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Related Experiment Videos

Developing a managed clinical network in palliative care: a realistic evaluation.

Debbie Tolson1, Jean McIntosh, Linda Loftus

  • 1School of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 OBA, UK. d.tolson@gcal.ac.uk

International Journal of Nursing Studies
|January 21, 2006
PubMed
Summary

Realistic evaluation aided a new cancer pain care network, despite challenges. This approach proved valuable for interdisciplinary practice development in healthcare settings.

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Area of Science:

  • Healthcare Management
  • Evidence-Based Practice
  • Clinical Network Development

Background:

  • Attaining evidence-based practice is a global priority in healthcare.
  • Robust evaluation is crucial for scrutinizing new service development approaches.
  • Managed clinical networks (MCNs) are a key strategy for service development.

Purpose of the Study:

  • To evaluate the merits and challenges of realistic evaluation design.
  • To assess the establishment of a new managed clinical network (MCN) for cancer-related pain care.
  • To explore the implementation of clinical guidelines within an MCN.

Main Methods:

  • Realistic evaluation framework applied across three MCN versions.
  • Identification of context, mechanisms, and outcomes at each evaluation stage.

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  • Patient-centered case studies informed realistic evaluation interviews with management.

    • Main Results:

    • Significant practitioner effort was required to implement the MCN approach.
    • Implementation faced delays due to change management inexperience and unfamiliarity with practice development.
    • Age appropriateness of the evidence base for frail older people and role changes for district nurses and community pharmacists were noted.

    Conclusions:

    • The realistic evaluation framework fostered a collaborative approach, becoming integral to the intervention.
    • Methodological challenges included limiting the depth of 'realistic unravelling'.
    • Realistic evaluation is a valuable formative design for complex interdisciplinary practice development.