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Randomized Controlled Trial
. 2017 Jun;73(6):1339-1354.
doi: 10.1111/jan.13219. Epub 2016 Dec 20.

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

Marijke Noome  1   2 , Boukje M Dijkstra  1   3 , Evert van Leeuwen  4 , Lilian C M Vloet  1   4
Affiliations
Randomized Controlled Trial

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

Marijke Noome et al. J Adv Nurs. 2017 Jun.

Abstract

Aim: 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.

Design: 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.

Conclusion: 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.

Keywords: cluster randomized controlled trial; end-of-life care; guideline; implementation; intensive care unit; nursing care.

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