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Title: A realist evaluation of a safe medication administration education programme in the Republic of Ireland
Author: Browne, Freda
ISNI:       0000 0004 7652 3246
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2018
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Background: Continuing professional education (CPE) for nurses is deemed an essential component to develop, maintain and update professional skills and practice in order to ensure that nurses respond effectively to care requirements and provide a high standard of patient care. However, there is little empirical evidence of its effectiveness or factors which may influence its application into practice. This thesis explores a continuing professional education programme on the safe administration of medication and how new knowledge and skills are transferred into clinical practice. Design: Realist evaluation provides the framework for this research study. Realist evaluation stresses the need to evaluate programmes within "context," and to ask what "mechanisms" are acting to produce which "outcomes." The realist evaluation cycle for this study had four distinct stages. Firstly, I built initial theories as conjectured CMO configurations (Stage 1 and 2), then these CMO conjectures were tested (Stage 3) and then they were refined (Stage 4). Methods: Data was collected and analysed separately for each of Stages 1, 2 and 3. However, as realist evaluation is iterative, I often returned to a previous stage to clarify meaning or understanding. Document analysis and interviews were used in Stage 1 to commence the process of building CMO conjectures. Realist interviews took place in Stage 2 to refine the conjectured CMO configurations. Stage 3 involved the testing of the conjectured CMO configurations through three embedded case studies which involved interview, clinical observation, analysis of further documents and analysis of data from reported critical incidents and nursing care metric measurements. Findings: This study has shown the significant role of the ward manager in the application of new learning from the safe medication administration education programme to practice. Local leadership was found to enable a patient safety culture and the adoption of a quality improvement approach in the local clinical area. The multi-disciplinary team at both organisation and local level was also found to be a significant context for the application of the safe medication administration education programme into practice. Reasoning skills, patient identification and receptivity to change were identified to be key mechanisms which were enabled within the described contexts. The exploration of the context and mechanisms and their relationship allowed for further exploration of outcomes associated with the context and mechanism constructs. Recommendations: The conjectured CMO configurations put forward at the end of the thesis should be further tested utilising a different CPE programme. These theoretical propositions could inform policy and practice on the factors required to ensure learning from CPE is applied in practice. The realist evaluation framework should be applied when evaluating CPE programmes as the rationale for providing CPE programmes is to maintain and improve patient care.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Nurs.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: LC5201 Education extension. Adult education. Continuing education