What works: a realist evaluation case study of intermediaries in infection control practice

Williams, Lynne; Burton, C.R.; Rycroft‐Malone, Jo

doi:10.1111/j.1365-2648.2012.06084.x

Cited by 33 publications

(60 citation statements)

References 34 publications

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“…They could also have provided greater supervision for unqualified nurses and been more proactive to ensure that ward areas were better serviced to promote a safe, clean environment with the necessary resources. Previous research has suggested that the presence of university teachers in clinical areas could encourage better compliance with IPC precautions by ward staff 11 .…”

Section: Discussionmentioning

confidence: 99%

“…This can be overcome with up-to-date e-learning packages 8 , while simulated patient care exercises in the clinical skills laboratory have been suggested as a way of helping student nurses grasp the complexity of clinical decisionmaking in relation to IPC 10 . The presence of university teachers in clinical areas has also been identified as a mechanism for encouraging compliance with IPC precautions by ward staff 11 . Student nurses have identified qualified nurses as important role models for key aspects of IPC 12,13 .…”

Section: Introductionmentioning

confidence: 99%

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Student nurses' experiences of infection prevention and control during clinical placements

Gould

Drey

2013

American Journal of Infection Control

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BackgroundLittle is known about nursing students' experiences of infection control in the clinical setting despite its importance protecting patients and reducing risks of occupational exposure. MethodsOnline survey involving a fixed choice Likert-type scale with nineteen items and an open question to solicit more detailed information with a national sample of student nurses in the United Kingdom. ResultsFour hundred and eighty eight student nurses completed questionnaires. All participants reported lack of compliance for every item on the Likert scale, most frequently from community settings and long-term care facilities for older people. Incidents most commonly witnessed were failure to comply with hand hygiene protocols, failure to comply with to isolation precautions, poor standards of cleaning in the patient environment, not changing personal protective clothing between patients and poor management of sharp instruments.Qualified nurses did not provide good role models. Medical staff were the occupational group most heavily criticised for poor compliance. ConclusionStudents demonstrated sound understanding of infection control and were able to identify lack of compliance on the basis of pre-clinical classroom instruction. The study findings indicate that ensuring safe infection control practice remains a challenge in the United Kingdom despite its high priority. words

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Student nurses' experiences of infection prevention and control during clinical placements

Gould

Drey

2013

American Journal of Infection Control

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“…Researchers have used RE to evaluate a range of programs including: nursing education (Stavropoulou & Stroubouki, 2014) (Brimdyr et al, 2012;Machin & Pearson, 2014); infection control interventions (Williams, Burton & Rycroft-Malone, 2012); the care of patients with dementia (Tolson& Schofield, 2012); and workplace culture (Wilson, McCormack & Ives, 2005). The authors' justifications (where provided) for using RE were: to capture the differing realities of a person's experience and the contextual factors that influenced their perceptions (Machin & Pearson, 2014); to tease out transferable lessons from interventions (Williams et al, 2012); to explore context factors (Tolson & Schofield, 2012); and to gain an in-depth exploration (Wilson et al, 2005).…”

Section: Realist Evaluation and Nursingmentioning

confidence: 99%

“…The authors' justifications (where provided) for using RE were: to capture the differing realities of a person's experience and the contextual factors that influenced their perceptions (Machin & Pearson, 2014); to tease out transferable lessons from interventions (Williams et al, 2012); to explore context factors (Tolson & Schofield, 2012); and to gain an in-depth exploration (Wilson et al, 2005).…”

Section: Realist Evaluation and Nursingmentioning

confidence: 99%

Preparing a Realist Evaluation to Investigate the Impact of Privately Practising Nurse Practitioners on Patient Access to Care in Australia

Currie¹,

Chiarella²,

Buckley³

2015

IJN

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Background: Evaluation of privately practising nurse practitioner (PPNP) services in Australia is an important issue, because the sustainability of viable health services requires that they are underpinned by sound research. As part of ongoing work in relation to the evaluation of PPNP services, the authors plan to use realist evaluation (RE) to explore, not only whether PPNP services increase patient's access to care, but also the means by which they achieve (or do not achieve) this outcome. RE is a complex methodology and its application requires careful preparation. Objective: To present the application of the RE methodology to an evaluation of PPNP services of health care in Australia. Method: This paper explores the philosophical underpinnings of RE and articulates the steps taken in preparing to apply RE to an evaluation of PPNP services in Australia. Discussion: RE is a complex methodology to understand and apply. There is an absence of documented detail in terms of how to apply RE to ensure that the evaluation is truly 'realist'. Yet making the choice to apply RE to evaluations of PPNP services in Australia and overseas holds many advantages, primarily because of RE's emphasis upon the context in which health care is delivered and how and why the context relates to the outcomes produced. This paper will contribute to the emerging dialogue on how to apply RE to evaluations of health care and will assist those considering using RE.

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“…[261][262][263][264][265][266] However, a number of challenges have emerged concerning the operationalisation of each component of the CMO configuration. These challenges are discussed in the following four sections.…”

Section: Realist Inquirymentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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What works: a realist evaluation case study of intermediaries in infection control practice

Cited by 33 publications

References 34 publications

Student nurses' experiences of infection prevention and control during clinical placements

Student nurses' experiences of infection prevention and control during clinical placements

Preparing a Realist Evaluation to Investigate the Impact of Privately Practising Nurse Practitioners on Patient Access to Care in Australia

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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