Nurses' adoption of diabetes clinical practice guidelines in primary care and the impacts on patient outcomes and safety: An integrative review

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.

Conclusion: 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.

Tweetable abstract: In primary care, empowering nurses with diabetes guideline education and tailoring strategies to local needs enhance guideline adherence and improve patient outcomes.

Keywords: Adherence; Clinical practice guidelines; Implementation strategies; Nurses; Nursing; Patient safety; Primary care; Self-management; Type 2 diabetes.