Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.

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