Introduction
There is enough literature to support the positive effects of evidence-based practice on the quality of healthcare as well as related costs (McKillop, Crisp & Walsh, 2012). However, the adoption of evidence-based practice in daily clinical practice has not been fully achieved. Therefore, the study aims to bring to light the factors that hinder or promote the implementation of evidence-based clinical guidelines in the primary care settings.
Participants
The participants are based in New Zealand and were drawn from different demographic areas including the rural settings, a small city as well as small towns. The participants work in the primary health care set up. The total number of participants was thirty-two which included twenty primary health care nurses, four general practitioners, five managers as well as three planners. According to McKillop et al. (2012), the inclusion criterion was based on whether the practitioner’s work had an element that required guideline implementation. The procedure of recruiting participants began with a nomination by fellow workmates, followed by an email detailing information about the study. The participants were supposed to confirm their willingness to participate via email and all those who confirmed were taken as participants in an attempt to ensure variations in perspectives.
Methods
The participants were divided into seven focused groups with five being for the nurses, one for the general practitioners, and one for the managers. Focused groups and interviews were conducted mainly in participant’s areas of work and were used to collect data from the participants for six months. The collection of data from the planners was carried out through audio-recorded interviews. The participants had the luxury of directing the time and venues for data collection (McKillop et al., 2012). All the focused group discussions were carried out by an individual researcher, and they lasted for about sixty-five minutes for the nurses, thirty minutes for the general practitioners and thirty minutes for the funders. The process used open-ended questions covering the methods used to obtain guidelines, the usefulness of the guidelines as well as processes that determine the implementation of clinical guidelines.
Main Findings
From the study, it is evident that the contextual differences impact the implementation of evidence-based guidelines in clinical settings. Organizational culture also interfered with the adoption of new practice guidelines as it affects the availability of resources required during the process. Leadership in the clinical setting has an input into how practitioners adopt newly provided guidelines of practice (McKillop et al., 2012). Lack of feedback on the progress of guideline implementation impacts on how effectively the evaluation of the process is conducted and ultimately the adoption of guidelines into practice. Most healthcare workers were shown to rely on their clinical experience as opposed to new guidelines. Client experience also interferes with the process of adopting evidence-based practices as some clients insist on retaining old procedures (McKillop et al., 2012).
Conclusion
The situation in the New Zealand study mirrors clinical practice in the USA. The rate of adopting evidence-based care is below the expected levels. The hindrance emanates from different issues related to clinical practice. According to Majid et al., (2011), some regulations that tend to stifle innovations in healthcare lead to laxity to adopt new clinical guidelines. On the other hand, most American clinicians are reluctant to adopt evidence-based care when it is supported by non-US data. The presence of clinicians who have served for several years has also stifled the process of adopting new guidelines (Munroe, Duffy & Fisher, 2008).
References
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229–236.
McKillop, A., Crisp, J., & Walsh, K. (2012). Barriers and Enablers to Implementation of a New Zealand-Wide Guideline for Assessment and Management of Cardiovascular Risk in Primary Health Care: A Template Analysis. Worldviews on Evidence-Based Nursing, 9(3), 159-171.
Munroe, D., Duffy, P., & Fisher, C. (2008). Nursing knowledge, skills, and attitudes related to evidence-based practice: before and after organizational supports. Medical Surgical Nursing, 17(1):55–6.