| Primary Author: | Jodie Gary, PhDc |
| Organization | Texas A&M Health Science Center |
Abstract
Purpose
There is the perception that nurses use positive deviance, an overt act of deviation from standard protocols or rules with the intent to improve outcomes, in order to provide patient- centered care when standard practice guidelines are lacking. The purpose was to understand nursing care when standard practice guidelines did not meet patient specific care needs and to develop various viewpoints related to the use of positive deviance in providing patient-centered care.
Background
How nurses respond when faced with the dilemma of providing patient-centered care in the absence of patient-centered practice guidelines remains relatively unreported. Standards may not be available to guide nurses or may not be realistic for implementation at the point of care. Nurses may be forced to react creatively to meet the needs of their patients.
Materials & Methods
Complexity theory and the framework of a wicked question were used to guide a three-round electronic policy Delphi with a panel of nurses accessed through the American Association of Critical Care Nurses to determine the presence of positive deviance and to expose the care provided when standard practice guidelines did not meet specific patient or situational needs.
Results
Findings support the presence of positive deviance and expose care provided by nurses when standard practice guidelines lacked the ability to provide patient-centered care. Nurses agreed that deviations are needed, but the best way to deviate is not apparent. The statements as generated and discussion surrounding their judgment enabled identification of gaps in guidelines that fail to meet needs as well as aim to areas to improve communication concerning these specific care needs of patients and situations.
Conclusion
Better guidelines are needed that work for nurses instead of against them would not force a nurse into actions that are not patient-centered. Guidelines should guide practice and assist in allowing nurses to provide care that is centered on the best needs of the patient in the specific care situation.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).