Bridging the policy–practice gap

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  • 2000 Harcourt PMost nurses are more interested in people than inpaperwork, at least experience indicates that thisis so. Probably nobody has ever measured thevolume of official health-related documentspassing between the Department of Health orother major official bodies and health careinstitutions. But there is little doubt that it hasincreased considerably over the last few decades.Those who have a desk at work often seem to bedrowning in paper. Some of it is related to short-term matters, indeed some may even be receivedtoo late to allow adequate time for action. Otherpapers contain information and sometimes policywhich has much longer-term and importantimplications for nurses who provide patient careand those for whom they provide it.

    Unfortunately, whether nurses providingcritical care directly learn of such documents


    Bridging the pogapbefore perhaps being subjected to changesresulting from them depends on many factors.These include: whether relevant reports or othersuch documents are made available in clinicalareas or somewhere else accessible (libraries aresometimes too distant for quick use); whethermanagers disseminate important information; orwhether nurses find out about such importantmaterial through other sources, and send for it(which entails time and often money). Often noneof these things happen and many nurses remainuninformed and, to be honest, sometimesuninterested in what is thought to be lessimportant than the immediate pressures ofcritical care nursing.

    This is perhaps understandable, particularlywhen there is a shortage of critical care nurses,and winter health problems reduce the numbersstill further while increasing the number of

    ubl ishers Ltd Icritically ill patients needing care. But it meansthat both the nurses concerned and the servicemay suffer. The solution to, or at least reductionof, problems like overloaded critical care bedsand nurses may lie in consideration of documentslike the recent Audit Commission report oncritical care (Audit Commission 1999) and thenaction. The usefulness of such reports is oftendependent on the data which they contain and onwhich they are based. The quality of those datadepends on the people who provide it quiteoften busy nurses, who are much more likely tomake the effort needed to provide adequate andaccurate data when they know that it is used toachieve valuable purposes, rather than merelyrequired as a routine.

    These are some of the reasons for starting anew, intermittent series in Intensive and Critical

    licypracticeCare Nursing entitled Policy into practice. Thiswill consist of papers appearing as appropriate toprovide information and informed comment onofficial reports and other such documents. Thefirst of these papers, in the next issue, addressesthe Audit Commission Report (1999) Critical toSuccess, and is written by Ruth Endacott, thecritical care nurse who was one of the AdvisoryGroup for the work. The report demonstratesvery well the importance of what is known, andsome of what is not known, about critical careservices, and is relevant for both policy andpractice. We hope readers will find this firstpaper informative and thought-provoking andthat it will provoke discussion and response.

    There often seems to be a gap between policywith those who make it and practice with thosemost involved in it. To achieve policies whichenable best practice, that gap must be bridged.

    ntensive and Critical Care Nursing (2000) 16, 12 1

  • Our aim is to help and perhaps stimulate nursesin practice to make informed and timelyresponses to relevant official documents, whichin turn may stimulate policy-makers to takenotice and involve such nurses more when policyis made or needs changing; in other words, tohelp to bridge that gap.

    There have always been patient-side (ratherthan bedside) nurses with information, opinionsand ideas of value to policy-makers.Unfortunately, those nurses were often not ableto recognize and communicate these in wayswhich would cause policy-makers to realize theirvalue and seek more from clinicians. This ischanging now, and such nurses just need help inthe midst of busy lives to know about, andpossibly gain access to and read, officialdocuments in order to provide informed, timelyand appropriate response rather than just getfrustrated belatedly about problematical new or

    Thanks to reviewersPeer review of papers is an important aspect ofmaintaining the quality of a journal. Thecomments provided can also be helpful toauthors and assist them in developing their work.In addition to people listed at the beginning ofthe journal, a number of others have contributedto ICCN in this respect in recent years and wewish to acknowledge the help of the followingpeople and express thanks to them:

    Joan Cameron Jane LovegrovePat Deeny Vidar MelbyIan Dyer Julienne MeyerSavoula Ghobrial Joan PerrinsMartin Haglund Jane RyanRichard Hatchett Caroline SaundersMargaret Lau-Walker Claire Whittle

    2 Intensive and C

    Intensive and Critical Care Nursingchanged policy. We hope the new series will behelpful and look forward to your response.


    Audit Commission 1999 Critical to Success: the place ofefficient and effective critical care services within theacute hospital. Audit Commission Publications,Abingdon

    Pat Ashworthritical Care Nursing (2000) 16, 12 2000 Harcourt Publ ishers Ltd

    ReferenceThanks to reviewers


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