What is protocol-based care? A concept analysis.
ABSTRACT To define protocol-based care to make this way of delivering health care amenable to theoretical and empirical studies.
Although protocol-based care is associated with the evidence-based practice and standardization movements, it is an ill-defined and understood concept.
A multiphase concept analysis, inspired by an evolutionary view was used to clarify 'what is protocol-based care'. The inductive, five-phase process drew upon content analysis of policy documents and the literature, plus interviews with a purposive sample of 35 opinion leaders.
The term was used interchangeably with protocols, pathways and guidelines in policy and guidance documents. A search of seven databases produced only 57 references to protocol-based care. The concept analysis revealed a continuum of scope and specificity and also distinguished specialist and generic applications of protocol-based care.
Managers need to take cognizance of the significance and complexity of protocol-based care when introducing this way of working.
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ABSTRACT: Through their formal mandate, position and authority, managers are responsible for managing everyday work in Emergency Departments (EDs) as well as striving for excellence and dealing with the individual needs of practitioners and patients. The aim of the present study is to explore managers’ experiences of managing everyday work in Swedish EDs. Method A qualitative and exploratory design has been used in this study. Seven managers were interviewed at two EDs. Data was analysed using qualitative content analysis with focus on latent content. Results Managers experience everyday work in the ED as lifesaving work. One of the characteristics of their approach to everyday work is their capability for rapidly identifying patients with life-threatening conditions and for treating them accordingly. The practitioners are on stand-by in order to deal with unexpected situations. This implies having to spend time waiting for the physicians’ decisions. Management is characterised by a command and control approach. The managers experience difficulties in meeting the expectations of their staff. They strive to be proactive but instead they become reactive since the prevailing medical, bureaucratic and production-orientated systems constrain them. Conclusion The managers demonstrate full compliance with the organisational systems. This threatens to reduce their freedom of action and influences the way they perform their managerial duties within and outside the EDs.International emergency nursing 10/2014; 22(4):190-196. DOI:10.1016/j.ienj.2014.02.001
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ABSTRACT: Background A high prevalence for the development of delirium after hip fracture was found in the group of geriatric patients. The National Institute for Health and Clinical Excellence has introduced a guideline for the management delirium (NICE, 2010). Protocols composed of detection, prevention and management of post-operative delirium required some adaptation to meet the needs of local nurses. Aim A protocol with a nursing care plan referenced from an international guideline and other literature was developed to predict, prevent and manage post-operative delirium for geriatric patients with hip fracture. Methods The literature suggests numerous risk factors are associated with post-operative delirium and its preventive interventions were adopted to develop the protocol and nursing care plan. Findings Six major risk categories included mental and behavioural influence, sensory impairment, physiological influence, immobility influence, electrolyte disturbance and infection influence. These were used for screening patients, accompanied by various preventive interventions. A protocol was developed to strive for the best management of geriatric patients receiving hip fracture surgery from admission to discharge. Conclusions The protocol incorporated with the Risk Assessment for Management of Postoperative delirium (RAMP) care plan was adapted for staff to implement in their local clinical area. Further study is required to determine its effectiveness on the prevention of the development of post operative delirium (POD) in the future.International Journal of Orthopaedic and Trauma Nursing 01/2013; DOI:10.1016/j.ijotn.2013.06.001
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ABSTRACT: Introduzione I piani standardizzati di assistenza forniscono un approccio strutturato al processo assistenziale. Essi mirano ad ottenere i migliori risultati assistenziali e utilizzano processi e attività omogenei, selezionati sulla base delle migliore prove di efficacia disponibili in situazioni cliniche simili (Motta 2002). Spesso la standardizzazione è stata percepita in contrapposizione con la personalizzazione; tuttavia tali concetti non dovrebbero essere visti come inconciliabili. Infatti l erogazione di un assistenza basata sulle prove di efficacia e secondo le linee-guida o standard assistenziali può essere compatibile con un assistenza individualizzata secondo i bisogni del singolo paziente (Motta 2002). Le linee-guida, i protocolli e gli standards di assistenza (Ilott et al 2006) sono strumenti fondamentali della standardizzazione. Essi sono importanti per ridurre nella pratica clinica le variabilità individuali inappropriate e migliorare la qualità dell assistenza erogata (Moiset & Vanzetta 2006). Valutazioni rigorose delle linee-guida cliniche hanno dimostrato che esse migliorano la qualità dell assistenza medica (Grimshaw & Russell 1993). Alcune valutazioni simili degli effetti delle linee-guida cliniche infermieristiche e di altre professioni sanitarie hanno fornito qualche evidenza che l assistenza basata sulle linee-guida può esser efficace nel modificare i processi ed i risultati dell assistenza (Thomas et al 2000). Tuttavia sono stati evidenziati anche potenziali limiti e danni delle linee-guida cliniche (Woolf et al 1999). Per esempio, le linee-guida cliniche potrebbero essere scorrette se basate su prove di efficacia insufficienti o potrebbero esser troppo rigide e non tenere conto delle circostanze e delle preferenze individuali dei pazienti.