Paper
Wednesday, July 21, 2004
This presentation is part of : Changing Nursing Practice
Implementing Guidelines and Changing Nursing Practice: Intentions and Outcomes
Lin Perry, MSc, PhD, RN, Health Care Research Unit, City University, London, United Kingdom and Susan M. McLaren, BSc, PhD, RGN, Faculty of Health and Social Care Sciences, Kingston University, Kingston upon Thames, Surrey, United Kingdom.
Learning Objective #1: Appreciate a variety of approaches to implement changes in nursing practice
Learning Objective #2: Gain insight into ways in which different strategies may function in differing situations
Recent policies within the UK National Health Service have flagged implementation of research evidence into clinical practice to effect improvements in quality of care. Evidence-based guidelines have been recommended as one means to achieve this. However, effecting changes in practice requires more than production of guidelines. Locally-tailored multi-method change management strategies have been recommended (1). Nursing nutritional support for vulnerable hospital patients has been a poorly-regarded aspect of nursing care (2). The deleterious effect of poor nutrition on patients’ survival and recovery has been flagged repeatedly, with little effect (3). To address this, a project was conceived to develop, implement and evaluate evidence-based guidelines for nutritional support of patients hospitalized with acute stroke. This paper considers the characteristics of the site and change management strategies employed in relation to their effectiveness in achieving intended changes in clinical practices.

The study was sited in medical and elderly services of an acute Trust hospital (approximately 700 beds) in South London. A Project Co-ordinator employed formal and informal approaches at project commencement to detail local characteristics, policies and practices. These comprised interviews and questionnaires to all key professionals who cared for stroke patients; observations of managerial and clinical meetings; analysis of key Trust quality-related documentation. Audits were conducted of nutritional patient care services before and after guideline implementation (n=400 stroke patients).

Findings will be presented in terms of intended changes in practice, discussed in relation to local characteristics and chosen change strategies. Major changes and benefits for patients were attained but success was not universal. Possible explanations will be considered and lessons for the future identified.

(1) NHS Centre for Reviews and Dissemination 1999. Getting evidence in to practice. Effective Health Care 1999:5:1. (2) Tierney AJ. JAdv Nursing. 1996;23:2:228-236, (3) Lennard-Jones J.E. 1992. A Positive Approach to Nutrition as Treatment. King's Fund, London

Back to Changing Nursing Practice
Back to Evidence-Based Nursing: Strategies for Improving Practice
Sigma Theta Tau International
July 21, 2004