They're NICE and neat, but are they useful?: a grounded theory of clinical psychologists' beliefs about, and use of NICE guidelines.

Court, Alex J. (2014) They're NICE and neat, but are they useful?: a grounded theory of clinical psychologists' beliefs about, and use of NICE guidelines. D.Clin.Psych. thesis, Canterbury Christ Church University.

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Abstract

There is a growing research interest into investigating why NICE (National Institute for Health and Care Excellence) guidelines are not consistently followed in UK mental health services. The current study utilised grounded theory methodology to investigate clinical psychologists’ use of NICE guidelines. Eleven clinical psychologists working in routine practice in the NHS were interviewed. A theoretical framework was produced conceptualising the participants’ beliefs, decision making processes and clinical practices. The overall emerging theme was “considering NICE guidelines to have benefits but to be fraught with dangers”. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, as a result of pressure, and also the rewards that follow from being seen to comply with NICE guidelines, they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. This is the first theoretical framework that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. Attention is drawn to the proposed benefits and limitations of guidelines and how these are managed. This study highlights the importance of clinical psychologists articulating and advertising their specialist skills. The findings are integrated with existing theory and research, and clinical and research implications are presented.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RA Public aspects of medicine > RA0399 Regulation of medical practice. Evaluation and quality control of medical care. Medical audit. Clinical governance
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0790 Mental health services. Mental illness prevention
R Medicine > RC Internal medicine > RC0435 Psychiatry > RC0475 Therapeutics. Psychotherapy
R Medicine > RC Internal medicine > RC0435 Psychiatry > RC0467 Clinical psychology
Divisions: pre Nov-2014 > Faculty of Social and Applied Sciences > Applied Psychology
Depositing User: Mrs Kathy Chaney
Date Deposited: 20 Oct 2014 16:43
Last Modified: 22 Oct 2017 17:31
URI: https://create.canterbury.ac.uk/id/eprint/12832

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Last edited: 29/06/2016 12:23:00