30 Chapter 2 Participants Twenty-seven studies provided no description of the targeted professionals other than ‘nurses’. In some studies, nurse aids, student nurses or nurse practitioners were (part of) the target group, few studies targeted multiple professionals (physicians, physical therapists, etc.). The median number of involved caregivers per study (n=27) was 118 (IQR 34 – 238); twenty-six studies did not provide the number of involved caregivers. Sixteen studies did not describe any details of the targeted patients; the other studies described basic characteristics regarding age and gender. Several studies described baseline characteristics related to the guideline of interest. Regarding 35 of all included studies, the median sample size of included patients was 373 (IQR 140 – 1577); seventeen studies did not report the sample size. Also shown in Supplement 2. Description of included studies. Risk of bias assessment Nine controlled studies scored low risk of bias on most items (seven or more out of the nine items), as shown in Supplement 4 Cochrane risk of bias for controlled studies. The remaining six studies scored unclear or high risk of bias on three or more out of nine items. Thirty-two of the 38 before-after studies scored poor, assessed with the Newcastle-Ottawa Quality Assessment form for Cohort Studies (Supplement 5). Thirty of these 32 studies scored poor on the comparability part. These studies did not control for age, sex, or other factors, or did not correct for confounding when comparing the before and after groups. Four before-after studies were assessed as good; two as fair. Implementation outcomes All studies used a variety of implementation strategies, which were rarely comparable and with variable outcomes. The duration of the measurements, the intensity and the degree of details of the used strategies varied across studies. Twenty-one studies measured both patient-related nursing outcomes and guideline adherence. Eleven of these studies found a significant improvement on both outcomes. Overall, thirty-six studies (68%) measured a significant positive change on either patient-related nursing outcome measure(s) or guideline adherence. Patient-related nursing outcomes Patient-related nursing outcomes were measured in 30 studies. Twenty-one (70%) measured a significant positive change, seven measured no change, and two studies did not perform statistical tests. All studies reported findings indicating a positive change or no change. However, one study [41] reported a significant negative effect on one of the patient-related nursing outcome measures that were addressed. Törmä et al. [41]
RkJQdWJsaXNoZXIy MTk4NDMw