Practice development: purpose,methodology, facilitation and evaluation

Different approaches to practice development are associated with different assumptions, and these need to be made explicit if practice development is to be transparent, rigorous and systematic in its intentions and approaches. A practice development methodology underpinned by critical social science is advocated because it focuses on achieving sustainable change through practitioner enlightenment, empowerment and emancipation and an associated culture, rather than focusing only on technical practice development. Implications of different worldviews about practice development for facilitation and outcome evaluation are highlighted. Emancipatory practice development underpinned by critical social science is argued as synonymous to emancipatory action research.     

Conference evaluation: development of an evaluation tool

The development and application of an evaluation tool based on Stufflebeam's model is described. This used the four areas of Context, Input, Process and Product as areas to evaluate. The tool was developed for the evaluation of an English National Board national study conference for Mental Health Nursing entitled 'Towards 2000', held at Ripon, 24-27 July 1989. A wealth of data, both quantitative and qualitative, was generated. The use of Stufflebeam's model for evaluation was found to be useful. However, a shorter evaluation form is needed for general use.     

Advanced practice nursing roles: development, implementation and evaluation

AIM: The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation. BACKGROUND: Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles. DISCUSSION: Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place. CONCLUSIONS: Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals.     

The spinal cord injury spasticity evaluation tool: development and evaluation

OBJECTIVE: To develop and assess the reliability and validity of a new scale designed to measure the impact of spasticity on daily life in people with spinal cord injury (SCI). DESIGN: Scale development and assessment. SETTING: General community. PARTICIPANTS: Community-dwelling persons with chronic SCI and spasticity participated in study 1 (n=9), study 2 (n=19), and study 3 (n=61). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Study 1: participant definitions of spasticity and list of scale items. Study 2: scale refinement, face validity, and time to complete. Study 3: internal consistency, test-retest reliability, and construct validity. RESULTS: The Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) is a 7-day recall self-report questionnaire that takes into account both the problematic and useful effects of spasticity on daily life in people with SCI. The scale exhibited good face validity and required 6.8+/-2.6 minutes to complete. The internal consistency (alpha) and intraclass correlation coefficient of the SCI-SET were .90 and .91, respectively. Construct validity was supported by correlations (r range, -.48 to .68; P<.01) between SCI-SET scores and theoretically meaningful constructs. CONCLUSIONS: The SCI-SET fills a need for a reliable and valid self-report measure of the impact of spasticity on daily life in people with SCI, taking into account both the problematic and useful effects of spasticity.     

Processes,outcomes and evaluation: challenges to practice development in gerontological nursing

When aligned to participants’ needs, evaluation may be used to enhance practice developers’ work. Process evaluation enables practice developers to evaluate as they develop; making evaluation an integral part of practice development rather than an ‘add on task’. It is contended that beginning practice developers can discharge their need to evaluate their work through the practice development techniques of critical reflection, dialogue and action learning. These form the basis of iterative and formative evaluation activity. However other types of evaluation are important for different audiences in practice development. Consideration of the purpose and utility of evaluation in a range of contexts in which gerontological nursing occurs, brings some clarity regarding the scope of the evaluation required to sustain practice development initiatives. In addition, it helps to clarify the nature of the evaluation required to provide evidence of patient‐centred outcomes from developments in the practice of gerontological nursing.     

Nursing development units: an opportunity for evaluation

The nursing development unit movement has recently generated a lot of financial and professional interest This is demonstrated by the large financial investment by the Department of Health, England, and the growing number of papers in the nursing literature The benefits of these units, however, are not as well documented This paper seeks to contribute to the debate by reviewing some of this literature and putting the movement in a historical perspective, discussing the purposes of the units, critically examining the characteristics of such units, evaluating their effectiveness, and suggesting a way forward for the future     

Introduction,development, and evaluation of the miniclinical evaluation exercise in postgraduate education of chiropractors

Objective

To determine if the clinical evaluation exercise (CEX) format is reliable, applicable and useful for evaluating clinical competency in the postgraduate chiropractic program as formative feedback.

Methods

Twelve mini-CEX clinical encounters were evaluated by 2 assessors per clinical encounter (7 assessors per session) in 23 chiropractic residents over a 12-month period. Two different rating scales (9 point and 5 point) were used, and the 2 assessors completed the forms independently. Individual competencies assessed consisted of history taking, physical examination, organization/efficiency, clinical judgment, professionalism/communication, counseling, and overall clinical performance. Interassessor reliability was calculated using κ and intraclass correlation coefficient statistics. Cronbach α assessed internal consistency of the mini-CEX. Spearman correlation coefficient evaluated correlation between the various competencies. The Mann-Whitney U test evaluated differences between the assessors'' median numerical scores.

Results

The κ value for the 9-point rating scale was 0.31 (fair) and for the 5-point scale was 0.42 (moderate) with statistically significant intraclass correlation values (p < .05) for 4 of the 6 competencies. High correlation coefficients (p = .0001) were found when comparing the various competencies at each clinical encounter. There were no significant differences between the 2 assessors per clinical encounter for the scores awarded to the residents.

Conclusions

The mini-CEX is a reliable and useful tool to provide valuable formative feedback to postgraduate chiropractic residents. The 5-point grading scale was more user-friendly with better reliability.     

网络无障碍的发展:政策、理论和方法

Internettechnologies,especiallytheWeb,havebeenchan gingsocietyineverypossibleway.Thenumberof"Netizens"is biggerthanthenumberofcitizensofanycountryorregion.In U.S.,72%ofadultsusedtheInternetbytheendof2005[1].In China,althoughthepercentageisnotcomparabletomanyde velopedcountries,thetotalnumberofonlineusershadreached90millionatthebeginningofyear2005,andisthenumbertwo countryintheworldintermsoftotalnumberofonlineusers[2].Tremendousamountsofpeopleareenjoyingtheproximityand conveniencebroughtbyth…