Demographic changes are leading to a significant shortage of skilled nurses, with a 50% increase in care needs predicted by 2030. By 2035, an additional 493,000 nurses will be needed in Germany, particularly in inpatient care. After the introduction of a new concept of long-term care needs in Germany in 2017 and the associated formulation of care-related tasks, nursing consultation is becoming increasingly important for care professionals. There is a call for an enhanced integration of nursing consultation in Germany to improve care quality amid these challenges.
Aims
The aim of this work is to show the diversity and necessity of nursing advice in the inpatient setting.
Method
A systematic literature search was conducted of the databases PubMed and Cochrane, focusing on title and abstract with the keywords “patient,” “relatives,” “nursing consultation,” and “inpatient setting” based on the PCC scheme (Patient, Concept, Context). After removing duplicates, 443 articles remained and were filtered according to the inclusion and exclusion criteria. A total of 26 studies investigating the topics and effects of nursing consultation on patients and relatives were selected for inclusion in the review. The selected studies were summarized with regard to the research questions and evaluated according to their quality.
Results
The studies encompass a broad spectrum of nursing consultations across various specialist fields, with notable emphasis on pediatrics, oncology, and intensive care. Thematically, the consultations addressed a diverse range of care phenomena, most frequently focusing on anxiety, family-centeredness, HIV, and cancer. The studies showcased a variety of counseling formats, including group and individual sessions, telephone consultations, and multimedia telemedicine, underscoring the adaptability of nursing consultations to patient needs. Notably, the outcomes of nursing consultations were positive, showcasing significant improvements in mental health, patient compliance, nutritional status, and overall quality of life, among other benefits.
Conclusion
Recommendations for nursing practice can be derived from the review, suggesting a focus on prevalent nursing phenomena for counseling across patient populations to improve outcomes. While nursing consultations are well-established in oncology and pediatrics, there is potential for expansion in other specialized areas, such as intensive care. Notably, certain aspects like family-centered care are not adequately covered, indicating a need for further research.
Hinweise
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Background
Demographic change and its impact on the shortage of skilled nurses represent a significant societal challenge. The Nursing Report 2030 by the Bertelsmann Foundation predicts that by 2030, the number of people in need of care will increase by 50%, while the number of nursing staff is simultaneously decreasing. A shortage of almost 500,000 full-time nurses is expected if current developments continue (Rothgang et al. 2024).
A growing proportion of nursing staff is already over 50 years old, and many older nurses are retiring or leaving the profession due to the high physical and psychological workloads. The German Economic Institute predicts a need for 493,000 additional nurses by 2035, with 60% of the demand in inpatient care and the rest in outpatient care. Overall, it is evident that demographic change has led to an increasing demand for nursing staff while the supply of qualified nurses is decreasing. This exacerbates the shortage of skilled workers in nursing and requires political and societal measures, such as restructuring the tasks of nurses, to ensure care for the growing number of people in need of it (Deutsches Pflegehilfswerk e. V. 2024).
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Since 2017, a new concept of care needs has been introduced in Germany. This serves as the basis for structuring and describing nursing tasks and also considers aspects of nursing consultation. Nursing consultation is an important part of care, but it has received little attention in current practice. In Germany specialist nursing staff are underrepresented in nursing consultation, although they possess the necessary knowledge and skills. The diversity and benefits of nursing consultation are often unknown, and there is a lack of systematic integration into everyday nursing care (Wingenfeld and Büscher 2017).
In summary, the political and societal goal should be to exploit the potential of nursing consultation by professionals and accordingly improve the quality of care for those in need. Therefore, it is important to research and develop these nursing consultations in Germany in order to demonstrate the diverse possibilities and the resulting benefits for those in need of care.
Aims
The aim of this study is to highlight the diversity and necessity of care advice in the inpatient sector. In particular, the topics of care counseling are addressed. It also describes how care consultations are structured and to what extent they take place. In addition, the general positive or negative effects of care counseling are shown; the study is not about the specific effects of care counseling for patients with a particular illness. This study therefore deals with the primary research question: What are patients and relatives advised about in the inpatient setting? In addition, the following two sub-questions are answered: How are care consultations organized? Is there evidence for the effects?
