Table 1 Characteristics of included studies
First author, year, journal | Design | Sample/subjects* | Setting/country | Type of research use (DV measured by) | Manager level | Leadership measured by | Bivariate • Test statistic Magnitude (if significant) | Multivariate • Test statistic Magnitude (if significant) | Leadership behaviors studied | Quality assessment (weaknesses) |
|---|---|---|---|---|---|---|---|---|---|---|
Quantitative studies (n = 9) | ||||||||||
 1. Ball 2010 [42] Association of perioperative Nursing (AORN) | Cross-sectional survey | N = 777 Nurses | Hospital USA | Level of compliance with research-based guideline recommendations for smoke evacuation practices for 8 surgical procedures in an operating room | Senior | Three items from a survey developed for the study: Support for clinical practices1 Support for smoke evacuation practices1 Support for policies and procedures1 | ANOVA F (2609) = 4.423 p = .012 + (magnitude not reported) F (2585) = 11.043 p < .001 + (magnitude not reported) F (2584) = 10.481 p < .001 + (magnitude not reported) |  | • Support the change • Embed practices in policy | High moderate -Self report -Management of missing data not reported -Response rate < 50% |
 2. Boström 2007 [43] Journal of Evaluation in Clinical Nursing | Cross-sectional survey | N = 132 Nurses Allied Healthcare Aides | Community Sweden | Single item from Research Utilization Questionnaire - ‘I use research findings in my daily practice’ scored on a 5-point Likert scale2 Sample divided into 2 groups: research users and non-research users | Point-of-care | One item from the Research Utilization Questionnaire: Support from unit manager2 | Chi square (χ2 = 22.194)* p < 0.001 +  50% more in research group (64 vs. 14%) *Proportion of nurses in RU group versus non-RU that agree there is leadership support | Logistic regression OR = 4.03; 95% CI = 1.04–15.71 (controlling for access to research findings; challenge, support from colleagues, trust, risk-taking) | • Support the change | High moderate -Self report -Dependent variable reliably and validly not reported |
 3. Boström 2009 [44] Journal of Clinical Nursing | Cross-sectional survey | N = 210 Nurses | Community Sweden | Nine item index for ‘research use in daily practice’ from the Research Utilization Questionnaire | Point-of-care | One item from the Research Utilization Questionnaire: Support from unit manager2 | Unadjusted logistic regression NS |  | • Support the change | High moderate -Self report -Dependent variable validity not reported -Missing data management not reported |
 4. Bostrom 2013 [45] BMC Health Services Research | Cross-Sectional Survey | N = 1256 Nurses | Hospital, primary care, care of older people, psychiatric care Sweden | Single item - Participate in implementing research-based knowledge in practice3 Responses were dichotomized as high or low (high extent = scores of 3 and 4; low extent = scores of 1 and 2). | Point-of-care | Score of 6 items from the QPS Nordic scale reflecting: Social support; Empowering leadership; Fair leadership3 |  | Logistic Regression High- versus low-quality leadership on high versus low extent of implementation p < 0.005 + OR = 2.0 (CI = 1.4; 2.8) | • Support the change • Encourage • Distribute work fairly | High moderate -Self report -Sample size not justified |
 5. Cummings 2018 [50] | Cross-sectional survey (data collected at the end of a cross-over study) | N = 333 Nurses Managers Healthcare Aids | Nursing homes Canada | Single item for instrumental research use (scoring not stated) | Point-of-care | Score of 11-items from manager support Scale Score of 5-items from coaching conversation scale |  | Structural equation model (SEM): model chi square (X2) Manager support: NS Coaching conversations: NS | • Support the change • Communicate with staff | High moderate -Probability sampling not used -Sample size not justified -Self report |
 6. Estabrooks 2009 [46] BMC Health Services Research | Cross-sectional survey | N = 764 Nurses | Hospital Canada | Single item for instrumental research use scored on 5-point frequency scales from ‘10% or less of the time’ to ‘almost 100% of the time’. | Point-of-care | Score of 6 items from the Alberta Context Tool reflecting emotionally intelligent leadership4 | Pearson’s correlation (r = 0.098) p < .05 + (0.098) ANOVA to assess changes in mean value of leadership score with increasing RU scores (test statistic not reported) NS |  | • Emotionally intelligent leadership behaviors | Strong -Self report -Response rate < 50% |
