Nurse-led projects for people experiencing homelessness and other inclusion health groups: a realist evaluation

2022 ◽  
Vol 27 (1) ◽  
pp. 32-39
Author(s):  
Stephen Abbott ◽  
Rosamund Bryar
Keyword(s):  
Transfer Of Learning ◽  
Realist Evaluation ◽  
Lessons Learned ◽  
Service Development ◽  
Small Scale ◽  
Positive Outcomes ◽  
Nursing Service ◽  
Marginalised Groups ◽  
Innovation Projects ◽  
Health Programme

Nursing service development or innovation projects, even small-scale ones, can be difficult to deliver and evaluate, due to a lack of resources and support. Results can also be difficult to disseminate, limiting transfer of learning. This paper presents findings from a realist evaluation of 10 small projects supported by the Queen's Nursing Institute Homeless and Inclusion Health Programme to deliver innovation in health care for people experiencing homelessness and other marginalised groups. These nurse-led projects were funded by the Queen's Nursing Institute and the Oak Foundation, and were largely successful in achieving outcomes to support the improved health of people experiencing homelessness and other marginalised groups. This realist evaluation explores the factors that contributed to the delivery of positive outcomes. All were impacted by the context and the response (mechanisms) of people experiencing homelessness and staff within these settings. It is hoped that the lessons learned will enable better support for nurse innovation projects in the future.

Lessons Learned from Small Scale Field Test Demonstrating CO2 EOR and Geologic Storage at Wellington Field in Southern Kansas

2019 ◽  
Author(s):  
Yevhen Holubnyak ◽  
Willard Watney ◽  
Tiraz Birdie ◽  
Dana Wreath ◽  
George Tsoflias ◽  
...  
Keyword(s):  
Field Test ◽  
Lessons Learned ◽  
Small Scale ◽  
Geologic Storage ◽  
Scale Field ◽  
Co2 Eor

scholarly journals Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Downey ◽  
Katie Shearn ◽  
Nicola Brown ◽  
Ross Wadey ◽  
Jeff Breckon
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Developed Countries ◽  
Realist Evaluation ◽  
Service Planning ◽  
Service Development ◽  
Activity Levels ◽  
Programme Theory ◽  
Implementation Framework ◽  
Exercise Referral

Abstract Background Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Methods An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. Results Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. Conclusions The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

Creating a culture of employability in mental health

2014 ◽  
Vol 18 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Naomi Boycott ◽  
Justine Schneider ◽  
Michael Osborne
Keyword(s):  
Mental Health ◽  
Supported Employment ◽  
Implementation Process ◽  
Lessons Learned ◽  
Service Development ◽  
Content Type ◽  
The Individual ◽  
The Uk ◽  
Early Intervention In Psychosis ◽  
The Impact

Purpose – The purpose of this paper is to draw out the lessons learned from the implementation of the Individual Placement and Support (IPS) approach to supported employment in two contrasting adult mental health teams; one “standard” CMHT, and one early intervention in psychosis (EIP) team. Design/methodology/approach – These inferences are based on the evidence from a four-year study of IPS in one mental health care provider in the UK, which began by setting up a new service, and went on to run a RCT looking at the impact of psychological input as an adjunct to IPS alone. Findings – In attempting to introduce IPS to mental health teams in Nottingham the authors came across numerous barriers, including service reorganisation, funding cuts and the wider context of recession. Differences were observed between mental health teams in the willingness to embrace IPS. The authors argue that this variability is due to differences in caseload size, recovery priorities and client profiles. The authors have learnt that perseverance, strenuous efforts to engage clinical staff and the use of IPS fidelity reviews can make a positive difference to the implementation process. Practical implications – The experience suggests that setting up an IPS service is possible even in the most challenging of times, and that EIP services may be a particularly fertile ground for this approach. The authors also discuss potential barriers to implementing new services in mental health teams. Originality/value – This paper will be of value to service development and the science of implementation in mental health.

