Mattila, E., Leino, K., Paavilainen, E., & AstedtKurki, P. (2009). Nursing intervention studies on patients and family members: A systematic literature review. Scandinavian Journal of Caring Sciences, 23, 611–622.

To identify the targets of intervention studies and obtain findings that will help in planning future intervention studies, support nursing, and promote the introduction of new family-centered nursing methods

• MEDLINE and CINAHL (2001–2006) databases were searched, in addition to hand searching of article references.
• Key words were nursing interventions, family, family health, family nursing, family members, caregivers, and spouse.
• Inclusion criteria included English-language studies with participants who were at least 18 years of age.
• Patients and family members, or family members only, described or tested a nursing intervention and its impact.

The initial search yielded 323 articles. The final analysis included 31 articles that met inclusion criteria. Evidence was assessed using the Finnish Federation of Nurses’ criteria, which is described in the article. Content analysis of interventions was used. The RE-AIM model was used to examine study findings. This model includes dimensions of reach, efficacy, adaptation, implementation, and maintenance. Only six of the studies were identified as a high level of evidence using the stated criteria.

• A final sample of 31 studies was used.
• Study sample sizes were not reported.
• Sample characteristics were not fully described, but the authors stated that the majority of interventions were aimed at patients with cancer.
• Other situations included patients with Alzheimer disease, dementia, stroke, and schizophrenia and their family members.

• Of the studies, 22 used quantitative methods, 4 used qualitative methods, and 5 used a combination of these.
• Support and counseling interventions on depressive symptoms of spouses of patients with Alzheimer disease were supported by the evidence.
• Education and support interventions were shown to help improve family members’ ability to control challenging behavior associated with Alzheimer disease and schizophrenia.
• Support and teaching interventions may enhance preparedness and social capability and alleviate depressive symptoms in family members of patients who experienced a stroke.
• Support and teaching interventions may help to improve quality of life in family members of patients with cancer.
• Interventions ranged in duration from 4 to 24 weeks and involved a variety of personal and group meetings and/or phone contact.
• The majority of studies were focused on a single family member and did not consider the wider family context.

• The studies included difficult categories of patients and families (e.g., cancer dementia) that have very different problems and needs, thereby decreasing the applicability of the results.
• Data from the studies was incomplete, such as dropout rates and missing data (particularly the differential dropout rate).
• Not all of the dimensions of RE-AIM were able to be assessed due to insufficient data.

• Interventions were not designed to achieve economic objectives, and consideration was not given to the costs of the intervention.
• Overall, interventions may be effective in alleviating burdens of care and depressive symptoms of family members, as well as assisting their coping. 
• These nursing interventions are in development and testing stages. Long-term effects and aspects of maintenance and implementation monitoring are not clear.
• Nursing interventions involving education, counseling, and incorporation of both individual and group activities can be effective in assisting caregivers. The most effective combinations of approaches, setting for provision, and long-term maintenance are not yet clear.