A multi-stakeholder qualitative evaluation of the impacts of the Outreach Nurse role

Background and Rationale
Healthcare disparities among vulnerable populations, including individuals experiencing homelessness, addiction, or chronic illness, represent a significant challenge in Stockton-on-Tees. Traditional healthcare systems often fail to engage these groups, leading to unmet medical needs, social isolation, and preventable health crises. The Outreach Nurse project was developed to address these gaps by providing flexible, patient-centred care in unconventional settings. This evaluation was conducted to assess the perceived effectiveness and impact of the project, focusing on the experiences of service users, key stakeholders, commissioners, and the Outreach Nurse herself.
Aims
The evaluation aimed to explore the perceived outcomes of the Outreach Nurse project, identify challenges and areas for improvement, and develop recommendations to optimise the role of the Outreach Nurse and ensure the sustainability of the programme.
Method
The evaluation employed a qualitative design, collecting data from four sources: face-to-face interviews with service users (n = 13), online interviews with key stakeholders (n = 7), an online interview with commissioners (n = 2), and three online interviews with the Outreach Nurse herself. The data were analysed using inductive thematic analysis to identify recurring patterns and perspectives across groups, focusing on successes, challenges, and suggestions for improvement.
Findings
The findings revealed that the Outreach Nurse played a transformative role in engaging marginalised populations, improving health outcomes, and fostering collaboration between healthcare and social services. Service users described how her holistic approach, addressing medical, practical, and emotional needs, restored their trust in healthcare and significantly improved their quality of life. Stakeholders and commissioners emphasised her role in reducing system-level burdens, such as hospital admissions and medical evictions, by bridging gaps in care and advocating for individuals.
Despite these successes, challenges such as high workloads, role misuse, and resource constraints were identified, which threatened the sustainability of the programme. Clear role boundaries, additional team members, and enhanced resources were proposed to address these issues. Structured professional development and collaboration with multidisciplinary teams were also highlighted as priorities.
Recommendations
Key recommendations arising from this evaluation include expanding the Outreach Nurse team, introducing mobile clinics, or dedicated clinical spaces, securing long-term funding, and fostering professional support networks for outreach nurses. Addressing these challenges would help ensure that the programme can continue to bridge healthcare gaps, improve outcomes for marginalised populations, and serve as a model for similar initiatives.

Lay Summary

Why this project matters
Some people in Stockton-on-Tees, such as those who are homeless, dealing with addiction, or living with long-term health problems, struggle to get the healthcare they need. Many traditional healthcare services don’t reach these groups, leaving them without help for medical problems, social support, or emotional care. The Outreach Nurse project was started to tackle these issues by bringing healthcare directly to people where they are, offering care that focuses on their specific needs. This study looked at how well the project is working and how it can be improved.
What we wanted to find out
We wanted to understand how the Outreach Nurse project helps people, what challenges it faces, and what changes could make it better. This was to make sure that the programme continues to work well and stays available for the people who need it most.
How we did it
We talked to 13 people who use the service, 7 professionals who work alongside the nurse, 2 commissioners who help fund the project, and the Outreach Nurse herself. We then studied these conversations to find common themes about what is working well and where things could be improved.
What we found out
The Outreach Nurse has made a big difference to people’s lives. Service users said the nurse helped with their medical needs, emotional struggles, and even practical problems like accessing food or clothing. Many said they trusted the nurse because she treated them with kindness and respect, which encouraged them to seek help when they might not have otherwise. Professionals and commissioners also saw the project as a success, saying it helped prevent unnecessary hospital visits and worked well with other services to make sure people got the care they needed.
But there were challenges. The nurse’s workload was very high, and she sometimes had to do tasks outside her main role, like going to meetings that take time away from looking after patients. There are also not enough resources, like private spaces for treatment, which makes the job harder. Everyone agreed that changes are needed to help the project run properly and keep making a difference.
How the project can be made better
To keep the project running well, we recommend hiring more nurses to share the workload, setting up mobile clinics or treatment spaces, and making sure that there is enough money to support the programme. The nurse would also benefit from extra training and professional support to make the job easier and improve care. By making these changes, the Outreach Nurse project can continue to help those who need it most and act as a model for similar projects elsewhere.