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The state of the science and art of practice guidelines development,dissemination and evaluation in Canada 总被引:1,自引:0,他引:1
Graham ID Beardall S Carter AO Tetroe J Davies B 《Journal of evaluation in clinical practice》2003,9(2):195-202
The Canadian Medical Association (CMA) maintains a database of clinical practice guidelines (CPGs) developed or endorsed by Canadian organizations. The study purpose was to describe how these guidelines were developed, disseminated and evaluated. A survey was mailed to the developer of each CPG registered in the CMA Infobase between June 1996 and December 1999. Data were received for 730 unique guidelines (response rate of 70%) developed by 75 organizations. Of these, 72% were developed by committees that had a formal process for selecting their members. The scientific literature was reviewed for all of the guidelines, a computerized search undertaken for 88% and the search strategy included 34% of CPG documents. An attempt was made to grade the quality of the evidence underpinning 54% of the guidelines. For most guidelines, consensus about values or judgements was reached by expert opinion through open discussion (78% of guidelines). The most common strategies used to disseminate the guidelines were direct mailing of guidelines to members of the developing organization (80% of all guidelines), publishing guidelines in newsletters/journals (76%), direct mailing to others (73%), electronic dissemination (62%), educational or continuing medical education activities (50%), and providing information about guidelines to patients/consumers (47%). Overall, 5% of the guidelines have been evaluated to determine their impact on health outcomes. During the 5-year study period (1994-99), the more recent guidelines were more likely to use multidisciplinary development panels, report the literature search strategies and grade the quality of the evidence. The CPG development process in Canada is becoming more rigorous and reproducible, but there is still considerable room for improvement. In addition to encouraging Canadian guideline developers to use more rigorous and transparent methods, considerably more attention must be focused on using and identifying effective and cost-effective strategies to promote and facilitate the uptake of guidelines by practitioners and to evaluate the impact of guidelines on patient outcomes. 相似文献
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Clarke HF Bradley C Whytock S Handfield S van der Wal R Gundry S 《Journal of advanced nursing》2005,49(6):578-590
AIMS: A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper. BACKGROUND: The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies. METHOD: The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data. RESULTS: Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers. CONCLUSIONS: There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and mechanisms for addressing the barriers. 相似文献
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AIM: The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation. BACKGROUND: Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles. DISCUSSION: Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place. CONCLUSIONS: Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals. 相似文献
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Clinical facilitation is critical to successful student clinical experience. The research reported in this paper used an interpretive case study to explore perspectives of clinical facilitators on what constitutes best practice in clinical facilitation of undergraduate nursing students.Eleven clinical facilitators from South East Queensland, Australia, participated in focus groups, interviews and a concept mapping exercise to gather their perspectives on best practice. The data gathered information regarding their prior and current experiences as registered nurses and facilitators, considering reasons they became clinical facilitators, their educational background and self-perceived adequacy of their knowledge for clinical facilitation. Analysis was through constant comparison.Findings of the study provided in-depth insight into the role of clinical facilitators, with best practice conceptualised via three main themes; ‘assessing’, ‘learning to facilitate’ and ‘facilitating effectively’. While they felt there was some autonomy in the role, the clinical facilitators sought a closer liaison with academic staff and feedback about their performance, in particular their assessment of the students. Key strategies identified for improving best practice included educational support for the clinical facilitators, networking, and mentoring from more experienced clinical facilitators. When implemented, these strategies will help develop the clinical facilitators' skills and ensure quality clinical experiences for undergraduate nursing students. 相似文献
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Jones NE Dhaliwal R Day AG Ouellette-Kuntz H Heyland DK 《Journal of critical care》2008,23(3):301-307
Purpose
The aim of this study was to determine factors that are associated with adherence to the Canadian nutrition support clinical practice guidelines (CPGs).Materials and Methods
We conducted a secondary analysis of data from a prospective observational cohort study of nutrition support practices in 58 intensive care units (ICUs) across Canada, grouped into 50 clusters. Adequacy of enteral nutrition (EN) (energy received from EN ÷ energy prescribed by the dietitian × 100), was used as a marker of adherence to the guidelines. We applied hierarchical modeling techniques to examine the impact of various hospital, ICU, and patient factors on EN adequacy.Results
The overall average EN adequacy was 51.3% (SE, 1.8%). In a multiple regression analysis, after adjusting for varying days of observation, hospital type (academic 54.3% vs community 45.2%, P < .001), admission category of the patient (medical 60.2% vs surgical 39.2%, P < .001), and sex of the patient (male 46.5% vs female 52.8%, P < .001) were found to be significant predictors of EN adequacy and adherence to the Canadian nutrition support CPGs.Conclusions
Specific hospital, ICU, and patient characteristics influence adherence to the Canadian nutrition support CPGs. Further research is required to illuminate the mechanisms by which female and surgical patients and community hospitals lead to lower guideline adherence. 相似文献9.
