Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Designing an Effective Evaluation Plan: A Tool for Understanding and Planning Evaluations for Complex Nursing Contexts

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Designing an Effective Evaluation Plan: A Tool for Understanding and Planning Evaluations for Complex Nursing Contexts

Article excerpt

INTRODUCTION

The last 20 years have seen a huge increase in the information available to healthcare practitioners and consumers regarding the effectiveness of health care interventions and practices. This is in keeping with the recent emphasis on evidence-based practice and cost effectiveness in an increasingly costly health care sector. This in turn has brought its own difficulties. The health care system is complex and health care delivery is reliant upon complex human interactions and practices based as much on custom and practice as on evidence. Initiatives such as health promotion, practice development, best practice guidelines and the implementation of research into practice bring with them the challenge of evaluating whether or not these initiatives make a difference. Evaluation has become part of the landscape of health care yet traditional methods of evaluation such as pre-test-post-test designs and the randomised controlled trial have been found to be lacking (Pawson & Tilly 1997; Victora, Habicht & Bryce 2004). The randomised controlled trial has long been considered the gold standard for assessing the efficacy of interventions, however in complex contexts such as occur in public health, such methods may be impractical or even unethical (Victora et al. 2004). Indeed with regard to health promotion the World Health Organisation (1998 cited in Green 2000) suggests that the use of randomised controlled trials is inappropriate in evaluating health promotion activities, is expensive and may give misleading results. The WHO advocates the use of mixed methods approaches.

Similarly, evaluating complex new nursing roles such as clinical chairs in nursing, practice development facilitators and nurse practitioners is also fraught with difficulty. The success or otherwise of such enterprises is not totally in the control of the incumbent and is subject to many variables and context specific factors. Understanding these factors is as important to the evaluation of these roles as more easily quantified measures of success.

PURPOSE OF EVALUATION

Evaluation looks to assess the actions of an individual or group. It involves systematic acquisition and assessment of information. The rationale for an evaluation is an important determinant in the selection of an appropriate methodology (Duignan 2003). Three broad purposes are recognised, spanning the scope of a study from inception to completion. Some studies will encompass more than one purpose and will utilise different methods for evaluation.

The three main purposes of evaluation outlined by Duignan (2003) are formative, process, and impact or outcome evaluation.

Formative evaluation is focussed on the design stage of a project to assess the plan and its objectives with the aim of identifying potential issues at a formative stage. Process evaluation aims to identify and describe what takes place in a project in an attempt to understand its strengths and weaknesses (Warburton & Black 2002). A focus on the internal dynamics and operational aspects of a programme enables onlookers to identify effective and ineffective components and processes that may facilitate replication elsewhere. However, funders may be reluctant to accept process evaluations because the use of case studies and other qualitative methods often adopted in such evaluations do not generate generalisable findings (Warburton & Black 2002). Similarly, peer reviewed journals tend to favour theory enhancing research over change-promoting research which is seen as less academically respectable.

The final category; impact or outcome evaluation, investigates the achievement and effectiveness of project goals whether short or long-term. This allows stakeholders to ascertain, for example, the contribution made by the project, the intended and unintended consequences and future resource and personnel requirements.

EVALUATION IN NURSING

One of the purposes of evaluation research in nursing is to provide information of practical value that supports informed decision-making in other nursing contexts (Clarke 2001). …

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