Aims of the Evaluation as per the Tender

The aims of the evaluation were informed by the objectives of the Tender set out by the HSE and included:

1. Evaluation of the HSE supported education programme in terms of:

a) Adherence to An Bord Altranais Requirements and Standards for Education Programmes for Nurse Prescribing of Ionising Radiation (An Bord Altranais 2008).

b) Evaluate programme participants’ preparedness for practice as a nurse prescriber of ionising radiation (fit for practice).

2. Evaluation of the implementation of HSE Guiding Framework by Healthcare Providers in terms of:

a) Establishment of Governance through Local Implementation Groups.

b) Impact of nurse prescribing of ionising radiation in clinical areas as quality improvement from the perspective of quality, access and cost.

c) Evaluation of the monitoring and audit procedures undertaken by healthcare providers and ONMSD (HSE).

3. Present findings and suggest recommendations through the Project Steering Group for consideration by the National Advisory Committee on the following:

a. Effectiveness of education programmes in developing a cohort of nurses competent in the role of nurse prescribers of ionising radiation.

b. Utility of the HSE Guiding Framework in supporting the continued implementation of nurse prescribing of ionising radiation in Ireland. c. Expansion of education programme and governance arrangements to

support nurse prescribing of ionising radiation in the area of children’s services.

3.3 Design of the Evaluation

The design of the evaluation is based on the theory underpinning evaluation research. Evaluation theory examines the effectiveness and merit of an intervention, in this case the implementation of nurse prescribing of ionising radiation in Ireland. Evaluation research may be carried out using quantitative methods, qualitative methods, or a combination of quantitative and qualitative methods (Creswell 1994, Weiss 1998). This study utilises a combination of qualitative and quantitative methodologies. This combination of a quantitative approach (survey questionnaires, audit of prescriptions) and qualitative approach (documentary analysis, and open-ended qualitative comments from the survey questionnaires) was used to add scope, breadth and comprehensiveness to the evaluation (Goodwin & Goodwin 1984, Creswell 1994, Weiss 1998, Dillman 2000, Drennan 2003).

3.4 Sample

Those who were involved in the nurse prescribing of ionising radiation initiative or had contact with prescribers were identified in the evaluation as stakeholders and were central to the evaluation process. Therefore the sample included, nurses (including prescribers and non-prescribers of medical ionising radiation), members of the medical and radiography professions, relevant regulatory bodies, hospital management, educators and patients and service users. In addition, the sample consisted of radiographic examinations requested by nurse prescribers of ionising radiation, the consultations associated with the request and the radiologists’ reports on the imaging requested.

3.4.1 Sample of Nurse Prescribers of Medical Ionising Radiation

At the time of the evaluation (i.e. postal surveys in August 2013), 164 nurses had completed educational programmes relating to the preparation of nurses for prescribing of medical ionising radiation in Ireland. The sample size was informed by best practice in survey research and included all registered nurses who had completed the medical ionising radiation prescribing educational programme at any of the following: The Regional Centre for Nursing and Midwifery Education, Regional Hospital, Tullamore, Co.

Offaly; the Regional Centre for Nursing and Midwifery Education, Connolly Hospital, Dublin; the School of Nursing and Midwifery, Trinity College Dublin; the School of Nursing, Midwifery, and Health Systems, University College Dublin and; St. James’s Hospital, Centre for Learning and Development. A sample frame of 164 nurses was created by the Health Service Executive, and this included 18 nurses who completed the programme in July 2013. Three programme participants could not be contacted (unknown addresses).

3.4.2 Sample of Patients

Patients who received a prescription for ionising radiation from a nurse were requested, following consultation, to complete a questionnaire which measured their level of satisfaction with the prescribing and consultation process. Eligibility for patient inclusion incorporated the following: 1) ability to understand English; 2) no evidence of cognitive impairment; 3) aged 18 years and older; 4) were not precluded from taking part in the survey due to their illness. Due to the ethical procedures associated with the study, patients were presented with the questionnaire and an information leaflet by the nurse prescriber of ionising radiation following the consultation in which the radiographic examination was requested. The patient was requested to fill in the questionnaire at a time suitable to them and to return the questionnaire directly to the research team. Patients were provided with a stamped addressed envelope to facilitate this process.

3.4.3 Sample of Stakeholders

This stage of the evaluation undertook a survey to ascertain key stakeholders’ perceptions of nurse prescribing of ionising radiation. Key stakeholders were defined as health professionals that had a specific interest, or were involved in the development of nurse prescribing of ionising radiation. Stakeholders surveyed included nurse clinicians, managers and administrators, radiographers, academics, medical doctors and members of Local Implementation Groups as well as key stakeholders in each of the relevant regulatory and policy bodies. The sample was identified through contact lists of key stakeholders involved in the development, initiation and governance of nurse prescribing of ionising radiation. Key medical, radiography and nursing stakeholders were identified from clinical sites where nurse prescribers of ionising radiation were currently practising. 3.4.4 Sample of Prescriptions Written and Consultations Completed

The units of analysis in this phase of the evaluation were radiographic images requested and consultations undertaken by nurse prescribers of ionising radiation. This sampling

procedure formed part of the audit component of the evaluation and explored the quality of the prescribing process.