ReviewBarriers and facilitators of nurses’ use of clinical practice guidelines: An integrative review
Section snippets
Integrative review: barriers and facilitators of nurses in their use of clinical practice guidelines
Preventable harm, most commonly defined as “a harm with an identifiable and modifiable cause” (Nabhan et al., 2012, p. 5), continues to be one of the leading causes of death; each year about 400,000 patients die from sepsis, hospital acquired infections, venous thromboembolism, and pulmonary embolism related to lapses in care (Andel et al., 2012, James, 2013). These instances of preventable harms cost the United States one trillion dollars per year or about one third of annual healthcare
Literature search
The literature about nurses’ use of clinical practice guidelines was searched using a methodology delineated by Whittemore and Knafl (2005). The following databases were used for search: PubMed, the Cumulative Index to Nursing and Allied Health Literature, ProQuest, Medline, also known as Web of Science, and Embase. We performed the initial literature search in March and April 2014, and updated the search in December 2015 and January 2016. The keywords and MeSH terms in Table 1 were determined
Search results
The initial search identified 15,829 articles, which were reduced to 13,582 after removing duplicates. First, the titles were reviewed for relevancy, resulting in reducing the number of articles to 989. Then the abstract of each article was reviewed with the inclusion and exclusion criteria applied, further narrowing the selection to 52 articles. Finally, after full text review, we identified 16 articles that met all the inclusion and exclusion criteria. The 36 articles were excluded because
Discussion
Even though many of barriers and facilitators that nurses face share commonality with other healthcare providers, nurses also face their unique challenges such as resource availability including staffing and equipment availability. In a systematic review of physicians’ barriers to the use of clinical practice guidelines, Cabana et al. (1999) found that awareness, familiarity and agreement with clinical practice guidelines, self-efficacy, outcome expectancy, and ability to overcome the
Conclusions
Well-conducted integrative reviews can stimulate further research (Torraco, 2005). In this integrative review, we analyzed primary quantitative and qualitative studies to identify the internal and external barriers and facilitators to the use of clinical practice guidelines for nurses. Attitudes, perceptions, and knowledge were identified as the internal barriers and facilitators, whereas clinical practice guidelines, resources, leadership and organizational culture were the external barriers
Acknowledgement
Special acknowledgment to Dr. Susan Sullivan-Boyai at New York University, College of Nursing.
Conflict of interest. None declared.
Funding. No funding was received for the preparation or writing of this manuscript.
References1 (52)
- et al.
Highlights of the national workforce survey of registered nurses
J. Nurs. Regul.
(2013) - et al.
The role of clinical practice guidelines in enhancing quality and reducing racial/ethnic disparities in paediatrics
Paediatr. Respir. Rev.
(2002) - et al.
Physicians’ attitudes towards guidelines for the treatment of hospitalized nursing home-acquired pneumonia
J. Am. Med. Dir. Assoc.
(2011) - et al.
Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia – a survey study
Intensive Crit. Care Nurs.
(2013) - et al.
The nursing work of hospital-based clinical practice guideline implementation: an explanatory systematic review using normalization process theory
Int. J. Nurs. Stud.
(2014) - et al.
Recent trends in clinical outcomes and resource utilization for pulmonary embolism in the United States Findings from the nationwide inpatient sample
CHEST J.
(2009) - et al.
Attitudes toward practice guidelines among intensive care unit personnel: a cross-sectional anonymous survey
Heart Lung
(2007) - et al.
Facilitators and barriers to clinical practice guideline use among nurses
Am. J. Nurs.
(2012) National Healthcare Quality Report 2004
(2004)AHRQ's Efforts to Prevent and Reduce Health Care-Associated Infection
(2014)
Lower Medicare mortality among a set of hospitals known for good nursing care
Med. Care
Hospital nursing staffing and patient mortality, nurse burnout, and job dissatisfaction
J. Am. Med. Assoc.
Nursing Fact Sheet
The economics of health care quality and medical errors
J. Health Care Finance
Improving guideline adherence, a randomized trial evaluating strategies to increase β-blocker use in heart failure
Circulation
Experiences of the implementation of clinical practice guidelines – interviews with nurse managers and nurses in hospital care
Scand. J. Caring Sci.
Changing attitudes about change: longitudinal effects of transformational leader behavior on employee cynicism about organizational change
J. Organ. Behav.
Why don’t physicians follow clinical practice guidelines? A framework for improvement
J. Am. Med. Assoc.
Barriers to and facilitators of clinical practice guideline use in nursing homes
J. Am. Geriatr. Soc.
Critical Appraisal Skills Programme appraisal tools
Factors influencing ambulance nurses’ adherence to a national protocol ambulance care: an implementation study in the Netherlands
Eur. J. Emerg. Med.
Systematic review of studies on compliance with hand hygiene guidelines in hospital care
Infect. Control Hosp. Epidemiol.
Relationship between work context and adherence to a clinical practice guideline for peripheral venous catheters among registered nurses in pediatric care
Worldviews Evid.-Based Nurs.
Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy
J. Nurs. Manag.
Association of unstable angina guideline care with improved survival
Arch. Intern. Med.
Lost in knowledge translation: time for a map?
J. Contin. Educ. Health Prof.
Cited by (105)
The role of nursing leadership in promoting evidence-based nursing practice
2023, Journal of Professional NursingBarriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review
2023, Journal of Tissue ViabilityThe Chinese version of the skin tear knowledge assessment instrument (OASES): Cultural adaptation and validation
2023, Journal of Tissue ViabilityUS physical therapist practice patterns evaluating concussion and clinical practice guideline adherence
2023, Physical Therapy in SportCitation Excerpt :The identified barriers and facilitators from this study are supported by previous CPG adherence research. “Investing in specialized training” was shown to increase guideline adherence (Greenberg et al., 2018; Ladeira et al., 2017; Quatman-Yates et al., 2020; Stache et al., 2016), while lack of “resources and organizational constraints” (Bierbaum et al., 2020; Jun, Kovner, & Stimpfel, 2016; Ladeira et al., 2017; Quatman-Yates et al., 2020; Stache et al., 2016) and reduced “confidence and lack of knowledge” (Jun et al., 2016) were identified as barriers to adherence. Though a large part of CPG adherence may be through an internal locus, facility resources and the ability to specialize in clinical practice could also provide future support for adherence.
- 1
References marked with an asterisk indicate studies included in the integrative review.