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To systematically review advanced nursing roles in caring for people with cognitive impairment and their relatives in acute care hospitals, focusing on describing roles and intervention components.
Systematic review.
We included qualitative and quantitative studies on nurses in advanced roles caring for people with diagnosed or suspected cognitive impairment and their relatives, assessing outcomes at patient, staff and organisational levels. Nurses' advanced role profiles ranged from nurse-led interventions up to Advanced Practice Nurses. We employed the Mixed Methods Appraisal Tool for critical appraisal and conducted a synthesis without meta-analysis using a content analysis approach.
MEDLINE, CINAHL, Cochrane Library, ALOIS, Web of Science and LIVIVO up to May 2024, along with forward and backward citation tracking.
We included 48 studies that described 39 distinct interventions. The majority of these studies employed a quasi-experimental design. Most interventions involved Advanced Practice Nurses (n = 23) and focused on people at risk of or experiencing delirium (n = 22). Nurses in advanced roles predominantly engaged in tasks related to direct clinical practice, as well as coaching and guidance for patients, relatives and colleagues. Their responsibilities also included leadership, collaboration and consultation on a regular basis. Activities related to research and ethical decision-making were infrequently reported.
Many areas of responsibility of nurses in advanced roles align with the needs of hospitalised people with cognitive impairment. Nurses in advanced roles increasingly take on diverse activities across all competence domains of Advanced Practice Nursing, with a focus on coaching and guidance, as well as clinical practice, while leadership, collaboration, research and ethical decision-making become more prominent as their formal training advances.
Our comprehensive description of advanced nursing roles in the care of people with cognitive impairment provides a foundation for developing and refining such roles in hospitals.
We followed the PRISMA guideline and SWiM guideline for reporting.
This study did not include patient or public involvement in its design, conduct or reporting.
Prospero number: CRD42021265157
Childhood overweight and obesity pose a growing public health problem with increasing prevalence both in Europe and globally. Reasons can be found in behavioural factors such as a sedentary lifestyle, eating habits or low exercise levels and to a lesser extent in a genetic predisposition or a metabolic disorder. Preventing children with obesity and overweight to grow into obese teenagers is therefore of high importance. However, there are currently no established care and prevention programmes in Germany for the early reduction of overweight and prevention of obesity in children aged 3–6 years. fruehstArt aims to close this gap with a cross-sector outreach and family-centred personal counselling approach, where parents receive support from paediatricians and trained coaches who conduct consultations in the home of the family. The main research question is whether the fruehstArt programme reduces overweight and obesity in children aged 3–6 years within 12 months, as measured by the body mass index-standard deviation score (BMI-SDS).
fruehstArt has been developed as a new form of care, which includes a family intervention with motivational interviews provided by paediatricians and individual home-based counselling provided by a trained coach on eating behaviour, exercising, sleeping behaviour and age-appropriate use of electronic devices. fruehstArt will be accompanied by an efficacy study (summative evaluation of change in BMI-SDS). In addition to German, the project is also offered in Turkish in order to reach families with a migration background and language barriers. 812 children with overweight or obesity and their families in the region North Rhine will be included and observed over 12 months. Recruitment of children occurred from December 2023 to April 2025 with the final visits scheduled for April 2026. The study is conducted as a randomised controlled trial with a social-ecological intervention approach, considering children in their living environment and conditions. Moreover, a formative evaluation at the process level, and the system level will be carried out and complemented by a health economic analysis. Those are carried out to provide information about the intervention’s success and relevant costs. Thus, fruehstArt is realised in the form of an effectiveness–implementation hybrid design that combines the analysis of effectiveness with an evaluation of the implementation process.
The study received ethics approval in a coordinated procedure from the ethics committee of the Medical Faculty University hospital of Cologne and the ethics committee of the North Rhine Medical Association. For all collected data, the relevant national and European data protection regulations will be considered. All personal data (contact details) will be removed for the data analysis in order to ensure pseudonymisation. Dissemination strategies include reports and quality workshops for organisations, peer-reviewed publications and the presentation of results at conferences.
The aim of the unique form of care fruehstArt is to improve the care of preschool children with overweight or obesity through innovative home-based counselling, cross-sectoral service integration and to address the cultural needs of Turkish families.
DRKS00030749 (29-09-2023)
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