Nurse‐Led/Involved Home‐Based Interventions for Older Adults With Chronic Obstructive Pulmonary Disease (COPD): A Mixed‐Methods Systematic Review

ABSTRACT

Aims

To determine the effectiveness of nurse-led/involved home-based interventions for older people with COPD and to explore the experiences of older people and nurses with the interventions.

Design

A mixed-methods systematic review following the JBI methodology for mixed-methods systematic reviews.

Data Sources

The search included relevant and peer-reviewed studies published from January 2010 to December 2023 in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, EMBASE, JBI, EMCARE and ProQuest.

Review Methods

English-language reports of nurse-led/involved home-based interventions for people with COPD were included based on authors’ consensus. Three reviewers performed independent quality appraisal using JBI tools. A convergent segregated approach was used for data synthesis and integration.

Results

Seven interventions were identified in two mixed-methods, two qualitative, two quasi-experimental studies, and one secondary analysis from a randomised control trial. The effectiveness of the interventions was measured with various outcomes and was effective to some extent, with reduced hospitalisation, hospitalisation days, hospitalisation cost and all-paid claims. However, the outcomes were not statistically significant, and the effectiveness was inconclusive. While patients appreciated support and resources, some perceived them as a double-edged sword.

Conclusions

Patients preferred more holistic interventions over extended periods. The inconclusive findings and limitations warrant further research with larger sample sizes and comparable measurement tools and outcomes.

Impact

This is the first mixed-methods systematic review on the effectiveness of home interventions for people with COPD with a clear definition of ‘nurse-led’. Nurses felt highly valued by patients and other health professionals; however, they reported a lack of support from management. The lack of interventions led by nurses challenges them to lead, deliver and evaluate what matters to people with COPD.

Reporting Method

This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Patient or Public Contribution

Not applicable.