Objective: analysis of literature data on international experience in studying the attitude and expectations of nurses in relation to clinical nursing guidelines
Relevance of the topic. Clinical practice guidelines are new quality improvement tools that are designed to maintain quality, minimize costs, and improve medical care. Clinical practice guidelines integrate treatment protocols, patient care plans and relevant medical professionals into a single care plan that clearly defines the patient's expected progress and results throughout their stay in hospital.
Search strategy: an analysis of 20 English language publications from the Cinahl, Google Scholar, PubMed, eLibrary databases for the last 10 years, from January 2008 to December 2018, was conducted. Inclusion criteria: publications that contain a tool for analyzing the state of attitude and expectation of nurses to new clinical nursing guidelines. The following search queries were used for the search: “Nursing guideline”, “Nursery guidelines”, “clinical practice guideline”, “nursing recommendation”, and clinical nursing guideline.
Results: the published studies found contained various information about the attitude of nurses in relation to new clinical nursing manuals. This literature review helped describe the attitudes of nurses in relation to clinical nursing guidelines. Evidence-based clinical nursing guidelines will be accepted as a reliable source of patient care guidelines in primary care.
Conclusions: Implementation measures improve attitudes towards guidelines and increase the use of guidelines. These interventions also improve familiarity with clinical nursing guides, which will also be associated with the use of clinical nursing guides.
Introduction. Clinical practice guidelines are new quality improvement tools that are designed to maintain quality, minimize costs, and improve health services. The clinical practice guidelines integrate treatment protocols, patient care plans, and allied health workers into a single care plan that clearly defines the patient's expected progress and outcomes throughout the hospital stay (13).
The use of evidence-based clinical nursing guidelines can be an important aid to ensure ongoing patient care among providers, assist in providing quality care, and improve patient outcomes (7). Evidence-based clinical guidelines can be used as a means to improve
and maintain the quality of patient care and potentially improve patient outcomes (7). Evidence-based clinical recommendations were developed with the intention to provide patients with quality care and improvement of results of treatment (7). As described in recent years, clinical guidelines based on evidencebased medicine have been developed and used in Western countries to improve the quality of health care. The purpose of the guidelines is to provide evidence in a user-friendly manner that is easily accessible to all medical practitioners. Evidence-based practice has also gained popularity among clinical nurses (2). However, the adoption of evidence-based guidelines has not been unanimous, although the attitude of nurses has been mostly positive in recent years.
Objective: analysis of literature data on international experience in studying the attitude and expectations of nurses in relation to clinical nursing guidelines.
Search strategy: an analysis of 30 English- and Russian-language publications from the Cinahl, Google Scholar, PubMed, eLibrary databases for the last 10 years, from January 2008 to December 2018, was conducted. Inclusion criteria: publications that contain a tool for analyzing the state of attitude and expectation of nurses to new clinical nursing guidelines. The following search queries were used for the search: “Nursing guideline”, “Nursery guidelines”, “clinical practice guideline”, “nursing recommendation”, and clinical nursing guideline. At the initial search stage, 505 English-language and publications were found. After excluding repeating publications and articles that do not correspond the inclusion criteria, 20 publications were taken in the study. The article is a review of literary sources.
Results and discussion. Clinical Nursing Guideline.
Clinical practice recommendations can improve the process, the quality of patient care and, consequently, improve patient outcomes (8, 16).
Evidence-based practice should be the standard of treatment. However, help is not always provided on the basis of evidence, and nurses are often not aware of the available evidence. Most nursing practitioners work on the basis of how their nurses have trained them, not on evidence. When making clinical decisions, nurses use sources of evidence, such as reflecting their own experience, rather than evidence-based practice (20).
It has been described that most nurses considered the recommendations helpful and that the care recommendations improve the care and outcomes of patients (17). It is believed that providing quality and costeffective care based on best practices is the responsibility of all nursing managers. Evidence-based assistance is associated with improved medical care and lower costs. Currently, it is more important to introduce evidence-based nursing care to prevent side effects and reduce costs (20).
According to Matthew-Maich and his colleagues (16), the nurses who participated in their research believed that clinical nursing guidance is based on research and comes from the provincial Professional Nursing Association, which makes it trustworthy and relevant to their practice. Therefore, nursing leadership should be recognized as trustworthy by the entire healthcare team (e. g, nurses, managers, administrators, and doctors) to inspire nurses and involve them in the implementation of nursing guidelines. Nurses had to learn and be able to correctly implement the new recommendations of clinical nursing manuals. For this, ongoing training activities on the use of clinical nursing guides are important (16).
The results of the implementation of nursing guidelines.
The introduction of best practice guidelines for nursing can lead to improved practice and patient outcomes in a variety of settings, but many indicators remain unchanged. Mobilizing the workforce for nurses to actively implement guidelines and monitor the delivery of their care is important so that patients can learn and receive recommended health care (8).
The guideline on hypertension has been well accepted in clinical practice in Finland. The implementation of the guidelines influenced clinical practice and the creation of a new division of labour between nurses and physicians (1).
Implementing evidence-based best practice guidance improves patient outcomes by reducing variation in practice and providing consistent quality care. Nurses make clinical decisions on a daily basis that affect the lives of their patients (12).
The results of a study conducted by Bjartmarz and his colleagues show that the introduction of stroke care recommendations improved patient care, as shown in the patient's electronic records. After the introduction of the stroke care manual, nurses reported improved patient and family education and providedgood training materials for patients and family specialists (6).
