Abstract：
BACKGROUND: Complications related to diabetes mellitus impose substantial health and economic burdens to individuals and society. While clinical practice guidelines improve diabetes management in primary care settings, the variability in adherence to these guidelines persist. Hence, there is a need to comprehensively review existing evidence regarding factors influencing nurses\' adherence to implementation of clinical practice guidelines to improve clinical care and patient safety.
OBJECTIVE: This integrative review seeks to investigate nurses\' adherence to clinical guidelines for diabetes management in primary healthcare settings and to explore factors influencing effective implementation, focusing on the role of nurses and impacts on patient outcomes.
METHODS: A comprehensive search was conducted in March 2023 across six electronic databases. The search targeted studies that examined the use of Type 2 diabetes mellitus guidelines by nurses in primary healthcare settings with a focus on clinical management outcomes related to diabetes care or patient safety. Included studies were classified using the Effective Practice and Organisation of Care taxonomy, synthesised narratively and presented thematically. Reporting of the review adhered to PRISMA guidelines. (PROSPERO ID CRD42023394311).
RESULTS: The review included ten studies conducted between 2000 and 2020, and the results were categorised into three themes. These were: (i) Implementation strategies to promote clinical practice guidelines adherence, including health professional development, reminders for clinicians, patient-mediated interventions, health information systems, role expansion, and comprehensive package-of-care. A multifaceted educational approach emerged as the most effective strategy. (ii) Impact of guidelines adherence: These strategies consistently improved clinical management, lowering HbA1c levels, improving blood pressure and lipid profiles, and enhancing patient self-care engagement, along with increased nurses\' adherence to diabetes clinical guidelines. (iii) The role of nurses in guideline implementation, enabling independent practice within multidisciplinary teams. Their roles encompassed patient education, collaborative practice with fellow healthcare professionals, program planning and execution, and comprehensive documentation review. Nurse-led interventions were effective in improving patient outcomes, underscoring the necessity of empowering nurses with greater autonomy in providing primary diabetes care.
CONCLUSIONS: Implementing a diverse range of strategies, focusing on comprehensive education for healthcare providers, is paramount for enhancing guideline adherence in diabetes care, to improve clinical management towards optimal patient health outcomes. Tailoring these strategies to meet local needs adds relevance to the guidelines. Empowering nurses to take a leading role in primary care not only enhances patient safety but also promotes quality of care, resulting in improved overall outcomes.
CONCLUSIONS: In primary care, empowering nurses with diabetes guideline education and tailoring strategies to local needs enhance guideline adherence and improve patient outcomes.
OBJECTIVE: This integrative review seeks to investigate nurses\' adherence to clinical guidelines for diabetes management in primary healthcare settings and to explore factors influencing effective implementation, focusing on the role of nurses and impacts on patient outcomes.
METHODS: A comprehensive search was conducted in March 2023 across six electronic databases. The search targeted studies that examined the use of Type 2 diabetes mellitus guidelines by nurses in primary healthcare settings with a focus on clinical management outcomes related to diabetes care or patient safety. Included studies were classified using the Effective Practice and Organisation of Care taxonomy, synthesised narratively and presented thematically. Reporting of the review adhered to PRISMA guidelines. (PROSPERO ID CRD42023394311).
RESULTS: The review included ten studies conducted between 2000 and 2020, and the results were categorised into three themes. These were: (i) Implementation strategies to promote clinical practice guidelines adherence, including health professional development, reminders for clinicians, patient-mediated interventions, health information systems, role expansion, and comprehensive package-of-care. A multifaceted educational approach emerged as the most effective strategy. (ii) Impact of guidelines adherence: These strategies consistently improved clinical management, lowering HbA1c levels, improving blood pressure and lipid profiles, and enhancing patient self-care engagement, along with increased nurses\' adherence to diabetes clinical guidelines. (iii) The role of nurses in guideline implementation, enabling independent practice within multidisciplinary teams. Their roles encompassed patient education, collaborative practice with fellow healthcare professionals, program planning and execution, and comprehensive documentation review. Nurse-led interventions were effective in improving patient outcomes, underscoring the necessity of empowering nurses with greater autonomy in providing primary diabetes care.
CONCLUSIONS: Implementing a diverse range of strategies, focusing on comprehensive education for healthcare providers, is paramount for enhancing guideline adherence in diabetes care, to improve clinical management towards optimal patient health outcomes. Tailoring these strategies to meet local needs adds relevance to the guidelines. Empowering nurses to take a leading role in primary care not only enhances patient safety but also promotes quality of care, resulting in improved overall outcomes.
