Abstract
ObjectivesResearch specifically addressing implementation strategies regarding nursing guidelines is limited. The objective of this review was to provide an overview of strategies used to implement nursing guidelines in all nursing fields, as well as the effects of these strategies on patient-related nursing outcomes and guideline adherence. Ideally, the findings would help guideline developers, healthcare professionals and organizations to implement nursing guidelines in practice. DesignSystematic review. PROSPERO registration number: CRD42018104615. Data sourcesWe searched the Embase, Medline, PsycINFO, Web of Science, Cochrane, CINAHL and Google Scholar databases until August 2019 as well as the reference lists of relevant articles. Review methodsStudies were included that described quantitative data on the effect of implementation strategies and implementation outcomes of any type of a nursing guideline in any setting. No language or date of publication restriction was used. The Cochrane Effective Practice and Organisation of Care taxonomy was used to categorize the implementation strategies. Studies were classified as effective if a significant change in either patient-related nursing outcomes or guideline adherence was described. Strength of the evidence was evaluated using the ‘Cochrane risk of bias tool’ for controlled studies, and the ‘Newcastle-Ottawa Quality Assessment form’ for cohort studies. ResultsA total of 54 articles regarding 53 different guideline implementation studies were included. Fifteen were (cluster) Randomized Controlled Trials or controlled before-after studies and 38 studies had a before-after design. The topics of the implemented guidelines were diverse, mostly concerning skin care (n = 9) and infection prevention (n = 7). Studies were predominantly performed in hospitals (n = 34) and nursing homes (n = 11). Thirty studies showed a positive significant effect in either patient-related nursing outcomes or guideline adherence (68%, n = 36). The median number of implementation strategies used was 6 (IQR 4–8) per study. Educational strategies were used in nearly all studies (98.1%, n = 52), followed by deployment of local opinion leaders (54.7%, n = 29) and audit and feedback (41.5%, n = 22). Twenty-three (43.4%) studies performed a barrier assessment, nineteen used tailored strategies. ConclusionsA wide variety of implementation strategies are used to implement nursing guidelines. Not one single strategy, or combination of strategies, can be linked directly to successful implementation of nursing guidelines. Overall, thirty-six studies (68%) reported a positive significant effect of the implementation of guidelines on patient-related nursing outcomes or guideline adherence. Future studies should use a standardized reporting checklist to ensure a detailed description of the used implementation strategies to increase reproducibility and understanding of outcomes.
Highlights
Nurses are increasingly expected to provide evidence-based care intended to enhance quality of care (Herron and Strunk, 2019)
The objective of this review was to provide an overview of strategies used to implement nursing guidelines in all nursing fields, as well as the effects of these strategies on patient-related nursing outcomes and guideline adherence
Studies were predominantly performed in hospitals (n = 34) and nursing homes (n = 11)
Summary
Nurses are increasingly expected to provide evidence-based care intended to enhance quality of care (Herron and Strunk, 2019). An increasing number of nursing guidelines are being published. A guideline in general contains evidence-based recommendations for health care providers, policy makers, and patients about health interventions intended to optimize patient care. Model or framework, is expected to increase the probability of success of the implementation (Nilsen et al, 2015). This holds for performing a barrier assessment and tailoring strategies (Geerligs et al, 2018), which are often elements in theories, models or frameworks
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