A Realist Synthesis of Practice Development

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A Realist Synthesis of Practice Development

• Commissioned by NHS Education for Scotland/NHS
  Quality Improvement Scotland.
• Intention to develop/inform the development of a
  Scotland-wide MD Practice Development Framework.
• Being undertaken by University of
  Ulster/Manchester Business School/Queen Margaret
  University College, Edinburgh.
• Two strands
• International Literature Review including grey
  literature
• Telephone interviews (international)

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• Please send us your grey literature!!
• and/or
• Would you like to participate in a telephone
  interview
• Contact
• brendan.mccormack_at_royalhospitals.n-i.nhs.uk or
  robert.garbett_at_royalhospitals.n-i.nhs.uk

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Development and Testing of the Context
Assessment Index (CAI)
National University of Ireland University
College Cork

• Brendan McCormack, Professor of Nursing Research,
  Institute of Nursing Research, University of
  Ulster, NI (PI)
• Geraldine McCarthy, Professor/Head of School of
  Nursing, University College Cork, RoI (PI)
• Jayne Wright, Research Associate, Institute of
  Nursing Research, University of Ulster
• Alice Coffey, Research Associate, School of
  Nursing, University College Cork, RoI
• Paul Slater, Research Associate, Institute of
  Nursing Research, University of Ulster

Project supported by a cross-border grant from
the NI DHSSPS RD Office and the RoI Health
Executive HRB
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Background
National University of Ireland University
College Cork

• Project developed to understand the contextual
  factors that prevent the use of evidence
  underpinning incontinence management and
  continence promotion in services for older
  people.
• Development of the tool indicated that it has
  relevance to other issues other than continence.

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Methodology (1)
National University of Ireland University
College Cork

• PHASE 1 In-depth case study (2 sites comprising
  7 clinical units)
• Individual audit of 220 case records using the
  Royal College of Physicians (London) audit tool
• Facility audit using the Royal College of
  Physicians (London) audit tool
• Knowledge and skills assessment with all staff in
  the two case study sites (Irwin, 1998)
• Observation of practice (32 hours) using
  Manleys (2004) indicators of an effective
  workplace culture and Essence of Care Benchmark
  continence (DoH 2001)
• Nurse Leadership using NWI-R (Aiken Patrician
  2000 adapted by Slater McCormack 2005)
• Audit data analysed using SPSS and all data
  mapped onto a matrix developed from the PARiHS
  Framework and Manleys effective workplace
  culture indicators
• Focus groups (multidisciplinary) to discuss
  themes
• Discussion of themes and identification of
  questionnaire items by project team

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Methodology (2)
National University of Ireland University
College Cork

• PHASE 2 REFINEMENT AND TESTING OF THE CAI
• Pre-pilot with convenience sample of continence
  link nurses refinement of items (wording and
  number)
• Pilot with 15 practice development nurses and
  continence nurse specialists from across the UK
• refinement of items (wording and number)
• Validity testing Distribution of the CAI (82
  item instrument) to 500 nurses drawn from a
  sample of nurses in all rehabilitation units on
  the Island of Ireland refinement of instrument.
• Reliability testing test-retest approach with
  nurse leaders in 50 rehabilitation units drawn
  from a sample of rehabilitation units on the
  Island of Ireland refinement of instrument

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Challenges
National University of Ireland University
College Cork

1. Isolating continence practice from other aspects
   of practice.
2. Tangibles and intangibles!
3. Competing discourses of context.
4. The impact of opinion leaders.
5. The usefulness of the CAI in practice
   development?

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Further Work
National University of Ireland University
College Cork

• Test the instrument with other groups/clinical
  specialities