What is protocol-based care? A concept analysis
Institute of Work Psychology, University of Sheffield, Sheffield, UK. Journal of Nursing Management
(Impact Factor: 1.5).
11/2006; 14(7):544-52. DOI: 10.1111/j.1365-2934.2006.00703.x
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.
Available from: Kerstin Nilsson
- "However, protocols can provide a false sense of security and belief that the work is being done in a certain way (Seddon, 2010). Previous research reveals problems associated with following protocols mindlessly or blindly without judging or considering whether this is appropriate in a particular situation (Ilott et al., 2006). Consequently, with such detailed control there is a risk that certain aspects of the patient's needs will not be met if those needs are not regulated in the protocols. "
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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.
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.
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.
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.
Available from: Lap Fung Tsang
- "The protocol based care was described as a generic term, making explicit ''who should do what, when, how and why'' in the form of algorithms, protocols, guidelines, policies, procedures and integrated care pathways (Ilott et al., 2010). Many nursing practices using protocols have been heralded as a means of ensuring evidence based care (Ilott et al., 2006). Protocols for each clinical condition have been developed using a multidisciplinary approach with various experts in that particular area contributing. "
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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.
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.
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.
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.
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.
Available from: PubMed Central
- "Although the implementation of nurse-initiated protocols in health care have been shown to improve patient care outcomes and perceptions of care, systematic shortfalls and interdisciplinary relationships, some studies highlight concerns related to nurse-initiated care protocols. Critics suggest that nurse-driven protocols may replace clinical judgment , devalue nursing knowledge and experience [34–37] and may lack proper guidelines for education of nursing staff prior to the implementation [15, 38]. Indeed, for successful implementation of nurse-driven protocols, these concerns must be addressed, including adequate education for nursing staff, assessment of patient outcomes, and exploring the impact on the health care team. "
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ABSTRACT: In an effort to improve the quality and flow of care provided to children presenting to the emergency department the implementation of nurse-initiated protocols is on the rise. We review the current literature on nurse-initiated protocols, validated emergency department clinical scoring systems, and the merging of the two to create Advanced Nursing Directives (ANDs). The process of developing a clinical pathway for children presenting to our pediatric emergency department (PED) with suspected appendicitis will be used to demonstrate the successful integration of validated clinical scoring systems into practice through the use of Advanced Nursing Directives. Finally, examples of 2 other Advanced Nursing Directives for common clinical PED presentations will be provided.
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