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National recommendations and guidelines.

Clinical guidelines and recommendations from organizations such as the National Institute for Clinical Excellence provide clinicians with information, based on an appraisal of the current evidence, regarding specific therapeutic interventions and conditions. These are designed to guide practice and to move towards achievement of best practice based on clinical and cost-effectiveness. The provision of such guidelines are potentially beneficial in developing health care practice. However, they also lead to potential problems or dilemmas for nurses. These include the conflict between standardization of service and client choice, the tension between professional autonomy and prescribed actions, and the balance between clinical and cost-effectiveness.