The Value of Clinical Practice Guidelines
In healthcare, evidence-based practice (EBP) plays a key role in enhancing patient outcomes, educating and training nurses, improving shared decision-making, and promoting interprofessional communication. Clinical Practice Guidelines (CPGs) are critical to EBP because they rely on scientific literature and observations and contain practical recommendations to inform the nursing practice (Institute of Medicine, 2011; Melnyk, 2015). CPGs do not offer just one solution, but rather describe some options, compare their costs and benefits, provide scientific justifications, and recommend or suggest their use. These guidelines rely on the standardization of practice, a fundamental element of the science of client safety (AHRQ Patient Safety, 2017). Without CPGs, providers would have limited guidance, requiring them to gather additional evidence for decision-making.
Clinical Practice Guideline’s Summary
Patient-on-patient and patient-on-nurse aggression rates in psychiatric units are a cause for raised concerns. Workplace violence has to be reduced to ensure the safety of clients and workers, and a CPG developed by the American Psychiatric Association (2016) contributes to solving the problem. The statements included in the document describe the process of the initial psychiatric evaluation of adults in psychiatric settings.
Various research methods were used for the separate recommendations. However, Guideline IV, which is of particular interest, is Level I evidence, as it is based on a systematic review of all randomized controlled trials that matched the clinical question (APA, 2016; Penn State University Libraries, 2023; Winona State University, 2023). During the initial assessment, the APA (2016) recommends analyzing aggression signs and history, substance abuse, and other elements that are found to contribute to patient violence. There are three statements in Guideline IV, all with low confidence levels, and the first two have more benefits than costs.
Relating the CPG to the DNP Topic
I selected this CPG because it relates directly to the topic of my DNP. In my project, I explore the concepts of training nurses and increasing their skills in using violence risk assessment tools to decrease the incidence of patient aggression. Considering the APA’s recommendations, such assessments have potential and can be effective in addressing the problem.
Nevertheless, it is concerning that the level of confidence in the proposed actions is low. According to the APA (2016), no robust evidence proves the association between assessment of aggressive signs and further prevention and reduction of violence cases. At the same time, the guideline is slightly outdated and suggests that further research may reveal this connection; therefore, it remains crucial to assess patients’ behavior and enhance nurses’ knowledge and skills.
Discussing the Peer-Review Process
A robust peer-review process, guided by a team of experts, informed the development of the CPG. According to the APA (2016), “the panel was composed of approximately 70% clinical experts, 20% research experts, and 10% experts in both categories” (p. 146). No specific process, such as the AGREE tool, was used to obtain the opinions of the team members. The APA (2016) developed several survey questions to assess which steps and instruments were most effective in identifying violent behaviors.
References
AHRQ Patient Safety. (2017). CUSP: Understand the science of safety [Video]. YouTube.
American Psychiatric Association. (2016). The American Psychiatric Association practice guidelines for the psychiatric evaluation of adults [PDF document].
Institute of Medicine. (2011). Clinical practice guidelines we can trust [PDF document].
Melnyk, B. M. (2015). Important information about clinical practice guidelines: Key tools for improving quality of care and patient outcomes. Worldviews on Evidence-Based Nursing, 12(1), 1–2.
PennState University Libraries. (2023). Levels of evidence.
Winona State University. (2023). Levels of evidence / evidence hierarchy.