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Review of the effect of implementation strategies within Nursing

Review of the effect of implementation strategies within Nursing. Ruud J.G. Halfens Roland van Linge. Content. Background Method Results Conclusions. Background. No tradition nursing research Multi-disciplinary guidelines

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Review of the effect of implementation strategies within Nursing

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  1. Review of the effect of implementation strategies within Nursing Ruud J.G. Halfens Roland van Linge

  2. Content • Background • Method • Results • Conclusions Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  3. Background • No tradition nursing research • Multi-disciplinary guidelines • Implementation research directed to physicians (general practitioners, Grol). • Acknowledge of deprivation of nursing research Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  4. Funding • Several reviews for guideline development • Review of implementation strategies Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  5. Method • Databases: Medline, CINAHL, Cochrane library, Sumsearch, DARE • Search terms: • Nursing guidelines, or nursing interventions, or nursing research, or evidence based nursing. • In combination with dissemination, diffusion, implementation, and/or utilization. • References articles Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  6. Inclusion criteria • Inclusion criteria: • RCT’s, and QE designs • Measures effect of dissemination and/or implementation strategies • Nurses (part of ) the sample • Strategies, which are used, are described Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  7. Exclusion criteria • No research based on opinions of nurses (for instance: BARRIERS scale) • No studies with only one measurement Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  8. Results: selection articles • Applying the research terms almost 1000 articles were found • Applying the in- and exclusion criteria only 13 RCT’s and 26 QE’s were found. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  9. Quality of articles • Description of strategies • Used research population • Outcome measurements Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  10. Results: description articles • Studies are very heterogeneous with respect to: • Clinical topic • Organization • Target group • Dependent variable: process, outcomes • Data units: patients, nurses, organizations Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  11. Results: Strategies I • Opinion leaders (2 RCT’s): • In one study a positive effect, in the other no effect • Education (5 RCT’s, 8 QE’s): • positive effect on knowledge, • less positive effect on behavior • Long-term effect unknown Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  12. Results: Strategies II • Reminders (2 RCT’s): • In one study a positive effect, in the other no effect • Participation (1 RCT, 2 QE’s): • No difference (RCT) when physician alone or physician and nurses were instructed. • In two QE’s a positive effect of strategy: participation in process of problem selection, dissemination of knowledge, and implementation Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  13. Results: Strategies III • Structural strategies (5 QE’s) • Coordinator: (1 QE): positive effect patient-outcomes • KU-model (2 QE’s): positive effect nursing behaviour, no long-term effect patient-outcome • CQI (2 QE’s): Both studies show no effect, although in one a positive trend was shown. • Multiple strategies (6 RCT’s, 11 QE’s): • Education plus other strategies: in general positive effects nurses behaviour, no effect patient-outcomes. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  14. Results: quality • Limited description, foundation and use of strategies • No uniformity of strategies • Less use of knowledge about barriers and facilitators. • Individual outcome measurements: nurse and/or patient. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  15. Conclusion Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  16. Conclusions • Number and quality of studies are low. • Education and multiple strategies tend to be effective strategies. • Not enough knowledge about other strategies. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

  17. Recommendations Need more: • Foundation (theory) of strategies • Uniformity within strategies • Broaden our strategies with organizational strategies • Studies which compare effect of strategies on nurse, patient and organizational level. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl

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