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Evaluating use of clinical guidelines: a crucial component of evidence-based practice

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  2. Evaluating use of clinical guidelines: a crucial component of evidence-based practice
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Svavarsdottir and Orlygsdottir’s (2009) paper in this issue of JAN represents an exceptionally important but unfortunately rare instance of evaluation of the use of clinical guidelines in the real world of nursing practice. Much has been written in books and journals about the importance of evidence-based practice over the past several years, and clinical guidelines are regarded as one of the ‘gold standard’ documents summarizing the best available evidence for various practice processes.

I regard clinical guidelines as empirically adequate middle-range theories that constitute evidence for practice. From my perspective, their use not only increases evidence-based practice but also eliminates the perceived gap between practice and theory. Clearly, that is a win-win situation for nurses and patients. Clinical guidelines may encompass detailed procedures for assessment of health conditions and/or interventions to manage responses to health conditions, as well as identification of the tools, equipment, and other resources needed for the assessment or intervention. The evidence may range from expert opinion to synthesis of results from randomized clinical trails. The clinical guidelines evaluated by Svavarsdottir and Orlygsdottir (2009) provide culturally sensitive, evidence-based direction for identifying and responding to Icelandic women who have experienced physical, emotional, or sexual abuse.

I believe that development of clinical guidelines and their wide dissemination through publications, conference presentations, the internet and news media is the third step toward evidence-based practice. The first step is to determine what current practice is and the source of knowledge guiding that practice, such as tenacious beliefs, authorities, common sense, or empirically adequate theories. The second step is to determine whether practice should be changed and if so, what the change should be. The evidence for nursing practice review summaries prepared by the Joanna Briggs Institute that are published in each issue of JAN exemplify the first, second and third steps. The fourth step is to evaluate whether the clinical guidelines are adopted and found to be effective; Svavarsdottir and Orlygsdottir’s (2009) paper is an informative example of this step.

The first three steps are becoming increasingly common. The fourth step is not, for we too frequently assume that once clinical guidelines have been developed and disseminated, they will be used. Indeed, little attention has been given to the validity of that assumption. Admittedly, a growing number of studies address barriers to and facilitators of evidence-based practice, such as those by Carlson and Plonczynski (2008) and Gerrish et al. (2008). The findings of these and other similar studies typically tell us that the many perceived barriers outnumber the factors that facilitate use of evidence, such as clinical guidelines. If we do not use clinical guidelines, on what do we base our practice? If we do use clinical guidelines but do not evaluate the effectiveness of their use, how do we avoid their becoming an unquestioned routine that does not take new evidence into account? Svavarsdottir and Orlygsdottir’s (2009) work provides a template for evaluation of other clinical guidelines. Let us hope that more nurses and midwives will be motivated to use and evaluate clinical guidelines so that the health of the public is enhanced through the advancement of evidence-based practice.

References

  1. Top of page
  2. Evaluating use of clinical guidelines: a crucial component of evidence-based practice
  3. References