How nurses seek and evaluate clinical guidelines on the Internet

Abstract

This paper is a report of a study conducted to assess nurses' information-seeking strategies and problems encountered when seeking clinical guidelines on the Internet, and to investigate the criteria they apply when evaluating the guidelines and the websites communicating the guidelines. As nurses are increasingly taking on clinical responsibilities, they should be able to use the Internet to access up-to-date clinical guidelines. Currently, nurses' information-seeking skills remain rather limited. In 2008, a convenience sample of 20 nurses solved scenario-based tasks using the Internet to seek clinical guidelines regarding methicillin-resistant Staphylococcus aureus while thinking aloud. General background information and universal precautions were successfully identified by participants, in contrast to more specific precautions. Nurses' information-seeking skills appeared rather basic, as they employed a limited number of search terms and consulted a limited number of websites. Ineffective searches were mainly caused by a mismatch between the guidelines and nurses' tacit knowledge. Perceived practical relevance and information completeness were the most frequently applied quality criteria. Accuracy and disclosures, which are emphasized in existing e-health literature, were considered less important. As long as information matched nurses' practical and experiential wisdom, they were satisfied. Nurses appeared to rely predominantly on tacit knowledge during the search process and while evaluating the retrieved guidelines. This is dangerous because nurses' reliance on inaccurate information might result in inadequate behaviour. It is therefore essential to expand nurses' current information base by tailoring both navigation structure and the guideline communication to dovetail with nurses' tacit knowledge.