Qualitative Evaluation Design Research Articles

Learning as a way of achieving quality improvement in long-term care: A qualitative evaluation of The Story as a Quality Instrument

Aim/ObjectiveThis study aimed to evaluate the use of the narrative quality instrument ‘The Story as a Quality Instrument’ (or SQI) for learning as a way of achieving quality improvement. BackgroundLearning is a widespread aim in long-term care. If professionals share detailed information about their views on the quality of care, they can see it from each other’s perspective and create a new joint perspective that may generate a broader meaning in total. One useful source for learning and improvement is the narratives of older adults. These narratives enable reflection and learning, which encourages action. In care organizations, there is a drive to find methods that can be used to facilitate learning and encourage quality improvement. DesignA qualitative evaluation design. MethodsData collection was performed in 2021–2022 at six field sites of four large care organizations providing long-term care to older adults in the Netherlands. At each field site, SQI was applied: an action plan was formulated in a quality meeting and, 8–12 weeks later, the progress was evaluated in a follow-up meeting. The data collected was participants’ responses during focus groups: the verbatim transcripts of both meetings and the observation reports of the researchers. 46 participants took part in the quality meetings and 34 participants were present at the follow-up meetings. The data was analyzed using thematic analysis. ResultsThe results are mechanisms that help learning, participant responses, and practical challenges and conditions. Four mechanisms became visible that encourage learning among participants for achieving quality improvements: in-depth discussions, exchange of perspectives, abstraction, and concretization. The participants listed several outcomes regarding individual learning such as change of attitude, viewing older adults more holistically and the realization that possibilities for working on quality improvement could be just a small and part of everyday work. Participants learned from each other as they came to understand each other’s perspectives. The added value lay in getting insights into the individual perceptions of clients, the concrete areas for improvement as an outcome, and getting a picture of the perspectives of diverse people and functions represented. Time was found to be the main challenge when applying SQI. ConclusionsSQI is deemed promising for practice, as it allows care professionals to learn in their workplace in a structured way from narratives of older adults in order to improve the quality of care.

Simulation as a joint learning activity in clinical placement-interaction between first-year nursing students and qualified nurses.

The purpose of the study was to explore students' experiences from joint simulation training with qualified nurses that took place in students' first-year placement at a nursing home. Nursing students' clinical placement in nursing homes has been pictured as inadequate, boring and irrelevant. There is a need for innovative learning designs that include increased collaboration between the educational institution and clinical placement site to support student learning in practice. Simulation training is highlighted as a learning activity that enhances practical skills and reflection. The study had a qualitative evaluation design to explore and capture students' experiences and provide an understanding of the impact of the joint simulation activity during placement. Three retrospective focus group interviews were conducted with a total of twenty nursing students. Written reflective notes from sixteen of the students were included in the study. The data were analysed by means of a thematic content analysis. COREQ reporting guidelines were used. Four themes were identified as follows: (a) anxiety and arrangements, (b) realistic scenarios-real nurses, (c) debriefing and reflection and (d) the aftereffect of the simulation training for the clinical placement. The joint simulation training gave the students an opportunity to actively participate in a complex clinical learning situation together with qualified nurses and within a safe environment. This learning activity provoked feelings and stress within the students. However, it also enriched the students' learning experience and strengthened the outcome of the clinical placement through an improved relationship between the students and qualified nurses. Creating collaborative learning activities between nursing homes and universities, such as joint simulation, can increase relevance and enhance learning and student satisfaction in their clinical placement. It can also promote nursing homes as interesting learning arena and future workplace for nursing students.

Effects of a Brief Mindfulness Intervention on After-Degree Nursing Student Stress.

This exploratory study investigated the effectiveness of a shortened version of an 8-week mindfulness-based stress reduction (MBSR) intervention with a small sample of after-degree nursing students for managing stress during their practicum. A qualitative evaluation design with a purposive criterion sample (n = 5) was used to investigate the impact of a Brief Mindfulness-Based Stress Reduction (MBSR-B) intervention on the experience of stress in after-degree nursing students. Thematic analysis of participants' narratives resulted in the identification of four categories: (a) hitting a reset button, (b) self-compassion, (c) avoiding a downward spiral, and (d) using an internal coping mechanism. These findings suggested a metatheme of self-awareness involving more efficient and effective detection and management of stress. The positive impact for participants in this study suggests that stress management for after-degree nursing students through the use of an MBSR-B intervention is worthy of nurse educators' consideration. [J Nurs Educ. 2019;58(3):165-168.].

A qualitative formative evaluation of a patient-centred patient safety intervention delivered in collaboration with hospital volunteers.

BackgroundEvidence suggests that patients can meaningfully feed back to healthcare providers about the safety of their care. The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect feedback from patients to support service improvement. The intervention is being implemented in acute care settings with patient feedback collected by hospital volunteers for the first time.ObjectiveTo undertake a formative evaluation which explores the feasibility and acceptability of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders.DesignA qualitative evaluation design was adopted across two acute NHS trusts in the UK between July 2014 and November 2015. We conducted five focus groups with hospital volunteers (n=15), voluntary services and patient experience staff (n=3) and semi‐structured interviews with ward staff (n=5). Data were interpreted using framework analysis.ResultsAll stakeholders were positive about the PRASE intervention as a way to support service improvement, and the benefits of involving volunteers. Volunteers felt adequate training and support would be essential for retention. Staff concentrated on the infrastructure needed for implementation and raised concerns around sustainability. Findings were fed back to the implementation team to support revisions to the intervention moving into the subsequent summative evaluation phase.ConclusionAlthough there are concerns regarding sustainability in practice, the PRASE intervention delivered in collaboration with hospital volunteers is a promising approach to collect patient feedback for service improvement.

