The Guidelines provide recommendations and guidance of clinical behavior whose purpose is to help stakeholders to decide on how best to apply in all circumstances. The guidelines do not restrict freedom of speech, but orient the choice of professionals.
In this context, the role of the coordinator is crucial. In fact, according to their knowledge and experience in the field, he must choose the most appropriate recommendations for each clinical case. They are classified according to five levels of scientific evidence (a, b, c, d, e) and, if it considers that none of these is valid and effective, may decide to edit them or create new ones. This decision is made, usually at the level of team work in which it is inserted. The procedures are internal rules of operation involving the activities of multiple people or functions. For the formalization process we understand a sequence of behaviors, however small, to standardize nursing activity. They are therefore examples of 'objects of Procedure': placement of a catheter indwelling in the adult male, the hygiene of hair in a person undergoing chemotherapy, as well as the interview at the time of nursing care of the client or the distribution of meals in an operational unit.
Even the ISO 9000 certification in health care has given rise to debates about the relationship between procedure and protocol: this is of more general, while the first is that part of the protocol which is used to detail the ways in which nursing takes place a certain action.
There are two types of procedures: those organizational, prepared under the supervision of the quality, and operational, written by professionals involved in the field and made operational by the directors of the department. Those of the second type take into account the legislation, guidelines and / or protocols of scientific societies. There are sometimes related to the procedures work instructions: These are detailed tasks, connected to specific situations. The procedures are approved by an Ipasvi based provincial / national level or through the national association of college of nursing.
The protocol, however, consists of a document that transfers at the level of professional conduct scientific knowledge gained. It is not, therefore, a statement of work, which takes care clinical content. The activity is divided into a sequence of behaviors: the operator remains free in the way in which to perform the individual steps, but this freedom must not compromise the consistency of performance.
The protocol is then encoded nursing course of action to be preferred in providing a given service in a given situation. The protocol can be considered as such only when, in its various components, is able to detail:
the patient's clinical situation for which the protocol can or must be activated;
the problem (or problems) pertaining to nursing that the protocol aims to address and manage and / or, again, the results to be achieved;
actions (which are also known in the literature acts, actions, behaviors, techniques, etc..) and the procedures to be activated;
indicators and standards for the evaluation of effectiveness.
The coordinator shall establish protocols that will be implemented in his department, assisted by a team of his choice. This work is done through the creation of ad hoc working groups, which he supervised, it is essential that the review, and any changes in procedural innovations are implemented with tight deadlines usually monthly.
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