title: Care providers' experiences of guidelines in daily work at a municipal residential care facility for older people.
abstract: OBJECTIVE
  To describe care providers' narrated experiences of guidelines in daily work at a municipal residential care facility for older people.
  
  
  BACKGROUND
  Guidelines are used as a way of promoting high-quality health care. Most research concerning guidelines has focused on physician behaviour and to improve one specific aspect of care. Care providers working within municipal residential care of older people have described that working with multiple guidelines sometimes exposed them to contradictory demands and trouble their conscience.
  
  
  METHODS
  A qualitative descriptive design was adopted.
  
  
  METHODS
  Interviews with eight care providers were carried out between February and March 2012 and analysed by qualitative content analysis.
  
  
  RESULTS
  Care providers described experiences that guidelines are coming from above and are controlling and not sufficiently anchored at their workplace. Furthermore, they described guidelines as stealing time from residents, colliding with each other, lacking practical use and complicating care, and challenging care providers' judgment. The overall understanding is that care providers describe experiences of struggling to do their best, prioritising between arcane guidelines while keeping the residents' needs in the foreground.
  
  
  CONCLUSIONS
  In order to prevent fragmented use, guidelines have to be coordinated and adapted to the reality of daily practice before implementation. It seems essential to provide opportunities for discussions between care providers, registered nurses and management about how to make guidelines work within their daily practice. Sufficient support, knowledge and involvement are likely key issues that can help care providers to constructively work according to guidelines and thus, by extension, improve the quality of care.
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Åhlin
authors.forename: Eva
authors.initials: E
authors.lastname: Ericson-Lidman
authors.forename: Astrid
authors.initials: A
authors.lastname: Norberg
authors.forename: Gunilla
authors.initials: G
authors.lastname: Strandberg
mesh_terms: D000368:Aged; D017408:Guidelines as Topic; D006282:Health Personnel; D006299:Health Services for the Aged; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*
keywords: care providers; content analysis; guidelines; municipal residential care; older people