Measured and perceived effects of audit and feedback on nursing performance: A mixed methods systematic review

Abstract

Background: The use of audit and feedback in health care has been shown to have generally positive effects with medical teams, but little is known about its effects on nursing care. The purpose of this systematic review was to examine the evidence of measured and perceived effects of such interventions on nursing performance. Methods: We used a mixed-methods systematic review design with thematic and narrative synthesis. Studies reporting quantitative and qualitative data on the effects of feedback interventions specific to nursing care were considered for inclusion. Studies were appraised for quality using the Mixed Methods Appraisal Tool. Quantitative and qualitative data were summarized in narrative and tabular form and were synthetized using the Joanna Briggs Institute segregated methodologies approach. Results: Thirty-one studies published between 1995 and 2021 were included. Thirteen quantitative studies provided evidence on measured effects and 18 qualitative studies provided evidence on perceived effects. The quantitative studies, the majority of which had low to moderate methodological quality, reported highly variable effects of audit and feedback. The characteristics of most of the audit and feedback interventions were poorly aligned with the recommendations developed by the experts and were not theoretically supported. Overall, the qualitative data demonstrated that nurses perceived several negative aspects in the way audit and feedback interventions were conducted, while recognizing the relevance of secondary use of the data to support improved care. Conclusions: Considering the practical benefits of using this type of intervention, we see in these results an important opportunity for action to improve the design and implementation of audit and feedback with nurses. Registration: PROSPERO CRD42018104973

How to Design Effective Audit and Feedback Interventions With Nurses

“…The findings in this article are based on an analysis of empirical data from a mixed-methods systematic review of the literature 9 and on the findings from a pilot study on the design and testing of an A&F intervention with a nursing team in primary care. 10 The review includes data from quantitative (n = 13) and qualitative (n = 18) studies that reported effects of A&F interventions conducted with nurses between 1995 and 2021.…”

“…Data on the process and outcome indicators related to wound care episodes were reported to the team. Full details of the methods used are described in the articles reporting the results of the review 9 and the pilot study. 10 By synthesizing quantitative and qualitative data from empirical studies, researchers identified patterns in nurses' responses to A&F interventions in different contexts.…”

“…10 By synthesizing quantitative and qualitative data from empirical studies, researchers identified patterns in nurses' responses to A&F interventions in different contexts. The characteristics of the interventions reported in the mixed-methods review 9 were poorly aligned with current recommendations for implementing A&F with health professionals, 5 while the pilot study 10 was designed according to these recommendations. 5 Researchers compared these empirical results to the sequential processes described in CP-FIT, as well as to the proposed hypotheses regarding the variables and mechanisms that influence the progression of these processes in the A&F cycle.…”

“…7,8 In terms of their professional characteristics, many nurses have a negative perception of A&F. It is reported that nurses may have difficulty reading and understanding quality indicators and may perceive many limitations in their ability to act on the reported indicators. 9 Taken together, these characteristics are not conducive to effective A&F. 6 In terms of their practice context, nurses most often work in teams, where communication issues add another layer of complexity to A&F including convoluted attribution. 6 At the same time, the characteristics of A&F conducted with nurses rarely conform to current recommendations 5 and often appear to be poorly adapted to the specific context in which they are implemented.…”

“…6 At the same time, the characteristics of A&F conducted with nurses rarely conform to current recommendations 5 and often appear to be poorly adapted to the specific context in which they are implemented. 9 These authors believe that adjusting or adding certain hypotheses to those originally proposed by Brown et al 6 could provide guidance for the design and implementation of A&F to adjust its variables more toward the characteristics of nurses and their work context. In this article, researchers revisit some of the assumptions made by Brown et al 6 based on empirical results from A&F interventions conducted specifically with nurses.…”