title: [The implementation of recommendations in daily practice: the experience of the nurses of the Oncology institute of Southern Switzerland].
abstract: BACKGROUND
  In spite of the wide spread and availability of the clinical practice guidelines, several problems limit and influence their implementation. Several studies explored how a protocol based care may influence nurses' decision making processes, while only few studies explored how it is used in everyday practice.
  
  
  OBJECTIVE
  This paper explores how the nurses of the Oncology Institute of Southern Switzerland implement the care protocols and problems encountered.
  
  
  METHODS
  Information on the frequency of use of protocols in the previous month, the need and reasons for modifications were collected with a semistructured questionnaire. Nurses were asked to briefly describe the situations that required a change of the protocol. The nurses'perceptions on the use of protocols in clinical practice were further explored with a focus group.
  
  
  RESULTS
  Of the 47 questionnaires distributed 38 were returned and 18 cases briefly described. In general, the protocols were widely used but at the same time, frequently adapted mainly by expert nurses (although 19/39 nursed declared that protocols were never modified). Reasons for modifications were mainly related to the clinical situation of the patient, to his/her values and preferences.
  
  
  CONCLUSIONS
  Instruments that standardize patients' care are frequently modified to account for patients preferences and characteristics. The nurses acknowledged the need of flexible instruments (and not hard rules) to guide their professional practice.
authors.forename: Carla
authors.initials: C
authors.lastname: Pedrazzani
authors.forename: Monica
authors.initials: M
authors.lastname: Bianchi
authors.forename: Dario
authors.initials: D
authors.lastname: Valcarenghi
authors.forename: Valerio
authors.initials: V
authors.lastname: Dimonte
mesh_terms: D000047:Academies and Institutes; D003657:Decision Making; D017144:Focus Groups; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008495:Medical Oncology; D024802:Nurse's Role; D011795:Surveys and Questionnaires; D013557:Switzerland