Implementation and Evaluation of Diabetes Clinical Practice Guidelines in a Primary Care Clinic Serving a Hispanic Community

2019 ◽  
Vol 16 (2) ◽  
pp. 142-150
Author(s):  
Eddy Marcial ◽  
Barbara Ann Graves
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Primary Care Clinic ◽  
Care Clinic ◽  
Hispanic Community

scholarly journals Between standardisation and discretion: the priority setting of triage nurses

2018 ◽  
Author(s):  
Lars Emil Fagernes Johannessen
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Priority Setting ◽  
Clinical Decision Making ◽  
Primary Care Clinic ◽  
Primary Concern ◽  
Care Clinic ◽  
Street Level ◽  
The Relationship

This dissertation explores the relationship between standardisation and discretion in professional work at street level, using the priority setting of triage nurses as its case. Triage nurses are employed at the frontline of emergency medical services, where they work to assess the urgency of patients’ complaints. This work can be very challenging, requiring rapid assessments of a large group of unknown and unsorted patients, some of whom may be critically ill. To aid these assessments, emergency services have increasingly introduced standardised triage systems that specify how nurses should proceed in interpreting and prioritising cases. Triage systems reflects a broader trend in healthcare, which has seen a widespread introduction of clinical practice guidelines, all seeking to generate uniformity and quality control by streamlining clinical decision making. The introduction of these guidelines has been described as an unprecedented form of standardisation of professional clinical work, but there is little consensus regarding their effects. While proponents argue that clinical practice guidelines are an important means of improving quality and efficiency, critics denounce them for promoting bureaucratisation, homogenisation and so-called ‘cookbook medicine’. Observing this impasse, there have been calls for an empirically grounded ‘sociology of standardisation’ to acknowledge that guidelines can have different effects in different settings and to explore standardisation on a case-by-case basis. Informed by that proposal, this dissertation explores the relationship between standardisation and discretion in triage nurses’ priority setting. The dissertation is based on nine months of fieldwork in a Norwegian emergency primary care clinic (EPCC), where nurses were required to assess patients using the Manchester Triage System (MTS). Observations revealed that nurses regularly departed from the MTS while also seeming to be influenced by the system in a number of ways. On this basis, the dissertation addresses the question of how and why nurses departed from the MTS and, conversely, how the MTS influenced their assessments. The introduction and the four associated articles show how nurses supplemented the MTS with additional skills and knowledge, and how this led them to adjust or override the priorities formally prescribed by the system. While they had several reasons for so doing, their primary concern was to ‘correct’ the MTS and to ensure more precise prioritisation of patients. However, the MTS also played a significant role in their assessments by restricting, enabling and supporting priority setting.Beyond shedding light on discretionary practices among triage nurses, the dissertation makes three more general contributions to the sociology of standardisation. First, it helps to bridge the gaps between the sociology of standardisation and the literatures on street-level bureaucracy and categorisation. In so doing, it identifies fruitful theoretical linkages for future studies of standardisation and discretion in street-level categorisation of clients.Secondly, the in-depth exploration of nurses’ use of the MTS provides a rich account of the difficulties of streamlining clinical practice. Despite its elaborate design, the MTS was too ‘thin’ to match the complexity of triage nurses’ work, and to follow it unreflectively would be to the detriment of both patients and staff. For that reason, nurses found it necessary to render the guidelines ‘thicker’ by making situated judgments, illustrating the crucial role of additional skills and knowledge in making standards work.Finally, the dissertation shows how the MTS (despite its shortcomings) affected nurses’ work in multiple ways, illustrating how guidelines interact with professional practice. In so doing, the dissertation transcends the either/or language that characterises much of the debate around standardisation, instead providing a nuanced account of the interplay between prescribed and discretionary aspects of triage nursing.

scholarly journals Clinical practice guidelines and principles of care for people with dementia: a protocol for undertaking a Delphi technique to identify the recommendations relevant to primary care nurses in the delivery of person-centred dementia care

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044843
Author(s):  
Caroline Gibson ◽  
Dianne Goeman ◽  
Mark William Yates ◽  
Dimity Pond
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Dementia Care ◽  
Care Nurse ◽  
Primary Care Nurse ◽  
People With Dementia ◽  
Primary Care Nurses

IntroductionNationally and internationally it is well recognised that dementia is poorly recognised and suboptimally managed in the primary care setting. There are multiple and complex reasons for this gap in care, including a lack of knowledge, high care demands and inadequate time for the general practitioner alone to manage dementia with its multiple physical, psychological and social dimensions. The primary care nurse potentially has a role in assisting the general practitioner in the provision of evidence-based dementia care. Although dementia-care guidelines for general practitioners exist, evidence on resources to support the primary care nurse in dementia care provision is scarce. The ‘Australian Clinical Practice Guidelines and Principles of Care for People with Dementia’ provides 109 recommendations for the diagnosis and management of dementia. This protocol describes a Delphi study to identify which of the 109 recommendations contained in these multidisciplinary guidelines are relevant to the primary care nurse in the delivery of person-centred dementia care in the general practice setting.Methods and analysisUsing a Delphi consensus online survey, an expert panel will grade each of the recommendations written in the ‘Clinical Practice Guidelines and Principles of Care for People with Dementia’ as high-to-low relevance with respect to the role of the primary care nurse in general practice. To optimise reliability of results, quality indicators will be used in the data collection and reporting of the study. Invited panel members will include Australian primary care nurses working in general practice, primary care nursing researchers and representatives of the Australian Primary Health Care Nurses Association, the peak professional body for nurses working in primary healthcare.Ethics and disseminationThis study has been approved by The University of Newcastle Human Research Ethics Committee (HREC) (H-2019-0029).Findings will be published in a peer-reviewed journal and presented at scientific conferences.

scholarly journals A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients

2014 ◽  
Vol 67 (11) ◽  
pp. 1251-1257 ◽  
Author(s):  
Nicholas Steel ◽  
Asmaa Abdelhamid ◽  
Tim Stokes ◽  
Helen Edwards ◽  
Robert Fleetcroft ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Primary Care Patients

Empfehlungen für das Management nicht spezifischer Rückenschmerzen

2020 ◽  
Vol 24 (01) ◽  
pp. 6-7
Author(s):  
Arne Vielitz
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Low Back

Oliveira CB, Maher CG, Pinto RZ et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018; 27: 2791–2803. doi: 10.1007/s00586–018–5673–2. Epub 2018 Jul 3

Implementing arthritis clinical practice guidelines in primary care

2009 ◽  
Vol 31 (3) ◽  
pp. 230-237 ◽  
Author(s):  
Sydney C. Lineker ◽  
Mary J. Bell ◽  
Jennifer Boyle ◽  
Elizabeth M. Badley ◽  
Lois Flakstad ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines
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