Healthcare practitioners' perceptions of clinical guidelines

Balancing cost-effectiveness with quality in tissue viability

The 21st century has seen an increase in the importance placed on the skills of healthcare practitioners. They now need to be able to demonstrate cost-effectiveness and balance it with quality in the delivery of care in the NHS. This emphasis is driven largely by the emergence of initiatives such as evidence-based practice, clinical governance and cost-effectiveness evaluations. The pressure to demonstrate cost-effective quality practices is becoming more and more prominent in the NHS. This article will discuss the practicalities and implications these pressures have on tissue viability and wound care providers.

Nursing practice should be informed by the best available evidence, but should all first-level nurses be competent at research appraisal and utilization?

The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) has for many years sought to promote the development of research knowledge and skills in registered nurses and has based its efforts on a particular model of the professional practitioner. This model has each registered nurse as a competent finder, appraiser and utilizer of research evidence. It has a vision of all registered nurses acting as autonomous practitioners, able to adapt their practice according to their own expert assessment of current research findings. Through its powers of strategic direction of nurse training and education, the UKCC has required the national boards to have approved education institutions prepare nurses for this role at both pre- and post-registration level. In this paper we argue that this model has proven ineffective. Our argument suggests that the technical complexity of research, and the skills and time required to find and integrate research evidence, renders such a model unattainable. Evidence from studies of clinical nurses indicates that little progress has in any case been made. Furthermore, the development of the apparatus of clinical governance and the basis of professional accountability further undermine the grounds for this approach. A modified approach is advocated based on the development of research specialists within nursing and the greater use of research-based clinical guidelines.

Influencing clinical practice: evidence-based wound care

Influencing clinical practice increasingly requires quality evidence to support recommendations and guidelines. Review of the evidence for wound care interventions provides practitioners with several challenges. Randomized controlled trials are scarce and have many limitations with respect to wound care, while other sources of evidence are often flawed because of the complexities of the wound-healing process or are limited by their methodology. This article attempts to explain some of the benefits and problems associated with different types of evidence, all of which need to be considered in order to influence wound management.