It was described that the nurses found the care guide practical and easy to use. However, implementing nursing advice is challenging and requires ongoing training for nurses and other professionals (6).
According to a study by Johnny and his colleagues, it was shown that patient satisfaction is an indicator of the quality of the result, it shows that clinical care guidelines improved the quality of care, and patients were more satisfied with the care services when nurses followed the clinical guidelines procedure. on care. The quality of nursing care is monitored in the nursing care process, when a nurse decides, plans, implements and evaluates nursing care. The clinical use of the patient care process and the availability of clear guidance can improve the quality of care (13) It was noted that the implementation of the nursing guide to pain has a positive effect on the results and nurses of the unit, but most importantly, on the results of treatment of patients (19).
The implementation of clinical care guidelines has strengthened the trust of medical staff. Achieve confidence to help create a more autonomous practice that ultimately benefits beneficiaries, and confidence allows nurses to engage in professional collaboration (5).
Prior to the introduction of best practice guidelines, nurses usually provided care based on their personal experience and practice. For this reason, each nurse gave different advice to patients in different ways. To improve care and treatment outcomes, clinical nursing guidelines have been introduced on all sites to translate nurses from practices based on personal experience and traditions to those based on evidence. Nurses need to learn and know how to competently implement new practices in clinical nursing guidelines, how to optimally manage hospital care plans, and how to intervene in specific problems (16).
The introduction of nursing clinical guideline is a continuous process of creating reliable and flexible procedures that encompass all employees, and expect that they will lead to better and safer patient care, as well as increasing knowledge and confidence among staff. Several factors contribute to the adoption and affect usage and compliance with nursing clinical guideline. In order to increase support and willingness to use nursing clinical guideline, it is important to involve all staff in the implementation process, as well as to monitor and continuously provide feedback to staff and management. It seems necessary to evaluate the process of monitoring compliance with the nursing clinical guideline and balance priorities and costs. The assessment can also demonstrate the importance of the application. The introduction of clinical care guidelines can be a quality assurance tool if the implementation is successful and the conditions for reliable and flexible procedures are met (4).
Nurses' attitude to guidelines. The general attitude of the nurses to the management was positive and the nurses considered the recommendations useful for patient care (2). It has been shown that nurses in Finland find guidelines reliable because they are evidence based and developed by experts. Although the nurses said they were less familiar with the guidelines than doctors. Among the nurses, barriers to using the guidelines were lack of time and lack of support from organizations and healthcare workers (15). It should be borne in mind that in Finland, primary health care nurses can independently consult on lifestyle issues, as they have the opportunity to devote more time to this task than doctors.
Increased awareness and use of recommendations can lead to improved treatment. In order for the manual to influence the outcome of a patient's treatment, it must influence the nurses 'knowledge and attitudes. Similarly, primary care nurses should be aware of the existence of a manual and then read its recommendations. Relationships include acceptance of recommendations, self-efficacy, expected results, and motivation to change current patient care practices (3).
The study, conducted by Johnny and his colleagues, stated that among 30 respondents, 26 health workers (86.67%) had a good attitude towards introducing clinical guidelines for nursing. If nurses have a good relationship to the feeding process in clinical practice, they will firmly believe that the feeding process is effective, since the attitude of a person can significantly affect his behavior. This reflects the fact that the nurses sought to practice the manual, even if it was new and rather long. Approximately 86.67% of nurses were ready for clinical use of clinical care guidelines (13). Nurses usually show a positive attitude towards the guidelines. The most positive attitudes were related to the general attitude towards the guidelines and the usefulness of the guidelines within the project. The guidelines were found to improve the quality of care, useful as a training tool and a convenient source of advice. In addition, the nurse's staff denied that he had seen any indications in the health department. Nurses believe that most members of their teams disapprove of the guidelines and that they simplify the practice of nurses. However, in relation to one point, the attitude of medical personnel changed from negative to positive: they stopped believing that the guidelines questioned their independence (5).
As described in studies by Matthew- Maich (16) and his colleagues, most nurses were initially unprepared to experience innovation; they did not trust practice changes. They were unhappy that their workload would be even more complex nurses expressed doubts and concerns about the effectiveness and safety of the practice changes. According to Matthew-Maich and his colleagues (16), nurses must trust enough to experience new methods, overcome their fear, doubts, resistance and personal beliefs.
According to Alanen and his colleagues (2), the attitude of nurses to patient care recommendations is less positive and that they are less familiar with the guidelines than doctors. These less positive attitudes towards the guidelines may be an important factor influencing the implementation of the recommendations in clinical practice, as they reported that attitudes and intentions towards specific behavior are important predictors of such behavior (2). According to Kalies and colleagues (14) distrust of the nursing guidelines was high, because the doctors and nurses, at first, believed that nursing management, limit the treatment of patients, and secondly to limit the flexibility of individual patient care (14). In conclusion, according to Kalies and his colleagues (14) that an individual approach to palliative care does not seem to contradict the adoption of the guidelines. The main obstacles were related to skepticism about the quality of the guidelines and the implementation of the guidelines in General (14).
Conclusion. Evidence-based guidelines will be accepted as a reliable source of patient care guidelines in primary care. Implementation activities improve attitudes towards guidelines and increase the use of guidelines. These interventions also improve familiarity with the guidelines, which will also be associated with the use of the guidelines.
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