Use and effects of implementation strategies for practice guidelines in nursing: a systematic review

Abstract Background Practice guidelines can reduce variations in nursing practice and improve patient care. However, implementation of guidelines is complex and inconsistent in practice. It is unclear which strategies are effective at implementing guidelines in nursing. This review aimed to describe...

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Autores principales:	Christine E. Cassidy, Margaret B. Harrison, Christina Godfrey, Vera Nincic, Paul A. Khan, Patricia Oakley, Amanda Ross-White, Hilary Grantmyre, Ian D. Graham
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Clinical practice guidelines Nursing Implementation Implementation strategies Systematic review Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/50fd607cea1c46f2845370d3ec88051e
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spelling	oai:doaj.org-article:50fd607cea1c46f2845370d3ec88051e2021-12-05T12:17:51ZUse and effects of implementation strategies for practice guidelines in nursing: a systematic review10.1186/s13012-021-01165-51748-5908https://doaj.org/article/50fd607cea1c46f2845370d3ec88051e2021-12-01T00:00:00Zhttps://doi.org/10.1186/s13012-021-01165-5https://doaj.org/toc/1748-5908Abstract Background Practice guidelines can reduce variations in nursing practice and improve patient care. However, implementation of guidelines is complex and inconsistent in practice. It is unclear which strategies are effective at implementing guidelines in nursing. This review aimed to describe the use and effects of implementation strategies to facilitate the uptake of guidelines focused on nursing care. Methods We conducted a systematic review of five electronic databases in addition to the Cochrane Effective Practice and Organization of Care (EPOC) Group specialized registry. Studies were included if implementation of a practice guideline in nursing and process or outcome of care provided by nurses were reported. Two reviewers independently screened studies, assessed study quality, extracted data, and coded data using the EPOC taxonomy of implementation strategies. For those strategies not included in the EPOC taxonomy, we inductively categorized these strategies and generated additional categories. We conducted a narrative synthesis to analyze results. Results The search identified 46 papers reporting on 41 studies. Thirty-six studies used a combination of educational materials and educational meetings. Review findings show that multicomponent implementation strategies that include educational meetings, in combination with other educational strategies, report positive effects on professional practice outcomes, professional knowledge outcomes, patient health status outcomes, and resource use/expenditures. Twenty-three of the 41 studies employed implementation strategies not listed within the EPOC taxonomy, including adaptation of practice guidelines to local context (n = 9), external facilitation (n = 14), and changes to organizational policy (n = 3). These implementation strategies also corresponded with positive trends in patient, provider, and health system outcomes. Conclusions Nursing guideline implementation may benefit from using the identified implementation strategies described in this review, including participatory approaches such as facilitation, adaptation of guidelines, and organizational policy changes. Further research is needed to understand how different implementation strategy components work in a nursing context and to what effect. As the field is still emerging, future reviews should also explore guideline implementation strategies in nursing in quasi or non-experimental research designs and qualitative research studies.Christine E. CassidyMargaret B. HarrisonChristina GodfreyVera NincicPaul A. KhanPatricia OakleyAmanda Ross-WhiteHilary GrantmyreIan D. GrahamBMCarticleClinical practice guidelinesNursingImplementationImplementation strategiesSystematic reviewMedicine (General)R5-920ENImplementation Science, Vol 16, Iss 1, Pp 1-29 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Clinical practice guidelines Nursing Implementation Implementation strategies Systematic review Medicine (General) R5-920
spellingShingle	Clinical practice guidelines Nursing Implementation Implementation strategies Systematic review Medicine (General) R5-920 Christine E. Cassidy Margaret B. Harrison Christina Godfrey Vera Nincic Paul A. Khan Patricia Oakley Amanda Ross-White Hilary Grantmyre Ian D. Graham Use and effects of implementation strategies for practice guidelines in nursing: a systematic review
description	Abstract Background Practice guidelines can reduce variations in nursing practice and improve patient care. However, implementation of guidelines is complex and inconsistent in practice. It is unclear which strategies are effective at implementing guidelines in nursing. This review aimed to describe the use and effects of implementation strategies to facilitate the uptake of guidelines focused on nursing care. Methods We conducted a systematic review of five electronic databases in addition to the Cochrane Effective Practice and Organization of Care (EPOC) Group specialized registry. Studies were included if implementation of a practice guideline in nursing and process or outcome of care provided by nurses were reported. Two reviewers independently screened studies, assessed study quality, extracted data, and coded data using the EPOC taxonomy of implementation strategies. For those strategies not included in the EPOC taxonomy, we inductively categorized these strategies and generated additional categories. We conducted a narrative synthesis to analyze results. Results The search identified 46 papers reporting on 41 studies. Thirty-six studies used a combination of educational materials and educational meetings. Review findings show that multicomponent implementation strategies that include educational meetings, in combination with other educational strategies, report positive effects on professional practice outcomes, professional knowledge outcomes, patient health status outcomes, and resource use/expenditures. Twenty-three of the 41 studies employed implementation strategies not listed within the EPOC taxonomy, including adaptation of practice guidelines to local context (n = 9), external facilitation (n = 14), and changes to organizational policy (n = 3). These implementation strategies also corresponded with positive trends in patient, provider, and health system outcomes. Conclusions Nursing guideline implementation may benefit from using the identified implementation strategies described in this review, including participatory approaches such as facilitation, adaptation of guidelines, and organizational policy changes. Further research is needed to understand how different implementation strategy components work in a nursing context and to what effect. As the field is still emerging, future reviews should also explore guideline implementation strategies in nursing in quasi or non-experimental research designs and qualitative research studies.
format	article
author	Christine E. Cassidy Margaret B. Harrison Christina Godfrey Vera Nincic Paul A. Khan Patricia Oakley Amanda Ross-White Hilary Grantmyre Ian D. Graham
author_facet	Christine E. Cassidy Margaret B. Harrison Christina Godfrey Vera Nincic Paul A. Khan Patricia Oakley Amanda Ross-White Hilary Grantmyre Ian D. Graham
author_sort	Christine E. Cassidy
title	Use and effects of implementation strategies for practice guidelines in nursing: a systematic review
title_short	Use and effects of implementation strategies for practice guidelines in nursing: a systematic review
title_full	Use and effects of implementation strategies for practice guidelines in nursing: a systematic review
title_fullStr	Use and effects of implementation strategies for practice guidelines in nursing: a systematic review
title_full_unstemmed	Use and effects of implementation strategies for practice guidelines in nursing: a systematic review
title_sort	use and effects of implementation strategies for practice guidelines in nursing: a systematic review
publisher	BMC
publishDate	2021
url	https://doaj.org/article/50fd607cea1c46f2845370d3ec88051e
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Use and effects of implementation strategies for practice guidelines in nursing: a systematic review

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