The effectiveness of nurse-led interventions for preventing urinary tract infections in older adults in residential aged care facilities: A systematic review

OBJECTIVES: To explore the effectiveness of nurse-led interventions to prevent urinary tract infections in older adults living in residential aged care facilities.

BACKGROUND: While most empirical studies focus on the treatment of urinary tract infections, few studies have examined the effectiveness of nurse-led interventions in preventing urinary tract infections.

DESIGN: Systematic review METHODS: Eight electronic databases were searched for relevant studies published between 2008 to 2018. The inclusion criteria were: (a) a focus on older adults, (b) evaluation of nurse-led interventions, focusing on prevention of urinary tract infection, (c) implemented in residential aged care facilities, and (d) outcomes reported as incidence or prevalence of urinary tract infection. The selected papers were critically appraised using the Mixed Methods Appraisal Tool. The data were analysed with narrative synthesis, and findings were reported following the PRISMA guidelines.

RESULTS: A review of 1614 titles and abstracts identified four studies that met the inclusion criteria. Three types of nurse-led interventions were identified: 1) the appointment of advanced practice nurses, 2) those focused on a single specific nursing intervention, and 3) implementation of a multicomponent nursing intervention. All included studies reported at least some positive outcomes. However, the included studies were highly heterogeneous and it was impossible to determine the most effective intervention approach.

CONCLUSIONS: Nurses are leaders in health care and are well-placed to lead prevention of urinary tract infections in residential aged care; however, evidence of the effectiveness of a nurse-led approach is limited. High-quality randomised controlled trials are warranted to address the knowledge gap and advance practice in this area.

RELEVANCE TO CLINICAL PRACTICE: When developing an effective nurse-led intervention program, the program should be grounded in nurse-led principles and consider the complex staffing factors to ensure that nurse-led programs are tailored to an effective level.