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Cancer nurses' assessment practice in the outpatient chemotherapy unit: a realist evaluation of the introduction of an assessment tool

Wilson, C. J. (2007). Cancer nurses' assessment practice in the outpatient chemotherapy unit: a realist evaluation of the introduction of an assessment tool. (Unpublished Doctoral thesis, City University London)


Assessment tools have been shown to increase the accuracy of professionals' assessment of patients (Heaven and Maguire 1997; Sollner et al 2001; Horton 2002; Hill et al 2003; Farrell et al 2005). Whilst structured assessment of patients with advanced cancer is recommended to enhance patients' experiences of illness and treatment and improve service provision to meet their needs NICE 2004, p24), little is known about the actual practice of using structured assessment tools. There is limited evidence that nurses have the skills required to use assessment tools. Evidence also suggests that nurses may be ill prepared and inadequately supported to deal with the consequences of more comprehensive assessment of patient need. This case study used realist evaluation to identify the impact of introducing a quality of life assessment tool in two outpatient chemotherapy units. Qualitative methods of non-participant observation, audio-recording, and individual interviews were used. 38 patients attending for palliative treatments and 10 nurses were recruited; 6 nurses completed all stages of the study. Data was collected in two phases with an interim period of training in between. In Phase 1, nurses assessed patients as usual. In Phase 2 the assessment tool was used. The nurse-patient assessment interaction was observed and tape-recorded. Interpretive interviews were conducted with nurses and patients to ascertain their perspectives of the assessment. Consistent with realist evaluation, data were analysed thematically to test and refine context-mechanism-outcome configurations. Social organisation as an underlying causal mechanism provided an explanatory framework for data analysis. Findings reveal that, prior to the introduction of the assessment tool, nurses' assessments were brief and treatment-related. After the introduction of the tool, assessments were patient-led, and focused on patients' experiences. Whilst patients valued this shift in focus, results demonstrate that the assessments were time-consuming and did not necessarily prompt appropriate multidisciplinary team referrals. The use of the tool was problematic for nurses, exposing them to emotionally challenging issues, and revealed gaps in their cancer and palliative care knowledge. These findings have been underplayed in recent policy and assessment guidance. Recommendations for practice, training and future research are made which may help to ensure that guidance is successfully rolled out in the future.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RT Nursing
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Nursing
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