[Evaluation of the adherence to nursing care protocols in a district]

An experience of construction and implementation of nursing care protocols and procedures for district nurses is described. A course was offered to all the district nurses, where the indications for the nursing care of some common patients' problems (pressure sores management, mobilization of the stroke patient, the management of patients in pain; the nursing care to stoma patients etc.) were presented. After having compared their work habits with the indications derived from the literature, the nurses were asked to produce protocols and procedures for the problems addressed during the course. The protocols were revised by experts and formally adopted by the responsible of the District, printed in a booklet and mailed with an official letter, to all the district nurses. After two years from the mailing, the knowledge of the nurses (44) on the areas covered by the guidelines was assessed with a multiple choice questionnaire. The level of knowledge varied from 100% of correct answers for the meatal care before catheterization, to the 23% of correct answers on how to remove the needle from a port-a-cath system. The level of knowledge was dishomogenous not only across nurses but also across subjects. In fact low level of correct answers were obtained also for frequently encountered problems, such as patients with pressure sores. The possible causes of the failure of the implementation of the guidelines are discussed.