Abstract:
OBJECTIVE:To evaluate the impact of protocol-based care on nursing roles, practice and service delivery. DESIGN:Case study evaluation informed by realistic evaluation methodology. Qualitative data collection methods were used including non-participant observation, post-observation interviews with nurses and patients, key informant interviews, tracking patient journeys and document review. PARTICIPANTS:141 participants took part including 73 nurses, midwives and health visitors, 4 allied health professionals, 20 doctors, 5 support staff and 39 patients. SETTINGS:Five sites were purposively sampled and included acute and primary care service provision. FINDINGS:As a mechanism for standardization, the use of protocol-based care approaches such as guidelines, care pathways, protocols and algorithms was patchy and dependent on contextual, professional and individual factors. Protocol-based care approaches were commonly used as checklists and for reference; nurses and doctors expressed concern that such use could lead to a 'tick box mentality' and restricted judgement. By using standardized care approaches nurses were taking on new tasks and developing skills beyond the traditional scope of practice including prescribing, diagnosing, ordering tests and sometimes deciding on treatments. The ability to perform these roles meant that they were able to run clinics or services independently. The extension of roles to incorporate prescribing, for example, meant that nurses were able to provide a more streamlined service for patients because they did not have to refer to doctors. In turn, it was reported that this reduced doctors' workload. Protocol-based care was viewed as a 'nurses' thing'; however, some General Practitioners and junior doctors were using available standardized care approaches. CONCLUSIONS:The potential of standardization was mediated by the patchy use of protocol-based care approaches and negative perceptions about standardization. Use of protocol-based care has the potential to impact on nurses' roles, increasing their autonomy and subsequently impacting on service delivery.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Rycroft-Malone J,Fontenla M,Bick D,Seers Kdoi
10.1111/j.1365-2753.2008.01015.xsubject
Has Abstractpub_date
2008-10-01 00:00:00pages
867-73issue
5eissn
1356-1294issn
1365-2753pii
JEP1015journal_volume
14pub_type
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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abstract::Medical malpractice claims can be analysed to gain insights aimed at improving quality of care. However, using medical malpractice claims in medical research raises epistemological and methodological concerns related to certain features of the litigation process. Medical research should therefore approach medical malp...
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journal_title:Journal of evaluation in clinical practice
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abstract:RATIONALE, AIMS AND OBJECTIVES:What factors determine the use of an anaesthesia preparation room and shorten non-operative time? METHODS:A logistic regression is applied to 18 751 surgery records from AZ Sint-Jan Brugge AV, Belgium, where each operating room has its own anaesthesia preparation room. Surgeries, in whic...
journal_title:Journal of evaluation in clinical practice
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更新日期:2015-04-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,多中心研究
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2011.01688.x
更新日期:2012-08-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
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doi:10.1111/j.1365-2753.2011.01764.x
更新日期:2013-02-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 评论,杂志文章
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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更新日期:2006-04-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
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