How evidence-based clinical practice guidelines for Venous Leg Ulcers impact on patient safety.
Date
2022-10-10Author
Kerr, Justin
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Abstract
Patient safety is central to nursing practice. It is the connecting term in the
Code of Professional Conduct and Ethics for Registered Nurses and
Registered Midwives in Ireland (NMBI, 2021). However, it would appear that
patient safety remains rooted in the avoidance of harm by minimising errors
from actions. The author explores the concept of patient safety from the
perspective of omission of care, particularly with regards to the application
of national evidence-based clinical practice guidelines in patients with
Venous Leg Ulcers (VLUs). This approach has not been considered before in
a community setting with this patient cohort. It, therefore, contributes to the
body of knowledge on patient safety. This thesis aims to ascertain if evidence based clinical practice guidelines impact on patient safety in patients with
VLUs. This work is structured around the Framework for patient safety
research and Improvement (Pronovost et al., 2009).
Aim
The overall aim of this research thesis is to determine how evidence-based
clinical practice guidelines for Venous Leg Ulcers impact on patient safety.
Objectives
[1] To systematically review the literature to identify the most effective
strategies to implement VLU guidelines.
[2] To explore the safety attitudes of Public Health Nurses (PHNs) and
Community Registered General Nurses (CRGNs) in the Republic of
Ireland.
[3] To understand the alignment of current practice in the management of
VLUs against a national guideline amongst PHNs & CRGNs in
Ireland.
[4] Identify if PHNs and CRGNs consider clinical practice guidelines
influence patient safety.
Methods
The Framework for Patient Safety Research and Improvement was the
framework used to underpin this research. The framework was developed by
Pronovost et al. (2009) to respond to an increasing need for improvements
and progress in patient safety. The framework includes five domains:
i) Evaluating progress in patient safety
ii) Translating evidence into practice
iii) Measuring and improving culture
iv) Identifying and mitigating hazards
v) Evaluating the association between organisational characteristics and
outcomes.
A variety of research methods were used to deliver on the framework. A
comprehensive literature review (Chapter 2) was undertaken to examine the
progress in patient safety. The author then undertook a systematic review
(Chapter 4) to explore the effective implementation strategies for the
implementation of venous leg ulcer guidelines to understand the best methods
to translate evidence into practice. A safety attitudes questionnaire (Chapter
5) was used examine the attitudes of PHNs and CRGNs towards safety culture
and climate and it was important to ascertain if published evidence based
clinical practice guidelines are used in practice. This was followed by a panel
group discussion (Chapter 6) to explore the findings from the survey, which
was informed by the literature review. The data from the survey was analysed
using a number of statistical techniques and the qualitative data from the
survey and the panel discussion was analysed using directed content analysis.
Key findings
The key findings in this study reflect the view that patient safety is central to
nursing practice. It also confirmed that within the Republic of Ireland CPGs
do inform how PHNS and CRGNs deliver nursing care. Themes such as
dissemination and implementation must be considered if we are to maintain
and improve standards of care through evidenced based practice. While the
findings do acknowledge that patient safety appears to central to nursing work
the results do reflect a passivity in practice in accepting the status quo – i.e.,
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as to how things are done: particularly in relation to the structure and process
of care, potentially resulting in delayed care.
Conclusion
It is the case that nurses do not practice with the intention to harm their
patients and that patient safety remains at the core of the work that nurses do;
the finding from the questionnaire and the panel discussion reflected this
while recognising the challenging environments in which they practice.
Patient safety is an important concept that has been underexplored in the
community/PHN practice setting. If we are to expand the perimeter of patient
safety as we currently understand it is important to understand the context in
which care is delivered and the professional constructs in how care is
delivered.