Bucknall et al (2001) examined best practice guidelines for acute pain against past research on pain. The paper evaluated the implications of the National Health and Medical Research Council (NHMRC) acute pain guidelines on nursing practice, and addressed the inadequacies of current implementation policies of hospitals. The authors argued that the NHMRC pain management guidelines failed to decrease patients’ pain because healthcare professionals, organisations and researchers largely ignored the impact of contextual issues on clinical decision making. Contextual issues included patient involvement and control, nurses’ pain assessment and management skills, multidisciplinary collaboration, organisational management, educational needs and evaluation of pain-management effectiveness. The authors recommended that future pain management programs should consider acknowledging contextual issues in their development and implementation.

With increasing technology and medication complexity, hospital policies and protocols are helpful in supporting nurses to integrate new knowledge into practice and to guide effective decision making. Manias et al (2005) examined how newly graduated nurses used hospital protocols in their medication management activities. While some protocols were developed from evidence-based guidelines, such as checking the patient’s identity before medication administration, others were derived from what was considered to be good practice in the hospital, such as double checking of opiate medications. Newly graduated nurses were observed and interviewed on how they carried out various medication protocols. These protocols included: checking the patient’s identity before administering medication; double checking the administration of parenteral or opioid medications with another nurse; checking the identity band of the patient against the identity label on the medication order; writing or initiating medication incident reports if a medication error occurred; following up of unclear medication orders with an experienced doctor or nurse; checking unknown medications using written medication resources; and observing patients actually consuming oral medications. Some protocols were observed to be followed according to expected recommendations. There were 34 situations observed where nurses were confronted with an unclear medication order, and in all of these situations they sought advice from an experienced doctor or nurse. Nurses observed patients taking oral medications in 90% of situations (118/131), and in 80% of situations they administered parenteral or opioid medications using a double checking procedure with other nurses (24/30). They were also observed to follow up on unknown medications in 86% of situations (12/14). There were two medication errors associated with medication administration; however, these were not documented as medication incidents. In addition, patients’ identity labels were only checked in 27% of situations (48/175). The study demonstrated that evaluation of protocol adherence can be a useful means of determining the extent to which nurses provide safe medication management.

Manias et al (2000) described the benefits of combining objective and naturalistic methods when undertaking a formative evaluation of a computer-assisted learning program in pharmacology for nursing students. During the design and development phases, the pharmacology program was evaluated using observation of student pairs, student questionnaires and student focus group interviews. The combination of evaluation methods enabled complex issues underlying the program effectiveness to be addressed.

Ellis and Hogard (2003) evaluated a pilot scheme for clinical facilitators in acute medical and surgical wards. The clinical facilitators were employed to address two issues: i) the nursing skills demonstrated by newly graduated nurses, and ii) concerns about supervision in clinical placement. The purpose of the clinical facilitators was to enhance undergraduate nurses’ competence on clinical placement. Evaluation involved a three-phase approach covering outcomes, process and multiple stakeholder views. The work of clinical facilitators was evaluated using interviews, focus groups and questionnaires with students, clinical staff and university staff. While clinical facilitators were evaluated in a positive way, concerns were raised about communication. University staff also tended to rate the clinical facilitators less favourably than did students and clinical staff.