Barriers and Facilitators in Implementing Clinical Nutrition Management Guidelines within Intensive Care Units: A Mixed-Methods Systematic Review

Objective: This systematic review and analysis aimed to explore relevant literature influencing the implementation of clinical nutrition management guidelines in the intensive care unit (ICU), providing healthcare professionals with a foundation to enhance nutrition support quality. Methods: A systematic search of PubMed, Embase, Medline, Cochrane, PsycINFO, and CNKI databases was conducted to identify studies addressing barriers and facilitators related to clinical nutrition management guidelines in intensive care unit. The inclusive study types encompassed quantitative, qualitative, and mixed-methods research. The search spanned from January 2003 to December 2023. Evaluation of the literature's quality employed the MMAT mixed-methods research evaluation tool, and analysis was performed using a data-based convergent integration approach. The study protocol was prospectively registered (PROSPERO 2023, CRD42023483287). Result: 22 papers were ultimately included, yielding 65 findings, summarized and integrated into 3 overarching categories: healthcare provider factors, practice settings, and patient values with nutritional support preferences, further classified into 8 distinct categories. Conclusion: Healthcare professionals are encouraged to analyze impediments and enablers to guideline implementation through a multifaceted lens, emphasizing the need to enhance healthcare collaboration, improve education and training systems, rectify misperceptions and heighten awareness of evidence-based practices.