Are NICE Guidelines Enabling Our Caring Professionals to Meet NMC Standards of Evidence-Based Practice?
By Stephen Williams, Sian Jackson and Sarah O’Donnell (2013)
This is a proposed @WeNurses chat co-written by Steve Williams aka @MHNurseLecturer, Sian Jackson aka @firecracker1305 and Sarah O’Donnell aka @sarah_searz. This proposed twitter chat came about as a result of a pre-registration nursing @BradfordUni debate on evidence-based practice in healthcare. This represents a strand of ‘SoMe’ (Social Media) integration and dissemination of student-nursing practice as explored in Williams (2013).
The NMC (Nursing and Midwifery Council) (2008) code states we must: “deliver care based on the best available evidence” (p.6) and keep our “knowledge and skills up to date” (p.6). NICE (National Institute of Health and Care Excellence) guidelines have assisted practice since 2001. With a variety of treatment options/pathways it seeks to enable professionals to provide evidence-based advice and care. However is the evidence assessed by NICE sufficiently contextually relevant for our patients’ clinical needs?
Research evidence can become rapidly out dated and some academics and practitioners might argue it’s not always sufficiently well developed for practice. Nurses establish their practice in a variety of ways and their ability to critically evaluate research varies (Funk et al., 1991; Kirkevold, 2008). NICE guidelines take two years to be developed prior to publication. This suggests that upon publication they are already out of date and indeed may not be updated for a further three to four years.
An example of such issues with NICE guidance can be seen in the development of guidelines for self-harm (Pitman and Tyrer, 2008). Pitman and Tyrer (2008) point out that this was developed on research evidence with only one recommendation based on a RCT (randomised controlled trial) quality of evidence. Most of the research at the time was on the physical impact of self-harm and the guidelines received criticism for amalgamating self-poisoning and self-laceration as a single kind of problem (Barker and Buchanan-Barker, 2004). Is it pertinent to argue then that a culture of ‘following NICE guidelines’ perhaps disables nurses obligation to critically review nursing research and related evidence themselves?
NICE guidelines set out to reduce inequalities in treatment provision. Whilst this is a laudable ideal the reality of treatment provision is considerably murkier. Take the provision of IVF (in vitro fertilization): NICE guidelines in 2004 recommended three full cycles of treatment for those who met agreed clinical criteria. By mid-2005 PCTs (primary care trusts) were being asked to make at least one cycle available by the secretary of state. There was no mandate or mechanism for ensuring the recommendations were implemented (House of Commons Health Committee, 2008). A further critical point is that PCT’s in England were able to set the eligibility criteria for access to NHS funding above and beyond clinical criteria set out in the guideline (House of Commons Health Committee, 2008). This being the case – are they really addressing health inequalities and are we confident the advice they prompt us to give is sufficiently empirically robust?
A twitter chat in conjunction with @WeNurses is scheduled for Tuesday 15th April 2014 at 8pm online.
Barker, P. Buchanan-Barker, P., (2004), NICE and self-harm: Blinkered and exclusive,Mental Health Nursing, 24,6,pp. 4–6.
Funk, S.G., Thornquist, E.M., Wiese, R.A. and Champagne, M. T. (1991), Barriers to using research findings in practice: The clinicians perspective. Applied Nursing Research. 4, pp 90-95.
House of Commons Health Committee (2008), Health Inequalities: Written Evidence, Session 2007-08, Volume II, Her Majesty’s Stationery Office.
Kirkevold M. (1997), Integrative Nursing Research – An Important Strategy to Further The Development of Nursing Science and Nursing Practice, Journal of Advanced Nursing, 25, pp 977-984.
Nursing and Midwifery Council (2008), The Code: Standards of conduct, performance and ethics for nurses and midwives, NMC.
Pitman, A. and Tyrer, P. (2008), Implementing clinical guidelines for self-harm – highlighting key issues arising from the NICE guidelines for self-harm, Psychology and Psychotherapy: Theory, Research and Practice, 81, 4, pp. 377-397.
Williams, S. (2013), Embracing Digital Education for Nursing (An @WeNurses Web-blog Article), The Inside Skinny Latte Blog, September 9th 2013, Available from: http://mhnurselecturer.co.uk/?p=8, [accessed 19th November 2013].