Nurse-led projects for people experiencing homelessness and other inclusion health groups: a realist evaluation
Nursing service development or innovation projects, even small-scale ones, can be difficult to deliver and evaluate, due to a lack of resources and support. Results can also be difficult to disseminate, limiting transfer of learning. This paper presents findings from a realist evaluation of 10 small projects supported by the Queen's Nursing Institute Homeless and Inclusion Health Programme to deliver innovation in health care for people experiencing homelessness and other marginalised groups. These nurse-led projects were funded by the Queen's Nursing Institute and the Oak Foundation, and were largely successful in achieving outcomes to support the improved health of people experiencing homelessness and other marginalised groups. This realist evaluation explores the factors that contributed to the delivery of positive outcomes. All were impacted by the context and the response (mechanisms) of people experiencing homelessness and staff within these settings. It is hoped that the lessons learned will enable better support for nurse innovation projects in the future.
In an area as complex as healthcare, it may seem a daunting task for an individual practitioner to make a difference in terms of improving healthcare services. Nevertheless, some organisations make small grants available to enable practitioners to experiment with or pilot ideas for service innovations and improvements. The hope with these will be that, if successful, the innovation will be adopted by mainstream services, either locally or further afield. However, such a result is dependent on a whole range of factors, varying from the willingness of the individual's employing organisation to welcome innovation to whether a project leader can find influential champions to advocate for the project's adoption.
To maximise the chances of wider adoption, it is essential that projects can demonstrate successful outcomes, which requires projects to be evaluated. The Health Foundation (2015) suggests that evaluation is concerned with:
‘… practical assessment of the implementation and impact of an intervention. It is conducted in a spirit of discovery, rather than management or monitoring. It is concerned with developing understanding and supporting more strategic judgement and decision-making, such as whether and how an intervention should continue, and continue to be funded.’
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