Measured and perceived effects of audit and feedback on nursing performance: A mixed methods systematic review

Abstract Background: The use of audit and feedback in health care has been shown to have generally positive effects with medical teams, but little is known about its effects on nursing care. The purpose of this systematic review was to examine the evidence of measured and perceived effects of such interventions on nursing performance. Methods: We used a mixed-methods systematic review design with thematic and narrative synthesis. Studies reporting quantitative and qualitative data on the effects of feedback interventions specific to nursing care were considered for inclusion. Studies were appraised for quality using the Mixed Methods Appraisal Tool. Quantitative and qualitative data were summarized in narrative and tabular form and were synthetized using the Joanna Briggs Institute segregated methodologies approach. Results: Thirty-one studies published between 1995 and 2021 were included. Thirteen quantitative studies provided evidence on measured effects and 18 qualitative studies provided evidence on perceived effects. The quantitative studies, the majority of which had low to moderate methodological quality, reported highly variable effects of audit and feedback. The characteristics of most of the audit and feedback interventions were poorly aligned with the recommendations developed by the experts and were not theoretically supported. Overall, the qualitative data demonstrated that nurses perceived several negative aspects in the way audit and feedback interventions were conducted, while recognizing the relevance of secondary use of the data to support improved care. Conclusions: Considering the practical benefits of using this type of intervention, we see in these results an important opportunity for action to improve the design and implementation of audit and feedback with nurses. Registration: PROSPERO CRD42018104973