The impact of individual and contextual factors on nursing care and the implementation of AHCPR practice guidelines.

Clinical practice guidelines are meant to assist practitioners in making decisions about appropriate care (Field and Lohr 1992). They are also an attempt to exercise control over practice variation and, by eliminating ineffective services, to reduce the cost of health care (Garber and Wagner 1991). The concept of practice guidelines has received renewed attention with the establishment of the Agency for Health Care Policy and Research (AHCPR) whose guidelines cross disciplinary lines and are expected to affect nursing care as well as medical