The significance of exploring conceptual equivalence within the process of the cross-cultural adaptation of tools: The case of the Patient's Perception of Feeling Known by their Nurses Scale.

INTRODUCTION: The exploration of conceptual equivalence within the process of the cross-cultural adaptation of tools is usually neglected as it generally assumed that the theoretical construct of a tool is conceptualized in the same way in both the original and target culture. This article attempts to throw light on the contribution of the evaluation of conceptual equivalence to the process of adaptation, and for tool development. To illustrate this premise, the example of the cross-cultural adaptation of the Patients' Perception of Feeling Known by their Nurses (PPFKN) Scale is presented. DESIGN: An adapted version of the Sousa and Rojjanasrirat (Journal of Evaluation in Clinical Practice, 2011, 17(2), 268-274) guidelines was used to translate and culturally adapt the PPFKN Scale to Spanish language and culture. A qualitative descriptive study was added to the traditional process of translation and pilot study to explore the concept in the target culture and recognize conceptual equivalence. METHODS: Experts in the tool concept, bilingual translators and the author of the tool participated in the translation of the original tool into Spanish. A pilot study of the Spanish version with a sample of 44 patients and a panel of six experts from different fields evaluated its clarity and relevance. In addition, seven patients participated in a descriptive qualitative study using semi-structured individual interviews to explore the phenomenon in the new culture. A content analysis following the Miles, Huberman & Saldaña (Qualitative data analysis, a methods sourcebook, 2014) approach was used to analyze qualitative data. RESULTS: The cross-cultural translation and adaptation of the PPFKN scale into Spanish required a thorough revision. More than half of the items needed discussions to reach consensus regarding the most appropriate Spanish term. In addition, the study confirmed the four attributes of the concept identified in the American context and allowed for new insights within those attributes to appear. Those aspects reflected characteristics of the phenomenon of being known in the Spanish context and were added to the tool in the format of 10 new items. CONCLUSIONS: A comprehensive cross-cultural adaptation of tools should incorporate, together with the study of linguistic and semantic equivalence, the analysis of the conceptual equivalence of the phenomenon in both contexts. The identification, acknowledgment and study of the conceptual differences between two cultures in relation to a phenomenon becomes an opportunity for deeper study of the phenomenon in both cultures, for understanding of their richness and depth, and for the proposal of changes that may enhance the content validity of the tool. CLINICAL RELEVANCE: The evaluation of conceptual equivalence of tools within the process of cross-cultural adaptation will make it possible for target cultures to rely on tools both theoretically sound and significant. Specifically, the cross-cultural adaptation of the PPFKN scale has facilitated the design of a Spanish version of the tool that is linguistically, semantically and theoretically congruent with Spanish culture. The PPFKN Scale is a powerful indicator that evidences nursing care contribution to the patient's experience.

Nurses' Perceptions of the Clinical Nurse Specialist Role Implemented in a Highly Specialized University Hospital in Spain: A Qualitative Study.

PURPOSE/AIMS: To explore nurses' perceptions of clinical nurse specialist practice as implemented in a highly specialized university hospital in Spain. DESIGN: A descriptive qualitative study was carried out in 3 inpatient wards, with a clinical nurse specialist within the team, at a high specialized university hospital in Spain. METHOD: Semistructured interviews were conducted by purposive sampling with 17 selected nurses with at least 2 years of professional experience who voluntarily agreed to participate and signed the informed consent form. Analysis of the qualitative data was conducted according to Burnard's method of content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used. RESULTS: Four main categories emerged from the analysis of the data: "qualities of the role-holder," "role competencies in practice," "integration with the team," and "impact of the role" on nursing, the patient, and the organization. CONCLUSIONS: The findings of this study have interesting implications for the development and implementation of clinical nurse specialist practice in healthcare organizations. They also provide evidence of the benefit of implementing clinical nurse specialist practice for improving the quality of care, patient outcomes, and healthcare efficiency.

Experiences of frontline nurse managers during the COVID-19: A qualitative study.

