Practice guidelines need to address the ‘how’ and the ‘what’ of implementation

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dc.contributor.author McKillop, Ann en
dc.contributor.author Crisp, J en
dc.contributor.author Walsh, K en
dc.date.accessioned 2012-03-06T19:57:16Z en
dc.date.issued 2011 en
dc.identifier.citation Primary Health Care Research & Development 13(1):48-59 2011 en
dc.identifier.issn 1463-4236 en
dc.identifier.uri http://hdl.handle.net/2292/13098 en
dc.description.abstract Aim: The aim of this study was to explore the realities of everyday nursing practice associated with the implementation of a guideline for the assessment and management of cardiovascular risk. Background: The use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable and, in spite of much investigation, remains resistant to explanation of what works and why. Exploration of the nature of guideline implementation has the potential to illuminate the complexities of guideline implementation by focussing on the nature of practice. Nurses are well placed at the front line of primary health care to contribute to an understanding of how guideline implementation plays out in their everyday practice. Methods: Qualitative description was used, involving focus groups and interviews with 32 participants (20 nurses, four doctors, five managers and three funder/planners), to explore the use of a guideline in everyday primary health-care practice. Thematic analysis of data was managed through an inductive process of familiarisation, coding, categorising and generation of themes. Findings: Four themes were generated from the data portraying the realities of guideline implementation for primary health-care nurses: self-managing patient, everyday nursing practice, developing new relationships in the health teamand impact on health-care delivery. The findings reveal that, even with the best of intentions to implement the guideline, health professionals were frustrated and at a loss as to how to achieve that in practice. Consequently, cardiovascular risk assessment and management was uneven and fragmented. Primary health-care practice environments vary so much that solutions to the difficulties of implementing evidence into practice requires context-specific solution-finding through collaborative teamwork. Furthermore, the attention of guideline developers, health-care policymakers, funders and researchers requires direct focus on the ‘how’ and the ‘what’ of evidence implementation. en
dc.publisher Cambridge University Press en
dc.relation.ispartofseries Primary Health Care Research & Development en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from http://www.sherpa.ac.uk/romeo/issn/1463-4236/ en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.title Practice guidelines need to address the ‘how’ and the ‘what’ of implementation en
dc.type Journal Article en
dc.identifier.doi 10.1017/S1463423611000405 en
pubs.issue 1 en
pubs.begin-page 48 en
pubs.volume 13 en
dc.rights.holder Copyright: Cambridge University Press en
dc.identifier.pmid 22008308 en
pubs.end-page 59 en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Article en
pubs.elements-id 246586 en
pubs.org-id Medical and Health Sciences en
pubs.org-id Nursing en
pubs.record-created-at-source-date 2011-11-29 en
pubs.dimensions-id 22008308 en


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