Standards and practice guidelines as the foundation for clinical practice

A qualitative investigation of the views of primary care dentists on participating in prospective studies in the North-West of England

BACKGROUND

There is a poor understanding of to how to recruit and involve primary care dentists in clinical trials.

AIM

To use a qualitative paradigm to explore the views of primary care dentists towards participating in clinical trials and develop an understanding of the factors that facilitate and prevent their involvement. DESIGN, SETTING, SUBJECTS AND METHODS: An iterative approach was undertaken using a focus group (n = 6) followed by phased semi-structured interviews (n = 18). Data were analysed using thematic analysis and constant comparative analysis.

FINDINGS

The semi-structured interviews generated nine codes which were organised into three themes: technical issues for trials in primary dental care, practical issues for research in primary dental care and primary care dentists as research consumers. Overall, primary care dentists had a poor understanding of research methodology and clinical research. Barriers to participation included loss of clinical freedom and control, practice disruption, patient welfare, staff workload, financial loss and time.

CONCLUSIONS

Barriers to primary dental care research need to be overcome through appropriate protocols, funding, training and support. Joint working of primary dental care teams and academic researchers is essential, along with a constructive and open dialogue, if clinical trials are to be successfully undertaken in a practice environment.

Innovations in nursing education: standard development for nurse educator practice

Standards are critical in creating a vision for role development and articulating an expected level of performance for professionals. This article focuses on the process and outcomes of professional standard development that were used to redefine the scope of the nurse educator role as an advanced nursing practice role, delineate performance expectations, and highlight the complexity and diversity of role functions within the context of a tertiary-quarternary healthcare setting.

Using action research to construct national evidence-based nursing care guidance for gerontological nursing

AIM

This paper explores the development of a low-cost, involving methodology for constructing nursing-focused evidence-based national care guidance, known as Best Practice Statements, the intended users of which are gerontological nurses practising throughout Scotland.

DESIGN

The Best Practice Statement construction methodology forms one cycle in a five-year longitudinal action research study that aims to achieve evidence-based nursing, facilitate professional networking to support practice development and promote the principles and practice of gerontological nursing. Achieving these aims involved designing a virtual Practice Development College.

METHODS

A Community of Practice comprising practising gerontological nurses, expert advisors, academic teaching and research nurses collaborated in face-to-face meetings and in the virtual Practice Development College to delineate and refine the procedural model for Best Practice Statement construction. Focus groups, telephone interviews, analysis of on-line archives and documentary outputs formed the analytic dataset.

RESULTS

Qualitative analysis indicated that, from the perspective of the community of practice, the emerging methodology facilitated the melding of knowledge sources reflecting the dominant evidence hierarchy with other forms of evidence valued by gerontological nurses, in the Best Practice Statement.

RELEVANCE TO CLINICAL PRACTICE

Current methods of care guidance construction rarely address the concerns of nurses and the evidence from which guidelines are developed is narrowly defined with regard to inclusion and acceptability. In contrast this model focuses on nursing issues, embraces a wider definition of evidence and ensures that the published Best Practice Statements are credible and achievable in gerontological practice, where they are tested and refined as an inherent aspect of the development process.

Guidelines for clinical practice: development, dissemination and implementation

Clinical guidelines are one of the most promising and effective advances for defining and improving the quality of care. However, their development, dissemination and implementation in practice are rarely straightforward. Within nursing practice, guidelines have the potential to ensure the clinical application of research findings, thus ensuring that the profession rejects ineffective practices while employing those shown to work. Nevertheless, the benefits and limitations of clinical guidelines should be carefully considered by practitioners, managers and consumers of health care alike.

Organizational interventions to encourage guideline implementation

Evidence-based guidelines hold considerable promise for continued improvement of health-care delivery. However, the availability of clinical practice guidelines does not automatically lead to changes in practice patterns. Using a "push-pull-capacity" model, this article describes strategies to improve guideline implementation for three types of organizations: national organizations, insurer and health-care organizations, and health-care purchasers. Push strategies focus on the guideline development process and include rigorous review and meta-analysis of peer-reviewed research, and use of multidisciplinary expert teams, subjecting guidelines to peer review and comment and using measurable clinical outcomes to define guidelines. PULL: strategies focus on creating a demand for guideline implementation and include professional organization endorsement, quality measures based on guideline-related outcomes, and guideline-based performance objectives in purchaser contracts and physician compensation agreements. Capacity strategies focus on systems that facilitate guideline implementation. Example strategies are providing benefit coverage and reimbursement for guideline-based treatment protocols, and implementing clinical information systems for population-based tracking, outcomes monitoring, and benchmarking feedback.