Method
This study includes a systematic literature search of two databases. The methodology of the systematic literature research was chosen to include literature in the review that reflects the latest clinical developments and thus serves as a solid basis for further clinical research. Through this structured approach, systematic reviews ensure that a clearly defined question is addressed using transparent and reproducible criteria.
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The research question was formulated using the PCC scheme (Population, Concept, Context), as described in Table 1. This scheme helps to structure the research question and narrow down the articles to be considered, based on specific criteria for the target population, concept, and context.
Table 1
PCC scheme
P (population)
Patient, relatives
C (concept)
Nursing consultation
C (context)
Inpatient setting
We conducted a systematic literature search of PubMed and Cochrane Library from November to December 2023. The systematic literature search, data collection, and critical quality assessment were carried out independently by two authors (A.R., L.S.S.).
The following research terms were used for the search: “nurse,” “consulting,” “education,” and “hospital.” Synonyms or related terms were linked with the Boolean operator “OR” and each topic was linked with the Boolean operator “AND.”
In this systematic review, only studies on care consultations in the inpatient sector by care professionals were included in order to ensure better comparability of care consultations. The consultations should be aimed at patients and/or caregivers. Only German- and English-language studies were considered. In addition, an abstract had to be available for each study and the study had to have been completed. Studies from psychiatric settings were excluded because the authors had no prior knowledge in this field. Commentaries, expert opinions, and non-systematic reviews were also excluded, as there is only limited scientific rigor. At the beginning, all study titles were checked for eligibility. If the inclusion or exclusion criteria were disputed, the study was included. After the exclusion of duplicates, the same procedure was carried out with the remaining abstracts, followed by a full-text screening. A separate chart was used for data collection. Data extraction focused on title, study design, authors, year of publication, topic, research question and aim, methodology, results with regard to the research question, specialty, and nursing phenomenon.
Depending on the study design, quality assessment was carried out using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) and MMAT (Mixed Methods Appraisal Tool) version 2018. AMSTAR 2 is an assessment tool that uses 11 items to evaluate the methodological quality of qualitative reviews (Coenen et al. 2013). The MMAT is an instrument for the critical evaluation of qualitative, quantitative, and mixed-method studies. It enables the assessment of methodological quality depending on the study design using a separate checklist (Hong et al. 2018).
Results
The initial search yielded a total of 1088 hits in the databases (Cochrane n = 182, PubMed n = 906). After setting the filters, a total of 443 hits remained (Cochrane n = 142, PubMed n = 301). No duplicates were found. After screening the abstract, 400 studies were excluded (Cochrane n = 126, PubMed n = 274). Thus, 43 studies (Cochrane n = 16, PubMed n = 27) were included in the full-text screening. After screening the full texts, 16 studies were excluded (Cochrane n = 4, PubMed n = 12). A total of 27 studies (Cochrane n = 12, PubMed n = 15) were assessed for scientific quality using MMAT and AMSTAR 2. One study from PubMed had to be excluded. Consequently, a total of 26 studies were eligible for inclusion, as shown in Fig. 1 (Cochrane n = 12, PubMed n = 14). The details of these included studies are presented in Table 2.
