Evaluating Nursing Interventions: A Theory-Driven Approach
Publication Year: 1998
The authors of this innovative book offer a comprehensive perspective on nursing intervention together with theory-driven guidelines for future study. They provide a clear explanation of the problems encountered in outcomes and intervention research and then proceed, via the Intervention Theory, to show how these studies can be undertaken reasonably and comprehensively.
- Front Matter
- Back Matter
- Subject Index
- Chapter n1: Introduction
- High-Quality Care: An Overview
- Requirements for Maintaining High-Quality Care
- Evaluating the Quality of Care
- Weaknesses of Outcomes-Focused Evaluation
- Organization of the Book
- Overview of the Illustrative Study
- Chapter n2: Outcomes Research
- The Conventional Approach
- Difficulties in Using the Conventional Approach in the Field
- Limitations of the Conventional Approach
- The Alternative: Theory-Driven Approach
- Chapter n3: The Theory-Driven Approach to Effectiveness Research
- Theory in Effectiveness Research
- Elements of Intervention Theory
- Sources of Theory
- Advantages of Intervention Theory
- Operationalizing the Theory-Driven Approach
- Chapter n4: Characteristics of Clients
- The Role of Client Characteristics
- Conventional Strategies for Dealing with Client Characteristics
- Alternative Strategies for Dealing with Client Characteristics
- Chapter n5: Intervener and Setting Characteristics
- Intervener Characteristics
- Setting Characteristics
- Chapter n6: Intervention Variables
- Characteristics of Interventions
- Conventional Strategies for Dealing with Type III Error
- Alternative Strategies for Dealing with Type III Error: Process Evaluation
- Chapter n7: Outcomes-Related Factors
- Characteristics of Outcomes
- Selection of Outcomes Variables
- Selection of Outcomes Measures
- Timing for Outcomes Measurement
- Illustrative Example
- Chapter n8: Implications for Effectiveness Research
- Advantages of Theory-Driven Evaluation
- Operationalizing the Theory-Driven Evaluation
To our families, mentors, and colleagues
Copyright © 1998 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Library of Congress Cataloging-in-Publication Data
Evaluating nursing interventions: A theory-driven approach/by Souraya Sidani and Carrie Jo Braden.
Includes bibliographical references and index.
ISBN 0-7619-0315-1 (cloth: acid-free paper).—ISBN 0-7619-0316-X (pbk.: acid-free paper)
1. Nursing audit. 2. Outcome assessment (Medical care). I. Braden, Carrie Jo, 1944-. II. Title.
99 00 01 02 03 04 10 9 8 7 6 5 4 3 2
Acquiring Editor: Daniel Ruth
Editorial Assistant: Anna Howland
Production Editor: Michele Lingre
Production Assistant: Karen Wiley
Typesetter/Designer: Yang-hee Syn Maresca
Cover Designer: Ravi Balasuriya
Print Buyer: Anna Chin
Evaluating the effectiveness of interventions in achieving the desired outcomes is a prerequisite for using interventions in clinical practice. To be able to implement a particular intervention and to use it appropriately in practice, clinicians require knowledge of the specific activities or components of the intervention, their related strength or dosage, the mechanisms underlying the intervention effects, the intervention's intended and unintended effects, the client population that would most benefit from the intervention, and the context in which the intervention is useful. In other words, clinicians need to know which intervention components, at which dosage, under what circumstances, and with which clients, result in which outcomes. This kind of information is essential for expanding the knowledge base for practice and for assisting clinicians in selecting and prescribing the most appropriate intervention to their clients.
Developing this kind of knowledge base for practice necessitates a change in the conceptual analysis and the methodology used in intervention effectiveness research. At the conceptual level, the change has to do with the assumptions underlying clinical effectiveness research. The notion that the intervention will produce the same response in all participants needs to be modified to allow for individual variations in response. Factors other than the intervention that are believed to influence the outcomes of an intervention should be identified a priori and incorporated in a theoretical [Page viii]framework that explains the mechanisms responsible for producing the desired outcomes. At the methodological level, the changes in conducting effectiveness research include judicious use of various types of research design to maximize the validity of the study conclusions when the study is conducted in a clinical setting where multiple extraneous factors have the potential of affecting the intervention outcomes, empirically examining the effects of extraneous factors such as client and setting characteristics on clients' response to treatment, examining the effects of the intervention at the individual or subgroup level, representing the various components of the intervention and the dosage received by the participants as the measure of the independent variable in the data analysis, and using different types of statistical approaches for analyzing the data. In short, the changes are directed toward a more comprehensive approach to effectiveness research for the purpose of developing clinically relevant knowledge that guides practice.
Our contention in this book is that the development of clinically relevant knowledge rests on identifying factors related to the intervention, the intervener, the clients, and the setting that influence the clients' response to the intervention and on determining the impact of these factors on outcome achievement. The identification and analysis of these factors' effects should be guided by the theory underlying the intervention. The intervention theory specifies the nature of the intervention, the nature of the effects expected of the intervention, processes mediating the expected effects, and the conditions under which the intervention processes take place. The intervention theory provides answers to the clinical questions about which intervention would be appropriate for what client population under which circumstances. The intervention theory directs the implementation of the intervention and all aspects of a study aimed at evaluating the effectiveness of the intervention in producing the desired outcomes. It forms the basis for selecting the study design, setting, sample, variables, and measures; for developing the treatment protocol; for formulating and carrying out the data collection procedure; for conducting the analyses; and for interpreting the results, whether favorable or unfavorable. Briefly, the intervention theory provides the rationale for the intervention and dictates research methods. In turn, findings of intervention evaluation research provide feedback for consolidating or refining the intervention. A close link between theory and research is essential for expanding knowledge.[Page ix]
The primary goals of this book are to present a comprehensive and in-depth analysis of the contribution of various factors to the validity of the study findings, to examine how these factors operate, to delineate the role of theory identifying and examining the effects of these factors, and to provide strategies for dealing with these factors successfully. Conventional strategies for dealing with these factors are reviewed and their limitations when used in the field settings are explained. Alternative strategies are suggested. The alternative strategies are geared toward operationalizing the theory-driven approach to effectiveness research that incorporates the conceptual and methodological changes needed for developing clinically relevant knowledge. Expanding clinically relevant knowledge is a means for reducing the gap between research and practice.
The book is intended to expand clinical effectiveness research methods available for investigators. The proposed research methods are most appropriate for evaluating the effectiveness of interventions or programs in practice, that is, under “real-life” conditions; the principles underlying these methods can also be used to guide the initial testing of the intervention efficacy under ideal conditions, however. The content of this book builds on basic intervention/program evaluation topics and addresses advanced issues in detail. The intervention evaluation methods covered in this book should be of interest to graduate students and to junior and senior researchers planning or conducting a study aimed at evaluating interventions. The book content pertinent to the factors that influence the outcomes expected of an intervention could assist investigators conducting meta-analyses examining the effectiveness of a particular intervention and clinicians reviewing or critically appraising the effects of an intervention in preparation for using it in their practice. Whenever possible, examples are provided to illustrate major points of discussion. Readers are strongly encouraged to think of their own work to put the issues discussed in a more familiar context. The book is designed to provide readers with the principles of effectiveness research methodology; we hope that readers will find them useful and will apply them in their own work.
The authors gratefully acknowledge the thoughtful comments and constructive feedback and suggestions offered by Diane Irvine and Lee Sechrest.
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