Change search
ReferencesLink to record
Permanent link

Direct link
Implementing evidence-based practices in an emergency department: contradictions exposed when prioritising a flow culture
Hvidovre University Hospital, Denmark; Hvidovre University Hospital, Denmark; Aarhus University, Denmark.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 3-4, 555-565 p.Article in journal (Refereed) PublishedText
Abstract [en]

Background. An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. Objectives. How does the flow culture in an emergency department influence nurses use of a research-based clinical guideline and a nutrition screening routine. Methods. Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means of semi-structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. Results. The main contradiction identified was that guidelines and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence-based practices; newcomers having different priorities; and conflicting views of what constituted being a professional. Conclusion. We found that research-supported guidelines and screening routines were not used if they were perceived to stop the patient flow, suggesting that the practice was not fully evidence based.

Place, publisher, year, edition, pages
WILEY-BLACKWELL , 2016. Vol. 25, no 3-4, 555-565 p.
Keyword [en]
acute care; advanced practice; clinical guidelines; emergency care; emergency department; evidence-based practice
National Category
Basic Medicine
URN: urn:nbn:se:liu:diva-126264DOI: 10.1111/jocn.13092ISI: 000370637600028PubMedID: 26818380OAI: diva2:913418

Funding Agencies|Capital Region of Denmark

Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2016-04-06

Open Access in DiVA

fulltext(219 kB)31 downloads
File information
File name FULLTEXT01.pdfFile size 219 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Nilsen, Per
By organisation
Division of Community MedicineFaculty of Medicine and Health Sciences
In the same journal
Journal of Clinical Nursing
Basic Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 31 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 315 hits
ReferencesLink to record
Permanent link

Direct link