Clinical guideline for nurse-led early extubation after coronary artery bypass: An evaluation

Claire Hawkes, David R. Foxcroft, Paul Yerrell

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Aim.: This paper is a report of an investigation of the development, implementation and outcomes of a clinical guideline for nurse-led early extubation of adult coronary artery bypass graft patients. Background.: Healthcare knowledge translation and utilization is an emerging but under-developed research area. The complex context for guideline development and use is methodologically challenging for robust and rigorous evaluation. This study contributes one such evaluation. Methods.: This was a mixed methods evaluation, with a dominant quantitative study with a secondary qualitative study in a single UK cardiac surgery centre. An interrupted time series study (N = 567 elective coronary artery bypass graft patients) with concurrent within person controls was used to measure the impact of the guideline on the primary outcome: time to extubation. Semi-structured interviews with 11 clinical staff, informed by applied practitioner ethnography, explored the process of guideline development and implementation. The data were collected between January 2001 and January 2003. Results.: There was no change in the interrupted time series study primary outcome as a consequence of the guideline implementation. The qualitative study identified three themes: context, process and tensions highlighting that the guideline did not require clinicians to change their practice, although it may have helped maintain practice through its educative role. Conclusion.: Further investigation and development of appropriate methods to capture the dynamism in healthcare contexts and its impact on guideline implementation seems warranted. Multi-site mixed methods investigations and programmes of research exploring knowledge translation and utilization initiatives, such as guideline implementation, are needed.

LanguageEnglish
Pages2038-2049
Number of pages12
JournalJournal of Advanced Nursing
Volume66
Issue number9
DOIs
Publication statusPublished - 1 Sep 2010

Keywords

  • Clinical guideline
  • Coronary artery bypass
  • Evaluation
  • Extubation
  • Nurse-led
  • Nursing

ASJC Scopus subject areas

  • Nursing(all)

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