Clinical practice guidelines (CPGs) are not new; more than 20 years ago, the Institute of Medicine published information about the development and use of guidelines for clinical practice. Field and Lohr (1990), editors of this Institute of Medicine document, tell us that CPGs "[horizontal ellipsis] are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (p. 38). Throughout the 1990s, CPGs became an increasingly familiar element of clinical practice in both medicine and nursing; they gained attention as evidence-based guides to practice that improved the quality of care while minimizing the potential harm associated with health care.
Guidelines also offer a way to improve the quality of care by translating research findings into practice. This is often best accomplished with CPGs that include "specific recommendations, sufficient supporting evidence, a clear structure and an attractive layout" (Wollersheim, Burgers & Grol., 2005, p. 188). The recommendations included in CPGs should include the practice norms of their intended users.
Today, CPGs can speed up often slow, and sometimes haphazard, work of translational research by systematically summarizing the available evidence. Dissemination of evidence-research findings-within the context of a CPG supports changes in practice and practitioner. CPGs provide us with the "facts" to support our clinical intuition; a less expert practitioner can study a CPG, review the evidence it provides, and take that knowledge more confidently to the patient's bedside.
Practice guidelines abound, so before we adopt a particular CPG for use, we have to ask ourselves several questions: Are its recommendations valid? What are the actual recommendations? Will the recommendations improve patient care in some meaningful way? We also need to critically evaluate CPGs in some ways that mirror the critique of all research; we need to evaluate validity, reliability and reproducibility, clinical applicability and flexibility, clarity, and plans for ongoing review.
Okay, you ask: "This is some interesting, maybe useful, information about CPGs but why here, why now?" In 1997, the American Association of Neuroscience Nurses (AANN) created a series of "guides to patient care" called AANN Reference Series for Clinical Practice. These were designed as educational tools for neuroscience nurses and were not strictly evidence based. In 2006, AANN began rethinking and revising the guides using essential components of evidence-based practice. AANN has now published 11 different CPGs-more than half of these reflect principles of evidence-based practice, with 5 others in development.
Our CPGs can be critically evaluated by asking the questions outlined earlier. They include specific recommendations, reflect the norms of neuroscience nursing practice, are valid, reliable, and produce reproducible outcomes. They are peer reviewed by content and practice experts. We review and reevaluate them routinely. Our CPGs can help us move current neuroscience research to the bedside.
Beginning in this issue, the Journal of Neuroscience Nursing will publish a CPG feature on a recurring basis-most likely three times each publication year. We will not print a CPG in its entirety but instead will provide readers with a synopsis of the current guidelines; we will include information about newly developed CPGs as well as those that have undergone recent revision so they remain current. The synopsis includes a brief abstract and a link to the full-text guideline. Our goal is to lead by example; we will disseminate research in this additional format so it might be more easily moved to the bedside. We should be able to trust our CPGs to support our clinical intuition and judgment.
Use these. Share them with your colleagues. Ask the tough questions [horizontal ellipsis] but always ask yourself, will the guidelines offer my patients the best possible outcomes?
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