Evidence-Based Practice for Nurses

Various professional associations and other clinical entities have developed

clinical practice guidelines to be used in practice settings. The National

Guideline Clearinghouse (NGC), under the auspices of the AHRQ and the U.S.

Department of Health and Human Services (http://www.guidelines.gov), hosts

a myriad of these documents. Nurses can purchase other guidelines through

professional associations. The NGC is a public resource for evidence-based

practice guideline summaries that provide inclusion criteria, attributes of the

guideline, a glossary, the classification scheme, and summary of the content

development.

Most guidelines have a standard format and therefore provide similar infor-

mation. Most often they identify the names of the reviewers or development

team or a listing of the background of experts who served on the panel plus any

disclosures. The method of review is generally presented, such as the number

of citations, databases searched, and other means to capture relevant research

and secondary sources of interest. Panel members typically review findings and

reach consensus about best practice. Usually limitations of the review are listed,

which may include exclusions of certain topics tangential to the guidelines or

issues that were beyond the scope of the review, such as issues related to legal

matters, economics, or healthcare system issues. Recommendations by the

panel members form the basis of CPGs. Appendixes often contain the rating

scales used to evaluate the evidence, tables, and figures. Often a disclaimer is

included that notes that recommendations serve as guides and are not to be

used in lieu of “critical thinking, sound judgment, and clinical experience”

(American Geriatrics Society, 2009, p. 1333).

Clinical practice guidelines are just that: guidelines. CPGs offer an evalu-

ation of the quality of the relevant scientific literature and an assessment of

the likely benefits and harms of a particular treatment (Institute of Medicine

[IOM], 2011, p. 1). As such, they serve as useful tools to direct clinical practice.

They typically include all relevant process and outcome measures that would

be indicated for the average patient with a specific diagnosis or treatment

problem. Guidelines provide an easy-to-read consolidation of research findings.

15.3 Clinical Practice Guidelines: Moving

Ratings and Recommendations into Practice

At the end of this section, you will be able to:

‹ Explain the development and use of clinical practice guidelines

KEY TERM

clinical practice

guidelines:

Recommendations

based on evidence

that serve as useful

tools to direct

clinical practice

414 CHAPTER 15 Weighing In on the Evidence