Evidence of Public Health Nursing Effectiveness: A Realist Review

OBJECTIVES: The purpose of this realist review was to examine PHN interventions and their outcomes during the period preceding the Affordable Care Act (1990-2010), to determine what types of interventions demonstrated effectiveness, and whether these were related to target population or setting. DESIGN AND SAMPLE: The review focused on PHN interventions with data support documented over 20 years. A search of the published literature using CINHAL, PubMed, and ancestry methods resulted in 64 articles meeting the search criteria. The researchers reviewed each article for the relevant variables; achieved consensus for each variable; and summarized results using descriptive statistics. RESULTS: Documented PHN interventions targeted vulnerable populations. Interventions included health education, behavior change, and screening. There was evidence of effectiveness of PHN interventions in a number of studies; however, the study limitations and variety of intervention types make overall conclusions about PHN effectiveness challenging. CONCLUSIONS: Despite the long history of PHN working in communities to promote and maintain the health of vulnerable populations, practice outcomes have not been well documented. Further work is needed to: strengthen the methods for documenting effectiveness of PHN practice; focus on promising PHN interventions via multisite studies; and translate evidence-based PHN interventions to practice settings.