Learning Objective #1: Explain the tension between EBP and individualized care based in the lived experience and the consequences for guideline development

Learning Objective #2: Explain the core concepts in such a guideline related to fluid restriction in dialysis patients

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Evidence Based Practice has led to a proliferation and an increased use of clinical guidelines. There is, however, an essential tension between the epidemiologic approach in which guidelines are rooted, and the need to individualize nursing care. This tension was addressed in the development of a guideline related to fluid restriction in dialysis patients. The guideline is built on a format that takes the lived experience of the patient as the point of departure. Nurses are offered choices and possibilities, and the rationale, including the available evidence, is discussed in the guideline. The guideline has been tested in the care of dialysis patients in three small scale projects, including 45 patients in total. Nurses have received instruction to use the guideline in the care of some of their patients. Patients and nurses were interviewed afterwards and their experiences systematically analyzed using qualitative research methods. The Interdialytic weight gain indicated to what extent patients were able to restrict their fluids. The analysis of the data showed that prescribing evidence informed individualized care to assist in the self-management of fluid restriction is a valuable approach. Individualized care based on the lived experience of the patient requires more than that prescriptions of guidelines are adapted to the specific situation of the patient. It should affect both the content and the format of guidelines. Akowledgement. We acknowledge the contributions of the following co-researchers: M.J. Litjens; M. Waterschoot; G. Verhoeven-Smeets, B. Vlaeminck.