Tradition, rituals and standards, in a realm of evidenced based nursing care
State Nursing Officer (SA) St John Ambulance; PhD Candidate, Department of Clinical Nursing, University of Adelaide, Adelaide SA
Deputy Head, Department of Clinical Nursing, University of Adelaide, Adelaide SA
PP: 300 - 308
Evidenced-based nursing is seen as the future of nursing but the real world in which practice occurs is limiting the possibilities for change. The practice of post-operative (PO) vital sign collection in the general ward setting is described as an example of the complexities that surround practice.
Despite the ongoing work around evidenced-based practice, elements of nursing practice remain based on tradition. Routines and rituals are driving care rather than clinical judgement. The complexities of practice limit the possibilities for change. These complexities include the systems in which nurses' practice, the fear of medico-legal repercussions, and the sense of security that rituals provide.
This paper discusses these themes including the barriers to change and the implications for practice. The development of evidenced-based practice is only one component of the solution to the provision of best practice. Care is required to ensure that the evidenced-based movement does not lead to recipe book care rather than patient centred practice.
post-operative vital signs; ritualised practice; clinical judgement; evidenced-based practice; standards
Allen, G., Byrne, M., King, C., Steelman, V., Weemering, M. L., & Beyea, S. (2002). Evidence-based Practice FAQs. The Association of Perioperative Registered Nurses. Available: http://www.aorn.org/research/ebpfaqs.htm 27/08/02].
Bayne, G. (1997).Vital Signs: are we monitoring the right parameters? Nursing Management, 28(5 May), 74-76.
Beyea, S. (2000).Why should perioperative RNs care about evidenced-based practice? AORN Journal, 72(i1), 109.
Binnie, A., & Tichen, A. (1998). Freedom to Practise - A study of the development of patient-centred nursing in an acute medical unit (Report No 18). Oxford: Royal College of Nursing.
Botti, M., & Hunt, J. (1994).The routine of post anaesthetic observations. Contemporary Nurse, 3(2 June), 52-57.
Botti, M., Williamson, B., & Steen, K. (2001). Coronary angiography observations: Evidence-based or ritualistic practice? Heart & Lung: The Journal of Acute and Critical Care, 30(2), 138-145.
Burroughs, J., & Hoffbrand, B. I. (1990). A critical look at nursing observations. Postgraduate Medical Journal, 66(775), 370-372.
Camp-Sorrell, D., & Wujcik, D. (1994). Intravenous immunoglobulin administration: an evaluation of vital monitoring. Oncology Nursing Forum, 21(3 Apr), 531-535.
Centre for Applied Nursing Research. (1998). Clinical Observations for Surgical Patients - What frequency of Post-operative observations are necessary to ensure safe recovery of adult surgical patients. Liverpool NSW: Centre for Applied Nursing Research.
Coggins, R. P. (2000). Delivery of Surgical Care in a district general hospital without high dependency unit facilities. Postgraduate Medicine, 76(April), 223-226.
Davis, M. J., & Nomura, L.A. (1990).Vital signs of Class I surgical patients. Western Journal of Nursing Research, 12(1 Feb), 28-37, 40-21.
Dempsey, D., Conroy-Hiller, T., O'Neill, S., & McCutcheon, H. (2002). Descriptive study of nurses' compliance with post-procedural vital sign measurement in a gastrointestinal investigation unit. Gastroenterology Nursing, 25(5), 181-187.
Estabrooks, C.A. (1999).Will evidence-based nursing practice make practice perfect? Canadian Journal of Nursing Research, 30(4), 273-294.
Evans, D., Hodgkinson, B., & Berry, J. (1999). Vital Signs Best Practice. The Joanna Briggs Institute for Evidence Based Nursing and Midwifery. Available: http://joannabriggs.edu.au/bp8.html20 March 2000].
Harley, J., & Tsmassiro, J. (1997). A pilot study analysing the occurrence and frequency of reoccurring vital signs outside normal parameters and other abnormal systems exhibited in the postoperative phase of short term surgical patients. Unpublished.
