Realist Synthesis of MD Practice Development in Scotland

1. A Realist Synthesis of Practice Development • Commissioned by NHS Education for Scotland/NHS Quality Improvement Scotland. • Intention to develop/inform the development of a Scotland-wide MD Practice Development Framework. • Being undertaken by University of Ulster/Manchester Business School/Queen Margaret University College, Edinburgh. • Two strands: • International Literature Review including grey literature • Telephone interviews (international)

2. Please send us your grey literature!! and/or • Would you like to participate in a telephone interview • Contact: brendan.mccormack@royalhospitals.n-i.nhs.uk or robert.garbett@royalhospitals.n-i.nhs.uk

3. National University of Ireland – University College Cork Development and Testing of the ‘Context Assessment Index (CAI) • Brendan McCormack, Professor of Nursing Research, Institute of Nursing Research, University of Ulster, NI (PI) • Geraldine McCarthy, Professor/Head of School of Nursing, University College Cork, RoI (PI) • Jayne Wright, Research Associate, Institute of Nursing Research, University of Ulster • Alice Coffey, Research Associate, School of Nursing, University College Cork, RoI • Paul Slater, Research Associate, Institute of Nursing Research, University of Ulster Project supported by a ‘cross-border’ grant from the NI DHSSPS R&D Office and the RoI Health Executive HRB

4. National University of Ireland – University College Cork Background • Project developed to understand the contextual factors that prevent the use of evidence underpinning incontinence management and continence promotion in services for older people. • Development of the tool indicated that it has relevance to other ‘issues’ other than continence.

5. National University of Ireland – University College Cork Methodology (1) PHASE 1: In-depth case study (2 sites comprising 7 clinical units): • Individual audit of 220 case records using the Royal College of Physicians (London) audit tool • Facility audit using the Royal College of Physicians (London) audit tool • Knowledge and skills assessment with all staff in the two case study sites (Irwin, 1998) • Observation of practice (32 hours): using Manley’s (2004) ‘indicators of an effective workplace culture’ and ‘Essence of Care Benchmark [continence] (DoH 2001) • Nurse Leadership: using NWI-R (Aiken & Patrician 2000 adapted by Slater & McCormack 2005) • Audit data analysed using SPSS and all data mapped onto a matrix developed from the PARiHS Framework and Manley’s ‘effective workplace culture’ indicators • Focus groups (multidisciplinary) to discuss themes • Discussion of themes and identification of questionnaire items by project team

6. National University of Ireland – University College Cork Methodology (2) PHASE 2: REFINEMENT AND TESTING OF THE CAI • Pre-pilot with convenience sample of continence link nurses – refinement of items (wording and number) • Pilot with 15 practice development nurses and continence nurse specialists from across the UK – refinement of items (wording and number) • Validity testing: Distribution of the CAI (82 item instrument) to 500 nurses drawn from a sample of nurses in all rehabilitation units on the Island of Ireland – refinement of instrument. • Reliability testing: test-retest approach with nurse leaders in 50 rehabilitation units drawn from a sample of rehabilitation units on the Island of Ireland –refinement of instrument

7. National University of Ireland – University College Cork Challenges • Isolating continence practice from other aspects of practice. • Tangibles and intangibles! • Competing discourses of context. • The impact of opinion leaders. • The usefulness of the CAI in practice development?

8. National University of Ireland – University College Cork Further Work • Test the instrument with other groups/clinical specialities