利用实施科学促进医疗保健机构的循证营养护理：一项混合方法的系统综述

IF 3.1 Q1 NURSING

International Journal of Nursing Studies Advances Pub Date : 2025-08-24 DOI:10.1016/j.ijnsa.2025.100414

Jerome Molle , Joris Agnel , Sebastien Colson , Audrey Chays-Amania

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引用次数: 0

摘要

多达一半的住院病人营养不良，这种情况会延长康复时间，增加并发症并增加医疗费用。尽管循证营养护理可以减轻这些影响，但其常规实施仍不一致。目的：综合和评估现有的证据，以实施和临床有效性的战略，旨在促进循证营养保健实践在医疗机构。方法采用混合方法系统评价，遵循乔安娜布里格斯研究所的指导方针。在15个数据库中检索了2015年1月至2025年1月间发表的研究，这些研究评估了针对任何患者或医疗保健专业群体的循证营养护理实施策略。两名审稿人独立筛选记录，提取数据并应用混合方法评估工具。由于研究设计、背景和结果指标各不相同，研究结果采用《实施研究综合框架》、《实施变革分类专家建议》和《实施成果框架》进行了叙述性整合。结果纳入29项初步研究，涉及1624名医护人员，13523名患者。所有干预措施都是多方面的，并根据具体情况量身定制。最常见的组成部分是员工教育（97%）、审计反馈（93%）、利益相关者参与结构（62%）以及适应电子或物理工作流程（28%）。医疗保健专业人员遇到的主要障碍包括资源稀缺、沟通分散、基础设施不足和知识不足；关键的促进因素是可见的领导、标准化的沟通工具、迭代计划和强有力的证据基础。卫生保健专业人员干预交付的保真度一直很高（中位数≥80%）；在所有评估它的研究中，可接受性超过70%，可行性评价良好。在测量中，渗透率和可持续性是中等但积极的。各种情况下的服务结果都有所改善，包括更早开始营养治疗，饮食更充足，治疗中断或营养相关并发症减少。患者层面的益处包括减轻体重、改善营养状况、改善健康相关生活质量和提高满意度。结论：情境敏感的、多方面的实施策略，特别是结合教育、审计反馈、领导参与和系统重新设计的实施策略，可以提高循证营养保健的吸收和影响。未来的研究应采用标准化框架、扩大后续行动和严格的评价设计来评估可持续性并为大规模实施提供信息。普洛斯彼罗注册未注册。

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Using implementation science to promote evidence-based nutritional care in healthcare settings: A mixed-methods systematic review

Background

Up to half of hospital inpatients are malnourished, a condition that prolongs recovery, increases complications and raises healthcare costs. Although evidence-based nutritional care can mitigate these effects, its routine implementation remains inconsistent.

Objective

To synthesise and evaluate current evidence on the implementation and the clinical effectiveness of strategies designed to promote evidence-based nutritional care practices within healthcare settings.

Methods

A mixed-methods systematic review followed the Joanna Briggs Institute guidelines. Fifteen databases were searched for studies published between January 2015 and January 2025 that evaluated implementation strategies targeting evidence-based nutrition care for any patient or healthcare professional group. Two reviewers independently screened records extracted data and applied the Mixed-Methods Appraisal Tool. Because study designs, contexts and outcome metrics varied, findings were integrated narratively using the Consolidated Framework for Implementation Research, the Expert Recommendations for Implementing Change taxonomy and the Implementation Outcomes Framework.

Results

Twenty-nine primary studies involving 1624 healthcare professionals and 13,523 patients were included. All interventions were multifaceted and tailored to the context. The most frequent components were staff education (97 %), audit with feedback (93 %), stakeholder engagement structures (62 %), and adaptations to electronic or physical workflows (28 %). Principal barriers experienced by healthcare professionals comprised scarce resources, fragmented communication, inadequate infrastructure, and knowledge deficits; key facilitators were visible leadership, standardised communication tools, iterative planning, and a strong evidence base. Fidelity of intervention delivery by healthcare professionals was consistently high (median ≥ 80 %); acceptability exceeded 70 % in all studies that assessed it, and feasibility was rated favourably. Where measured, penetration and sustainability were moderate but positive. Service outcomes improved across settings, including earlier initiation of nutrition therapy, greater dietary adequacy, and fewer treatment interruptions or nutrition-related complications. Patient-level benefits comprised reduced weight loss, improved nutritional status, better health-related quality of life, and higher satisfaction.

Conclusion

Context-sensitive, multifaceted implementation strategies, particularly those coupling education, audit-feedback, leadership engagement, and system redesign, can improve the uptake and impact of evidence-based nutritional care. Future studies should employ standardised frameworks, extended follow-up, and rigorous evaluation designs to assess sustainability and inform large-scale implementation.