Containing anxiety, contributing to care or compromising practice? Nurses' experience of guidelines in primary care

Mayers, Pat M

Monday, 18 November 2013

Pat M Mayers, PhD, M Sc Med (Psych), B Cur (Nursing education) B Nursing
Department of Health & Rehabilitation Sciences, Division of Nursing and Midwifery, University of Cape Town, Cape Town, South Africa

Learning Objective 1: Identify and describe the usefulness of clinical guidelines in primary care nursing practice

Learning Objective 2: Evaluate the challenges of the use of evidence-based guidelines in busy primary health care settings

Accessible and affordable care at primary level in South Africa is reliant primarily on nurses, who are under-resourced and often overwhelmed by the complex needs of their clients in the context of the HIV and AIDS epidemic.

Guidelines using best evidence are considered key to changing professional practice particularly at primary care level, where busy practitioners do not have time or sufficient access to the best evidence. The Practical Approach to Lung Health and HIV/AIDS study comprised multiple interventions aimed at improving the quality of care at the primary level, through the reworking of evidenced based guidelines into a user friend format, in conjunction with dedicated training and support of nurses. As a trainer and evaluator, I worked with the nurses and engaged with them over an extensive period.

How do nurses really experience the guidelines in their practice? This paper aims to explore, using a psychoanalytic lens, the experiences of nurses at primary care level in using guidelines. A secondary analysis was done of data obtained in a qualitative evaluation of primary care nurses’ responses to a new guideline.

Use of guidelines in primary care settings facilitates decision-making, may contain practitioner anxiety and improve the quality of care; yet guidelines pose challenges to creative discernment of the patient’s symptoms in relation to his/her personal circumstances and may impact on the personalised holistic care approach which characterises the essence of nursing.

See more of: Evidence-Based Practice Posters Session 2
See more of: Oral Paper & Poster: Evidence-Based Practice Sessions