Bridging the gap between guidelines and practice in the management of emerging infectious diseases: a qualitative study of emergency nurses

J Clin Nurs. 2016 Oct;25(19-20):2895-905. doi: 10.1111/jocn.13343. Epub 2016 Aug 9.


Aims and objectives: To explore the difficulties and strategies regarding guideline implementation among emergency nurses.

Background: Emerging infectious diseases remain an underlying source of global health concern. Guidelines for accident and emergency departments would require adjustments for infectious disease management. However, disparities between guidelines and nurses' practice are frequently reported, which undermines the implementation of these guidelines into practice. This article explores the experience of frontline emergency nurses regarding guideline implementation and provides an in-depth account of their strategies in bridging guideline-practice gaps.

Design: A qualitative descriptive design was used.

Methods: Semi-structured, face-to-face, individual interviews were conducted between November 2013-May 2014. A purposive sample of 12 frontline emergency nurses from five accident and emergency departments in Hong Kong were recruited. The audio-recorded interviews were transcribed verbatim and analysed with a qualitative content analysis approach.

Results: Four key categories associated with guideline-practice gaps emerged, including getting work done, adapting to accelerated infection control measures, compromising care standards and resolving competing clinical judgments across collaborating departments. The results illustrate that the guideline-practice gaps could be associated with inadequate provision of corresponding organisational supports after guidelines are established.

Conclusions: The nurses' experiences have uncovered the difficulties in the implementation of guidelines in emergency care settings and the corresponding strategies used to address these problems. The nurses' experiences reflect their endeavour in adjusting accordingly and adapting themselves to their circumstances in the face of unfeasible guidelines.

Relevance to clinical practice: It is important to customise guidelines to the needs of frontline nurses. Maintaining cross-departmental consensus on guideline interpretation and operation is also indicated as an important component for effective guideline implementation.

Keywords: accident and emergency department; emergency care setting; emergency nurse; guideline-practice gap; infectious disease outbreak; outbreak management.

MeSH terms

  • Adult
  • Communicable Diseases, Emerging / nursing
  • Communicable Diseases, Emerging / prevention & control*
  • Emergency Nursing / standards
  • Emergency Service, Hospital / standards*
  • Female
  • Hong Kong
  • Humans
  • Infection Control / standards
  • Interviews as Topic
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Practice Patterns, Nurses'*
  • Young Adult