Here is the standardised PICO analysis for the fifty-third uploaded article:
Full Title
Implementation strategies used to implement nursing guidelines in daily practice: A systematic review
Authors: Denise Spoon, Tessa Rietbergen, Anita Huis, Maud Heinen, Monique van Dijk, Leti van Bodegom-Vos, Erwin Ista
Journal: International Journal of Nursing Studies, 2020; 111:103748
DOI: 10.1016/j.ijnurstu.2020.103748
Type of Study
Systematic review of 53 guideline implementation studies (including RCTs, before-after studies)
PICO Summary
Population (P)
- Nursing staff in a wide range of healthcare settings, including hospitals (n = 34), nursing homes (n = 11), home care, general practice, and rehabilitation units
- Some studies included multidisciplinary participants (e.g. physicians, physical therapists)
- Patients were mostly adults, often older adults with relevant care needs like pressure injury prevention, pain management, nutrition, or infection control
Intervention (I)
- Implementation of nursing guidelines via a wide range of strategies, including:
- Educational strategies (e.g. training sessions, educational materials)
- Audit and feedback
- Use of local opinion leaders
- Interprofessional education
- Tailored interventions
- Barrier assessments
- Reminders and supervision
- Median of 6 implementation strategies used per study (IQR 4–8)
Comparison (C)
- Studies compared pre- vs. post-intervention or intervention vs. control groups
- Some trials included alternative implementation arms (e.g. peer-led vs. planned care vs. control)
Outcomes (O)
Primary outcomes:
- Patient-related nursing outcomes (e.g. pressure ulcer incidence, pain scores, oral health, mobility)
- Guideline adherence by nursing staff
Key findings:
- 30 studies measured patient-related outcomes; 21 (70%) showed significant improvement
- 44 studies measured adherence; 26 (59%) showed significant improvement
- No single implementation strategy or combination was directly linked to successful implementation
- Education was the most commonly used strategy (98.1%), followed by opinion leaders (54.7%) and audit/feedback (41.5%)
Implementation features:
- Only 43% performed a barrier assessment, and even fewer used the results to tailor strategies
- 31% used an implementation theory, model, or framework (e.g. PARIHS, JBI model, Normalization Process Theory)
- No statistically significant difference was found between studies that used a theory or performed barrier assessments and those that didn’t
Findings Summary
This comprehensive review shows that multifaceted strategies are most often used to implement nursing guidelines, yet effectiveness varies, and there is no clear evidence that more strategies lead to better outcomes. Key insights include:
- Education remains central, but often needs to be reinforced with leadership, audit, feedback, and peer support
- Supervised implementation, especially in oral care and pressure ulcer prevention, was associated with improved outcomes
- There is a critical need for standardised reporting of strategies (e.g. using TIDieR or StaRI checklists) to enhance reproducibility
- Despite wide use, many studies underreport implementation details, limiting learning from their outcomes
Conclusion
More than two-thirds of studies reported improvements in care or adherence, but implementation science in nursing still suffers from poor reporting, limited use of theoretical frameworks, and infrequent tailoring. Nursing homes remain an underrepresented setting, highlighting the importance of context-specific evaluations in future work.
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