Implementing evidence-based practices in an emergency department: contradictions exposed when prioritising a flow culture

Journal of Clinical Nursing
Jeanette W Kirk, Per Nilsen

Abstract

An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. How does the flow culture in an emergency department influence nurses' use of a research-based clinical guideline and a nutrition screening routine. Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means of semi-structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. The main contradiction identified was that guidelines and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence-based practices; newcomers having different priorities; and conflicting views of what constituted being a professional. We found that research-supported guidelines and screening routines were not used ...Continue Reading

References

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Citations

Aug 27, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Hemal K KanzariaChristopher R Carpenter
Jun 3, 2017·Epilepsy & Behavior : E&B·Jennifer WilliamsColin P Doherty
Dec 12, 2017·Scandinavian Journal of Caring Sciences·Jekaterina DemidenkoTarja Suominen
Nov 14, 2018·American Journal of Public Health·Eric G Carbone, Erin V Thomas
Jul 10, 2019·Journal of Clinical Nursing·Dimelza OsorioÁngeles Barba-Flores
Sep 5, 2019·Journal of Health Organization and Management·Jeanette KirkJanne Petersen
Oct 4, 2021·Addiction Science & Clinical Practice·Ditte Maria SivertsenJeanette Wassar Kirk

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