Fig. 1
PRISMA flow diagram for Databases and Registers 2009
Table 2
Characteristics of nursing consultation
Title
authors
Publication date
Study design
1. Specialized field
2. Nursing phenomenon
Design of nursing consultations
Effects of nursing consultations
Rating
(AMSTAR/MMAT)
Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors
– Real-time video-conferencing, which was used either alone or in combination
– Six categories (monitoring of a chronic condition, provision of treatment or rehabilitation, nurses delivering education to patients, specialist consultations for diagnosis and treatment decisions, real-time assessment of clinical status, screening)
– Improvement in blood pressure, independence
AMSTAR +
Care delivery and self-management for children with epilepsy
– Discussion about preoperative procedures, surgical procedure, postoperative care, stress scenarios related to surgery, complications, pain management, movements to avoid
– Conducted multidisciplinary by nurses and physiotherapists
– Various forms of training: oral individual communication, group sessions, videos, brochures without oral communication
– Useful additions to conventional advice
– Reduces anxiety, pain, function especially for patients with depression, anxiety, unrealistic expectations
– Good response from patients to education tailored to their needs
AMSTAR +
Telephone-delivered intervention for reducing morbidity and mortality in people with HIV infection
– Parents are taught how to provide most of the care
– By caregivers, experienced parents, and program coordinators (nurse)
– Training sessions, ward briefing, access to equipment, required diary entries, encouragement to take on more responsibility, daily attendance at ward rounds
– Nursing guidance on feeding, bathing, dressing, skin care
– Psychological support in coping with NICU situation
– Skills checklist for parents
– Improving the weight gain of newborn babies
– Lower mortality and morbidity
MMAT +
A nurse-delivered brief health education intervention to improve pneumococcal vaccination rate among older patients with chronic diseases: a cluster randomized controlled trial
– 3-min brief educational intervention by nurses over the phone before the doctor’s appointments and 3‑min personal intervention during the scheduled doctor’s appointment in addition to standard care with brochures and videos
– Vaccination uptake among older patients with chronic diseases has been effectively increased
MMAT +
A case series of an off-the-shelf online health resource with integrated nurse coaching to support self-management in COPD
– Significant improvement in the activation and control of anxiety, mood, self-confidence, physical functioning
MMAT +
Does an additional structured information program during the intensive care unit reduce anxiety in ICU patients? A multicenter randomized controlled trial
– No improvement in conventional consulting with similar time intensity
MMAT +
A nurse versus a chatbot—the power of an empowerment program on chemotherapy-related side effects and the self-care behaviors of women living with breast cancer: a randomized controlled trial
– Personal training by nurse on the first day of chemo about side effects and self-help measures
– General information about self-help measures
– Less frequent, less severe, and less stressful psychological and physical symptoms
MMAT +
Effectiveness of text messaging and face to face training on improving knowledge and quality of life of patients undergoing hemodialysis: a randomized clinical trial
– Improvement in strengthening and weight-bearing exercises, calcium intake, osteoporosis knowledge, activation
– Improved nutritional self-efficacy
– Better satisfaction with osteoporosis treatment
MMAT +
AMSTAR 2 A Measurement Tool to Assess Systematic Reviews, MMAT Mixed-Methods Appraisal Tool, COPD chronic obstructive pulmonary disease, DXA dual-energy X‑ray absorptiometry, NICU neonatal intensive care unit, PLHIV people living with HIV, RCT randomized controlled trial
×
Study characteristics
Among the 26 studies included, 20 were published between 2013 and 2020, while the remaining six were published between 2021 and 2023. A total of 13 reviews, 11 randomized controlled trials (RCTs), one research protocol, and one mixed-method study were included.
The studies included in the systematic search originate from different countries. Most of the studies originate from the United Kingdom (Whitford et al. 2017; Fleeman et al. 2022; Ojha et al. 2020; Gurusamy et al. 2014; McDonald et al. 2015; Van-Velthoven et al. 2013; Ream et al. 2020; Early et al. 2017; Schofield-Robinson et al. 2018) followed by the United States (Lewis et al. 2018; Schofield-Robinson et al. 2018; Gentry et al. 2013; Ream et al. 2020; Roblin et al., 2017), Australia (East et al., 2019; McDonald et al. 2015; O’Brien et al. 2015), Canada (Ojha et al. 2020; East et al., 2019; O’Brien et al. 2015), China (Lewis et al. 2018; Chan et al., 2015), and Germany (Lewis et al. 2018; Reiter et al. 2021; Fleischer et al. 2014; Schofield-Robinson et al. 2018). Only one study each was from Croatia (Van-Velthoven et al. 2013; Zulec et al., 2022), Turkey (Lewis et al. 2018; Ertürk and Ünlü, 2018; Ünver et al. 2018), Egypt (Tawfik et al. 2023), Denmark (Schofield-Robinson et al. 2018), Spain (Romero-Castillo et al. 2022), Iran (Asl et al. 2018), Japan (Komatsu and Yagasaki 2014), and Sweden (Schofield-Robinson et al. 2018).