Nursing students' spiritual talks with patients - evaluation of a partnership learning programme in clinical practice.

To evaluate the impact of a partnership learning programme designed to support undergraduate nursing students' competence in speaking with patients about spiritual issues. Spiritual care is an oft-neglected and underexposed area of nursing practice. Despite the increasing amount of research on spiritual care in educational programmes, little is known about nursing students' experiences with existential/spiritual talks and the process of learning about spiritual care in the clinical placement. The project used a qualitative evaluation design to evaluate the impact of a partnership-initiated intervention focusing on student learning of spiritual care in a hospital ward. Data were collected through three focus group interviews with bachelor of nursing students from one Norwegian university college and supplemented with notes. Data were analysed by means of qualitative interpretative content analysis. The intervention was found to enhance students' competence in spiritual talks. The students developed an extended understanding of spirituality, became more confident in speaking with patients about spiritual issues and more active in grasping opportunities to provide spiritual care. Participating nurses significantly contributed to the students' learning process by being role models, mentoring the students and challenging them to overcome barriers in speaking with patients about spiritual issues. The partnership learning programme proved to be a useful model in terms of enhancing students' confidence in speaking with patients about spiritual concerns. Collaboration between nursing university colleges and clinical placements could help nursing students and clinical nurses to develop competencies in spiritual care and bridge the gap between academic education and clinical education, to the benefit of both.

How should we train consultant appraisers? Description and evaluation of a pilot training model developed in Scotland

This paper outlines a model developed by NHS Education for Scotland to pilot consultant appraiser training. The training was aimed at both new/inexperienced appraisers and experienced appraisers. A Course for New/Inexperienced Appraisers was held over 2 days and the Experienced Course over 1 day. Both are described, as is an initial tutor induction day designed to recruit consultant tutors who could contribute to delivering the courses. A thorough qualitative evaluation of the courses was undertaken and this is reported. The paper also discusses the desirability and implications of rolling out the pilot on a wider scale. A qualitative evaluation design using interviews to collect feedback from participants who had attended all three courses - the Induction event, the Inexperienced Appraiser Course and the Experienced Appraiser Course - was employed. Telephone interviews were transcribed and analysed using framework analysis and aided by NVivo 7. The response of those interviewed for this evaluation of the three courses was very positive. The content, organization, skills of the tutors and usefulness of the courses were commended. Suggested improvements were relatively minor and included: introducing more material on the requirements of revalidation, more small group discussions and making the course more secondary care-orientated. However, it was recognized that with the requirements for 'enhanced' appraisal and revalidation still uncertain, this created difficulties and the course would evolve to take account of further developments. The training piloted represents an effective way to train consultants in appraisal skills. Interviewees were supportive of the pilot being continued: either nationally or cascaded down locally. Exactly what model is achievable and desirable will depend on the number of appraisers to be trained and the availability of resources to support 'enhanced' appraisal in secondary care.

Evaluation of the ‘Mealtime Magic’ brief leaflet-based intervention in general practice

AimTo assess current primary care childhood obesity prevention activity and experiences of general practitioners (GPs) and practice nurses in delivering the ‘Mealtime Magic’ brief intervention. To determine the acceptability of the brief intervention and reported impact upon confidence and behaviour of parents.BackgroundA gap persists in the evidence base regarding brief childhood obesity prevention interventions in primary care, where good opportunities for primary prevention work lie.MethodsA quantitative and qualitative evaluation design, without control group, with post-intervention evaluation of parental outcomes and ‘before and after’ evaluation of healthcare professional perspectives was employed, using questionnaires. Five primary care practices in Worcestershire, England took part: six GPs, seven practice nurses (11 females and two males). 110 of 223 parents receiving the intervention completed follow-up measures (107 females, two males and one gender unknown; 106 White British). The intervention involved providing the ‘Mealtime Magic’ leaflet regarding childhood healthy eating behaviours, with verbal reinforcement of three main messages, to all parents with children aged five years and younger presenting to primary care over a six-week period. Staff received a 30-minute training session.FindingsTwelve of 13 health professionals ranked childhood obesity of importance relative to other priorities. Secondary prevention activities were undertaken more frequently than primary prevention. All professionals found the intervention easy to deliver; 12 of 13 stated they would use the leaflet in the future. Reported professional confidence in knowledge of evidence-based healthy eating behaviour messages increased following intervention delivery. Resource barriers and perceived parental sensitivity with subject were reported. Ninety two percent (100/109) of parents stated the leaflet was helpful. Up to 52% (57/110) of parents reported more confidence regarding leaflet suggestions and up to 47% (49/105) reported positive behaviour changes. Evaluation of brief intervention approaches may help address perceived barriers to undertaking childhood obesity prevention work in primary care in the UK.

"Feel the fear and do it anyway": the hard business of developing Shared Governance.

The article provides an overview of recent lessons from the Shared Governance literature, a description of a 4-year evaluation study and a highlighting of important issues which emerge from this. Early UK Shared Governance implementation relied heavily on North American experience, but there is now a growing body of UK experience. The literature review draws upon evaluation research to date, provides a contextual description of the Shared Governance site and the approach adopted, together with a description of the quantitative and qualitative evaluation design used. The findings indicate that early problems had the most profound impact, that there were continuing chronic difficulties and that a number of important issues have subsequently emerged. The article concludes that there are some significant successes, but that Shared Governance implies cultural change, is subject to "fashion swings" and that there are practical limits to what can be achieved. Implementation means hard work but can produce worthwhile results.