The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis

Implementation Science

Donna Ciliska⁴  Maureen Dobbins⁴  Ann McKibbon¹  Afeez Hazzan²  Kristine Newman⁵  Fazila Aloweni⁶  David Thompson³  Rebecca Ganann⁴  Jennifer Yost⁴ 

[1] Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Main Street West, Hamilton, ON, Canada;Department of Medicine, McMaster University, St. Peter’s Hospital-Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, Canada;School of Nursing, Faculty of Health and Behavioural Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON, Canada;School of Nursing, Faculty of Health Sciences, McMaster University, Main Street West, Hamilton, ON, Canada;Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, ON, Canada;Singapore General Hospital, 31 Third Hospital Avenue, Singapore, Singapore

关键词: Meta-analysis;    Systematic review;    Tertiary care;    Nursing practice;    Evidence-informed decision-making;    Knowledge translation;   

Others  :  1218996
DOI  :  10.1186/s13012-015-0286-1

 received in 2014-07-22, accepted in 2015-06-30,  发布年份 2015

【 摘 要 】

Background

Nurses are increasingly expected to engage in evidence-informed decision-making (EIDM) to improve client and system outcomes. Despite an improved awareness about EIDM, there is a lack of use of research evidence and understanding about the effectiveness of interventions to promote EIDM. This project aimed to discover if knowledge translation (KT) interventions directed to nurses in tertiary care are effective for improving EIDM knowledge, skills, behaviours, and, as a result, client outcomes. It also sought to understand contextual factors that affect the impact of such interventions.

Methods

A systematic review funded by the Canadian Institutes of Health Research (PROSPERO registration: CRD42013003319) was conducted. Included studies examined the implementation of any KT intervention involving nurses in tertiary care to promote EIDM knowledge, skills, behaviours, and client outcomes or studies that examined contextual factors. Study designs included systematic reviews, quantitative, qualitative, and mixed method studies. The search included electronic databases and manual searching of published and unpublished literature to November 2012; key databases included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica (EMBASE). Two reviewers independently performed study selection, risk of bias assessment, and data extraction. Studies with quantitative data determined to be clinically homogeneous were synthesized using meta-analytic methods. Studies with quantitative data not appropriate for meta-analysis were synthesized narratively by outcome. Studies with qualitative data were synthesized by theme.

Results

Of the 44,648 citations screened, 30 citations met the inclusion criteria (18 quantitative, 10 qualitative, and 2 mixed methods studies). The quality of studies with quantitative data ranged from very low to high, and quality criteria was generally met for studies with qualitative data. No studies evaluated the impact on knowledge and skills; they primarily investigated the effectiveness of multifaceted KT strategies for promoting EIDM behaviours and improving client outcomes. Almost all studies included an educational component. A meta-analysis of two studies determined that a multifaceted intervention (educational meetings and use of a mentor) did not increase engagement in a range of EIDM behaviours [mean difference 2.7, 95 % CI (−1.7 to 7.1), I²  = 0 %]. Among the remaining studies, no definitive conclusions could be made about the relative effectiveness of the KT interventions due to variation of interventions and outcomes, as well as study limitations. Findings from studies with qualitative data identified the organizational, individual, and interpersonal factors, as well as characteristics of the innovation, that influence the success of implementation.

Conclusions

KT interventions are being implemented and evaluated on nurses’ behaviour and client outcomes. This systematic review may inform the selection of KT interventions and outcomes among nurses in tertiary care and decisions about further research.

