this paper is to explore if and how studies are handling questions concerned with contextual influences, by re-doing a systematic literature review on literature used in an already published literature study (Fridlund et al 2014) in which two of the authors of this study took part. .…”