Encouraging interprofessional collaboration: The effects of clinical protocols.

AIMS AND OBJECTIVES: To consider the characteristics of protocol documents themselves as a factor influencing the nature of care delivery and their potential to facilitate greater interprofessional collaboration. BACKGROUND: Healthcare guidelines and clinical protocols provide important guidance and direction to health professionals in their delivery of care. By detailing requirements and actions to be taken in specified circumstances or contexts, these documents may facilitate a broadening of the pool of people able to deliver care. DESIGN: Critical reading of four clinical protocols representing the range of protocol types in use was carried out to consider the extent to which the documentation of guidelines and protocols and the documents themselves might be considered as vehicles for increased collaboration in health care. METHODS: A "close reading" rubric was developed directing the researcher to look for evidence in each protocol of the following: authorship, person or group responsible for the protocol's development; stated document purpose; target readers, either stated or implied; the particular subjects, the document names and the objects created by them such as care pathways; the use of specific terminology and imagery, the documents' form and structure; and evidence of intertextuality referring to other documents, for example legislation or policy statements. Tabulation of the coding analysis is presented. RESULTS: Nurses were the only professional group named in the documents as assignees or subjects. "Patients" and "care" are the objects created, and the scientific-biomedical discourse with its associated procedural language was dominant. CONCLUSIONS: Many protocols have been developed to standardise practice and increase the effectiveness of teamwork. They may, however, constrain collaboration in healthcare settings because they diminish a nursing "voice" and create the expectation that nurses alone work across the spectrum of protocols. RELEVANCE TO CLINICAL PRACTICE: An unintended consequence of the global use of clinical protocols and guidelines to support safe and efficient healthcare delivery may be to reduce interprofessional collaboration.

Mothering a hospitalized child: it's the 'little things' that matter.

This article reports one aspect of a phenomenological study that described the lived experience of mothering a child hospitalized with acute illness or injury. The significance for mothers that nurses do the 'little things' emerged in considering the implications of this study's findings for nurses in practice. Seven mothers whose child had been hospitalized in the 12 months prior to the first interview agreed to share their stories. The resulting data were analysed and interpreted using van Manen's interpretation of phenomenology. This description of mothering in a context of crisis is useful in the potential contribution it makes to nurses' understanding of mothers' experience of the hospitalization of their children. It supports the philosophy of family-centred care and highlights the ability of individual nurses to make a positive difference to a very stressful experience by acknowledging and doing 'little things', because it is the little things that matter to the mothers of children in hospital.

Making research real: embedding a longitudinal study in a taught research course for undergraduate nursing students.

Learning how and why scholarly research underpins and informs professional nursing practice is a continual challenge for undergraduate nursing students. They find the language and methods of research to be unfamiliar and unsettling. The work of educators thus becomes the process of breaking down barriers to students' understanding of research processes and application. Such work is increasingly important in the current era of evidence based practice, where students must be competent in sourcing, critiquing and applying research to meet real clinical questions. In response, as lecturers who taught the course, Research for Health Professionals, we have reinvented how research is taught to second year undergraduate students. This article outlines our creative approach to facilitate students learning research theory and methodology by conducting a "real-life" research study in a local retirement community.