Barriers and facilitators to nurses addressing social needs and associated outcomes in the ambulatory setting in adult patients: Systematic review.

AIM: To examine the barriers and facilitators nurses experience in addressing social needs in the United States and the associated outcomes of addressing these needs in adults in the ambulatory care setting. DESIGN: A systematic review with inductive thematic and narrative synthesis. DATA SOURCES: PubMed, CINAHL, Web of Science, and Embase from 2010 through 2021. REVIEW METHODS: Cochrane Handbook of Systematic Reviews; Risk of Bias-CASP and the JBI checklist; Certainty of evidence-GRADE-CERQual assessment. RESULTS: After duplicates were removed, 1331 titles and abstracts were screened, and a full-text review was performed on 189 studies. Twenty-two studies met inclusion criteria. The most frequently cited barriers to addressing social needs were lack of resources, workload burden, and lack of education in social needs. The most cited facilitators were engaging the person and family in decision-making, a well-integrated standardized data tracking and referral documentation system, clear communication within the clinic and with community partners, and specialized education and training. Seven studies measured the nurse's impact of screening for and addressing social needs, and outcomes improved in most of these studies. CONCLUSION: Barriers and facilitators specific to nurses in the ambulatory setting and associated outcomes were synthesized. Limited evidence suggests that screening for social needs by nurses may impact outcomes by decreasing hospitalizations, decreasing emergency department utilization, and improving self-efficacy towards medical and social services navigation. IMPACT: These findings inform practice and facilitate changes within nursing towards care that accounts for a person's individual social needs in ambulatory care settings and are most directly applicable to nurses and administrators in the United States. REPORTING METHOD: PRISMA guidelines, supplemented by the ENTREQ and SWiM guidelines. NO PATIENT OR PUBLIC CONTRIBUTION: This systematic review is the result of work performed by the four authors exclusively.

The Value of History and Physical Examination to Optimize Outcomes of Cataract Surgery: A Systematic Review.

This systematic review was conducted to examine the value of the preoperative history and physical (H&P) examination and preoperative care prior to cataract extraction and the resulting outcomes of adverse events, patient experience, and cost. Four databases were searched using appropriate keywords from 2012 to 2022. Observational studies, randomized controlled trials, and quality improvement studies with data on the precataract H&P were included. Outcome measures were adverse events, cost, and patient experience. Of the 4,170 studies screened, 12 studies were included. Risk stratification of patients into a high-risk group with an H&P and a low-risk group without an H&P resulted in an increased incidence of minor adverse events in the low-risk group but did not increase the incidence of major adverse events or surgical adverse events. A short-term cost savings was reported, and patient experience was unchanged. In 2020, the Centers for Medicare and Medicaid Services removed the requirement for the precataract H&P within 30 days prior to ambulatory surgery, which has implications for surgery center policy. More research on the role of the preoperative H&P on patient experience, adverse events, cost, and outcomes should be conducted, given the methodological heterogeneity of this review.