How evidence-based clinical practice guidelines for Venous Leg Ulcers impact on patient safety.
Kerr, Justin
Kerr, Justin
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Publication Date
2022-10-10
Type
Thesis
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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., xxi 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.
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Publisher
NUI Galway