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Clinical Guideline Development

In the past, nurses have used procedure books or manuals to guide aspects of care, and have been criticized for basing practice strictly on routine and ritual. Today, nurses are expected to base their practice on sound evidence and research.

Guidelines provide a framework for the implementation of evidence-based care, and this learning exercise helps you learn more about guidelines and how they can benefit patients. You will discover how guidelines are developed and how evidence and recommendations are graded.

Select one of the links to the right to get you started.

It’s probably best to work through the different learning exercises as an introduction to understanding guidelines. Select the first title on the list to begin.

You may feel you can skip this section, but why not test yourself with a simple quiz to ensure that you have a basic grasp of what guidelines are?

What is a Guideline?

We hear about guidelines in many walks of life. The activities of government, education and public transport are associated with guidelines developed in an attempt to improve the quality of service. In health care, guidelines have been developed in an attempt to improve the quality of service given to patients.

Confusion over terminology sometimes arises because various terms are associated with the delivery of quality care to patients. Terms such as guidelines, best practice guidelines, guidance, standards and protocols are all associated with quality care, but each has a specific meaning. Do you know the difference between guidelines, guidance, standards and protocols?

If you are to make effective use of guidelines, you need to be clear about the meaning of different terminology.

Try the Quick quiz to check your understanding.

Definitions

Guideline: The Canadian Nurses Association (CNA) defines clinical practice guidelines, specifically, as “systematically developed statements to assist practitioner and client decisions about appropriate care. They relate to specific clinical circumstances. They are set to influence practitioners. The goal of…guidelines should be to improve the quality of care.” (Achieving Excellence in Professional Practice: A Guide to Developing and Revising Standards, CNA 2002)

Guiding principle: This is a “fundamental truth or method of operation (principle) that leads, directs or shows the way (guides). (CNA, 2002)

Standard: A standard is “a desired and achievable level of performance against which actual performance can be compared.” (CNA, 2002)

Protocol: A protocol is a written plan “specifying the procedures to be followed in giving a particular examination, in conducting research, or in providing care for a particular condition.” (Mosby’s Medical, Nursing, and Allied Health Dictionary, 4th ed., 1994)

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Why Guidelines?

Making decisions about care is a complex process. The potential benefits and hazards of possible interventions need to be weighed against limited resources and the needs of the population and particular individuals.

Increased treatment options mean that nurses choose from an ever-broadening selection of interventions. In recent years, it has been recognized that increased choices in health care have increased the variation but not necessarily the quality and effectiveness of patient care.

A number of factors provide the impetus for guideline development. The three most frequently cited are:

  • unacceptable variations in practice patterns;
  • concern with appropriateness of care; and
  • increasing costs.

When carefully developed and implemented, guidelines can reduce variation in practice patterns, ensure appropriate care is provided and improve the cost-effectiveness of care.

Example: A pressure ulcer guideline should guide the caregiver — based on the most up to date clinical evidence — on the best way to assess the patient's risk of developing a pressure ulcer. The guideline would put in place preventive measures and, if necessary, explain how to treat an existing pressure ulcer so that the patient receives the best quality care.

Record what you have learned.