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“Nursing consultation” was defined in different ways in the included studies, as there is no standardized model for nursing consultations (Schofield-Robinson et al. 2018) Ojha et al. (2020), for example, defined care counseling in the area of nutrition as “any combination of educational strategies, accompanied by environmental supports (…)”. According to Ojha et al. (2020), the consultations can be carried out by nursing staff with the help of various media with patients and their relatives.
The duration of the nursing counseling interventions in the studies varies greatly, which illustrates the diversity of nursing counseling. In the study by Schofield-Robinson et al. (2018), for example, four counseling sessions were conducted on consecutive days, while in the study by Tawfik et al. (2023), three consecutive counseling sessions were conducted, each lasting approximately 45 min. In the study by Chan et al. (2015), a 3-min telephone consultation was also conducted before an examination appointment in combination with a 3-min face-to-face consultation during the appointment.
Specialist fields and phenomena of nursing consultations
The included studies focused on nursing consultations in various specialist areas. Most studies (n = 5) described consultations in pediatrics (Fleeman et al. 2022; Whitford et al. 2017; Ojha et al. 2020; East et al. 2019; O’Brien et al. 2015) followed by oncology (n = 4; Ream et al. 2020; Komatsu and Yagasaki 2014; Tawfik et al. 2023; Reiter et al. 2021), intensive care medicine (n = 3; Schofield-Robinson et al. 2018; Lewis et al. 2018; Fleischer et al. 2014), surgery (n = 3; Gurusamy et al. 2014; McDonald et al. 2015; Ünver et al. 2018), infectiology (n = 2; Gentry et al. 2013; Van-Velthoven et al. 2013), and cardiology (n = 2; Ahmadi et al. 2022; Ertürk and Ünlü 2018). There were also studies from the field of angiology (n = 1; Zulec et al. 2022), diabetology (n = 1; Romero-Castillo et al. 2022), geriatrics (n = 1; Chan et al. 2015), pneumology (n = 1; Early et al. 2017), nephrology (n = 1; Asl et al. 2018), orthopedics (n = 1; Roblin et al. 2017), and mixed specialties (n = 1; Flodgren et al. 2016).
Thematically, consultations were held on various care phenomena. Advice was most frequently given on anxiety (n = 3; Schofield-Robinson et al. 2018; Ertürk and Ünlü 2018; Fleischer et al. 2014) followed by advice on family-centeredness (n = 2; Ojha et al. 2020; O’Brien et al. 2015), HIV (n = 2; Gentry et al. 2013; Van-Velthoven et al. 2013), and cancer (n = 2; Tawfik et al. 2023; Reiter et al. 2021). Furthermore, advice was given on epilepsy (n = 1; Fleeman et al. 2022), breastfeeding (n = 1; Whitford et al. 2017), communication and information (n = 1; Lewis et al. 2018), laparoscopy (n = 1; Gurusamy et al. 2014), joint replacement (n = 1; McDonald et al. 2015), depression (n = 1; Ream et al. 2020), low birth weight in infants (n = 1; East et al. 2019), uncertainty (n = 1; Komatsu and Yagasaki 2014), chronic venous insufficiency (n = 1; Zulec et al. 2022), acute coronary heart disease (n = 1; Ahmadi et al. 2022), diabetes (n = 1; Romero-Castillo et al. 2022), respiration (n = 1; Ünver et al. 2018), vaccinations (n = 1; Chan et al. 2015), chronic obstructive pulmonary disease (COPD; n = 1; Early et al. 2017), hemodialysis (n = 1; Asl et al. 2018), osteoporosis (n = 1; Roblin et al. 2017), and professional behavior (n = 1; Flodgren et al. 2016).
