2 21 Implementation strategies used to implement nursing guidelines in daily practice Search Relevant studies were searched in the Embase, Medline, PsycINFO, Web of Science, Cochrane, CINAHL and Google Scholar databases until August 2019. Various search terms were purposefully selected to cover all nursing fields and implementation synonyms. A biomedical information specialist of the medical library of the Erasmus MC – University Medical Centre Rotterdam guided the search. The full search strategy is presented in Overview of the supplemental files: Supplement 1. Search strategy. The titles and abstracts of all search results were screened on relevance by DS and EI independently, according to specified eligibility criteria, using Endnote® [17]. Next, the full texts of possibly relevant articles were checked for inclusion by DS. Consensus on final inclusion was achieved by discussion (DS, EI). After the initial search, a reference and citation check was performed for all relevant studies (by DS, EI). To ensure having a complete overview of all published studies, several previously published systematic reviews were screened for relevant included studies [12-14, 18]. Eligibility criteria The scope of the review was limited to studies that considered the implementation of a nursing guideline, defined as recommendations about health interventions mainly provided by nurses (>50%), intended to optimize patient care and based on either national or international guidelines. The following inclusion criteria were applied: 1) studies had to describe the implementation strategies and outcomes of the implementation of the nursing guideline; 2) studies had to measure either the effects of the implemented nursing guideline on patient-related nursing outcomes (e.g. pain, falls, pressure ulcers), or adherence to the guideline by the healthcare professionals measured by observation or documentation; 3) studies had to include a reference group (e.g., with and without guideline). Case studies of individual patients, letters and editorials were not eligible. To optimize the objectivity of the included study results, we excluded studies with only survey outcomes. We excluded bundle implementation studies because of their protocollike characteristics. No search limitations were imposed on language. Outcome measures The primary outcomes were; 1) impact on patient-related nursing outcomes, and 2) adherence to the guideline. Studies were classified with a positive effect when a statistically significant improvement in patient-related nursing outcomes and/or adherence was reported.
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