2 23 Implementation strategies used to implement nursing guidelines in daily practice Analysis and synthesis Meta-analysis was precluded due to heterogeneity across studies. This heterogeneity concerned differences in guidelines, implementation strategies, outcome measures, timing of follow-up measurements, and the level of detail of the used strategies. Instead we provided a descriptive and narrative synthesis of the primary outcomes guideline adherence and patient-related nursing outcomes of the individual implementation studies. We provided a summary table with all crucial elements of the implementation processes (duration, used implementation strategies, barrier assessment, use of implementation framework, used implementation outcomes Supplement 2). The number of implementation strategies were categorized into the four EPOC categories (Delivery, Financial, Government and Implementation strategies). The total number of implementation strategies that were used in the implementation studies were summarized as median with IQR. The median number of used implementation strategies was provided for all studies, per EPOC category (Delivery, Financial, Government and Implementation strategies), for the studies that presented a positive significant change on one or more of their primary outcomes, and for the studies who reported no significant change. Further, the relative change percentage was calculated for the studies providing patientrelated nursing outcomes. Calculating a relative change of guideline adherence before the (re)implementation of a guideline is expected to be of low-value, because the adherence rate to a not yet implemented guideline will always be low at baseline. Moreover, not all studies measured adherence at baseline. Therefore, we chose not to calculate the relative change of our other primary outcome ‘adherence’. For the before-after studies, the relative change was computed by dividing the absolute outcome by the baseline level, preferably for the primary outcome of that individual study. However, in some studies the patient-related nursing outcome was a secondary outcome. For controlled studies, we first computed the relative change separately for the intervention group and the control group. Subsequently, the calculated relative change percentage in the intervention group was divided by the calculated relative change in the control group [23]. Supplement 3 Calculations of relative change percentage for the patient-related nursing outcomes provide an example of how the relative changes were calculated for both study groups. Of note is that the relative change for the before-after studies could have been overestimated due to the lack of a control group. The association between the relative change and the total number of EPOC strategies used in the included studies was visualized in a scatterplot, for the controlled studies and the before-after studies separately. The difference between the median relative change for studies using only strategies from the EPOC category Implementation
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