title: A systematic review of the effectiveness of advanced practice nurses in long-term care.
abstract: OBJECTIVE
  To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long-term care residential settings.
  
  
  BACKGROUND
  Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted.
  
  
  METHODS
  Quantitative systematic review.
  
  
  METHODS
  Twelve electronic databases were searched (1966-2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group.
  
  
  METHODS
  Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria.
  
  
  RESULTS
  Four prospective studies conducted in the USA and reported in 15 papers were included. Long-term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services.
  
  
  CONCLUSIONS
  Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long-term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff.
authors.affiliation: Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada.
authors.forename: Faith
authors.initials: F
authors.lastname: Donald
authors.forename: Ruth
authors.initials: R
authors.lastname: Martin-Misener
authors.forename: Nancy
authors.initials: N
authors.lastname: Carter
authors.forename: Erin E
authors.initials: EE
authors.lastname: Donald
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.forename: Abigail
authors.initials: A
authors.lastname: Wickson-Griffiths
authors.forename: Monique
authors.initials: M
authors.lastname: Lloyd
authors.forename: Noori
authors.initials: N
authors.lastname: Akhtar-Danesh
authors.forename: Alba
authors.initials: A
authors.lastname: DiCenso
mesh_terms: D057179:Advanced Practice Nursing / Q000458:organization & administration*; D000368:Aged; D005851:Geriatric Nursing / Q000458:organization & administration; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D009720:Nurse Clinicians / Q000458:organization & administration*; D009722:Nurse Practitioners / Q000458:organization & administration*; D009735:Nursing Homes / Q000458:organization & administration; D011446:Prospective Studies
keywords: advanced practice nurses; clinical nurse specialists; long-term care; nurse practitioners; nursing homes; outcome assessment; quantitative systematic review