Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada.
GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.
Implement Sci. 2021 Jul 9;16(1):70. doi: 10.1186/s13012-021-01140-0.
The long-term care setting poses unique challenges and opportunities for effective knowledge translation. The objectives of this review are to (1) synthesize barriers and facilitators to implementing evidence-based guidelines in long-term care, as defined as a home where residents require 24-h nursing care, and 50% of the population is over the age of 65 years; and (2) map barriers and facilitators to the Behaviour Change Wheel framework to inform theory-guided knowledge translation strategies.
Following the guidance of the Cochrane Qualitative and Implementation Methods Group Guidance Series and the ENTREQ reporting guidelines, we systematically reviewed the reported experiences of long-term care staff on implementing evidence-based guidelines into practice. MEDLINE Pubmed, EMBASE Ovid, and CINAHL were searched from the earliest date available until May 2021. Two independent reviewers selected primary studies for inclusion if they were conducted in long-term care and reported the perspective or experiences of long-term care staff with implementing an evidence-based practice guideline about health conditions. Appraisal of the included studies was conducted using the Critical Appraisal Skills Programme Checklist and confidence in the findings with the GRADE-CERQual approach.
After screening 2680 abstracts, we retrieved 115 full-text articles; 33 of these articles met the inclusion criteria. Barriers included time constraints and inadequate staffing, cost and lack of resources, and lack of teamwork and organizational support. Facilitators included leadership and champions, well-designed strategies, protocols, and resources, and adequate services, resources, and time. The most frequent Behaviour Change Wheel components were physical and social opportunity and psychological capability. We concluded moderate or high confidence in all but one of our review findings.
Future knowledge translation strategies to implement guidelines in long-term care should target physical and social opportunity and psychological capability, and include interventions such as environmental restructuring, training, and education.
长期护理环境对有效知识转化提出了独特的挑战和机遇。本研究的目的是：(1) 综合长期护理中实施基于证据的指南的障碍和促进因素，将其定义为居民需要 24 小时护理且 50%的人口年龄在 65 岁以上的住所；(2) 将障碍和促进因素映射到行为改变轮框架，以告知基于理论的知识转化策略。
根据 Cochrane 定性和实施方法组指南系列和 ENTREQ 报告指南的指导，我们系统地回顾了长期护理人员在将基于证据的指南实施到实践中的经验。从最早可获得的日期开始，我们在 MEDLINE Pubmed、EMBASE Ovid 和 CINAHL 中进行了搜索，直到 2021 年 5 月。如果研究是在长期护理中进行的，并报告了长期护理人员在实施有关健康状况的基于证据的实践指南方面的观点或经验，则两名独立的审查员将其纳入研究。使用批判性评估技能计划清单对纳入的研究进行评估，并使用 GRADE-CERQual 方法对研究结果的置信度进行评估。
在筛选了 2680 篇摘要后，我们检索到 115 篇全文文章；其中 33 篇文章符合纳入标准。障碍包括时间限制和人员配备不足、成本和资源缺乏以及缺乏团队合作和组织支持。促进因素包括领导力和拥护者、精心设计的策略、方案和资源以及充足的服务、资源和时间。行为改变轮的最常见组件是物理和社会机会以及心理能力。除了一项研究结果外，我们对所有研究结果的置信度均为中度或高度。
未来在长期护理中实施指南的知识转化策略应针对物理和社会机会以及心理能力，并包括环境重构、培训和教育等干预措施。