 7. Forberg 2014 [47] Worldviews on Evidence-Based Nursing | Cross-sectional survey | N = 639 Nurses | Hospital Sweden | Adherence to 3 research-based practices. Scoring was dichotomized for each practice as ‘always’ versus ‘not always’ (represents response alternatives never, rarely, occasionally, frequently) | Point-of-care | Score of 6 items from the Alberta Context Tool reflecting Emotionally intelligent leadership4 | Logistical regression 1. Disinfection of hands NS 2. Disposable gloves NS 3. Daily inspection NS | Logistic regression 1. Disinfection of hands: NS | • Emotionally intelligent leadership behaviors | Low moderate -Management of missing data not reported -Self report -Sample size not justified -Probability sampling not used |
 8. Squires 2013 [48] BMC Health Services Research | Cross-sectional survey | N = 735 Nurses | Hospital Canada | Single item for instrumental research use scored on 5-point frequency Scales from ‘10% or less of the time’ to ‘almost 100% of the time’. | Point-of-care | Score of 6-items from the Alberta Context Tool reflecting emotionally intelligent leadership4 |  | Generalized estimating equations (GEE) Estimate: NS | • Emotionally intelligent leadership behaviors | Strong -Self report -Response rate < 50% |
 9. Yamada 2017 [49] BMC Health Service Research | Cross-sectional survey | 779 Nurses | Hospital Canada | Single item for instrumental research use scored on 5-point frequency scale from 1 = never use to 5 = almost always use | Point-of-care | Score of 6 items from the Alberta Context Tool reflecting emotionally intelligent leadership4 | Binomial distribution and logit link (analogous to logistical regression) Pain assessment: NS Pain management: NS | Generalized estimating equations (GEE) Estimate: chi square (x2) Pain intensity: x2 = 7.03; p = 0.008 | • Emotionally intelligent leadership behaviors | Low moderate -Probability sampling not used -Sample size not justified -Self report -Response rate < 50% -Management of missing data not reported |
Mixed methods (n = 3) | ||||||||||
Balbale 2015 [51] Implementation Science | Mixed methods Cross-sectional survey and qualitative | N = 295 survey N = 30 interviews Nurses, allied therapists, physicians, physician assistants | Nursing home USA | Summary score of level of guideline-based practice—facilities categorized as fully implemented or not fully implemented | Senior | 3 items from survey developed for the study: 1) Provided adequate staff resources to implement 2) Provided adequate training to implement 3) Provided adequate funding resources to implement | Chi square (x2 value not reported) p = .0004 84–62% (fully - not fully implemented) p = .0042 82–64% (fully - not fully implemented) p = .0008 70–43% (fully - not fully implemented) |  | • Provide resources • Support learning activities | Weak (quant) -Probability sampling not used -Sample size not justified -Response rate < 50% -Self report -Dependent variable reliably and validly not reported -Management of missing data not reported Strong (qual) -Relationship between researcher and participants not reported -Research design not justified |
Gifford 2012 [31] Worldviews on Evidence-Based Nursing | Mixed methods Experimental pilot and qualitative | N = 88 N = 26 interviews Nurses facilitators managers | Community Canada | Documentation of 5 guideline-based practices for diabetic foot ulcers | Point-of-care | 3-month leadership intervention consisting of priority setting and planning Interviews | Chi square (x2 value not reported) p = 0.015 Higher mean number of research based practices in experimental group than control (1.74 vs 2.44) |  | • Build coalitions • Support the change • Communicate with staff • Encourage • Monitor indicators • Provide resources • Support learning activities • Plan | High moderate (quant) -Sample size not justified -Post-test only -Dependent variable reliably and validly not reported -Management of missing data not reported Strong (qual) -Relationship between researcher and participants not reported |
