Implementing evidence-based practices in an emergency department: contradictions exposed when prioritising a flow culture

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

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.

Original languageEnglish
JournalJournal of Nursing and Healthcare of Chronic Illness
Pages (from-to)555-565
Number of pages11
Publication statusPublished - Feb 2016

    Research areas

  • acute care, advanced practice, clinical guidelines, emergency care, emergency department, evidence-based practice, CONTEXT, DYNAMICS, SERVICES

See relations at Aarhus University Citationformats

Download statistics

No data available

ID: 110657281