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Design of nursing consultations
Various forms and methods of nursing counseling were described in the included studies. The most common form of counseling was group and individual counseling (n = 16) on various nursing topics (Fleeman et al. 2022; Whitford et al. 2017; Ojha et al. 2020; Lewis et al. 2018; McDonald et al. 2015; Ertürk and Ünlü 2018; Romero-Castillo et al. 2022; Ünver et al. 2018; O’Brien et al. 2015; Chan et al. 2015; Fleischer et al. 2014; Tawfik et al. 2023; Asl. et al. 2018; Reiter et al. 2021; Roblin et al. 2017; Komatsu and Yagasaki 2014). The second most common form of counseling was telephone consultation by nurses (n = 4), e.g., in the form of a follow-up (Schofield-Robinson et al. 2018; Gentry et al. 2013; Van-Velthoven et al. 2013; Ream et al. 2020). The form of multimedia telemedicine (n = 4) was also frequently used for consultations (Flodgren et al. 2016; Gurusamy et al. 2014; Ahmadi et al. 2022; Early et al. 2017). Occasionally, combinations of home visits and telephone consultations (n = 1) were also used (East et al. 2019) or patients were advised on a topic via brochures (n = 1) prepared by nurses (Zulec et al. 2022).
Effects of nursing consultations
The studies demonstrated the effects of nursing advice using various measuring instruments. The most frequently measured effect of counseling is the reduction of mental disorders (n = 9), e.g., anxiety or depression (Schofield-Robinson et al. 2018; Lewis et al. 2018; McDonald et al. 2015; Gentry et al. 2013; Ream et al. 2020; East et al. 2019; Ertürk and Ünlü 2018; Early et al. 2017; Tawfik et al. 2023). The studies used various instruments to measure anxiety and depression. The Hospital Anxiety and Depression Scale (HADS) and the Generalized Anxiety Disorder Scale (GAD‑7 and GAD-2) were used in several studies to measure anxiety and depression in different health conditions (Lewis et al., 2018; McDonald et al., 2015). The State–Trait Anxiety Inventory (STAI) was also used (McDonald et al., 2015; Ertürk and Ünlü, 2018). Other measurement tools are the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS), which provide self-reported insights into depression and anxiety. These instruments are comparable in terms of their validated use for the clinical assessment of anxiety and depression. However, they differ in their specificity (e.g., GAD‑7 for generalized anxiety vs. HADS for combined anxiety and depression). In addition, the differences in the response formats (self-report vs. clinician-led) could influence comparability.
Patients and relatives receiving counseling showed improved (n = 8) compliance and understanding of health issues, e.g., knowledge about their own illness increased and medication was taken more regularly (Fleeman et al. 2022; Lewis et al. 2018; Gentry et al. 2013; Van-Velthoven et al. 2013; Zulec et al. 2022; Ahmadi et al. 2022; Romero-Castillo et al. 2022; Ünver et al. 2018; Asl et al. 2018; Reiter et al. 2021; Roblin et al. 2017).
Various measurement instruments were used in the studies in this aspect. The instruments are comparable in that they all aim to assess patients’ understanding and ability to cope with their illness. However, they differ in terms of their focus and method (e.g., questionnaire vs. scale). While some instruments are specific to certain diseases such as diabetes or hemodialysis, others are more general and relate to psychosocial factors that may be relevant to multiple diseases.
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The nutritional status of patients who received advice from caregivers improved (n = 5) and infants grew faster (Ojha et al. 2020; Romero-Castillo et al. 2022; O’Brien et al. 2015; Reiter et al. 2021; Roblin et al. 2017).
The measurement tools used to record nutritional status in the studies show limited comparability, as they are tailored to the respective target group and disease. While continuous glucose monitoring in patients with diabetes specifically measures blood glucose control, Z‑scores for weight and height are more universal measures that are suitable for different age groups, such as infants. Biochemical markers such as hemoglobin and serum albumin, which have been used for cancer patients, provide specific information on nutritional deficiencies and are less suitable for general nutritional assessment. The differences in measurement approaches make it difficult to directly compare study results, but they highlight the specific adaptation to individual health needs.
