title: A systematic review of the outcomes of educational interventions relevant to nurses with simultaneous strategies for guideline implementation.
abstract: OBJECTIVE
  To systematically review the literature on the outcomes of educational interventions relevant to nurses with regard to guideline implementation.
  
  
  BACKGROUND
  Previous reviews on interventions to implement guidelines have focused on particular clinical problems, but only one included nursing studies.
  
  
  METHODS
  A systematic review based on the procedure of the Centre for Reviews and Dissemination.
  
  
  METHODS
  We searched for papers published from 1 January 2008 to 26 February 2015 using the Cochrane, CINAHL and PubMed MEDLINE databases and paper references were searched manually. Quality appraisal was conducted with tools developed by Thomas et al.(Worldviews on Evidence-based Nursing, 1, 2004, 176) and National Heart, Lung, and Blood Institute. Data were analysed with qualitative content analysis and narrative synthesis.
  
  
  RESULTS
  The data included 13 studies based on a quasi-experimental study design of 13 different educational interventions, described according to their development and realisation, learning content and teaching and learning methods. Seven interventions were supported by simultaneous strategies, 12 studies reported statistically significant outcomes for the interventions on at least one measurement area and six studies reported improvements in the quality of patient care. Interventions with multi-dimensional content, teaching and learning methods produced several good outcomes.
  
  
  CONCLUSIONS
  Guidelines were implemented in a heterogeneous way and the interventions were delivered once and mainly on a local basis. In the future, we need to test these interventions in different nursing contexts, measure the outcomes on patient care and carry out randomised controlled trials on their effectiveness. It is important to standardise interventions, as this will allow them to be replicated and compared.
  
  
  CONCLUSIONS
  Educational interventions to implement guidelines could be beneficial in enhancing nurses' evidence-based decision-making and care practice. The combination of teaching and learning methods proved useful, and educational interventions should be supported with simultaneous strategies. There remains a lack of strong evidence on the subject.
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
authors.forename: Arja
authors.initials: A
authors.lastname: Häggman-Laitila
authors.affiliation: Helsinki, Finland.
authors.forename: Lea-Riitta
authors.initials: LR
authors.lastname: Mattila
authors.affiliation: Department of Social and Health Care, VAMK University of Applied Sciences, Vaasa, Finland.
authors.forename: Hanna-Leena
authors.initials: HL
authors.lastname: Melender
mesh_terms: D003657:Decision Making; D003695:Delivery of Health Care / Q000592:standards*; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006282:Health Personnel / Q000193:education*; D006801:Humans; D009726:Nurses; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D058996:Quality Improvement
keywords: educational interventions; evidence-based nursing; guideline implementation; systematic review