Why bother with practice guidelines?

C. Stewart‐Amidei
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引用次数: 1

Abstract

Practice guidelines have garnered a great deal of attention in health care. Institutions, practice lines, professional organizations, specialty groups, and even advocacy groups are producing practice guidelines and promoting their use. Practice guideline development is a timeconsuming and sometimes daunting task. Aside from being trendy, why do we bother with practice guidelines? Practice guidelines were originally proposed as a way to standardize care across geographic boundaries. After all, nursing care should not differ from Alaska to Florida. Guidelines are especially useful for common diseases, such as asthma, or common problems, such as deep-vein thrombosis. The AHCPR series of guidelines is a good example. Guidelines such as these are usually developed from review of the evidence base as well as from expert consensus. These tools are helpful in guiding overall management, enhancing safety, minimizing unnecessary tests and treatments, and promoting cost and time savings. Care can be streamlined and standardized, and we can avoid re-inventing the proverbial wheel. The most important reason we have practice guidelines is to identify the standard of care. Guidelines say, “This is how it should be done.” In turn, guidelines serve as the benchmark to which we compare our practice. Another reason practice guidelines exist is to protect overlapping interests. Identifying responsibilities and scope of practice through guidelines serves to enhance collaboration in care and promote a multidisciplinary approach to difficult problems. This is particularly important in the most challenging of neuroscience problems. In order to develop practice guidelines, it is necessary to critically analyze our practice. We ask questions about how we do what we do, whether it is enough, whether it is safe, and whether it has a scientific basis. Such critical analysis improves quality of care, which in itself is worth the effort it takes to develop a guideline. Developing consensus also promotes communication and collaboration among professionals. To make guidelines useful, we must first understand why they exist. Second, we must use them. Guidelines that are not put into everyday practice are of no benefit. Third, we must critically analyze guidelines in use and update them when necessary. Changes in treatment options, new technology, and environmental changes all may prompt us to update practice guidelines, keeping in mind the reasons we have guidelines in the first place. Next, as nursing professionals, we must share the guidelines we develop as a way of promoting excellence in care. Consider sharing your practice guidelines with our readers. Know your professional organization’s practice guidelines, become involved in developing and revising them, and propose suggestions for new guidelines. You should find practice guidelines useful and not a bother at all.
为什么要纠结于实践指南呢?
实践指南在卫生保健领域获得了极大的关注。机构、实践线、专业组织、专业团体,甚至倡导团体都在制定实践指南并促进其使用。实践指南的开发是一项耗时且有时令人望而生畏的任务。除了赶时髦,我们为什么要费心制定实践指南呢?实践指南最初是作为一种跨地域标准化护理的方法而提出的。毕竟,阿拉斯加和佛罗里达的护理不应该有什么不同。指南对于常见疾病(如哮喘)或常见问题(如深静脉血栓形成)尤其有用。AHCPR系列指南就是一个很好的例子。诸如此类的指导方针通常是根据对证据基础的审查以及专家共识制定的。这些工具有助于指导整体管理,提高安全性,最大限度地减少不必要的检测和治疗,并促进成本和时间的节省。护理可以简化和标准化,我们可以避免重复发明众所周知的轮子。我们制定实践指南的最重要原因是确定护理标准。指导方针说,“应该这样做。”反过来,指导方针作为我们比较实践的基准。实践指南存在的另一个原因是为了保护重叠的利益。通过指导方针确定责任和实践范围有助于加强护理方面的合作,并促进对困难问题采取多学科方法。这在最具挑战性的神经科学问题中尤为重要。为了制定实践指南,有必要批判性地分析我们的实践。我们问的问题是我们如何做我们所做的,是否足够,是否安全,是否有科学依据。这种批判性分析提高了护理质量,这本身就值得为制定指南而付出努力。形成共识也促进了专业人员之间的沟通与合作。要使指南有用,我们必须首先了解它们存在的原因。第二,我们必须利用它们。没有付诸日常实践的指导方针是没有任何好处的。第三,我们必须批判性地分析使用中的指南,并在必要时对其进行更新。治疗方案的变化、新技术和环境的变化都可能促使我们更新实践指南,牢记我们制定指南的首要原因。其次,作为护理专业人员,我们必须分享我们制定的指导方针,作为促进卓越护理的一种方式。考虑与我们的读者分享你的实践指南。了解你所在专业组织的实践指南,参与制定和修订它们,并为新的指南提出建议。你会发现实践指南很有用,一点也不麻烦。
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