Pluralistic Evaluation Research Articles

Teamwork in primary care: an evaluation of the contribution of integrated nursing teams.

This paper examines the community nursing contribution to primary care by reporting on a qualitative evaluation study of the introduction of integrated nursing teams by an NHS community trust in one location in the United Kingdom. A pluralistic evaluation approach (Smith & Cantley 1985) was used to identify the various criteria by which the different stakeholders involved in the initiative judged the integrated nursing teams to be successful. Six teams at various stages of development were included in the study, together with other groups who had a vested interest in the performance of the teams. Data were collected by means of in-depth individual interviews with team coordinators, team facilitators, senior trust managers, GPs and practice managers; and focus group interviews with team members. The criteria for success identified by the various stakeholders provided a framework through which the overall success of the initiative was judged. Five meanings of success were identified, namely: team working; effective communication; an orientation towards the general practice; changes in working practices; and responsiveness to change. Key findings relating to each of the criteria are presented and consideration given to the implications arising for the development of Primary Care Groups (PCGs). The paper concludes that, paradoxically, by stepping aside from the traditional hierarchy inherent in the primary health care team (PHCT), integrated nursing teams may provide community nurses with the opportunity to make a more active contribution to the future development of primary care.

The use of pluralistic evaluation to explore people's experiences of stroke services in the community.

The aim of the present study was to explore the experience of stroke survivors and their informal carers of stroke services in the community, as part of a pluralistic evaluation of a Pilot Community Stroke Service (PCSS) in Nottingham, England. The research design involved qualitative in-depth interviews with four main stakeholder groups in the evaluation, in combination with analyses of varied data sources, including participant observational and documentary. In addition to interviews with 57 stroke survivors and their carers (as appropriate), interviews were conducted with the team of the PCSS, individually and as a group, and with a range of other workers. The pluralistic approach of the evaluation revealed that tensions and social conflicts at the interface between services, and particularly between health and social care services, had a negative impact on the quality of life of clients and carers alike, which were experienced as 'setbacks', and which could be shown to be system induced. Such 'System Induced Setbacks' also had negative consequences for the team of the PCSS, since rather than being a 'top up' service, in such cases it became a 'mop up' service, compensating for the shortfall in service provision. Thus its aims and objectives could not be fully realized. It was concluded that pluralistic evaluation had a number of strengths including that, because of its attention to process and social context, it revealed the existence of System Induced Setbacks and their negative and long-term impact on the daily lives of clients and carers, and on the team of the PCSS, in a way which would not have been possible had a quantitative approach been used.

Outcome of admission to an acute psychiatric facility for older people: A pluralistic evaluation

In this pilot study we sought to find brief, usable, reliable and valid measures of outcome from a variety of viewpoints for older adults admitted to hospital with depression or dementia. We examined patients', carers', primary nurses', consultants' and general practitioners' perceptions of outcome using a variety of measures. For the depressed patients we used nurse-rated change on the Montgomery Asberg Depression Rating Scale (MADRS) as the main outcome measure. Adequate data for analysis were collected on 24 depressed and 16 demented patients. In the depressed group there was a highly significant improvement on the MADRS. Factor analysis of the scales used produced four factors. The MADRS and the depression subscale of the Hospital Anxiety Depression (HAD-D) were strongly weighted on the first factor, the GPs' linear analogue scale on the second, the Selfcare-D (and the HAD-D) on the third and the anxiety subscale of the HAD (HAD-A) on the fourth. The HAD, which is brief and easy to use, and the GPs' linear analogue are suggested for further evaluation as routine outcome measures for depressed elderly people. For demented patients carers' rating of resolution of perceived problems is tentatively suggested for further investigation.

Pluralistic evaluation of belief plausibility and its application to nonmonotonic reasoning

A pluralistic evaluation of belief plausibility is introduced by extending the notion of plausibility index introduced by Rescher. The properties of the extended plausibility are analyzed by comparing its properties with those of probability theoretic indexing and Rescher's indexing of beliefs. Also it is shown that the new indexing method can be effectively utilized in truth maintenance of beliefs in complex and dynamically changing situations. First, the reason we focus our attention on Rescher's plausibility index of beliefs and the necessity for its extension are clarified by referring to the method of knowledge organization and maintenance called ATMS (assumption-based truth maintenance system) introduced by De Kleer, which is an extension of Doyle's TMS. Second, Rescher's plausibility index is briefly reviewed. Third, the index is compared with the probability theoretic index of beliefs by referring to a system of logic called preference logic that reflects essential features of the indices. The comparison clarifies the monotonic, inflexible nature of Rescher's index and the need to extend it in order to cope with the nonmonotonic nature of truth maintenance in dynamically changing situations. An extension of Rescher's plausibility index is introduced, and its properties are examined. Finally, an application of the indexing method to ATMS and to default reasoning is presented, showing that the proposed indexing method can be effectively utilized in truth maintenance of beliefs in complex and dynamically changing situations.

Implementing a Pluralistic Approach to Evaluation in Health Education

This article reflects upon why a pluralistic evaluation approach was adopted by the research team concerned with the evaluation of a regional alcohol education programme. The article describes why such an approach was adopted and then discusses some of the advantages and disadvantages that have been encountered. It is argued that such an approach enables an evaluation team to map and contextualise the differential accounts about progress and blockages which tend to be generated by such programmes.

Patient Turnover in a new Psychogeriatric Day Hospital: a Pluralistic Evaluation

ABSTRACTStudies designed to evaluate the services of a health or welfare institution face the major difficulty of selecting evaluative criteria to serve as measures of successful performance. This paper explores that difficulty in the context of a study of a new psychogeriatric day hospital. The study and its methods of data collection are described. ‘Patient turnover’ features prominently as a measure of success within the hospital. Consultants, nurses, general practitioners, social workers, staff of a related hospital and patients’ relatives interpret this measure in different ways and adopt different strategies to pursue ‘success’ in their own interests. These differences are described. The paper concludes that a ‘pluralistic evaluation’ has several advantages as compared to other approaches.