Paper
Thursday, July 12, 2007
Protcol-based care: an approach to advancing evidence-based practice?
Jo Rycroft-Malone, PhD, MSc, BSc, RN, Centre for Health Related Research, School of Healthcare Sciences, University of Wales, Bangor, Bangor, United Kingdom, Marina Fontenla, MSc, BSc, Research Function, RCN Institute, Oxford, United Kingdom, and Debra Bick, PhD, MedSc, BA, RM, RGN, Faculty of Health & Human Sciences, Thames Valley University, Slough, United Kingdom.
| Learning Objective #1: understand what protocol-based care is, and its role in delivering patient care. |
| Learning Objective #2: understand the impact of protocol-based care on patient care, nursing roles and evidence-based practice. |
Background
Protocol-based care is part of the evidence-based practice and standardisation movements that are influencing health care throughout the developed world. Whilst an increasingly popular way to deliver care, questions remain about the nature, benefits, and impact of protocol-based care on service delivery, evidence-based practice and patient care, and, about the nursing contribution to its development and implementation.
Aim
This presentation will share the findings from a Department of Health funded research study evaluating how and why protocols impact on practice, and service delivery.
Approach
A multi-site, multiple method case study was conducted (Yin 1993 & 1994). 5 case study sites in the United Kingdom, which included community and acute sites were purposively sampled. Qualitative data collection methods included non-participant observation of practice, interviews with staff and patients, and document analysis. Realistic evaluation was the study’s overarching methodological framework (Pawson & Tilley 2000)
Findings
Findings include that protocols are used as checklists, particularly by junior or new members of staff; can become ‘internalised’; cause a tension for staff between individualising and standardising care; and can have both positive and negative impacts on care and roles. Additionally protocols do not necessarily simplify or standardise decision-making, but can provide a heuristic. Furthermore the context of decision-making impacts on how protocols are used and other sources of evidence, other than that contained in protocols is used to inform patient-relevant decision-making.
Discussion
Findings will be discussed in the context of their implications for evidence-based practice and the delivery of patient-centred care, and whether protocols have the capability to standardise decision making.