Nurses in the fight to end food insecurity: An integrative review

BACKGROUND: As the largest part of the health care workforce, nurses are vital to efforts to meet the social and environmental needs of individuals' health. Food insecurity is a growing problem globally and contributes to disproportionally higher mortality and morbidity rates, particularly within communities that have been intentionally and historically disinvested. However, literature that examines research related to food insecurity where nurses are involved as researchers, clinicians, or authors is scant. PURPOSE: The purpose of this integrative review was to systematically synthesize and critically analyze findings of nurse-involved studies that address food insecurity, identifying key interventions and outcomes across diverse health care and community settings. 

METHODS: A systematic search was conducted of multiple databases for peer-reviewed literature from database inception through December 4, 2023. Databases searched were Web of Science, Embase (Ovid), CINAHL, Ovid MEDLINE, Academic Search Complete (EBSCO), and CABI (Centre for Agriculture and Biosciences International) Digital Library. The search used a combination of keywords and controlled vocabulary related to the concepts food insecurity and nursing. The quality of the evidence was evaluated using the scoring system of Olsen and Baisch, which rates articles according to study type, sampling method, details of data collection, and analysis. Articles are scored on a scale of 2 to 13, with higher scores indicating higher-quality evidence. The contributions of nurses to each article as researchers, clinicians, and/or authors were also recorded. 

RESULTS: Fifty-three articles met the inclusion criteria and were included in the in-depth analysis. Article types included one randomized controlled trial, 18 nonrandomized experimental studies, nine mixed-methods studies, eight cross-sectional studies, 10 qualitative studies, five quality improvement projects, one cohort study, and one program evaluation. The mean score for the quality of evidence was 9.1, indicating reasonable rigor. Four themes emerged from the analysis: health outcomes, health behaviors, building capacity, and building belonging. Across the articles, nurses were shown to have contributed in various roles to the alleviation of food insecurity and to improvements in the health and well-being of individuals and communities. 

CONCLUSIONS: In this integrative review, many positive changes were found in food insecurity and health (including mental health) outcomes. Nurses added to the state of the science of food insecurity as researchers, clinicians, and/or authors, although it is likely that many nurse-driven actions were not captured in the articles. This integrative review adds to the body of knowledge of methods being studied to alleviate this global problem and nurses' contributions to improvements in health outcomes, health behaviors, community capacity, and community members' sense of belonging.