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[-a|K8g>wJxk}RÔ;2SIn:/1~x 辄0Wqٗ=v ,[&0G XB ~4v[ XqAŸxS7fKYJ+7$hg׹zg;R?'na^G;lrtvTh8hSֶ b} kv-|+?t%{\ly}[l_n)_I(aNBeVe`A;+9lf^ /u'|kB[KvfTmK|_Z^lv\oEˎZWo|w:WOrs5C=K܎8dy(s|7KDow?L"I(     Chart Excel.Chart.80*Microsoft Excel Chart Chart Excel.Chart.80*Microsoft Excel Chart  Chart Excel.Chart.80*Microsoft Excel Chart`/ 0DArialNew Romantt/ 0DTimes New Romantt/ 0@ .  @n?" dd@  @@`` X$J      "% ')*+-./0123456789:;<=>?@ABC Eob$iW 17R$yb)33TuJ7$"$`8FҰ>_+"$ц*>_lpf Bϊ"$^PiI< 0JQ  0AAP3f@f3+ ʚ;ʚ;g4GdGd< 08ppp@  <4dddd@l 0t80___PPT10 pp?  %?:A Pragmatic approach to Evaluation in Utilisation Research;;(: .Professor Brendan McCormack (with Rob Garbett). -Current Challenges in Evaluating Utilisation.. - $Little conceptual clarity and murky language Dominant focus on evaluating technical interventions (instrumental utilisation) Linear and logical approaches to evaluation that don t always take account of complex organisations Reliance on input and output models of evaluation-Current Challenges in Evaluating Utilisation.. - xComplexity of decision-making processes, meaning that no single evaluation mechanism can capture this complexity The balance of process and outcome and the privileging of one over the other `Evidence-based person-centred practice  what are we doing to evaluate the person-centredness? What is it we are evaluating?=Z=< RWhere is the evaluation of person-centeredness in the current utilisation agenda? SSQ  Receiving the right intervention, at the right time etc based on an assessment of a need/problem Person as a disconnected entity from the context in which they receive healthcare Practitioners as disconnected entities from the contexts in which they provide healthcare &    @A Problem -  Unclean endoscopes!!$  Major public concern and media profile RGH  3000+ patients recalled 2 departments in RGH involved  DPU and main theatre suite (Same unit) DPU = no cases of contaminated scopes Main theatres = many cases of contaminated scopes DPU use guidelines developed by the  Association of Endoscopic Surgeons Main theatres use guidelines developed by the  National Association of Theatre Nurses Similar but differently worded guidelines leading to differing interpretationsP&  .What questions does this example raise for us?// . Why the use of two different sets of guidelines in the same unit? What interpretations led to safe and unsafe practices? What changes would have led to the agreement of  best practice ? What contextual factors acted as barriers to the sharing of knowledge? /$Contextual Factors as Barriers Person-centred perioperative nursing project (Kerr, McCormack et al, in progress) 150 hours of non-participant observation Appreciative inquiry groups Stakeholder analysis with steering group&RnRn 0%Barriers Identified "Culture of busyness  call for the next one! Inconsistent/inappropriate approaches and styles of leadership Ineffective use of the nursing resource available Poor delineation of roles Reactive training rather than learning through practice Factions, Cliques and Tribes Lack of person-centredness, i.e. Patient as product Nurse as producer Doctors as product controllers Managers as quality controllers..ZdZ.d Context PARiHS Framework: Culture, Leadership and Evaluation Evaluation [weak]: Absence of feedback Narrow use of performance information Reliance on single methods*JZUZJUDU 1&Being person centred ,&Creating the conditions that help us to: Know another as a unique individual Understand and acknowledge individuals beliefs, values, wants and needs Provide care characterised by flexibility, mutuality, respect and care Create environments that are flexible, respectful and caring of peoplebbbb&))" ,  ,!#The person centered nursing project$$(# ,8 clinical areas in the intervention group, 3 in the control group Includes critical care, acute areas, peri-operative care, rehabilitation and clinics $&h , ,1 ," Methodology  ($  Quasi-experimental design Pre-post test; Instruments to measure particular dependent variables via patient and staff questionnaires at 4 monthly intervals Intervention Phase Practice Development (PD) Framework Mapping the journey Qualitative data sourcesPPP%PPP$     #Quantitative measures$ Two questionnaires developed and administered Nursing Context Index (NCI) 21 Constructs/ Caring Dimensions Index Perceptions of Nursing Index (PNI) Satisfaction and Experience of being nursed.XZXZ'XZ#XZ,XZ.'#,   $Qualitative sources ,Taping of interactions Practically challenging Field notes Meetings, working with individuals Thoughts and feelings Contextual issues: staffing, competing priorities etc. L q q ,%Using the data ,b Problematising Workload scores and  well, what do we do with our time? Questioning and reflecting Communicating constructs and  how do we get through to people? Confirming v:@ :@   ,&$ Food for thought  ,X The project is giving us food for thought, especially the information from the nurse questionnaires, it gives us an idea of how the staff are really thinking. Also what (our facilitator) has told us what she is hearing on the tapes.  This project has spurred us to make changes which we never had thought we needed to make, for example how EENT and recovery are actually managed staff wise. It has identified that we need to perhaps have more senior staff nurse grades. And the noise level in the unit has been reduced after feedback.  I particularly enjoy being involved. It has certainly motivated me to make and accept changes and differences to the department to ensure that it is more patient centred and person centred.  I know that over time when staff do see the benefits to patients, the department and to themselves that they will be less timid about the project. This will take time and more upbeat promotion from the team &  P'Mapping the journey ,Evidence of reduced stress in all intervention areas over 1 year Greater sense of feeling supported and of workload becoming more manageable ,( Some examples  , Not enough time to complete all nursing tasks October  03: 40% said often, frequently or always April  04: 21% said often, frequently or always  Not enough staff to adequately cover the unit October  03: 80% said often, frequently or always April  04: 53% said often, frequently or always  Lack of opportunities to talk openly about problems on the ward October  03: 40% said often, frequently or always April  04: 5% said often, frequently or always 0ZbZ1ZdZCZcZ0 % %1 & &C1    /    2'?Tape recorded data: Interaction between nurses and patients (2)@@(?  ) Reduction in stress ,oEvidence that staff feel: More appreciated Clearer about their own development More supported in the workplace &VVo ,*! Some examples  ,Work in the clinical areas has provided opportunities for people to talk, and the emphasis of person centeredness is resulting in more openness  People are saying things to each other that wouldn t do at the beginning &  Working on changes provides people with recognition and affirmation  This project has given me a new interest &  TZMZDZ-ZMD-M ,+"Feeling more in control ,wThe journey in intensive care: Taking control over continuity of care Becoming more reflective, learning from practice &YYw , Evaluation as praxis Praxis: Doing action. Concerned with an  ethical end that cannot always be predetermined in advance and is context dependent Quality of the end product is inseparable from the process of getting there. Not rule-following behaviour but based on  practical; wisdom , i.e. combined perception, reasoning, virtue and technical competence.6ZHZGO 4)A Programmatic Approach(,# Conclusions  ,Using multiple sources of data allows us to demonstrate the impact of a practice development programme over time Placing a quasi-experimental design within an overarching philosophy of  praxis enables ownership, participation and changes in culture whilst ensuring rigour. A programmatic approach to evaluation may offer us a way forward in the development of our understandings of knowledge useZ  ,/8-.   0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@,?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> 4,(    6} "'g  T Click to edit Master title style! !$  0 "'g  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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