Influence of policies on nursing practice in long-term care environments for older people


  • Debbie Tolson BSc MSc PhD RGN,

  • William Maclaren BSc MSc PhD,

  • Sian Kiely MA,

  • Andrew Lowndes BA RNT RCNT RMN

Debbie Tolson,
School of Nursing,
Midwifery and Community Health,
Glasgow Caledonian University,
Govan Mbeki Building,
Cowcaddens Road,
Glasgow G4 0BA,


Aim.  This paper reports a study exploring nurses’ awareness of, access to and use of policies within long-term care environments for older people in Scotland.

Background.  The provision of the highest quality of nursing care for older people with continuing care needs is facilitated through a number of strategic mechanisms. These encompass regulatory systems, national and local policies and care guidance. Failure of practitioners to engage with the ‘policy context’ may compromise care standards.

Method.  This was a two-stage investigation. A Delphi approach with 33 panel members was used to generate consensus as to the 10 most important current policies in this area of practice. A postal survey was undertaken with 2072 nurses to identify the practice impact of policies, including the 10 identified items.

Findings.  Identification of the 10 most important policies proved challenging for panel members. Initially they identified 137 policy items, which were reduced after clustering and two further rounds to 10 items (consensus agreement 57%). Completed questionnaires were returned by 986 (48%) nurses. A long list of problems limited access to policy information. Nurses reported little time to keep up to date, compounded by communication inefficiencies and limited access to the internet. Awareness of the 10 selected items ranged from 46 to 83% and clarity of the practice message was high (85–94%); however, the reported influence on practice varied, with 10–26% of respondents indicating no effect. Professional priorities did not coincide with the priorities of older people themselves.

Conclusion.  Nurses appear bewildered by the number and status of policy items. Current methods to provide nurses with information and keep them up to date were not ideal. Processes need to be developed that will engage nurses in policy and pursue closer alignment with the priorities of older people. Strategies are required to identify key policies and promote their implementation.