AIM: To explore experiences of frontline nurse managers during COVID-19. BACKGROUND: The COVID-19 pandemic has complicated care provision and healthcare management around the world. Nurse managers have had to face the challenge of managing a crisis with precarious resources. Little research has been published about the experiences of nurse managers during the COVID-19 pandemic. METHODS: A qualitative descriptive study of 10 frontline nurse managers at a highly specialized university hospital in Spain was carried out. Semi-structured interviews were conducted between June and September 2020. The Consolidated Criteria for Reporting Qualitative Research checklist was used for reporting. RESULTS: Six themes emerged: constant adaptation to change, participation in decision-making, management of uncertainty, prioritization of the biopsychosocial well-being of the staff, preservation of humanized care and 'one for all'. CONCLUSIONS: This study provides evidence for the experiences of nurse managers during the COVID-19 pandemic. In addition, analysing these experiences has helped identify some of the key competencies that these nurses must have to respond to a crisis and in their dual role as patient and nurse mediators. IMPLICATIONS FOR NURSING MANAGEMENT: Knowing about the experiences of frontline nurse managers during the pandemic can facilitate planning and preparing nurse managers for future health disasters, including subsequent waves of COVID-19.

Unexplored Aspects of the Meaning of Living with Chronic Heart Failure: A Phenomenological Study within the Framework of the Model of Interpersonal Relationship between the Nurse and the Person/Family Cared for.

The complicated situation experienced by chronic heart failure (CHF) patients affects their entire well-being but clinical practice continues to fail to adequately respond to their demands. The aim of this study was to understand the meaning of living with CHF from the patient's perspective. A hermeneutic phenomenological study was conducted according to Van Manen's phenomenology of practice method. Individual conversational interviews were held with 20 outpatients with CHF. Six main themes emerged from the analysis: (1) Living with CHF involves a profound change in the person; (2) The person living with CHF has to accept their situation; (3) The person with CHF needs to feel that their life is normal and demonstrate it to others; (4) The person with CHF needs to have hope; (5) Having CHF makes the person continuously aware of the possibility of dying; (6) The person with CHF feels that it negatively influences their close environment.

Nurses' protocol-based care decision-making: a multiple case study.

AIM: To describe and explain nurses' protocol-based care decision-making. BACKGROUND: Protocol-based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol-based care decision-making. Understand this process is key to successful implementation. METHOD: A multiple embedded case study was carried out. Nurses' protocol-based care decision-making was studied in three inpatient wards (medical, surgical and medical-surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non-participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting. RESULTS: The multiple embedded case study revealed protocol-based care decision-making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost. CONCLUSION: This study has allowed progress in protocol-based care decision-making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol-based care. RELEVANCE TO CLINICAL PRACTICE: Strategies to promote protocol-based care should address the contexts of practice and the ability of professionals' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost.

Implementation and evaluation of a training programme to promote the development of professional competences in nursing: A pilot study.

BACKGROUND: Clinical narratives may be used as a means to improve the acquisition of clinical competences. Even though there are studies that recognize the potential value of clinical narratives to promote nursing professional development, there is no evidence that shows their value as a tool to improve nurses' competences to provide person-centred nursing care. PURPOSE: To evaluate the preliminary efficacy of narratives for the development of three nursing professional competences -respect, intentional presence and knowing the person- for providing person-centred care. METHOD: Using a pre-post quasi-experimental design, a pilot study with a total of 34 nurses enrolled in a training course of nursing specialization was conducted between September 2016 and June 2017. All the nurses received a multi-component intervention based on the Critical Reflective Inquiry model. The strategies of this programme consisted of writing three narratives, attending two masterclasses, participating in a discussion group, and participating in a face-to-face interview. The NarratUN Evaluation tool was used to assess the outcomes. Changes among nurses were analysed using the Wilcoxon signed Rank test. RESULTS: The difference in the means between the pre- and post-intervention scores were statistically significant for respect [0.59 (95% CI 0.23-0.95; p = 0.001)], intentional presence [0.75 (95% CI 0.32-1.17; p < 0.0001)] and knowing the person [0.62 (95% CI 0.25-0.99; p = 0.001)]. The difference in the mean score for use of the narrative and reflection also increased significantly [0.65 (95% CI 0.32-0.98, p < 0.001)]. CONCLUSIONS: The use of narratives combined with other reflective strategies (masterclass sessions and discussion groups) proved to be effective for the development of professional competences of nurses.