【 授权许可】

   
2015 Yost et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]DiCenso A, Ciliska D, Guyatt G. Introduction to evidence-based nursing. In: Evidence-based nursing: a guide to clinical practice. DiCenso A, Guyatt G, Ciliska D, editors. Elsevier-Mosby, St. Louis, MO; 2005: p.3-19.
• [2]Canadian Nurses Association. Position statement: evidence-informed decision-making and nursing practice. 2013.
• [3]Kitson A. The state of the art and science of evidence-based nursing in UK and Europe. Worldviews Evid Based Nurs. 2004; 1(1):6-8.
• [4]Sigma Theta Tau International Honor Society of Nursing. Evidence-based nursing position statement. 2005.
• [5]Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L et al.. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001; 39(8 Suppl 2):II2-45.
• [6]Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L et al.. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004; 8(6):iii-72.
• [7]Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien Mary A, Grimshaw J et al.. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2011; 8: Article ID CD000125
• [8]Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006; 2: Article ID CD000259
• [9]Heselmans A, Van d, V, Donceel P, Aertgeerts B, Ramaekers D. Effectiveness of electronic guideline-based implementation systems in ambulatory care settings—a systematic review. Implement Sci. 2009; 4:82. BioMed Central Full Text
• [10]Weng YH, Kuo Ken N, Yang CY, Lo HL, Chen C, Chiu YW. Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings. Implement Sci. 2013;8(112) doi:. 10. 1186/1748-5908-8-112
• [11]Thomas L, Cullum N, McColl E, Rousseau N, Soutter J, Steen N. Guidelines in professions allied to medicine. Cochrane Database Syst Rev. 2000; 2: Article ID CD000349
• [12]Thomas LH, McColl E, Cullum N, Rousseau N, Soutter J. Clinical guidelines in nursing, midwifery and the therapies: a systematic review. J Adv Nurs. 1999; 30(1):40-50.
• [13]O’Brien Mary A, Rogers S, Jamtvedt G, Oxman Andrew D, Odgaard-Jensen J, Kristoffersen Doris T et al.. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007; 4: Article ID CD000409
• [14]Shojania Kaveh G, Jennings A, Mayhew A, Ramsay Craig R, Eccles Martin P, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009;3.
• [15]Thompson DS, Estabrooks CA, Scott-Findlay S, Moore K, Wallin L. Interventions aimed at increasing research use in nursing: a systematic review. Implement Sci. 2007; 2:15. BioMed Central Full Text
• [16]Shojania KG, Jennings A, Mayhew A, Ramsay C, Eccles M, Grimshaw J. Effect of point-of-care computer reminders on physician behaviour: a systematic review. CMAJ. 2010; 182(5):E216-25.
• [17]Tilson JK, Kaplan SL, Harris JL, Hutchinson A, Ilic D, Niederman R et al.. Sicily statement on classification and development of evidence-based practice learning assessment tools. BMC Med Educ. 2011; 11:78. BioMed Central Full Text
• [18]Scott SD, Albrecht L, O’Leary K, Ball GD, Hartling L, Hofmeyer A et al.. Systematic review of knowledge translation strategies in the allied health professions. Implement Sci. 2012; 7:70. BioMed Central Full Text
• [19]Higgins Julian PT, Altman AM, Sterne JAC. Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). Higgins Julian PT, Green S, editors. John Wiley & Sons, Chichester, UK; 2011.
• [20]SUMARI: user manual: version 5.0 system for the unified management, assessment and review of information [computer program]. 2013.
• [21]Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P et al.. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336(7650):924-6.
• [22]Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J et al.. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64(4):383-94.
• [23]Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J et al.. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011; 64(4):401-6.
• [24]Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D et al.. GRADE guidelines 6. Rating the quality of evidence—imprecision. J Clin Epidemiol. 2011; 64(12):1283-93.
• [25]Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003; 41(5):582-93.
• [26]Revman computer program [computer program]. Version 5.2 2012.
• [27]Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2):77-101.
• [28]Yost J, Thompson D, Ganann R, Aloweni F, Newman K, McKibbon A et al.. Knowledge translation strategies for enhancing nurses’ evidence-informed decision making: a scoping review. Worldviews Evid Based Nurs. 2014; 11(3):156-67.
