BACKGROUND Practitioner-level implementation interventions such as audit and feedback, communities of practice, and local opinion leaders have shown potential to change nurses' behaviour in clinical practice and improve patients' health. However, their effectiveness remains unclear. Moreover, we have a paucity of data regarding the use of theory in implementation studies with nurses, the causal processes-i.e. mechanisms of action-targeted by interventions to change nurses' behaviour in clinical practice, and the constituent components-i.e. behaviour change techniques-included in interventions. Thus, our objectives are threefold: (1) to examine the effectiveness of practitioner-level implementation interventions in changing nurses' behaviour in clinical practice; (2) to identify, in included studies, the type and degree of theory use, the mechanisms of action targeted by interventions and the behaviour change techniques constituting interventions and (3) to examine whether intervention effectiveness is associated with the use of theory or with specific mechanisms of action and behaviour change techniques. METHODS We will conduct a systematic review based on the Cochrane Effective Practice and Organization of Care (EPOC) Group guidelines. We will search six databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science) with no time limitation for experimental and quasi-experimental studies that evaluated practitioner-level implementation interventions aiming to change nurses' behaviour in clinical practice. We will also hand-search reference lists of included studies. We will perform screening, full-text review, risk of bias assessment, and data extraction independently with the Covidence systematic review software. We will assess the quality of evidence using the GRADEpro software. We will code included studies independently for theory use (Theory Coding Scheme), mechanisms of action (coding guidelines from Michie) and behaviour change techniques (Behaviour Change Technique Taxonomy v1) with QSR International's NVivo qualitative data analysis software. Meta-analyses will be performed using the Review Manager (RevMan) software. Meta-regression analyses will be performed with IBM SPSS Statistics software. DISCUSSION This review will inform knowledge users and researchers interested in designing, developing and evaluating implementation interventions to support nurses' behaviour change in clinical practice. Results will provide key insights regarding which causal processes-i.e. mechanisms of action-should be targeted by these interventions, and which constituent components-i.e. behaviour change techniques-should be included in these interventions to increase their effectiveness. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019130446).

中文翻译：

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实施干预措施对临床实践中护士行为的影响：系统评价，荟萃分析和荟萃回归方案。

背景技术从业者水平的实施干预措施，例如审计和反馈，实践社区和当地意见领袖，已经显示出改变护士在临床实践中的行为并改善患者健康的潜力。但是，它们的有效性仍不清楚。此外，我们缺乏有关与护士进行实施研究时使用理论的数据，因果过程（即干预措施在临床实践中通过干预改变护士行为的目标作用机制）以及构成要素（即行为改变技术）的数据。包括在干预措施中。因此，我们的目标是三方面的：（1）检验从业者水平的实施干预措施在临床实践中改变护士行为的有效性；（2）在纳入的研究中确定 理论使用的类型和程度，干预措施针对的作用机制以及构成干预措施的行为改变技术；以及（3）检查干预效果是否与理论的使用或特定的作用机理和行为改变技术有关。方法我们将根据Cochrane有效实践和护理组织（EPOC）小组指南进行系统的审查。我们将搜索六个没有时间限制的数据库（CINAHL，EMBASE，ERIC，PsycINFO，PubMed和Web of Science），以进行实验和准实验研究，以评估从业人员水平的实施干预措施，旨在改变护士在临床实践中的行为。我们还将手工搜索包含研究的参考列表。我们将进行筛选，全文审查，偏倚评估的风险，并使用Covidence系统审查软件独立提取数据。我们将使用GRADEpro软件评估证据的质量。我们将使用QSR International的NVivo定性数据分析软件对包括在内的研究进行独立编码，以供理论使用（理论编码方案），作用机制（来自Michie的编码指南）和行为改变技术（行为改变技术分类法v1）。荟萃分析将使用Review Manager（RevMan）软件进行。元回归分析将使用IBM SPSS Statistics软件进行。讨论本评论将为有兴趣设计，开发和评估实施干预措施以支持护士在临床实践中改变行为的知识用户和研究人员提供信息。结果将提供关于这些干预措施应针对哪些因果过程（即行动机制）以及这些干预措施应包括哪些构成要素（即行为改变技术）以提高其有效性的关键见解。系统评价注册该协议已在国际系统评价预期登记册（PROSPERO；注册号：CRD42019130446）中进行了注册。