PP19 Primary care streaming in emergency departments- contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A9.1-A9
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Freya Davies ◽  
Andrew Carson Stevens ◽  
Adrian Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Care Service ◽  
Realist Evaluation ◽  
Primary Care Service ◽  
Evaluation Methodology ◽  
Service Development ◽  
Service Models

BackgroundRecent policy has encouraged emergency departments (EDs) to deploy nurses to stream patients from the ED front door to GPs working in a separate GP service operating within or alongside an ED. We aimed to describe mechanisms relating to effectiveness of streaming in different primary care service models identified in EDs. We explored perceptions of whether patients were perceived to be appropriately streamed to emergency care, primary care, other hospital services or community primary care services; and effects on patient flow (waiting times and length of stay in the ED); and safe streaming outcomes.MethodsWe used realist evaluation methodology to explore perceived streaming effectiveness. We visited 13 EDs with different primary care service models (purposively selected across England & Wales; 8 streamed primary care patients to a primary care clinician) and carried out observations of triage/streaming and patient flow and interviews with key members of staff (consultants, GPs, nurses). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to streaming effectiveness.ResultsWe identified five contexts (nurses’ knowledge and experience, streaming guidance, teamwork and communication, operational management and strategic management) that facilitated mechanisms that influenced the effectiveness of streaming (streaming to an appropriate service, patient flow, delivering safe care). We integrated a middle range psychological theory (cognitive continuum theory) with our findings to recommend a focus for training nurses in streaming and service improvements.ConclusionsWe identified key mechanisms relating to the effectiveness of primary care streaming in different models of service. We recommend a collaborative approach to service development, guidance and training (including input from ED clinicians and primary care clinicians) and a range of training strategies that are suitable for less experienced junior nurses and more experienced senior nurses and nurse practitioners.

Design and Development of a Simulation for Testing the Effects of Instructional Gaming Characteristics on Learning of Basic Statistical Skills

2018 ◽  
pp. 256-277
Author(s):  
Elena Novak ◽  
Tristan E. Johnson
Keyword(s):  
Experimental Study ◽  
Learning Environments ◽  
Game Design ◽  
Lessons Learned ◽  
Small Scale ◽  
Instructional Interventions ◽  
Design And Development ◽  
Actual Learning ◽  
The Relationship ◽  
Practical Implications

Considerable resources have been invested in examining the game design principles that best foster learning. One way to understand what constitutes a well-designed instructional game is to examine the relationship between gaming characteristics and actual learning. This report discusses the lessons learned from the design and development process of instructional simulations that are enhanced by competition and storyline gaming characteristics and developed as instructional interventions for a study on the effects of gaming characteristics on learning effectiveness and engagement. The goal of the instructional simulations was to engage college students in learning the statistics concepts of standard deviation and the empirical rule. A pilot study followed by a small-scale experimental study were conducted to improve the value and effectiveness of these designed simulations. Based on these findings, specific practical implications are offered for designing actual learning environments that are enhanced by competition and storyline gaming elements.

scholarly journals Towards an understanding of GPs’ viewpoint on diagnosing postnatal depression in general practice: a small-scale realist evaluation

2020 ◽  
Vol 21 ◽  
Author(s):  
Ashvanthi Nadira Sriranjan ◽  
Ruth Abrams ◽  
Geoff Wong ◽  
Sophie Park
Keyword(s):  
Primary Care ◽  
Postnatal Depression ◽  
Realist Evaluation ◽  
Small Scale ◽  
Thought Processes ◽  
Programme Theory ◽  
Self Reflection ◽  
Assessment Guidelines ◽  
Case Vignettes ◽  
Diagnostic Approaches

Abstract Background: Less than half of postnatal depression cases are identified in routine clinical assessment. Guidelines and current literature suggest that general practitioners (GPs) may have an opportunistic role in detecting postnatal depression due to their early contact and existing rapport with many new mothers. There is limited research on the diagnostic approaches chosen by GPs in different GP−patient contexts. Our small-scale study evaluates the thought processes of seven GPs based in one practice when forming a clinical diagnosis of postnatal depression under different contexts. Methods: Seven GP participants were interviewed using case vignettes about postnatal depression, based on an adapted Johari’s window framework. A realist approach to analysis was undertaken with the intention of understanding GPs’ responses to different situations. Context−mechanism−outcome configurations were constructed, and a programme theory was formed to consolidate the findings. Findings: Findings suggest that diagnoses may be a clinician-led or collaborative process between GP and patient. In collaborative contexts, stigmatising views were addressed by GPs, time for self-reflection was encouraged and mothers’ views were accounted for. Clinician-led diagnoses often occurred in contexts where there was a lack of acknowledgement of symptoms on behalf of the patient or where safety was a concern. The personal and clinical experience of GPs themselves, as well as effective communication channels with other primary care professionals, was significant mechanisms. Conclusion: GPs use a variety of strategies to support patient disclosure and acceptance of their condition. The complexity of GP−patient contexts may influence the clinical thought process. We address some of the gaps in existing literature by exploring postnatal depression diagnosis in primary care and provide tentative explanations to suggest what works, for whom and in what contexts.

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