This article focuses on the process of development of protocols for family planning nurse practitioners. A rationale for the use of protocols, a definition of the types and examples, and the pros and cons of practice with protocols are presented. A how-to description for the development process follows, including methods and a suggested tool for critique and evaluation. The aim of the article is to assist nurse practitioners in developing protocols for their practice.
PIP: The process of developing and defining protocols for family planning nurse practitioners and providing a rationale for their use is examined. A protocol which is a standardized format for any or all steps of the nursing process it can range in composition from a formal list of steps to follow to an extensive narrative. The most common types of protocols are narrative, algorithm, and branching (logic tree). Narrative protocols are usually descriptive and fairly open ended. They often imply or direct the use of the SOAP (subjective, objective, assessment, and plan) format for record keeping. Algorithms impose a format upon which notes are written for a client and, thus, may be somewhat limiting in practice by stifling creativity and problem solving. The logic tree presumes to draw on presenting symptoms and other data to lead to 1 or more options for nursing and/or medical action. Protocols need to be differnetiated from standing orders and general guidelines for practice. Protocols include guidelines for data collection, analysis, and a plan. Standing orders often begin with a diagnosis and then tell the practitioner what to do as treatment. Opponents argue that protocols prolong the dependency syndrome of nurse practitioners and delay assumption of accountability by nurses, particularly when protocols are prepared by physicians with little or no input from the nurses who must use them in practice. Yet, protocols afford research data for validation of nursing management strategies. By providing a framework for standardization of data collection, a record audit can be done to support or reject client outcomes as beneficial. A dearth of protocols specific to the practice of family planning nurse practitioners exists. The following steps are necessary for creating a protocol: 1) identifying the common presenting problems seen in practice, 2) deciding the intent and type of protocol to be developed, 3) preparing a draft based on the literature and practice experiences and circulating it to practitioner colleagues in the setting and other nurse practitioners. The nurse practitioner will find it best to work with the protocol for a period of time and then review and rewrite it.