Exploring the relationship between nursing protocols and nursing practice in an Irish intensive care unit

Abstract

Nursing practice no longer relies on tradition or ritual; instead, it is based on research and empirical evidence. The emphasis on evidence-based nursing, as well as standardization of nursing practice, has resulted in the production of policies, protocols and guidelines aimed at directing numerous aspects of nursing care. The aim of this study was to explore the relationship between these documents and actual nursing practice. To this end, this descriptive study employed a case study approach to examine the experiences of nurses in an Irish intensive care unit with a protocol on endotracheal tube suctioning. Focus group interviews of 17 nurses in six focus groups provided a significant insight into the experiences of these nurses in relation to policies, protocols and guidelines. Analysis of the data afforded some highly relevant findings, including the fact that nurses adapt clinical protocols as they see fit, thus demonstrating the importance that they place on their own professional judgement and autonomy.

Protocol‐based care: the standardisation of decision‐making?

“…2004a, Blackwood & Wilson‐Barnett 2007). In contrast, a study exploring the perceptions of intensive care nurses to policies, protocols and guidelines found that there was a fear that protocols were ‘taking the thinking out of nursing’ and deprived inexperienced nurses of an opportunity to develop decision‐making skills (Flynn & Sinclair 2005).…”

Attitudes Toward Guidelines in Finnish Primary Care Nursing: A Questionnaire Survey

“…Thus it has been argued that the evidence base of guidelines has been rather narrow and too medically oriented, and to the neglect of other kinds of knowledge important to nursing practice (Swinkels et al 2002; Geanellos 2004). It is also argued that guidelines oversimplify patient care by forgetting the uniqueness of each patient's situation; and, finally, it is also said to threaten the clinical autonomy of nurses (Bradshaw 2000; Flynn & Sinclair 2005; Taylor & Allen 2007).…”

Multiprofessional survey of protocol use in the intensive care unit

“…More than 20% of respondents in a recent survey of more than 1300 predominantly nursing clinicians agreed that practice "guidelines are too cookbook and prescriptive" [25]. Another study also found that nurses were afraid that protocols "were taking the thinking out of nursing" [26]. Within the current survey, greater than 25% of respondents also indicated that protocols cause confusion among clinicians.…”