CONCLUSIONS: In primary care, empowering nurses with diabetes guideline education and tailoring strategies to local needs enhance guideline adherence and improve patient outcomes.
摘要：
背景：与糖尿病相关的并发症给个人和社会带来了巨大的健康和经济负担。虽然临床实践指南改善了初级保健机构的糖尿病管理，遵守这些指南的差异仍然存在.因此，有必要全面审查有关影响护士坚持实施临床实践指南的因素的现有证据,以改善临床护理和患者安全.
目的：本综合综述旨在调查基层医疗机构护士对糖尿病管理临床指南的依从性，并探讨影响有效实施的因素。关注护士的角色和对患者预后的影响。
方法：于2023年3月在六个电子数据库中进行了全面搜索。该搜索有针对性的研究，研究了初级医疗机构护士对2型糖尿病指南的使用，重点是与糖尿病护理或患者安全相关的临床管理结果。纳入的研究使用有效的护理实践和组织分类法进行分类，叙事综合和主题呈现。审查报告遵循PRISMA准则。（PROSPEROIDCRD42023394311）。
结果：该综述包括2000年至2020年间进行的十项研究，结果分为三个主题。这些是：(I)促进临床实践指南依从性的实施策略，包括健康专业发展，提醒临床医生，患者介导的干预措施，卫生信息系统,角色拓展,和全面的一揽子护理。多方面的教育方法成为最有效的策略。（ii）指南依从性的影响：这些策略持续改善了临床管理，降低HbA1c水平，改善血压和血脂，提高病人的自我护理参与度，随着护士对糖尿病临床指南的依从性增加。(三)护士在指南实施中的作用,在多学科团队中实现独立实践。他们的角色包括患者教育，与其他医疗保健专业人员合作实践，计划的规划和执行，和全面的文件审查。护士主导的干预措施有效地改善了患者的预后，强调赋予护士更大自主权提供初级糖尿病护理的必要性。
结论：实施各种策略，专注于医疗保健提供者的全面教育，对于提高糖尿病护理的指南依从性至关重要，改善临床管理，以实现最佳患者健康结果。定制这些策略以满足当地需求增加了准则的相关性。授权护士在初级保健中发挥主导作用，不仅提高了患者的安全性，而且提高了护理质量，改善总体结果。
结论：在初级保健中，授权护士进行糖尿病指南教育,并根据当地需求调整策略,提高指南依从性,改善患者预后.
目的：本综合综述旨在调查基层医疗机构护士对糖尿病管理临床指南的依从性，并探讨影响有效实施的因素。关注护士的角色和对患者预后的影响。
方法：于2023年3月在六个电子数据库中进行了全面搜索。该搜索有针对性的研究，研究了初级医疗机构护士对2型糖尿病指南的使用，重点是与糖尿病护理或患者安全相关的临床管理结果。纳入的研究使用有效的护理实践和组织分类法进行分类，叙事综合和主题呈现。审查报告遵循PRISMA准则。（PROSPEROIDCRD42023394311）。
结果：该综述包括2000年至2020年间进行的十项研究，结果分为三个主题。这些是：(I)促进临床实践指南依从性的实施策略，包括健康专业发展，提醒临床医生，患者介导的干预措施，卫生信息系统,角色拓展,和全面的一揽子护理。多方面的教育方法成为最有效的策略。（ii）指南依从性的影响：这些策略持续改善了临床管理，降低HbA1c水平，改善血压和血脂，提高病人的自我护理参与度，随着护士对糖尿病临床指南的依从性增加。(三)护士在指南实施中的作用,在多学科团队中实现独立实践。他们的角色包括患者教育，与其他医疗保健专业人员合作实践，计划的规划和执行，和全面的文件审查。护士主导的干预措施有效地改善了患者的预后，强调赋予护士更大自主权提供初级糖尿病护理的必要性。
结论：实施各种策略，专注于医疗保健提供者的全面教育，对于提高糖尿病护理的指南依从性至关重要，改善临床管理，以实现最佳患者健康结果。定制这些策略以满足当地需求增加了准则的相关性。授权护士在初级保健中发挥主导作用，不仅提高了患者的安全性，而且提高了护理质量，改善总体结果。
结论：在初级保健中，授权护士进行糖尿病指南教育,并根据当地需求调整策略,提高指南依从性,改善患者预后.