Nursing narratives and reflective practice: A theoretical review.

AIM: To explore the literature regarding how nursing narratives have been used to enhance reflective practice. DESIGN: Theoretical review. DATA SOURCES: A literature search from 1990 - 2017 was conducted in PubMed, CINHAL and PsycINFO databases. REVIEW METHODS: After applying the selection criteria, 13 studies were identified. The quality of articles was evaluated. RESULTS: Three themes were identified as the main components of an ongoing narrative process based on looking back to past clinical experiences, creating spaces for dialogue and bringing the worlds of theory and practice closer together. CONCLUSIONS: This review provides a forum for exploring the use of narratives to enhance reflective practice, which may lead to the acquisition of professional competences.

Transforming care in nursing: a concept analysis.

Although the concept of 'Transforming care' is promising for improving health care, there is no consensus in the field as to its definition. The aim of this concept analysis is to develop a deeper understanding of the term 'Transforming care' within the nursing discipline, in order to facilitate its comprehension, implementation, and evaluation. We performed a comprehensive literature review on electronic databases such as Medline (PubMed), Cinahl (Ebsco), Cochrane Library, PsycINFO (Ovid), Web of Science, Wiley-Blackwell, ScienceDirect, and SpringerLink and used Walker and Avant's approach to analyse the concept. From the 20 studies selected for this analysis, 3 main attributes of 'Transforming care' were identified: patient-centredness, evidence-based change, and transformational leadership driven. We suggest an operational definition to facilitate the implementation of the concept in practice. Furthermore, we propose that implementation is guided by the following key ideas: (1) fostering a culture of continuous improvement; (2) encouraging bottom-up initiatives; (3) promoting patient-centred care; and (4) using transformational leadership. Lastly, the evaluation of 'Transforming care' initiatives should assess care processes and professionals' and patients' outcomes.

The personal experience of living with chronic heart failure: a qualitative meta-synthesis of the literature.

AIMS AND OBJECTIVES: To determine, from a systematic literature review, the experience of living with heart failure and to propose some practice guidelines and research questions. BACKGROUND: Chronic heart failure has been one of the fastest growing illnesses in recent decades, with almost 23 million people affected worldwide. This complex syndrome has multiple causes and appears when underlying heart disease is advanced. Currently, heart failure has no cure and leads to a significant deterioration in patients' quality of life. DESIGN: Qualitative meta-synthesis. METHODS: A qualitative meta-synthesis was conducted to extract and analyse qualitative research from the Cochrane, PubMed, CINAHL, PsycINFO, Web of Science and Cuiden databases. Snowball sampling and a manual search were performed to identify other relevant studies. RESULTS: Twenty-five qualitative studies were selected. The findings indicate that there are three main themes that describe the phenomenon. The first theme refers to the experiences related to the beginning of the process. The second theme is connected with the effects on the person: physical, emotional, social and spiritual changes. The third theme is linked with how to live with heart failure despite the illness, including the adjustment and coping process and how external resources can help them to manage. CONCLUSIONS: Heart failure has a major impact on the entire person, but some areas have not been addressed. By creating new tools to understand and evaluate the impact of this illness and interventions that prevent or improve some situations, we can promote the well-being and the quality of life of this population. RELEVANCE TO CLINICAL PRACTICE: Nurses must have a personal knowledge of the experiences and needs of the patients. To do this, nurses should create care environments that promote an exchange of experiences and knowledge between the nurse and the patient and family.