• [29]Dufault MA, Bielecki C, Collins E, Willey C. Changing nurses’ pain assessment practice: a collaborative research utilization approach. J Adv Nurs. 1995; 21(4):634-45.
• [30]Koh SLS, Hafizah N, Lee JY, Loo YL, Muthu R. Impact of a fall prevention programme in acute hospital settings in Singapore. Singapore Med J. 2009; 50(4):425-32.
• [31]Schultz MJ, Harmsen RE, Korevaar JC, Abu-Hanna A, Houckgeest FV, Van Der Sluijs JP et al.. Adoption and implementation of the original strict glycemic control guideline is feasible and safe in adult critically ill patients. Minerva Anestesiol. 2012; 78(9):982-95.
• [32]Daly M, Kermode S, Reilly D. Evaluation of clinical practice improvement programs for nurses for the management of alcohol withdrawal in hospitals. Contemp Nurse. 2009; 31(2):98-107.
• [33]Kirshbaum M. Translation to practice: a randomised, controlled study of an evidence-based booklet for breast-care nurses in the United Kingdom. Worldviews Evid Based Nurs. 2008; 5(2):60-74.
• [34]Girouard S. The role of the clinical specialist as change agent: an experiment in preoperative teaching. Int J Nurs Stud. 1978; 15(2):57-65.
• [35]Tsai SL. The effects of a research utilization in-service program on nurses. Int J Nurs Stud. 2003; 40(2):105-13.
• [36]Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D’Este C et al.. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. Lancet. 2011; 378(9804):1699-706.
• [37]Melnyk BM, Bullock T, McGrath J, Jacobson D, Kelly S, Baba L. Translating the evidence-based NICU COPE program for parents of premature infants into clinical practice: impact on nurses’ evidence-based practice and lessons learned. J Perinat Neonatal Nurs. 2010; 24(1):74-80.
• [38]Titler M. Translating research into practice. Am J Nurs. 2007; 107(6):26-33.
• [39]Day T, Wainwright SP, Wilson-Barnett J. An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. J Clin Nurs. 2001; 10(5):682-96.
• [40]Hyndman KJ. An evaluation of a dissemination intervention to enhance registered nurses’ use of clinical practice guidelines related to tobacco reduction. University of British Columbia, Canada; 2005.
• [41]Seers K, Crichton N, Carroll D, Richards S, Saunders T. Evidence-based postoperative pain management in nursing: is a randomized-controlled trial the most appropriate design? J Nurs Manag. 2004; 12(3):183-93.
• [42]Tranmer JE, Lochhaus-Gerlach J, Lam M. The effect of staff nurse participation in a clinical nursing research project on attitude towards, access to, support of and use of research in the acute care setting. Can J Nurs Leadersh. 2002; 15(1):18-26.
• [43]Lewicki LJ. Diffusion of pressure ulcer guidelines: testing an intervention. Case Western Reserve University (Health Sciences), ᅟ; 1997.
• [44]Linde BJ. The effectiveness of three interventions to increase research utilization among practicing nurses. University of Michigan, ᅟ; 1989.
• [45]Fan J, Woolfrey K. The effect of triage-applied Ottawa ankle rules on the length of stay in a Canadian urgent care department: a randomized controlled trial. Acad Emerg Med. 2006; 13(2):153-7.
• [46]Wesorick DH, Grunawalt J, Kuhn L, Rogers MAM, Gianchandani R. Effects of an educational program and a standardized insulin order form on glycemic outcomes in non-critically ill hospitalized patients. J Hosp Med. 2010; 5(8):438-45.
• [47]Sulch D, Perez I, Melbourn A, Kalra L. Randomized controlled trial of integrated (managed) care pathway for stroke rehabilitation. Stroke. 2000; 31(8):1929-34.
• [48]Manias E, Gibson SJ, Finch S. Testing an educational nursing intervention for pain assessment and management in older people. Pain Med. 2011; 12(8):1199-215.
• [49]Dykes PC, Carroll DL, Hurley A, Lipsitz S, Benoit A, Chang F et al.. Fall prevention in acute care hospitals: a randomized trial. JAMA. 2010; 304(17):1912-8.
• [50]Stetler CB, Caramanica L. Evaluation of an evidence-based practice initiative: outcomes, strengths and limitations of a retrospective, conceptually-based approach. Worldviews Evid Based Nurs. 2007; 4(4):187-99.
• [51]Gifford WA, Davies B, Edwards N, Graham ID. Leadership strategies to influence the use of clinical practice guidelines. Can J Nurs Leadersh. 2006; 19(4):72-88.
• [52]Ploeg J, Davies B, Edwards N, Gifford W, Miller PE. Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders. Worldviews Evid Based Nurs. 2007; 4(4):210-9.
