Analytically established statements to support medical practitioner and patient’s choices about proper health care for definite conditions is called clinical practice guidelines. They are planned to suggest summarized directions for providing better healthcare facilities. The most significant advantage of clinical practice guidelines is prospective to progress both the superiority and procedure of healthcare and patient's outcome. Implementation of guiding principles of doubtful rationality can lead to the use of useless intervention, wasteful usage of rare resource and maltreatment of patients. Formatting correct guidelines can be intimidating. Every effort should be made to recognize present strategies that have been thoroughly improved and approved for practice. Guidelines established by professionals or administration should not be exempted from detailed inspection as it was found that these guidelines may be of inferior quality. The Practice Guidelines Evaluation and Adaptation Cycle is a basis for sorting out and decision-making about adopting guiding principles. The objective of CPGs for the management of stroke rehabilitation is to deliver scientific information for practice and evaluation. Guideline appraisal tools are used to thoroughly evaluate and compare guidelines.
Evaluating CPGs for Mary Pierce’s recovery is very much essential. Accurate guidelines must be chosen for improving her daily living activities and mental state. An increasing figure of evidence indicates that patients recovered quickly with a disciplined, multidisciplinary attitude towards rehabilitation after a stroke (Moatti, 2014). So far, various appraisal instruments have been advanced. The Appraisal of Guidelines for Research and Evaluation instrument is becoming well accepted as a valued standard for guideline evaluation. This tool measures the feature of CPGs, provides a procedural strategy for the improved development of practicing guidelines and informs about how information should be described the in guidelines (agreetrust.org, 2016).
The overall idea of the guidelines and health related issues must be specifically described. The type of patient or health issue to whom this guideline will be applied is an essential purpose. The purpose of this CPG is to prevent complication during stroke for pregnant women and providing guidance in a rehabilitation setting. Another purpose is the formation of an interdisciplinary guideline evaluation group. The objective of establishing a medical group to appraise guidelines are the allocation of effort among team associates decreased the possibility for bias in the assessment procedure and amplified responsiveness of guidelines and prospects for team members to mature ownership of the resultant conclusion (Hollon et al., 2014). Choosing proper clinical practice guidelines for managing a sensitive case like Mary Pierce, a team effort is better than individual decision making. The central aim of the guideline is to provide clear description age range, clinical explanation, and comorbidity.
When the clinical practice guideline appraisal procedure is commenced on behalf of a medical team, the resulting summary of recommendation should be directed to experts, multiple stakeholders and organizational policy developer for appraisal and review. It is also suggested even if a solitary guideline is accepted. Looking for feedback on the suggested guidelines guarantees that persons intended to practice the guidelines have a scope to analysis the manuscript and detect potential complications for application before it is finalized (Moreau et al., 2013). Based on the vastness of the adaptation method, it may also be sensible to refer the guideline to external specialists for appraisal of content rationality, transparency, and applicability. It can confirm that recommendations from prevailing guiding principles have not been occupied out of background or adapted inaptly. The total process will make sure that appropriate CPGs have been taken for the management of Mary Pierce’s rehabilitation (Tate, and Bushnell, 2011).
Selecting evidence for the patient's issues and use them in the guidelines is a major responsibility. Superior clinical results are attained when stroke patients are treated in a situation that offers coordinated, multidisciplinary stroke associated guideline evaluation and amenities (Langhorne, 2011). The trained medical team, well-organized facilities and earlier implementation of clinical practice guideline interventions are essential constituents in cases like Mary Pierce. According to Alfaro-LeFevre, (2015) all guiding principles that meet the appropriate standards should be salvaged. Since the evaluation practise is grounded on the evidence described by guideline creators, all appropriate documents connected to the CPG building method should be retrieved. In some cases, the available documents can have marginal information about the development route as that information is obtainable from elsewhere. The health advantages, side effects, and hazards should be considered in formulating the recommendations (Langhorne, 2011). Efforts should be taken to gain such additional documents.The operational team should detect acquainted guidelines previously introduced in their settings and inspect the bibliographies to find other guidelines.
Assessment quality and clarity of the clinical practice guideline is necessary for stroke service improvement. Motivational guidelines and counselling is vital for lifestyle improvement the patient. Mary Pierce has to recover soon not only for her but also for her newborn baby. Clarified clinical guidelines can help her for effective recovery. Diverse alternatives for management of the condition should clearly present (Sockolow, 2014). As for Mary Pierce, CPGs should include details of visual examinations as she experienced visual loss in one eye. Computer aided visual restitution can be used to improve visual function. Her difficulty in walking should be given the chance of practising walk under observation. Constraint-induced movement therapy and repetitive task-specific assisted training must be included in CPGs for upper limb activity. Activities of daily living (ADL) included in CPGs should be noticeably described and important recommendations must be easily identifiable. As stated by Sockolow (2014), these recommendations should answer the central queries that have been covered by the guidelines and can be recognized in different ways.
Pregnancy-related stroke recovery guideline recommends the use of validated and standardized methods in evaluating stroke patients (Party, 2012). Mary Pierce’s tolerance for therapy will depend on several factors including her degree of recovery of the stroke, mental status, medical stability and ADL. Her family members are an essential part of the recovery process. The family members should be well informed about her CPGs. The patient and her family should be given information and an opportunity to learn about the causes, consequences and potential complications of stroke during pregnancy; aims, progression, and prognosis of rehabilitation. Pregnancy stroke facilities should be engaged in quality upgrading activities that include systematic audit and feedback. Facilitators and barriers for the implication of the guidelines are very much essential to describe. A CPG on stroke may refer that care should be direct through stroke units and stroke services. There must be a distinct funding mechanism in the locality to support the development of effective stroke unit (agreetrust.org, 2016).
