Exploring the barriers, facilitators and needs to use patient outcomes in district nursing care: A multi-method qualitative study.
Jessica Desirée Veldhuizen, Frans Van Wijngaarden, Misja Chiljon Mikkers and 2 others
PMID 39177259WHAT IT FOUND
District nurses identify time pressure, administrative burden, and a lack of clear definitions as the main barriers to using patient outcomes.
They want simplified measurement tools, autonomy to interpret results for individual patients, and organisational support that values care quality over hours delivered.
Key findings
01Lack of time, high workload, and staff shortages are significant barriers to systematically measuring and learning from patient outcomes.
02Nurses perceive the current focus on financial productivity (hours delivered) rather than patient outcomes as a major hindrance to adopting outcome-based care.
03Nurses desire autonomy to interpret outcomes and tailor interventions to individual patient needs, rather than following rigid national norms or checklists.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The survey sample was relatively small (132 respondents), and the focus group participants were not representative of the wider district nursing workforce, being younger and less likely to be nurse assistants than the national average. Focus group participants all expressed positive attitudes towards using outcomes, whereas the survey revealed more negative attitudes, suggesting potential selection bias or social desirability bias in the interviews. The study was conducted in the Netherlands, where district nursing has specific funding and organisational structures (fee-for-service), which may limit transferability to other healthcare systems.
Declared interests
The study was funded by the Dutch Association of Nurses and Nurse Assistants and the University of Applied Sciences Utrecht. The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the nurses' expressed desire for outcome measurement as evidence that current systems are working or that nurses are adequately trained. The study reveals that nurses are often hindered by lack of time, unclear definitions, and a productivity-focused culture, meaning that simply mandating outcome measurement without addressing these structural barriers is likely to fail.