• [53]Weber S. A qualitative analysis of how advanced practice nurses use clinical decision support systems. J Am Acad Nurse Pract. 2007; 19(12):652-67.
• [54]Happell B, Johnston L, Hill C. Implementing research findings into mental health nursing practice: exploring the clinical research fellowship approach. Int J Ment Health Nurs. 2003; 12(4):251-8.
• [55]Happell B, Martin T. Changing the culture of mental health nursing: the contribution of nursing clinical development units. Issues Ment Health Nurs. 2005; 26(9):921-33.
• [56]Kajermo KN, Nordström G, Krusebrant A, Lutzén K. Nurses’ experiences of research utilization within the framework of an educational programme. J Clin Nurs. 2001; 10(5):671-81.
• [57]Royle JA, Blythe J, Ingram C, DiCenso A, Bhatnager N, Potvin C. The research utilization process: the use of guided imagery to reduce anxiety. Can Oncol Nurs J. 1996; 6(1):20-5.
• [58]Ellis I, Howard P, Larson A, Robertson J. From workshop to work practice: an exploration of context and facilitation in the development of evidence-based practice. Worldviews Evid Based Nurs. 2005; 2(2):84-93.
• [59]Wallin L, Rudberg A, Gunningberg L. Staff experiences in implementing guidelines for Kangaroo Mother Care—a qualitative study. Int J Nurs Stud. 2005; 42(1):61-73.
• [60]Wallen GR, Mitchell SA, Melnyk B, Fineout-Overholt E, Miller-Davis C, Yates J et al.. Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme. J Adv Nurs. 2010; 66(12):2761-71.
• [61]Graham ID, Logan J, Davies B, Nimrod C. Changing the use of electronic fetal monitoring and labor support: a case study of barriers and facilitators. Birth. 2004; 31(4):293-301.
• [62]Wu L, Ashton CM. Chart review. A need for reappraisal. Evaluation & the Health Professions. 1997; 20(2):146-63.
• [63]Gregory KE, Radovinsky L. Research strategies that result in optimal data collection from the patient medical record. Appl Nurs Res. 2012; 25(2):108-16.
• [64]Middleton S, Levi C, Ward J, Grimshaw J, Griffiths R, D’Este C et al.. Fever, hyperglycaemia and swallowing dysfunction management in acute stroke: a cluster randomised controlled trial of knowledge transfer. Implement Sci. 2009; 4:16. BioMed Central Full Text
• [65]Middleton S, Levi C, Ward J, Grimshaw J, Griffiths R, D’Este C et al.. Death, dependency and health status 90 days following hospital admission for acute stroke in NSW. Intern Med J. 2011; 41(10):736-43.
• [66]Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004; 8(4):283-91.
• [67]Edwards N, Davies B, Ploeg J, Dobbins M, Skelly J, Griffin P et al.. Evaluating best practice guidelines. Can Nurse. 2005; 101(2):18-23.
• [68]Davies B, Hodnett E, Hannah M, O’Brien-Pallas L, Pringle D, Wells G et al.. Fetal health surveillance: a community-wide approach versus a tailored intervention for the implementation of clinical practice guidelines. CMAJ. 2002; 167(5):469-74.
• [69]Dizon JM, Grimmer-Somers KA, Kumar S. Current evidence on evidence-based practice training in allied health: a systematic review of the literature. Int J Evid Based Healthc. 2012; 10(4):347-60.
• [70]Desomer A, Dilles T, Steckel S, Duchesnes C, Van Meerbeek M, Peremans L, et al. Dissemination and implementation of clinical practice guidelines in Belgium. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE); 2013. Report No.: KCE Reports 212. D/2013/10.273/89.
• [71]Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O’Brien Mary A, Wolf Fredric M et al.. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009; 2: Article ID CD003030
• [72]Thomas LH, McColl E, Cullum N, Rousseau N, Soutter J, Steen N. Effect of clinical guidelines in nursing, midwifery, and the therapies: a systematic review of evaluations. Qual Health Care. 1998; 7(4):183-91.
• [73]Gross PA, Pujat D. Implementing practice guidelines for appropriate antimicrobial usage: a systematic review. Med Care. 2001; 39(8):II55-69.
• [74]Giguère A, Légaré F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, et al. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;10.
• [75]Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, Landsverk J. Mixed method designs in implementation research. Adm Policy Ment Health. 2011; 38(1):44-53.
• [76]Aarons GA, Fettes DL, Sommerfeld DH, Palinkas LA. Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services. Child Maltreat. 2012; 17(1):67-79.