Rol de las enfermeras en la notificación de reacciones adversas medicamentosas / Nursing role in reporting adverse drug reactions

FUNDAMENTO: La notificación espontánea de reacciones adversas a medicamentos por el personal sanitario, representa en la actualidad uno de los métodos básicos para la prevención y detección de nuevas y serias reacciones adversas a medicamentos comercializados. La participación de los profesionales de enfermería en esta tarea, permite mejorar la seguridad del paciente y disminuir gastos derivados de las mismas. Aun así, en Navarra en el año 2011 se realizaron un total de 781 notificaciones, de las cuales, apenas un 7,33%, fueron realizadas por enfermeras. Los objetivos planteados fueron: identificar los factores que influyen en la notificación enfermera y definir las estrategias que favorecen un aumento de la misma. MATERIAL Y MÉTODOS: Se realizó una búsqueda bibliográfica en las bases de datos PubMed y Cinhal de artículos que incluyeran las palabras: reacciones adversas medicamentosas, notificación y enfermería. Se obtuvieron inicialmente 107 artículos, de los cuales se seleccionaron 27, de acuerdo a los criterios de inclusión y exclusión. RESULTADOS: De la lectura y análisis de los artículos seleccionados se extrajo que, los factores que influyen en la notificación dependen de las actitudes del notificador y de factores personales y profesionales. Las principales estrategias para fomentar la notificación son: educación y formación, motivación y disponibilidad de herramientas facilitadoras. CONCLUSIONES: Los principales factores que influyen en la infranotificación son la falta de conocimientos y de motivación de los profesionales. Para solventar estos problemas las principales intervenciones parten de la educación, la motivación y la constancia

BACKGROUND: The spontaneous report system, in which suspected adverse drug reaction (ADR) are reported by healthcare workers, is currently one of the primary methods to prevent and discover new and serious ADR to marketed medicinal products. The collaboration of nursing professionals with this task makes it possible to improve patient safety and to reduce ADR costs. Although a total of 781 cases of ADR cases were reported in Navarra in 2011, only 7.33% were reported by nurses. The objectives werw to determine the factors that influence nurses in reporting of ADR, and second, to devise strategies which help to increase reporting. MATERIAL AND METHODS: A bibliographic search for articles that included the words: reacciones adversas medicamentosas (adverse drug reactions), notificación (reporting) and enfermería (nursing) was conducted using the PubMed and Cinhal databases. A total of 107 articles were retrieved, of which 27 were selected according to inclusion and exclusion criteria. RESULTS: The conclusion learned by reading and analyzing the selected articles was that the factors that affect the notification depend on the attitude of the notifier, as well as personal and professional factors. The main strategies to encourage notification are education and training, motivation, and the availability of facilitating tools. CONCLUSIONS: The main factors that have an influence on under-notification are the lack of knowledge and motivation among professionals. To solve the problem of under-notification, the main actions and strategies to undertake are education, motivation and persistence

[Nursing role in reporting adverse drug reactions]. / Rol de las enfermeras en la notificación de reacciones adversas medicamentosas.

BACKGROUND: The spontaneous report system, in which suspected adverse drug reaction (ADR) are reported by healthcare workers, is currently one of the primary methods to prevent and discover new and serious ADR to marketed medicinal products. The collaboration of nursing professionals with this task makes it possible to improve patient safety and to reduce ADR costs. Although a total of 781 cases of ADR cases were reported in Navarra in 2011, only 7.33% were reported by nurses. The objectives werw to determine the factors that influence nurses in reporting of ADR, and second, to devise strategies which help to increase reporting. MATERIAL AND METHODS: A bibliographic search for articles that included the words: reacciones adversas medicamentosas (adverse drug reactions), notificación (reporting) and enfermería (nursing) was conducted using the PubMed and Cinhal databases. A total of 107 articles were retrieved, of which 27 were selected according to inclusion and exclusion criteria. RESULTS: The conclusion learned by reading and analyzing the selected articles was that the factors that affect the notification depend on the attitude of the notifier, as well as personal and professional factors. The main strategies to encourage notification are education and training, motivation, and the availability of facilitating tools. CONCLUSIONS: The main factors that have an influence on under-notification are the lack of knowledge and motivation among professionals. To solve the problem of under-notification, the main actions and strategies to undertake are education, motivation and persistence.

