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Clinical guideline for nurse-led early extubation after coronary artery bypass : an evaluation
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Hawkes, C. M., Foxcroft, David R. and Yerrell, Paul (2010) Clinical guideline for nurse-led early extubation after coronary artery bypass : an evaluation. Journal of Advanced Nursing, 66 (9). pp. 2038-2049. doi:10.1111/j.1365-2648.2010.05337.x ISSN 0309-2402.
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Official URL: http://dx.doi.org/10.1111/j.1365-2648.2010.05337.x
Abstract
AIM:
This paper is a report of an investigation of the development, implementation and outcomes of a clinical guideline for nurse-led early extubation of adult coronary artery bypass graft patients.
BACKGROUND:
Healthcare knowledge translation and utilization is an emerging but under-developed research area. The complex context for guideline development and use is methodologically challenging for robust and rigorous evaluation. This study contributes one such evaluation.
METHODS:
This was a mixed methods evaluation, with a dominant quantitative study with a secondary qualitative study in a single UK cardiac surgery centre. An interrupted time series study (N = 567 elective coronary artery bypass graft patients) with concurrent within person controls was used to measure the impact of the guideline on the primary outcome: time to extubation. Semi-structured interviews with 11 clinical staff, informed by applied practitioner ethnography, explored the process of guideline development and implementation. The data were collected between January 2001 and January 2003.
RESULTS:
There was no change in the interrupted time series study primary outcome as a consequence of the guideline implementation. The qualitative study identified three themes: context, process and tensions highlighting that the guideline did not require clinicians to change their practice, although it may have helped maintain practice through its educative role.
CONCLUSION:
Further investigation and development of appropriate methods to capture the dynamism in healthcare contexts and its impact on guideline implementation seems warranted. Multi-site mixed methods investigations and programmes of research exploring knowledge translation and utilization initiatives, such as guideline implementation, are needed.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Journal of Advanced Nursing | ||||||||
| Publisher: | Wiley-Blackwell Publishing Ltd. | ||||||||
| ISSN: | 0309-2402 | ||||||||
| Official Date: | September 2010 | ||||||||
| Dates: |
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| Volume: | 66 | ||||||||
| Number: | 9 | ||||||||
| Page Range: | pp. 2038-2049 | ||||||||
| DOI: | 10.1111/j.1365-2648.2010.05337.x | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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