Clinical guidelines: development and use

Clinical guidelines in community hospitals

Nineteen F and G grade nurses, one practice development nurse, two physiotherapists and two occupational therapists working in 11 community hospitals in Leicestershire and Rutland were interviewed about their use of clinical guidelines and their attitude towards them. They were asked questions about sources of clinical guidelines, and a simple gap analysis was carried out.

The interviewees were able to identify clinical guidelines that were used locally, and human and organisational resources of guidelines: resource rooms, practice development nurses, link nurses and study days.

The use of link nurses, and regular study days, both of which provide cascade learning, work well. Furthermore, in the opinion of the ward nurses, the practice development nurse has a useful role in making nurses aware of guidelines.

Generally, the responses about the use of clinical guidelines were positive, although some reservations were noted. There was agreement that regular professional meetings and ward hand-overs provide a natural and effective dissemination route.

The interviewees were not aware of any national clinical guidelines. Despite many of the interviewees having access to the internet (generally from home rather than from the hospitals), none could identify any online resources for clinical guidelines or knew that they existed.

Evidence-based practice in Hong Kong: issues and implications in its establishment

Evidence-based practice has been widely discussed in the literature, but it is not common or well adopted in nursing practice, both in Hong Kong and other countries. This article aims to examine the relationships between three important elements of evidence-based practice: systematic reviews, clinical guidelines and protocols. Current issues associated with evidence-based practice in Hong Kong are explored. Specific suggestions are given to researchers, practitioners, managers and academics so that the current situation can be advanced.

Quality improvement projects: finding a pathway through policies

It is increasingly common for mental health nurses to develop and implement quality improvement and/or research projects. The requirement that these activities be conducted in accordance with local, state and national policy; organizational accreditation frameworks; and within ethical frameworks is daunting. This paper aims to define relevant terms, relate some of the competing demands to each other and outline a pathway for developing nurse-based quality-related projects. When a specific exemplar is required, protocols from Central Sydney Area Mental Health Service will be drawn upon as it is likely that policy developed in this health area will not be significantly different to that of other health areas in New South Wales and other Australian States.

Emergency department staff responses to a protocol of care for abused women

While there is increasing recognition by health care providers of the need to identify and intervene in cases of partner abuse, there has been little evaluation of the interventions that have been implemented. This article documents emergency department staff responses to a five-step protocol of care on partner abuse implemented in a public hospital. It draws on in-depth interviews with a range of emergency department staff members, undertaken as part of the project's process evaluation. Findings suggest protocol training provided staff members with an opportunity to gain a greater awareness and understanding of partner abuse. Protocol use improved and consolidated existing practices; however, staff members were concerned about screening all women for abuse and highlighted areas in which further support and resources are required. Taking these factors into account may assist the appropriate and effective introduction of such protocols in other health care settings.

Eyecare for the sedated patient undergoing mechanical ventilation: the use of evidence-based care

There is a need to evaluate different nursing procedures to determine whether in today's cost-conscious climate of health care they genuinely benefit the patient. If such procedures are indeed found to be of value, ways must be explored of ensuring that the manner in which they are performed conforms to acceptable standards. In the study reported here eyecare for the ventilated, sedated patient was examined because variations in clinical practice had been observed and a preliminary examination of the literature indicated that this patient group was at particular risks of developing serious ocular complications. The study was conducted in two phases. Phase 1 took the form of a literature review which demonstrated that although many questions remained unanswered, sufficient information relating to eyecare existed to help develop protocols to guide care. Phase 2 consisted of non-participant observation with 15 nurses employed in an intensive care unit to examine the standard of eyecare actually delivered. The standard of eyecare fell short of the ideal and as in other studies designed to observe nursing procedures accurately and in detail, there was no demonstrable relationship between clinical practice, knowledge or clinical experience. From the study overall it was possible to conclude that patients would benefit from the implementation and audit of guidelines of eyecare but that before these innovations are undertaken barriers to good practice should be explored in intensive care units.