Evaluation and Policy in Transforming Nursing Martha Ann Carey, PhD, RN Kells Consulting, Media, PA, USA 1st International Nursing Conference Kuching, Sarawak, Malaysia 2014

Pressures From Advances in health sciences and technology Increased complexities in morbidities Complicated health care systems Changing women’s roles © Carey 2014

To Respond and Manage Change A broad perspective Global, national, regional Societal norms and expectations, beyond nursing Professional standards Local situation Organizational policies Resources © Carey 2014

Transforming or Evolving? 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 © Carey 2014

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 © Carey 2014

Programs Based on research, generally System level focus Environment & sustainability Cost benefit © Carey 2014

Practice Implementation at local level Possibly evaluation Monitor performance indicators Focus generally at the patient level © Carey 2014

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 © Carey 2014

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 © Carey 2014

Evaluation Formative and summative Evaluation and research - overlap Develop & refine useful practices (i.e., EBP) Evaluation and research - overlap Program evaluation & evaluation research Theories and models, in addition to traditional science methods © Carey 2014

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 © Carey 2014

Policy - Recent Emphasis Translation Links science, policies, and programs “Science to service”, “bench to bedside” Community, patient, and family involvement Models are being developed © Carey 2014

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

“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

National Academy of Science, 2014

Resistance to Change From nurses -“Old School/Old Guard” Seen as risky, not appropriate Questionable rewards Other professions - “turf” wars © Carey 2014

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 © Carey 2014

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 © Carey 2014

Balance Caring and Transforming

Terima Kasih

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 © Carey 2014

Power Point file at www.KellsConsulting.com © Carey 2014