title: Effectiveness of supporting intensive care units on implementing the guideline 'End-of-life care in the intensive care unit, nursing care': a cluster randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study was to examine the effectiveness of supporting intensive care units on implementing the guidelines.
  
  
  BACKGROUND
  Quality of care can be achieved through evidence-based practice. Guidelines can facilitate evidence-based practice, such as the guidelines 'End-of-life care in the intensive care unit, nursing care'. Before intensive care nurses are able to use these guidelines, they needs to be implemented in clinical practice. Implementation is a complex process and may need support.
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  Intensive care nurses of eight intensive care units in the intervention group followed a supportive programme that educated them on implementation, strategies, goals, project management and leadership. The intervention group focused on a stepwise approach to implement the guidelines. The control group (n = 5) implemented the guidelines independently or used the standard implementation plan supplementary to the guideline. The effectiveness of the programme was measured using questionnaires for nurses, interviews with nurses and a questionnaire for family of deceased patients, in the period from December 2014-December 2015.
  
  
  RESULTS
  Overall, an increase in adherence to the guidelines was found in both groups. Overall, use of the guidelines in the intervention group was higher, but on some aspects the control group showed a higher score. Care for the patient and the overall nursing care scored significantly higher according to family in the intervention group.
  
  
  CONCLUSIONS
  The increase in adherence to the guidelines and the significantly higher satisfaction of family in the intervention group indicate that the supportive programme had a more positive effect.
authors.affiliation: Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands.|The Hague University of Applied Sciences, the Netherlands.
authors.forename: Marijke
authors.identifier: http://orcid.org/0000-0002-9176-2291
authors.initials: M
authors.lastname: Noome
authors.affiliation: Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands.|Intensive Care Unit, Radboud University Medical Centre Nijmegen, the Netherlands.
authors.forename: Boukje M
authors.initials: BM
authors.lastname: Dijkstra
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Centre Nijmegen, the Netherlands.
authors.forename: Evert
authors.initials: E
authors.lastname: van Leeuwen
authors.affiliation: Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands.|Scientific Institute for Quality of Healthcare, Radboud University Medical Centre Nijmegen, the Netherlands.
authors.forename: Lilian C M
authors.initials: LCM
authors.lastname: Vloet
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009732:Nursing Care; D009741:Nursing Staff, Hospital; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*; D055815:Young Adult
keywords: cluster randomized controlled trial; end-of-life care; guideline; implementation; intensive care unit; nursing care