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

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

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

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

5. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl 5 Method Databases: Medline, CINAHL, Cochrane library, Sumsearch, DARE Databases: Medline, CINAHL, Cochrane library, Sumsearch, DARE Search terms: 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 References articles

6. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl 6 Inclusion criteria 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

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

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

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

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

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

12. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl 12 Results: Strategies II Reminders ( 2 RCT’s): Reminders ( 2 RCT’s):  In one study a positive effect, in the other no effect Participation ( 1 RCT, 2 QE’s ): 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

13. Department Nursing Science Universiteit Maastricht, www.nursingscience.nl 13 Results: Strategies III Structural strategies ( 5 QE’s ) 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 ): Multiple strategies ( 6 RCT’s, 11 QE’s ):  Education plus other strategies: in general positive effects nurses behaviour, no effect patient-outcomes.

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

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

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

17. 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.