With our limited resources, the national colleges of general practice in the Nordic countries should select only a few important topics and only get involved in guideline preparations if they have a primary care perspective. We need not develop our own guidelines from scratch, but should take existing international GP clinical guidelines and literature reviews as a starting point and conduct the first steps in the guideline preparation jointly in the Nordic countries. More effort could then be directed towards the subsequent stages of guideline preparations and the implementation process. Key stakeholders should be involved at all stages in guideline development and at all levels of the health services to ensure commitment and improve the likelihood of implementation. 相似文献
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《Nurse education in practice》2016,16(6):512-516
Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners.Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings.Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders. 相似文献
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Alanen SI Johannala-Kemppainen R Ijäs JJ Kaila M Klockars M Mäkelä M Välimäki MA 《Scandinavian journal of primary health care》2007,25(4):232-236
OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264 health centres (91%) in Finland. The HT Guideline had been introduced into clinical practice in most health centres (89%). The style of implementation varied widely between health centres: at opposite ends of the implementation scale were 21 implementer health centres, which used multiple implementation channels, and 23 disseminator health centres, which used few or no implementation channels. The implementers had typically larger population bases and had organized services around the family doctor system, while the disseminators were smaller and had organized services according to a traditional model (appointments could be with any doctor in the surgery). CONCLUSION: The Finnish HT Guideline has become well known in most health centres since being introduced into clinical practice. However, the style of implementation varies markedly between health centres. 相似文献
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目的 整合现有的妊娠期糖尿病孕产妇管理相关指南,形成高质量本土化证据资源。方法 以ADAPTE方法为指导,形成妊娠期糖尿病临床护理实践指南草案,采用专家现场论证及孕产妇论证对草案进行评审,修订形成正式版指南。结果 共纳入14份相关指南,49份系统评价,整合形成的指南内容包括妊娠期糖尿病的诊断、产前护理、分娩期护理、新生儿护理、产后护理5个主题,21个健康问题,69条推荐意见。结论 本次指南整合形成了妊娠期糖尿病管理领域高质量的循证资源,为临床护理实践提供参考和依据。 相似文献
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构建护理临床实习三级教学管理模式的探讨 总被引:5,自引:1,他引:4
目的探讨临床实习教学管理模式,提高护生临床实习的教学质量。方法在传统临床实习管理模式的基础上,创新护理学院与教学基地的护理部共同构建三级教学管理模式。结果通过4年实践,临床实习三级教学管理模式不断改进与提高,临床实习的管理水平、老师的带教质量、护生理论联系实际的综合能力均得到提升。结论护理学院与护理部共同构建临床实习三级教学管理模式,符合国家卫生部、教育部《医学教育临床实践管理暂行规定》的要求,提高了护理教学质量,达到教学目的。 相似文献
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王晓洁 《中华现代护理杂志》2014,(18):2257-2258
目的:了解不同实习指导方法对实习护生的自我效能和临床实践行为的影响,为提高护生的临床实习水平提供理论依据。方法选取某三级甲等教学医院的2008级和2009级本科实习护生413名为研究对象,2008级护生采用常规实习教学指导方法,2009级护生采用以学生为主体的实习教学指导方法,在实习结束后进行一般自我效能及临床实践行为情况的问卷调查,比较其差异。结果2009级本科护生实习后自我效能得分为(2.79±0.46)分,高于2008级实习护生的(2.58±0.53)分,差异有统计学意义(t=4.344,P<0.01)。2009级本科护生实习后临床实践行为总分为(3.84±0.51)分,高于2008级实习护生的(3.69±0.45)分,差异有统计学意义(t=3.299,P<0.01)。结论以学生为主体的实习教学指导方法可以有效提高学生的自我效能和临床实践行为水平,可广泛应用于实习护生的教育中。 相似文献
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护理临床实习教学质量的规范化管理 总被引:10,自引:0,他引:10
目的 探讨临床护理实习教学质量管理方法,规范实习教学管理,以期提高教学质量.方法 临床实习教学管理的重要环节包括教学管理架构、师资队伍、教学计划责任定位和院、校考核评价的协调4个要素,对整个实习教学过程实行全方位的规范化管理.结果 临床各科室都能认真完成规定的实习教学目标,院、校对学员的实际操作和毕业考核成绩逐步提高,护生和带教老师双向满意度显著增加,表明其综合素质明显提高.结论 临床学员护理实习教学目标的责任定位是保证教学质量的关键,教学质量实行内部制度化的教师-学生双向考核评价是提高教学质量的有效保证. 相似文献