Will current clinical effectiveness initiatives encourage and facilitate practitioners to use evidence‐based practice for the benefit of their clients?

Abstract

1996 saw the implementation of Clinical Effectiveness Initiatives by the NHS Executive and the Royal College of Nursing to promote the use of evidence-based care. This paper examines whether or not nurses will be encouraged and facilitated by these initiatives to provide evidence-based care for their clients. Both initiatives appear to assume that the use of evidence-based care leads to improved client care, but several issues are raised which still need to be resolved before this assumption can be made. The NHS Executive advocates the use of randomized controlled trials as the method of choice for providing evidence of clinical effectiveness. However, this may not necessarily be the best methodology for some areas of nursing practice. The paper concludes that the Royal College of Nursing's Clinical Effectiveness Initiative has great potential to provide the necessary motivation and facilitation, providing other professional issues are resolved.

Barriers to research utilisation: the clinical setting and nurses themselves

“…Interestingly, some of these commentators are themselves nurses or nurse academics (e.g. Regan 1998). However, there is a strong opposing argument; as the evidence based practice agenda becomes stronger, the only way nurses will continue to develop as respected equal partners in patient care is by ensuring that they are well prepared not only to follow new guide-lines but to develop and implement them.…”

The capability of nurse practitioners may be diminished by controlling protocols

“…29,30,31 Berg 24 notes critics have argued that guidelines/protocols lead to cookbook medicine, deskilling by reducing the need for independent thought, and reduction of professional autonomy. Conversely, advocates have argued that such documents do permit room for individual interpretation, allow for deviation, and act to formalise the knowledge base of a professional group.…”

Improving tracheostomy care for ward patients

“…Despite adopting this approach and agreement at network board level to standardise the type of tracheostomy tube used in the trust, we still encountered resistance to this change in practice. Regan (1998) suggests that it is reasonable to expect adjustment problems in an overworked and understaffed profession.…”