Evaluación de una intervención enfermera para la educación para la salud en pacientes intervenidos de cirugía cardiaca / Evaluation of a nursing intervention for health training in cardiac surgery patients

OBJETIVO: evaluar una intervención para mejorar la preparación del alta del paciente intervenido de cirugía cardiaca. MATERIAL Y MÉTODO: estudio longitudinal cuasi experimental. Grupo control (GC): pacientes con cirugía cardiaca y tratamiento enfermero habitual; grupo intervención (GI): pacientes con cirugía cardiaca y educación sanitaria protocolizada antes del alta(Anexo I). Los datos del GC se recogieron en los meses previos a la introducción de la intervención en la práctica enfermera y los del GC a partir de los tres meses después de la introducción de la intervención. En ambos grupos se recabó información durante el ingreso para la intervención y un mes después de esta, coincidiendo con la fecha de la revisión. Mediante cuestionarios validados administrados por las investigadoras, se midieron en los pacientes la satisfacción con el cuidado, el nivel de conocimientos y el grado de adherencia al tratamiento, y en las enfermeras se midió el impacto de la introducción de la intervención en la práctica mediante un cuestionario ad hoc. RESULTADOS: la muestra de pacientes fue homogénea (GC= 20)y (GI= 23). La satisfacción de estos fue alta en ambos grupos con una puntuación media de 4,6 (en una escala del 1 al 5). Al mes del alta, se observó una mejoría significativa en los conocimientos del GI (GC= 0,22 (0,2) GI=-0,08 (0,31) p< 0,01)); mejoró significativamente el número de veces que realizan ejercicio a la semana en ambos grupos, el tiempo en minutos fue mayor en el GI. Las comidas ricas en colesterol disminuyeron considerablemente en ambos grupos (z= -0,905, p= 0,366). La satisfacción de las enfermeras con la educación al paciente antes y después de la intervención no fue significativa (z= -0,455, p= 0,115), aunque hubo una mejora considerable en los aspectos relacionados con los recursos disponibles para la educación en el grupo intervención. CONCLUSIONES: la intervención es efectiva en cuanto al nivel de conocimientos de los pacientes, aunque su efecto en el perfil de hábitos saludables no es tan notable. Este hecho puede deberse a la edad los pacientes o a que la modificación de hábitos precise de mayor tiempo

OBJECTIVE: to evaluate an intervention in order to improve the preparation for hospital discharge in cardiac surgery patients. MATERIALS AND METHODS: a quasi-experimental longitudinal study. Control arm (CA): Patients with cardiac surgery and regular nursing treatment; Intervention arm (IA): Patients with cardiac surgery and health education under protocol before discharge(Appendix I). CA data were collected during the previous months to the intervention in nursing practice, and IA data were collected since three months after introducing the intervention. In both groups, information was collected during hospitalization for the intervention and one month after, coinciding with the examination date. Through validated questionnaires applied by the researchers, the following were measured in patients: satisfaction with care, level of knowledge, and degree of treatment adherence; while the impact of the introduction of the intervention in practice was measured in nurses through an ad hoc questionnaire. RESULTS: the patient sample was homogeneous: (CA= 20) and(IA= 23). Patient satisfaction was high in both arms, with a mean score of 4.6 (on a scale of 1 to 5). At one month of discharge, a significant improvement in knowledge was observed in the IA (CA= 0.22 (0.2) IA= -0.08 (0.31) p< 0.01)); there was a significant improvement in the number of times both groups did some exercise per week, and the time in minutes was higher in the IA. There was a significant reduction in cholesterol-rich foods in both groups (z= -0.905, p= 0.366). Nurse satisfaction with patient education before and after the intervention was not significant (z= -0.455, p= 0.115), though there was a considerable improvement in those aspects associated with resources available for education in the Intervention Arm. CONCLUSIONS: the intervention is effective regarding the patients' level of knowledge, though its effect on their healthy habit profile is not so noticeable. This fact might be due to patient age, or habit modification may require more time

Implementing a computerized tool for shift handover report writing.

