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Type: Report
Title: Improving older people's care in one acute hospital setting: a realist evaluation of a KT intervention
Author: Kitson, A.
Wiechula, R.
Zeitz, K.
Marcoionni, D.
Page, T.
Silverston, H.
Publisher: School of Nursing, The University of Adelaide
Issue Date: 2011
Series/Report no.: Nursing Research Reports: 1
ISBN: 9780987212603
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Alison Kitson, Rick Wiechula, Kathryn Zeitz, Danni Marcoionni, Tammy Page and Heidi Silverston
Abstract: Background: Older people make up an increasingly large group using acute care facilities yet the nature of the care is often not conducive to their personal needs, wellbeing and recovery. This research explored how a structured intervention (called the KT Toolkit) could help frontline clinical staff improve the care for older people going through one acute hospital setting in South Australia. Methods/Design: The case study approach used draws on the overarching framework of realist evaluation, a methodology designed to test, refine and explain what is happening in complex situations. Seven parallel teams within the organisation selected one discrete clinical area each for improvement through the introduction of evidence based practice guidelines. Each improvement team’s progress was recorded using multiple data sources including ethnographic observations, semi structured interviews, document reviews and other routinely collected data on nursing care. Each of the seven journeys was analysed and synthesised according to the principles of realist evaluation where the role of the researchers (and stakeholders) is to elucidate what things work for which teams in what particular circumstances thus arriving at a set of explanatory statements. Results: Four broad mechanisms appeared to be affecting the way improvements were being introduced into the clinical areas by the seven different teams: building on existing structures and support; optimising existing human potential; focus on the older person and on-going support through facilitation. Within these mechanisms a range of different actions and behaviours were noted but collectively the teams were able to show how these mechanisms enabled them to make progress in improving discrete aspects of care for their older patients. Conclusions: The use of realist evaluation as the overarching methodological framework enabled the research team to document and interpret the complex interactions happening at the level of everyday practice. Such interpretations enabled the research team to engage the clinical teams and work with them on on-going improvements. We found that even trying to improve the so-called simplest of aspects of care (e.g. weighing patients as part of nutritional care) was fraught with challenges. Also, our use of the realist method raised a number of theoretical and methodological questions that need further refining and in particular how realist evaluation relates to knowledge translation (KT) conceptual frameworks.
Keywords: KT intervention; realist evaluation; facilitation; older people; acute care
Rights: © 2011 Alison Kitson, Rick Wiechula, Kathryn Zeitz, Danni Marcoionni, Tammy Page and Heidi Silverston
RMID: 0030001001
Appears in Collections:Nursing research series
Nursing publications

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