Rangachari 2015 [52] Health Care Management Review | Mixed method Quasi-experimental Chart audit and qualitative text | N = 107 Nurses Managers Physicians | Hospital USA | Catheter certification rate = total number of central catheter insertions observed and certified as adhering to components of the guideline-based central line bundle (CLB) | Point-of-care | 52-week communication by managers to promote implementation | Statistical tests or p value not provided. Changes over time evaluated using difference-in-proportions tests. Catheter certification rate increased 66 to 100% in one unit; 76–100% in the other unit |  | • Communicate with staff | High moderate (quant) -Probability sampling not used -Sample size not justified -Dependent variable reliably and validly not reported -No comparison strategy Strong (qual) -Relationship between researcher and participants not reported |
Qualitative studies (n = 19 studies/22 articles) | ||||||||||
1. Angus 2003 [53] Nursing Inquiry | Qualitative | N = 61 Nurses Managers | Hospitals Canada | Research-based practice | Point-of-care | Interviews |  |  | • Build coalitions • Support the change • Support learning activities | Strong -Relationship between researcher and participants not reported -Ethical issues not mentioned |
2. Cheng 2017 [63] Journal of Clinical Nursing | Qualitative | N = 56 Nurses Managers Senior leaders Physician | Hospitals China | Evidence-based practice | Point-of-care and senior | Interviews |  |  | • Align with organisational mission/vision • Build coalitions • Participate in planning • Support the change • Encourage • Enforce/embed practice in policy • Monitor indicators | Strong -Relationship between researcher and participants not reported |
Cheng 2018 [64] journal of nursing management | Qualitative Secondary analysis | N = 15 Nurses Managers | Hospitals China | Evidence-based practice | Point-of-care and senior | Interviews |  |  | Strong -Relationship between researcher and participants not reported | |
3. Chimeddamba 2015 [65] Implementation Science | Qualitative | N = 40 Nurses Managers Physician | Family health centres Mongolia | Guideline use | Point-of-care | Interviews |  |  | • Align with organisational mission/vision • Build coalitions • Participate in planning • Monitor indicators | Strong -Relationship between researcher and participants not reported -Research design not justified |
4. Fleiszer 2016 [54] International Journal of Nursing Studies | Qualitative | N = 39 Nurses Facilitators Managers | Hospitals Canada | Guideline use | Point-of-care | Interviews |  |  | • Align with organisational mission/vision • Participate in planning • Support the change • Communicate with staff • Monitor indicators • Support learning activities | Strong -Relationship between researcher and participants not reported |
Fleiszer_2 2016 [66] Journal of Nursing Management | Qualitative | N = 39 Nurses Facilitators Managers | Hospitals Canada | Guideline use | Point-of-care | Interviews Observations Document reviews |  |  | Strong -Relationship between researcher and participants not reported | |
5. Gifford (2006) [55] Nursing Leadership | Qualitative | N = 17 Nurses Facilitators Managers Senior leaders | Hospitals Nursing home Canada | Guideline use | Point-of-care and senior | Interviews |  |  | • Align with organisational mission/vision • Build coalitions • Support the change • Communicate with staff • Encourage • Monitor indicators • Support learning activities | Strong -Relationship between researcher and participants not reported |
6. Graham 2004 [56] Birth | Qualitative | N = 59 Nurses Facilitators Managers Senior leaders | Hospitals Canada | Guideline use | Point-of-care and senior | Interviews |  |  | • Support the change • Embed practice in policy | Strong -Relationship between researcher and participants not reported |
7. Herbert 2017 [67] BMC Health Services Research | Qualitative | N = 26 Nurses Facilitators Managers Allied Health | Hospital England | Evidence-based practice | Senior | Interviews |  |  | • Support the change | Strong -Relationship between researcher and participants not reported |
8. Higuchi 2017 [68] Journal of Wiley Clinical Nursing | Qualitative | N = 132 Nurses Facilitators Managers Senior leaders Healthcare aid Physician Other providers | Hospitals, long-term care, community health agencies, community health centre Canada | Guideline use | Senior | Interviews focus groups |  |  | • Support the change • Build coalitions | Strong -Relationship between researcher and participants not reported |
