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Wednesday, July 13, 2011: 2:25 PM
Learning Objective 1: The learner will be able to catch what were nurses' predicaments of regulation to professional relations with patients and family.
Learning Objective 2: The learner will be able to view the co-construction process with nursing practice in various clinical setting and the CPG based on EBM in Taiwan.
The incidence and mortality rate of cancer was significantly increased in Taiwan, and chemotherapy was the most common regimen for cancer treatment. While drug toxicity has known to threaten nurses’ health, the Regulation of Cancer Care Quality Assurance Measures established in 2008 had demanded the establishment of the clinical practice guideline (CPG) based on evidence based medicine (EBM) to protect nurses away from chemotherapy hazards. EBM had implemented more than fifteen years in Taiwan and become the mainstream in medical direction practice. This study explored (1) how would nurse protect themselves under CPG of chemotherapy; (2) what strategies used by nurses to perform the best safety protection while fulfill their social role expectations such as mother. The research design was employed with participant observation and ethnographic interviews. Nurses who performed chemotherapy in medical centers in Taiwan were invited to participate. Data were collected, transcribed verbatim and analyzed by the constant comparison method. The results indicated that patterns of nursing judgments of various cancer patient conditions were normalized and disciplined as scientific evidence. Under the name of standardization, a series of training programs for nurses and practice protocols have developed based on EBM research results claiming its scientific objectivity, thus resulted in clinical rigid practice requirements. However, clinical care experiences of expert nurses have showed that the modification of chemotherapy procedures in bedside is more efficient and safe such as transformed restricted bedside environment into sufficient protection using bedside available materials. Furthermore, clinical guidelines have disciplined nurses to present their professional image, while their local knowledge and modified bedside care practices have been normalized as safety guideline. In conclusion, experiences of nursing daily practices should be taken into consideration to be good evidence integrated into nursing exemplars in CPG.