Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.
Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands.
Int J Nurs Stud. 2020 Nov;111:103748. doi: 10.1016/j.ijnurstu.2020.103748. Epub 2020 Aug 18.
Research 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.
Systematic review. PROSPERO registration number: CRD42018104615.
We 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.
Studies 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.
A 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.
A 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.
专门针对护理指南实施策略的研究有限。本研究的目的是综述所有护理领域中用于实施护理指南的策略，以及这些策略对患者相关护理结局和指南依从性的影响。理想情况下，这些发现将有助于指南制定者、医疗保健专业人员和组织在实践中实施护理指南。
系统评价。PROSPERO 注册号：CRD42018104615。
我们检索了 Embase、Medline、PsycINFO、Web of Science、Cochrane、CINAHL 和 Google Scholar 数据库，检索时间截至 2019 年 8 月，并查阅了相关文章的参考文献列表。
纳入了描述任何类型护理指南在任何环境下实施策略及其实施结果对患者相关护理结局或指南依从性影响的定量数据的研究。未对语言或出版日期进行限制。采用 Cochrane 有效实践和护理组织关怀分类法对实施策略进行分类。如果描述了患者相关护理结局或指南依从性的显著变化，则认为研究具有效果。使用“Cochrane 偏倚风险工具”对对照研究和“纽卡斯尔-渥太华质量评估表”对队列研究进行证据强度评估。
共纳入 54 篇关于 53 项不同指南实施研究的文章。其中 15 项为（整群）随机对照试验或对照前后研究，38 项为对照前后设计。实施指南的主题多种多样，主要涉及皮肤护理（9 项）和感染预防（7 项）。研究主要在医院（34 项）和养老院（11 项）进行。30 项研究显示在患者相关护理结局或指南依从性方面有积极的显著效果（68%，n=36）。每项研究使用的实施策略中位数为 6 项（IQR 4-8 项）。几乎所有研究（98.1%，n=52）都使用了教育策略，其次是部署当地意见领袖（54.7%，n=29）和审核反馈（41.5%，n=22）。23 项（43.4%）研究进行了障碍评估，19 项使用了针对性策略。
实施护理指南时使用了多种实施策略。没有一种单一的策略或策略组合可以直接与护理指南的成功实施联系起来。总体而言，36 项研究（68%）报告了指南实施对患者相关护理结局或指南依从性的积极显著影响。未来的研究应使用标准化报告清单，以确保详细描述所使用的实施策略，从而提高可重复性和对结果的理解。
