evaluation and policy in transforming nursing martha ann carey, phd, rn kells consulting, media, pa,...
TRANSCRIPT
Evaluation and Policy in
Transforming Nursing
Martha Ann Carey, PhD, RNKells Consulting, Media, PA, USA
1st International Nursing ConferenceKuching, Sarawak, Malaysia
2014
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Pressures From
• Advances in health sciences and technology
• Increased complexities in morbidities
• Complicated health care systems
• Changing women’s roles
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To Respond and Manage Change
• A broad perspective– Global, national, regional – Societal norms and expectations, beyond nursing– Professional standards
• Local situation– Organizational policies– Resources
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Transforming or Evolving?
• Transforming – Implies substantial, basic change– History of caring – Addition of science base, theoretical frameworks,
evidence-based practice
• Evolving – Adding to the basic structure– Include science/research and caring tradition
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Policy• High level rules – Embedded in legislation or local regulations– Focus on national or broad issues
• Research results knowledge policy
• Allocation of resources
• Enables & constrains practice– Intended to be of service for the public good
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Programs
• Based on research, generally
• System level focus
• Environment & sustainability
• Cost benefit
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Practice
• Implementation at local level
• Possibly evaluation
• Monitor performance indicators
• Focus generally at the patient level
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Two Components of Research
• Doing research to develop knowledge– Quantitative– Qualitative– Mixed methods
• Using research results– “Translating”– Efficacy and effectiveness– Adopting vs adapting• Fidelity vs salience, rigor AND relevance
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Credibility
• Bestowed by audience – Different audiences hear differently, based on
expectations & history
• Necessary for utilization and sustained support
• Facilitated by apparent use of agreed upon norms
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Evaluation
• Formative and summative– Develop & refine useful practices (i.e., EBP)
• Evaluation and research - overlap– Program evaluation & evaluation research
• Theories and models, in addition to traditional science methods
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Developmental Evaluation
• Patton, 2011 – As contrasted with formative & summative
• Complex, uncertainty, innovation– Explore dynamics of complex system– Stable vs oscillating or continuing– Feedback to support development, not focus on
the end outcome
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Policy - Recent Emphasis
• Translation
– Links science, policies, and programs• “Science to service”, “bench to bedside”
– Community, patient, and family involvement
– Models are being developed
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National Center for Advancing Translational Science (NCATS), NIH
• Accelerate the use of scientific discovery – Basic science patient studies clinical practice– Using an integrated approach – Common goals
• Sharing information at each stage ensures – Researchers are meeting community health needs – Problems in the clinic informs work in the
laboratory
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“Convergence Model” US National Academy of Science
• Expanded form of interdisciplinary research
• Paradigm capable of generating new ideas, discoveries, methodologies
• Conceptual approaches and tools that stimulate advances in basic research and application
• Leads to new inventions, innovations, treatment protocols, and strategies for education & training
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National Academy of Science, 2014
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Resistance to Change
• From nurses -“Old School/Old Guard”
– Seen as risky, not appropriate
–Questionable rewards
• Other professions - “turf” wars
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What are Nursing’s Role and Responsibility?
• Recognize the opportunity to continue to develop– Who to collaborate with, and how to do this– Identify resources and plan– Include evaluation & dissemination
• Input to policy
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Implications for Nursing
• Blend of clinical, organizational, economic, and leadership skills – Advanced degree professionals at the clinical level
and academic level
• Critique nursing and other clinical scientific findings, and design care delivery • Acceptable and economically feasible• Significantly impacts health care outcomes
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Balance Caring and Transforming
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Terima Kasih
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• Patton, M.Q. (2011). Developmental evaluation: Applying complexity concepts to enhance innovation and use. New York, NY: Guilford
• The National Academies Press at http://www.nap.edu/catalog.php?record_id=18722
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