• [77]Eccles MP, Armstrong D, Baker R, Cleary K, Davies H, Davies S et al.. An implementation research agenda. Implement Sci. 2009; 4:18. BioMed Central Full Text
• [78]Petticrew M, Rehfuess E, Noyes J, Higgins JP, Mayhew A, Pantoja T et al.. Synthesizing evidence on complex interventions: how meta-analytical, qualitative, and mixed-method approaches can contribute. J Clin Epidemiol. 2013; 66(11):1230-43.
• [79]Gifford W, Davies B, Edwards N, Griffin P, Lybanon V. Managerial leadership for nurses’ use of research evidence: an integrative review of the literature. Worldviews Evid Based Nurs. 2007; 4(3):126-45.
• [80]Cummings GG, Estabrooks CA, Midodzi WK, Wallin L, Hayduk L. Influence of organizational characteristics and context on research utilization. Nurs Res. 2007; 56(4S):S24-39.
• [81]Cummings GG, Hutchinson AM, Scott SD, Norton PG, Estabrooks CA. The relationship between characteristics of context and research utilization in a pediatric setting. BMC Health Serv Res. 2010; 10:168. BioMed Central Full Text
• [82]Squires JE, Estabrooks CA, Scott SD, Cummings GG, Hayduk L, Kang SH et al.. The influence of organizational context on the use of research by nurses in Canadian pediatric hospitals. BMC Health Serv Res. 2013; 13:351. BioMed Central Full Text
• [83]Meijers JMM, Janssen MAP, Cummings GG, Wallin L, Estabrooks CA, Halfens RYG. Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review. J Adv Nurs. 2006; 55(5):622-35.
• [84]Effective Practice and Organization of Care (EPOC). What study designs should be included in an EPOC review and what should they be called? Norwegian Knowledge Centre for the Health Services; 2013.
• [85]Blackwood B, Alderdice F, Burns Karen EA, Cardwell Chris R, Lavery G, O’Halloran P. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database Syst Rev. 2010;5.
• [86]Rotter T, Kinsman L, James Erica L, Machotta A, Gothe H, Willis J et al.. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010; 3: Article ID CD006632
• [87]Albrecht L, Archibald M, Arseneau D, Scott SD. Development of a checklist to assess the quality of reporting of knowledge translation interventions using the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations. Implement Sci. 2013; 8:52. BioMed Central Full Text
• [88]Michie S, Fixsen D, Grimshaw JM, Eccles MP. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009; 4:40. BioMed Central Full Text
• [89]Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010; 340:c332.
• [90]Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ et al.. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010; 340:c869.
• [91]Des Jarlais DC, Lyles C, Crepaz N. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004; 94(3):361-6.
• [92]von EE, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61(4):344-9.
• [93]Howell SL, Foster RL, Hester NO, Vojir CP, Miller KL. Evaluating a pediatric pain management research utilization program. Can J Nurs Res. 1996; 28(2):37-57.
• [94]Kavanagh PM. Appreciative inquiry: an interactive organizational intervention to translate acute pain management evidence into pediatric nursing practice University of Toronto (Canada). 2010.
• [95]Tolson D, Booth J, Lowndes A. Achieving evidence-based nursing practice: impact of the Caledonian Development Model. J Nurs Manag. 2008; 16(6):682-91.
• [96]Wiechula R, Kitson A, Marcoionni D, Page T, Zeitz K, Silverston H. Improving the fundamentals of care for older people in the acute hospital setting: facilitating practice improvement using a Knowledge Translation Toolkit. Int J Evid Based Healthc. 2009; 7(4):283-95.
• [97]Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review—a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005; 10 Suppl 1:21-34.
• [98]Squires JE, Valentine JC, Grimshaw JM. Systematic reviews of complex interventions: framing the review question. J Clin Epidemiol. 2013; 66(11):1215-22.
• [99]Petticrew M, Anderson L, Elder R, Grimshaw J, Hopkins D, Hahn R et al.. Complex interventions and their implications for systematic reviews: a pragmatic approach. J Clin Epidemiol. 2013; 66(11):1209-14.
• [100]Hesterly SC. Nurse credentialing in an acute care setting. J Nurs Qual Assur. 1991; 5(3):18-26.
• [101]Haynes RB, Wilczynski NL. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: methods of a decision-maker-researcher partnership systematic review. Implement Sci. 2010; 5:12. BioMed Central Full Text