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Evaluation research in nursing and health care
In recent years health service managers and health care practitioners have shown a growing interest in evidence-based decision making. Consequently this has created a demand for good quality evaluation studies. Alan Clarke identifies the broad dimensions of health care evaluation and outlines the role evaluation plays in the context of nursing research
The closing decades of the 20th century witnessed a marked growth in the development and application of techniques designed to evaluate the performance of public sector institutions in the UK. Some commentators have referred to this as `the rise of the evaluative state' (Neave 1988). In the UK the National Health Service (NHS) quickly became subject to performance review procedures and processes. This is perhaps not surprising given the radical reorganisation of the management and delivery of health care services in the 1990s and the ever increasing costs of providing care. However, this is only part of a bigger picture, for as Marsland and Gissane (1992) assert, `health care world-wide has become a major arena of systematic evaluation research'.
Policy-makers, health service managers and health care practitioners are all involved, albeit in different ways and at different levels, in making decisions about the nature, organisation and delivery of services. As Gray (1997) observes, decision making in the health service is usually influenced by three sets of factors: the values held by those people responsible for making the decisions, the resources they have at their disposal and the evidence derived from research as to what constitutes good and effective practice. In Gray's view, much decision making is based on values and resources and is therefore `opinion-based'. However, the author adds, `as the pressure on resources increases, there will be a transition from opinion-based decision making to evidencebased decision making' (Gray 1997). Early signs of this transition are evident in the general call for evidence-based health care (Department of Health 1996) and, recently, the growing interest in evidence-based practice in medicine (Sackett et al 1996) and nursing (Flemming 1998). In this context, evaluation is seen as a way of providing information that can contribute to better-informed decision-making.
In addressing the role of evaluation in the field of health care this paper defines evaluation, identifies the broad...