They’re-NICE-and-neat-but-are-they-useful-A-ground.ppt

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1、Theyre NICE and neat but are they useful?A grounded theoryof clinical psychologists beliefs about,and use of NICE guidelines.A DClinPsychol research project by Alex Court,3rd year Trainee Clinical Psychologist.Supervised by Anne Cooke,Canterbury Christ Church University and Dr Amanda Scrivener,KMPT.

2、Why do we need to conduct research into the use of NICE guidelines in mental health services?NICE AimsTo improve clinical effectiveness and reduce variations in practice across NHS Trusts(DH,1998).Not so NICE ImplementationConsistent reports that uptake of NICE guidelines in UK mental health service

3、s is low.(e.g.Lewis et al.,2012;Mankiewicz&Turner,2012;Mears et al.,2008;Prytys et al.,2011;Evaluation and Review of NICE Implementation Evidence(ERNIE)database “Doubts about or mixed impact in practice”/“Practice appears not to be in line with guidance”)Conflicting Views“The way in which they have

4、been developed and presented should be such that few recipients would ever have cause to dispute the basis of the recommendations.”(Littlejohns,2000).“NICE guidelines are misleading,unscientific,and potentially impede good psychological care and help.”(Mollon,2009)In relation to NICE guidelines for

5、mental health conditions,research has investigated adherence to guidelines by:GPs,(Gyani et al.,2011;Gyani,et al.,2012;Toner et al.,2010),care co-ordinators(Prytys et al.,2011;Sin&Scully,2008),CMHT staff(Michie,et al.,2007;Rhodes,et al.,2010),psychiatrists and paediatricians(Kovshoff et al.,2012)and

6、counselling psychologists(Hemsley,2013).My StudyInterviewed 11 clinical psychologists.Grounded theory(Charmaz,2006)was utilised to guide the data collection and analysis.Aimed to develop a theoretical model,conceptualising the clinical psychologists beliefs,decision making processes and clinical pra

7、ctices.Results Overall Emerging Theme:“Considering NICE guidelines to have benefits but to be fraught with dangers.”Key PointsGuidelines were seen as a useful guide to the evidence base.The power of NICE endorsement was valued.The CPs worried that guidelines could easily be misunderstood and used in

8、 a rigid and limiting manner.CPs managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner.There were concerns about the harm that misuse of guidelines could do to service users and also to the profession of clinical psychology.Beliefs About

9、 the Purpose of&Future of CPA difficult fit between the actual practice of CPs and the language of NICE.Diagnosis vs formulation.Manualised therapy vs idiosyncratic,collaborative,integrative approaches.As a result of pressure,and also the rewards that follow from being seen to comply with NICE guide

10、lines,they tended to practice in ways that prevent these skills from being recognised.Threat to Professional IdentityWhy train CPs in a variety of therapeutic models if the“illusion”is that CBT is all that is practiced?Why do we need CPs at all if services only need CBT therapists?Final Thoughts on

11、GuidelinesA common conclusion from the participants was wanting NICE to be viewed as guidelines and not instructions.The CPs wanted NICE guidelines to be seen as a work in progress with numerous limitations.“I think it deserves further research.So perhaps I would say that Im not sure that it(NICE)should be there,Im not sure it shouldnt be there.I think it needs to be absolutely reviewed.”(Jan).