It was also clear from the studies that the quality of life of patients who received nursing advice improved significantly (n = 3; Romero-Castillo et al. 2022; Asl et al. 2018; Reiter et al. 2021). The quality-of-life measurement instruments used in the studies are comparable in that they cover all dimensions of quality of life, but they are adapted to different clinical pictures and their specific needs.
The postoperative mobility was also increased (n = 3; Ünver et al. 2018; Early et al. 2017; Roblin et al. 2017). All studies use the physical activity of the patients as a measure.
Patient independence (n = 1; Flodgren et al. 2016), postoperative pain (n = 1; Ertürk and Ünlü 2018), and the feeling of safety (n = 1) were described in some studies (Schofield-Robinson et al. 2018). The mortality and morbidity of patients receiving counseling were also reduced (n = 1; O’Brien et al. 2015).
However, a few studies also showed that there was no effect of nursing advice (n = 3; Whitford et al. 2017; Fleischer et al. 2014; Gurusamy et al. 2014).
Discussion
This systematic review provides a comprehensive analysis of the role and impact of nursing consultations in different medical specialized fields. Against the background of a growing need for nursing care and the shortage of nurses in Germany, the study highlights how nursing consultations can be used to improve both patient care and support for relatives in the inpatient context.
A literature search was conducted of the PubMed and Cochrane databases, which led to the identification of 26 relevant studies answering the main question “What are patients and relatives consulted on in an inpatient setting?” and the sub-questions “How are the nursing consultations designed? Is there evidence for the effects?” These studies covered a wide range of counseling topics, from anxiety management and family-centeredness to specific medical conditions and care phenomena, such as HIV and cancer. The variety of counseling formats, including group and individual sessions, telephone consultations, and the use of telehealth, demonstrates the adaptability of care counseling to different needs and preferences of patients and their families.
The results of the selected studies underline the positive effects of nursing consultations on patients’ mental health, adherence to treatment, nutritional status, and general quality of life (n = 23). A minority of studies (n = 3) failed to identify significant advantages from nursing consultations. These findings support the call for greater integration of nursing counseling into inpatient care practice in order to improve the quality of care and respond to the challenges of demographic change and the shortage of skilled staff.
The quality of the included studies ranged from middle to high as measured by AMSTAR‑2 and MMAT. Each study passed the ranking by one of the two quality measurement tools.
In summary, the review offers valuable insights into the diversity and necessity of care counseling in the inpatient setting. It underlines the importance of targeted, needs-oriented advice and forms a solid basis for future research and for the further development of care practice.
Limitations
Some studies did not show with certainty that the nursing consultation was provided just by nurses; advice is often provided by multiple professionals. It was difficult to demonstrate the benefits of counseling by nurses.
Because the inclusion criteria were limited to completed studies, and the psychiatric context was disregarded, ongoing research relevant to the research question was omitted. This exclusion may have hindered a more thorough representation of the diversity inherent in counseling practices.
Conclusion
The review showed that care advice internationally is provided in different ways, in a variety of settings, and with different focal points. Its effects are also clearly recognizable. Nevertheless, it is clear from the literature review that, compared to other countries, little research has been carried out into care counseling in Germany and that it is therefore rarely practiced. Recommendations for nursing practice in Germany can be derived from this work, which aim to improve the well-being and treatment outcomes of patients and relatives through targeted counseling approaches. Particular emphasis is placed on the potential for expanding nursing advice in areas outside of oncology and pediatrics, such as intensive care. There is also a need for further research, particularly with regard to family-centered care, in order to further optimize care advice and adapt it to the needs of those affected. Research should also be conducted into the framework conditions that mean that care advice is not as widespread in Germany as in other countries.
Conflict of interest
A. Riege, L.-S. Sommer and C. Petersen-Ewert declare that they have no competing interests.
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