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Nurse academics' understanding and experience of guidelines in clinical practice

20 March 2025

Abstract

Background:

The literature suggests there are numerous factors relating to adherence to guidelines in clinical practice. It is proposed that a potential barrier to adherence is that nurses may not view guidelines as mandatory and instead see them as more of a tool for guidance.

Aims:

To analyse nurse educators' understanding and experience of the term ‘guidelines’ in relation to clinical practice and clinical decision-making.

Methods:

One focus group interview was undertaken; the data collected were analysed using interpretive phenomenological analysis.

Findings:

Data analysis resulted in the identification of three personal experiential themes: lack of consensus regarding a definition of ‘guideline’, barriers to guideline adherence, and the impact of clinical guidelines on professional judgement.

Conclusion:

Nurse academics discussed a lack of understanding of what guidelines are and how this may influence their decision to follow guidelines when making clinical decisions. When guidelines are viewed as ‘recommendations’ rather than ‘rules’ then nurses may be inclined to use their own intuition and experience instead when decision-making. As this may lead to inconsistent use of guidelines in clinical practice, further research is recommended to investigate potential implications.

A literature review exploring reasons why nurses prescribed palliative oxygen therapy in non-hypoxaemic patients suggested there are numerous factors relating to adherence to guidelines in clinical practice (Collis, 2018). A wider literature review of nurses' adherence to clinical guidelines suggested a lack of adherence is common in many specialties, not only in oxygen prescription. Only one study was located that focused on UK nurses' adherence to clinical guidelines (Puffer and Rashidian, 2004).

Relevant studies show similar reasons for non-adherence, including the following common themes:

Reviewing the literature on barriers to adherence to guidelines suggests that the term ‘guidelines’ is commonly understood – the term is not questioned or challenged in any of the studies located. It should be noted that most dictionaries offer two separate definitions, including the Oxford Learner's Dictionaries (2025):

It is proposed that a potential barrier to adherence is that nurses may not view guidelines as mandatory and instead see them more as a tool for guidance.

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