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2016 ; 25
(19-20
): 2895-905
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Bridging the gap between guidelines and practice in the management of emerging
infectious diseases: a qualitative study of emergency nurses
#MMPMID27507678
Lam SK
; Kwong EW
; Hung MS
; Pang SM
J Clin Nurs
2016[Oct]; 25
(19-20
): 2895-905
PMID27507678
show ga
AIMS AND OBJECTIVES: To explore the difficulties and strategies regarding
guideline implementation among emergency nurses. BACKGROUND: Emerging infectious
diseases remain an underlying source of global health concern. Guidelines for
accident and emergency departments would require adjustments for infectious
disease management. However, disparities between guidelines and nurses' practice
are frequently reported, which undermines the implementation of these guidelines
into practice. This article explores the experience of frontline emergency nurses
regarding guideline implementation and provides an in-depth account of their
strategies in bridging guideline-practice gaps. DESIGN: A qualitative descriptive
design was used. METHODS: Semi-structured, face-to-face, individual interviews
were conducted between November 2013-May 2014. A purposive sample of 12 frontline
emergency nurses from five accident and emergency departments in Hong Kong were
recruited. The audio-recorded interviews were transcribed verbatim and analysed
with a qualitative content analysis approach. RESULTS: Four key categories
associated with guideline-practice gaps emerged, including getting work done,
adapting to accelerated infection control measures, compromising care standards
and resolving competing clinical judgments across collaborating departments. The
results illustrate that the guideline-practice gaps could be associated with
inadequate provision of corresponding organisational supports after guidelines
are established. CONCLUSIONS: The nurses' experiences have uncovered the
difficulties in the implementation of guidelines in emergency care settings and
the corresponding strategies used to address these problems. The nurses'
experiences reflect their endeavour in adjusting accordingly and adapting
themselves to their circumstances in the face of unfeasible guidelines. RELEVANCE
TO CLINICAL PRACTICE: It is important to customise guidelines to the needs of
frontline nurses. Maintaining cross-departmental consensus on guideline
interpretation and operation is also indicated as an important component for
effective guideline implementation.
|*Practice Guidelines as Topic
[MESH]
|*Practice Patterns, Nurses'
[MESH]
|Adult
[MESH]
|Communicable Diseases, Emerging/nursing/*prevention & control
[MESH]