护理实践指南实施策略的使用和效果：系统评价

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.

摘要翻译（仅供参考）

背景

实践指南可以减少护理实践的变化并改善患者护理。然而，指南的实施在实践中是复杂且不一致的。目前尚不清楚哪些策略在实施护理指南方面是有效的。本综述旨在描述实施策略的使用和效果，以促进采用以护理为重点的指南。

方法

除了 Cochrane Effective Practice and Organization of Care (EPOC) Group 专门注册之外，我们还对五个电子数据库进行了系统评价。如果报告了护理实践指南的实施以及护士提供的护理的过程或结果，则研究被纳入。两名审查员使用实施策略的 EPOC 分类法独立筛选研究、评估研究质量、提取数据和编码数据。对于那些未包含在 EPOC 分类法中的策略，我们对这些策略进行了归纳分类并生成了其他类别。我们进行了叙事综合来分析结果。

结果

搜索确定了 46 篇报告 41 项研究的论文。三十六项研究结合使用了教育材料和教育会议。审查结果表明，包括教育会议在内的多组分实施策略与其他教育策略相结合，报告了对专业实践成果、专业知识成果、患者健康状况成果和资源使用/支出的积极影响。41 项研究中有 23 项采用了 EPOC 分类法中未列出的实施策略，包括根据当地情况调整实践指南 ( n  = 9)、外部促进 ( n  = 14) 以及组织政策的变化 ( n = 3)。这些实施策略也符合患者、提供者和卫生系统结果的积极趋势。

结论

参与式方法，例如促进护理指南的实施可能受益于使用本综述中描述的已确定的实施策略，包括、指南的调整和组织政策的变化。需要进一步研究以了解不同的实施策略组件如何在护理环境中发挥作用以及产生何种效果。由于该领域仍处于新兴阶段，未来的审查还应探索准或非实验性研究设计和定性研究中的护理指南实施策略。

原文链接：

https://implementationscience.biomedcentral.com/articles/10.1186/s13012-021-01165-5?utm_source=xmol&utm_medium=affiliate&utm_content=meta&utm_campaign=DDCN_1_GL01_metadata

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