Some answers were not relevant e.g. the problem is even getting nurses time to read the notes.
4 (6.55%) participants' answers related to performance appraisal [5, 29, 32, 60] . 2 (3.27%) participants made reference to specific audits (documentation and IV). [ 17, 2 1 ] and 1 ( 1 .63%) to peer review [3] .
1 participant stated there was no review [25]
Non commital
7 ( 1 1 .47%) participants gave non committal answers:
It's an interesting phenomena about that. I expect [X] might get round to doing that in due course [2]
I think in general most things get evaluated formally or informally and some things definitely get formally evaluated [9]
Well it 's probably something we, we 're looking at through the leading edge, you know 2000 project in terms of this . . . I'd say we haven 't formally evaluated in the past [ 1 0]
There 's probably no major all encompassing evaluation. There 's been evaluation in individual areas. We 're looking at the whole delivery of nursing care and making recommendations how things might be done differently [ 1 6]
I think health care has to re-evaluate how nursing is practising at the moment [35] I think it's time we stood back and looked closely at that [39]
For each professional group you 've got to respect their particular needs. We need to keep evaluation alive and well [40]
Work done or being done
6 ( 9.83%) participants commented on work done or being done:
A number of studies have looked at activity analysis-in parts. Tracked patient processes, patient flow [Other regular activities listed but not nursing specific] [ 14] Now there 's a constant ongoing review [of the service, including nursing] . We know structurally the whole system will change with the redesign project [20]
We 're looking to see if the nursing acuity system matches the reality on a practical basis [sees NCDS as part of PCDS so no separate evaluation] [ 1 5]
Using the new information system which is focussed on giving good information about what nurses do, where they do it, and that sort of thing [50]
There was a huge study. My information is that it showed more resources were needed and never got off the ground [5 1 ]
We 've now got all the promised policies and standards and they are up and running [59]
Answers indicated that participants did not consider planned, systematic and ongoing evaluation of the NCDS [however this is interpreted] a priority. Participants did not appear to clearly distinguish between reviewing, auditing, monitoring and evaluation.
Not evaluated
7 ( 1 1 .47%) participants believed it was not evaluated or evaluated against the contract:
Bugger all at the clinical leve!. At the contracting level all the energy is being put in there [3 1 ]
Only evaluated against the contract [33]
The system has never been evaluated [44]
They 've never sat down to say 'What are you actually doing ?' [45]
Not nursing. But nurses have been evaluated. But the structure of nursing, the processes involved with nursing, no [8]
We haven 't put in the system yet so we haven 't got an evaluation plan. Some is being evaluated by the RHA [7]
There 's not a regular system for evaluating nursing care. It 's ad hoc, as necessary [23]
Reviews/audits
5 (8. 1 9%) participants mentioned audits or reviews
We had an outside expert come and look at [review] our system [4 1 ]
We 're just starting to set up some formal audits of care plans, patient satisfaction surveys [46]
There 's been a major review [48]
The auditor is auditing everybody. He asks questions like "why is there six of you " ? . . . " Why don 't you just get at team of relievers " [37]
Problems identified
6 (9.83%) participants identified problems: Nurses always do informal checking [26]
It 's just being evaluated basically on a crisis point-but again I make the point that evaluation is really about how we use resources .. . and there is a big problem with nurses not wanting to see that wider issue [27]
It's all financially driven [43] and Evaluation is financially based [22]
Each year is evaluated separately so you have no idea if you are dealing with the same people [patients] or not [ 1 9]
As for the nurses I set objectives but you don 't actually know if it's being effective or not [ 1 9]
Remaining
They 're fairly traditional in the way they do things and they need to be a bit more critical [3]
That 's what most nurses would consider the usual way of doing things so they just fit in without questioning if it is best or not [6]
We 're evaluating all the resource issues but I refuse to eva1uate practice issues until we are a little further down the track. But we need to. We need to do a piece of research and see what happened. They leaped to evaluate it very quickly because it [new structure] created a lot of resource issues [ 1 2]
We 've come afair way in shaking the tree and seeing what falls out [ 1 3]
The answers of 4 participants offer some insight into the reasons for the lack of planned, systematic and ongoing evaluation.
No-one seems to know if recent [last 2 years] structural changes to nursing have resulted in changes in nursing delivery [X]
Structural change was not linked to nursing care delivery.
As moving to a new system beginning to recognise that a great deal is not known about how nurses actually work. [X] .
A new system was put in place without being preceded by evaluation o f the old. My attitude is that it 's really up to the nurses to decide what overall philosophy they want to adopt and how they want to go about things [X]
This CEO participant had not delegated authority and responsibility for the nursing service to a nurse executive.
No-one 's spoken to me. No, that 's not right one consultant did speak to me [X] This nurse was the most senior staff member on duty at night in a busy hospital.
All participants were senior staff members. It could be expected that all would have a significant role to play in the ongoing evaluation of the care delivery. That they did not supports the view that, at the time of the interviews, nurses and executives did not see the need to work together to evaluate the effectiveness of care delivery. Nor do they seem to have perceived a need to establish a baseline effectiveness of present systems before introducing changes.