Clinical practice guideline maintains a critical role in preserving the evidence-based clinical practice in pregnancy associated stroke and rehabilitation. Clinical practice guidelines should be customary by the means of detailed evidence-based preparation. Healthcare staffs should have the proficiency and wisdom to skilfully judge the guidelines earlier of application for better care of their patients. Studies showed that guidelines for the introduction of innovative care escalates united decision making and modify its social cognitive links (Légaré & Witteman, 2013). Research also propose that appropriate guidelines can construct effective communication between the health caregivers and patient. Moreover, it can fund the caregivers in facilitating self-determination of a patient like Mary Pierce to deal with her current disabilities.
The simplicity of performing of the guidelines in real life clinical practice must always be a foremost consideration if a progressive operation is to take place. CPGs can lead to variation in clinical practice. At the individual level, the worth of linking clinicians and patients in the improvement process, implementation and decisions about satisfactory variation from clinical protocols is well known. It is well recognised mainly where there are quite a lot of choices for treatment with comparable values or evidence. Clinicians need to consider that the guidelines are correct if they are to use them. Examples of medical zones where first choices of clinician and patient have been fruitfully assimilated into clinical practice guidelines include stroke rehabilitation, different cancer treatment and the ICU (Van der Weijden et al., 2013). But unwanted variations must be avoided. The most common initiative to decrease undesirable variation in clinical practice is the advancement and implementation of CPG, clinical protocol, and data-based pathway. Implementation of guidelines needs to be sustained by training, infrastructure, evidence support, promotion, authorisation, and incentives or penalties to inspire guideline application. Initiative to raise the finest practice and diminish unwarranted variation need local, state-wide and national approaches (Jun et al., 2016). Clinical practice guideline promotes shared decision making. Shared decision making provides several benefits for patients, clinical staffs, and the healthcare organization. It increases knowledge, reduces distress about the treatment method, enhances health outcomes, declines unwanted variation in care and superior arrangement of care with patients’ ethics.
Clinical practice guidelines for Mary Pierce's condition are taken after a detailed evaluation of every aspect. It should be acceptable for all medical experts, Mary Pierce herself and her family members. Factors regarding the implication of guidelines like individual and team attitude, perceptions, knowledge, essential resources, effective leadership and organizational culture can have both facilitating or barrier influences. Lack of evidence-based system can be the major barrier for implementation of CPGs. The chief cause identified was the time required to find appropriate guidelines and the resources necessary to implement them. Certain issues frequently deteriorate the eminence and dependability of CPGs. These include inconsistent quality of distinct logical studies, barriers in systematic reviews (SRs) upon which guidelines are constructed, failure to raise multi-disciplinary guideline development team, dearth of clarity in the advancement of methods (mainly regarding the evidence quality and strength of the recommendation reviews), failure to set up multiple stakeholders, unmanaged conflicting guidelines and total collapse to custom rigorous approaches in clinical practice guideline development. Therefore, a readily available online database of clinical practice guidelines is regarded as a major facilitator. In addition, the guidelines must be easily comprehended by all (Jun et al., 2016 and Légaré & Witteman, 2013).
Clinical practice guidelines have the perspective to improve the route of care as well as patient outcomes. However, favourable effects of clinical practice guidelines are dependent on effective implementation. Medical organisations can move towards explicit usage of evidence in practice by accepting prevailing guidelines or by adaptation of current guidelines. CPG uses present and prominent experimental evidence in critical decision-making about patient’s health. CPG teaches the culture of innovation in every aspect of healthcare. It supports the individual need of each patient. It also supplies chances for treatment to be more dynamic. Alert contemplation of accessible guidelines using the methods illustrated above can update medical decision making about guidelines and recommendations which are most apposite for their setting and patients. Utilization of a demanding and clear process for recognizing, evaluating, and acclimatizing guidelines is vital as practice guidelines are fundamentally manifold interventions and the conclusions prepared can have an impact on both patients and caregivers. This piece of the article describes the significance of clinical practice guidelines for pregnancy-related stroke management. A detailed description of guideline evaluation, facilitating and barrier components on the implementation of clinical practice guidelines are provided.
Alfaro-LeFevre, R., & Msn, R. N. (2015). Critical Thinking, Clinical Reasoning and Clinical Judgment: A Practical Approach, Pageburst E-book on Kno. Elsevier Health Sciences.
Hollon, S. D., Areán, P. A., Craske, M. G., Crawford, K. A., Kivlahan, D. R., Magnavita, J. J., ... & Galper, D. I. (2014). Development of clinical practice guidelines. Annual review of clinical psychology, 10, 213-241.
Jun, J., Kovner, C. T., & Stimpfel, A. W. (2016). Barriers and facilitators of nurses’ use of clinical practice guidelines: An integrative review. International Journal of Nursing Studies, 60, 54-68.
Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693-1702.
Légaré, F., & Witteman, H. O. (2013). Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Affairs, 32(2), 276-284.
Moatti, Z., Gupta, M., Yadava, R., & Thamban, S. (2014). A review of stroke and pregnancy: incidence, management and prevention. European Journal of Obstetrics & Gynecology and Reproductive Biology, 181, 20-27.
Moreau, P., San Miguel, J., Ludwig, H., Schouten, H., Mohty, M., & Dimopoulos, M. (2013). Clinical practice guidelines. Annals of oncology, 1(5), 00.
Party, I. S. W. (2012). National clinical guideline for stroke.
Sockolow, P. S., Rogers, M., Bowles, K. H., Hand, K. E., & George, J. (2014). Challenges and facilitators to nurse use of a guideline-based nursing information system: Recommendations for nurse executives. Applied Nursing Research, 27(1), 25-32.
Tate, J., & Bushnell, C. (2011). Pregnancy and stroke risk in women.Women's health, 7(3), 363-374.
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