Hann, G. J., & Ross, A.W. (1987). Post-anaesthetic Patterns of Care in Minor Gynaecological Surgery. Anaesthesia and Intensive Care, 15(3 August), 305-309.
Hanney, B. (1992). Post-operative observations. Journal of Clinical Nursing, 1(4), 174.
Higgs, J., Burn, A., & Jones, M. (2001). Integrating Clinical Reasoning and Evidence-based Practice. AACN Clinical Issues, 12(4), 482-490.
Hirsch, A. M. (1990).Vital signs of Class I surgical patients - Commentary. Western Journal of Nursing Research, 12(1 Feb), 37-39.
Kitson, A. (1999).The essence of nursing: part II. Nursing Standard, 13(24), 34-36.
Leinonen, T., & Leino-Kilpi, H. (1999). Research in peri-operative nursing care. Journal of Clinical Nursing, 8(2), 123-138.
Linton, S. J. (1998). In defense of reason: Meta-analysis and beyond in evidence-based practice. Pain Forum, 7, 46-54.
Long, L., Dahl, D., Hogan Miller, E., & Cassibo, L. (1998).'Evidence-Based Approach to Patient Care: An Analysis of Post-PACU Vital Sign Frequency and Complications'. Paper presented at The University of Iowa College of Nursing Gerontological Nursing Interventions Research Center. Abstract. 23 April.
Manias, E., Botti, M., & Bucknall, T. (2002). Observation of pain assessment and management - the complexities of clinical practice. Journal of Clinical Nursing, 11, 724-733.
McMurray, A. (1989).Time to extend the 'process'? The Australian Journal of Advanced Nursing, 6(4), 40-43.
Mussallem, H. (1979).The Nursing Profession: ritualized, routinized or research-based? Journal of Advanced Nursing, 4(2), 87-98.
Overfield, T. (1990).Vital signs of Class I surgical patients - Commentary. Western Journal of Nursing Research, 12(1 Feb), 39-40.
Philpin, S. (2002). Rituals and Nursing: a critical commentary. Journal of Advanced Nursing, 38(2), 144-151.
Rycroft-Malone, J., Harvey, G., Kitson, A., McCormack, B., Seers, K., & Tichen, A. (2002). Getting evidence into practice: ingredients for change. Nursing Standard, 16(37), 38-43.
Schumacher, S. (1995). Monitoring vital signs to identify postoperative complications. MEDSURG Nursing, 4(2 April), 142-145.
Sentinel Event Alert - Operative and Post-Operative Complications: Lessons for the Future (2000, 4 February). Joint Commission on Accreditation of Healthcare Organizations. Available: http://www.jcaho.org [Issue12, 27/08/02].
Simon, S. B., & Clark, R. (2002). (Mis) Using pulse oximetery: a review of pulse oximetery use in acute care medical wards. Clinical Effectiveness in Nursing, 6:3-4, 106-110.
Toms, E. (1993).Vital Observations. Nursing Times, 89(51), 32-34.
Vital Signs (2000). 'Nurseminerva'. Available: http://www.nurseminerva.co.uk/vital.htm [27//08/02].
Walsh, M., & Ford, P. (1991). Nursing rituals, research and rational actions. London: Butterworth Heinemann.
Zeitz, K., & McCutcheon, H. (2002). Policies that drive the nursing practice of post operative observations. International Journal Nursing Studies, 39, 831-839.
Zeitz, K., & McCutcheon, H. (2003). Evidenced-based practice: To be or not to be, this is the question! In Press. International Journal of Nursing Practice, 9(5), 272-279.
Zeitz, K. (2004a) Nursing observation during the first 24 hours after a surgical procedure: What do we do? Journal of Clinical Nursing. Accepted for publication August 2003.
Zeitz, K. McCutcheon, H. and Albrecht, A. (2004b) Postoperative complications in the first 24-hours:A general surgery audit. Journal of Advanced Nursing, 46 (6), 633-640.