Evaluating Digital Health and Telenursing Strategies in Clinical Nursing Care: A Systematic Review and Meta-analysis

Review question
What are the effects of nurse-led, nurse-delivered, or nurse-supported digital health and telenursing strategies on clinical, patient-centred, behavioural, and health-service outcomes in clinical nursing care populations?

Condition/domain being studied
Clinical nursing care for patients and caregivers affected by chronic or complex conditions, including diabetes, heart failure, hypertension, stroke, haemodialysis, COVID-19 recovery, cancer ostomy care, paediatric inflammatory rheumatic disease, and other long-term conditions.

Participants/population
Adults, children, and caregivers receiving clinical nursing care through digital health or telenursing strategies.

Intervention(s)
Nurse-led or nurse-supported digital health and telenursing interventions, including telephone follow-up, telecoaching, telemonitoring, remote physiological surveillance, mobile telehealth, automated or interactive telephone systems, nurse case management, digital education, adherence support, and care coordination.

Comparator(s)
Usual care, standard face-to-face care, education without follow-up, attention control, traditional outpatient management, non-telehealth nursing care, alternative remote care models, pre-intervention periods, or non-exposed control groups.

Primary outcomes
Clinical disease-control outcomes including HbA1c, blood glucose, systolic blood pressure, fasting glucose, body mass index, and other disease-specific clinical indicators; health-service utilisation outcomes including readmission, rehospitalisation, time to first readmission, heart-failure admission, mortality, and composite outcomes; and patient-centred outcomes including quality of life, satisfaction, caregiver burden, and self-efficacy.

Secondary outcomes
Treatment adherence, dietary compliance, medication compliance, self-care behaviour, symptom control, disease knowledge, cost outcomes, and process outcomes related to remote nursing care.

Study designs to be included
Randomised controlled trials, cluster-randomised trials, crossover randomised trials, quasi-experimental studies, controlled before-and-after studies, and comparative cohort studies with extractable quantitative outcome data.

Search strategy / databases
MEDLINE/PubMed, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, and Google Scholar will be searched from inception to the final search date. Reference lists of included studies and relevant reviews will also be hand-searched.

Data extraction and management
Two reviewers will independently screen studies, assess full texts, and extract data on author, year, country, population, sample size, intervention, nursing role, comparator, follow-up duration, outcome definitions, effect measures, and statistical results. Disagreements will be resolved by discussion or third-reviewer adjudication.

Risk of bias assessment
Randomised trials will be assessed using Cochrane RoB 2. Non-randomised comparative studies will be assessed using ROBINS-I. Crossover studies will be assessed with attention to carry-over effects, period effects, and adequacy of washout.

Strategy for data synthesis
Random-effects meta-analysis will be conducted when at least two studies report clinically and methodologically comparable outcomes with compatible effect measures. Continuous outcomes will be pooled as mean differences or standardised mean differences. Dichotomous outcomes will be pooled as risk ratios or odds ratios. Time-to-event outcomes will be pooled as hazard ratios. Where pooling is not appropriate, findings will be synthesised narratively by clinical condition, intervention type, and outcome domain.

Subgroup and sensitivity analyses
Where data permit, analyses will examine clinical condition, intervention family, degree of nursing control, follow-up duration, patient age group, outcome domain, and study design. Sensitivity analyses will exclude studies at high risk of bias, studies without extractable precision estimates, and studies with weakly described nursing components.

Certainty of evidence
Certainty will be assessed using a GRADE-informed approach considering risk of bias, inconsistency, indirectness, imprecision, and publication bias.

Keywords
Telenursing; digital health; telehealth; chronic disease management; systematic review; meta-analysis; remote patient monitoring; nurse-led intervention.