Barriers to and Facilitators of Nurses ‘Adherence to Clinical Practice Guidelines: A Qualitative Study

Abstract

BackgroundGuidelines for clinical practice are needed in order for nurses to provide consistent, standardized care and avoid preventable harm.AimsThe present study aims to explore the barriers to and facilitators of nurses' adherence to clinical practice guidelines.MethodsDetailed semistructured interviews were conducted with 14 nurses from two educational hospitals in Kurdistan University of Medical Sciences, Sanandaj, Iran, about their involvement with clinical practice guidelines. The text of the interviews was analyzed by qualitative content analysis.FindingsIdentified barriers to full adherence to clinical practice guidelines were work pressure, lack of facilities, paperwork, lack of motivational environment, and nonapplicability of guidelines. Facilitators identified were encouragement, improving working conditions, conscientiousness, training, and supervision.ConclusionInterventions to remove barriers to and provide facilitators of adherence to clinical practice guidelines should be designed and implemented. Removing organizational barriers is the responsibility of nursing managers.

Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review

“…A poorly equipped physical work environment, with erratic drug supply, inadequate resources and infrastructure and insufficient financial resources, was most frequently cited as negatively impacting on compliance with clinical guidelines in LMICs 3 12–42. For instance, in Malaysia, the restricted availability of combination hypertensive drugs and lack of infrastructure for medication storage were deterrents to implementation of hypertension management clinical guidelines 21.…”

“…Of the factors relating to working condition, time constraints and heavy workloads, partly due to staff shortages and skills mix, are the most frequently cited constraints to the use of clinical guidelines by healthcare providers 12 14–16 20 22 25 26 28–33 35 36 38–40 42–48. Various studies suggest task-shifting among stakeholders, including healthcare professionals and community health workers, can contribute to mitigating issues associated with increasing workload in settings with limited availability of certain types of human resources for health 19 31 38 44.…”

“…However, Puchalski Ritchie et al 28 highlight that role confusion may arise from task shifting and is associated with poor communication and a lack of intercadre collaboration. Provision of relevant training opportunities3 12 14 16–19 22 25 26 28 30 33 34 36 38 40–44 47 49 50 and clinical audits or supervision followed by feedback3 13 22 29 32–34 36 48 49 51 were positively cited as influencing compliance with and use of clinical guidelines. Furthermore, communication of audit findings promotes the effective use of clinical guidelines 29 33…”

“…Key attributes influencing the use of clinical guidelines by healthcare providers include clarity in the guideline contents,20 23 25–27 37 40 43 47 48 53 54 credibility (inclusion of current evidence)3 17 26 29 34 40 43 44 47 51 and applicability or adaptability to the local context 3 15 18–20 24 25 32 36 40 42 44 48 53. Involvement of healthcare providers in the guideline development process also facilitated guideline use 24 25 27 44 47 48.…”

Clinical placements as a challenging opportunity in midwifery education: A qualitative study

“…In this context, various studies have demonstrated that multiple problems in clinical settings have prevented the achievement of educational goals (Valiee et al., 2013). Therefore, it seems that midwifery education needs fundamental changes in clinical education (Haghani & Hojat, 2013).…”