9. Ireland 2013 [57] Worldviews on Evidence-Based Nursing | Qualitative | N = 95 Nurses Allied Health | Hospitals Canada | Guideline use | Point-of-care | Interviews focus groups |  |  | • Support the change • Participate in planning • Monitor indicators | Strong |
|  |  |  |  |  | Senior |  |  |  | • Support the change • Build coalitions | |
10. Kueny 2015 [69] Journal of Healthcare Leadership | Qualitative | N = 9 Nurses Managers | Hospitals USA | Evidence-based practice | Point-of-care | Interviews |  |  | • Align with organisational mission/vision • Build coalitions • Participate in planning • Communicate with staff • Encourage • Support learning • Activities | Strong -Relationship between researcher and participants not reported |
Senior | Â | Â | Â | Communicate with staff | ||||||
11. Matthew-Maich 2012 [59] Journal of Clinical Nursing | Qualitative | N = 112 Clients Nurses Facilitators Managers Senior leaders Physicians Midwives | Hospital Canada | Guideline use | Point-of-care | Interviews |  |  | • Build coalitions • Support the change • Encourage • Embed in policy • Support learning activities | Strong -Relationship between researcher and participants not reported |
Matthew-Maich 2013 [58] Worldviews on Evidence-Based Nursing | Qualitative | N = 112 Clients Nurses Facilitators Managers Senior leaders Physicians Midwives | Hospital Canada | Guideline use | Point-of-care | Interviews |  |  | Strong -Relationship between researcher and participants not reported | |
|  |  |  |  |  | Senior |  |  |  | • Support the change | |
12. Munce 2017 [70] Health Services Research | Qualitative | •N = 33 Nurses, Managers Allied Health | Rehabilitation centres Canada | Guideline use | Point-of-care | Telephone focus groups |  |  | • Build coalitions • Support the change | Strong -Relationship between researcher and participants not reported |
13. Ploeg 2007 [60] Worldviews on Evidence-Based Nursing | Qualitative | N = 125 Nurses, Facilitators Managers Senior leaders Allied Health | Hospitals Community Nursing Home Canada | Guideline use | Point-of-care and Senior | Interviews |  |  | • Align with organisational mission/vision • Participate in planning • Support the change • Communicate with staff • Encourage • Embed practice in policy • Provide resources • Support learning activities | Strong -Relationship between researcher and participants not reported |
14. Raijmakers 2015 [71] BMJ Supportive & Palliative Care | Qualitative | N = 28 Nurses Managers Physicians | Nursing homes and home care organisations Netherlands | Evidence-based practice | Point-of-care | Interviews and focus group |  |  | • Support the change | Strong -Relationship between researcher and participants not reported |
15. Spyridonidis 2016 [72] British Journal of Management, | Qualitative | N = 46 Nurses Managers Physician | Hospitals UK | Guideline use | Point-of-care | Interviews |  |  | • Build coalitions | Strong -Relationship between researcher and participants not reported -Unclear if ethical approval was sought |
16. Stetler 2014 [5] Worldviews on Evidence-Based Nursing | Qualitative | N = 95 Nurses Managers | Hospitals USA | Evidence-based practice | Point-of-care | Interviews and focus groups |  |  | • Support the change • Communicate with staff • Encourage | Strong -Relationship between researcher and participants not reported -Number of participants not clear |
Senior |  |  |  | • Align with organisational mission/vision • Participate in planning • Support learning activities | ||||||
17. Sving 2017 [73] Journal of Clinical Nursing | Qualitative | N = 36 Nurses Managers | Hospital Sweden | Evidence-based practice | Point-of-care | Interviews and focus groups |  |  | • Support the change • Communicate with staff • Provide resources | Strong -Relationship between researcher and participants not reported |
18. Van der Zijpp 2016 [61] Worldviews on Evidence-Based Nursing | Qualitative | N = 127 Nurses Facilitators Managers | Long-term care England, Netherlands, Republic of Ireland, Sweden | Guideline use | Senior | Interviews |  |  | • Align with organisational mission/vision • Support the change | Strong -Relationship between researcher and participants not reported -Recruitment strategy not clear |
19. Wallin 2005 [62] International Journal of Nursing Studies | Qualitative | N = 45 Nurses | Hospitals Sweden | Guideline use | Point-of-care | Interviews |  |  | • Communicate | Strong -Relationship between researcher and participants not reported |