Communication failures have been identified as the main cause of safety-related incidents in patient care. Shift handover, as communication between two shifts of nurses about patients' situations, is important in the exchange of information. Automation and use of computer technology are considered key for more effective and standardized communication. The aim of the study was to assess nurses' perceptions of the use of a computerized tool for shift report writing in a teaching hospital in Spain. A comparative-descriptive study was carried out. A questionnaire was designed and distributed among nurses in hospital wards; 87 nurses (72%) completed the questionnaire. Most deemed the tool useful: it conveyed the most important information about the patient and enhanced the quality of the information, and a decrease in time needed for report writing was perceived by nurses. Surgical wards had a more positive perception than medical wards. In conclusion, nurses' perception of the use of a computerized tool for shift handover report writing was positive and acknowledged the pivotal role of computerization.

Nurses' perception of the use of computerised information systems in practice: questionnaire development.

AIM: To develop and validate a questionnaire to explore the perceptions of nurses about the implementation of a computerised information system in clinical practice. BACKGROUND: A growing interest in understanding nurses' experience of developing and implementing clinically relevant Information Technology systems and the lack of measurement tools in this area, justifies further research into the development of instruments to provide an insight into nurses' experience. DESIGN: Survey and questionnaire development. METHOD: An initial draft of the questionnaire was developed based on the literature and expert opinion. The questionnaire was piloted by ten nurses to check face validity, reliability and test-retest reliability. A revised version of the questionnaire was distributed to nurses working in the in-patient area of a university hospital in Spain (n = 227). Principal components analysis with oblique rotation was carried out to test theoretically developed underlying dimensions and to test construct validity. Cronbach's alpha coefficient was used to determine internal consistency. RESULTS: Cronbach's alpha for all the items included in the different scales was 0.88 in the pilot questionnaire and test-retest reliability was adequate. Principal components analysis of items related to mechanisms produced a three-component structure ('IT support', 'usability' and 'information characteristics'). The three factors explained 48.6% of the total variance and Cronbach's alpha ranged from 0.66-0.79. Principal components analysis of items related to outcomes produced a three factor solution ('impact on patient care', 'impact on communication' and 'image profile'). The factors explained 65.9% of the total variance and Cronbach's alpha ranged from 0.64-0.85. CONCLUSION: The study provides a detailed description and justification of an instrument development process. The instrument is valid and reliable for the setting where it has been used. RELEVANCE TO CLINICAL PRACTICE: The instrument could provide insight into nurses' experience of IT implementation that will guide further development of systems to enhance clinical practice.

A quantitative analysis of the impact of a computerised information system on nurses' clinical practice using a realistic evaluation framework.

OBJECTIVE: To explore nurses' perceptions of the impact on clinical practice of the use of a computerised hospital information system. DESIGN: A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. This is a theory-driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes (CMO) configurations. MEASUREMENTS: A questionnaire was distributed to all nurses working in in-patient units of a university hospital in Spain (n=227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), was used for cross-tabulation of variables searching for CMO relationships. RESULTS: Nurses (n=179) participated in the study (78.8% response rate). Overall satisfaction with the IT system was positive. Comparisons with context variables show how nursing units' context had greater influence on perceptions than users' characteristics. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. CONCLUSION: Results from the study looking at subtle variations in users and units provide insight into how important professional culture and working practices could be in IT (information technology) implementation. The socio-technical approach on IT systems evaluation suggested in the recent literature appears to be an adequate theoretical underpinning for IT evaluation research. Realistic evaluation has proven to be an adequate method for IT evaluation.

Review: evaluating information systems in nursing.

AIMS: To review existing nursing research on inpatient hospitals' information technology (IT) systems in order to explore new approaches for evaluation research on nursing informatics to guide further design and implementation of effective IT systems. BACKGROUND: There has been an increase in the use of IT and information systems in nursing in recent years. However, there has been little evaluation of these systems and little guidance on how they might be evaluated. METHODS: A literature review was conducted between 1995 and 2005 inclusive using CINAHL and Medline and the search terms 'nursing information systems', 'clinical information systems', 'hospital information systems', 'documentation', 'nursing records', 'charting'. RESULTS: Research in nursing information systems was analysed and some deficiencies and contradictory results were identified which impede a comprehensive understanding of effective implementation. There is a need for IT systems to be understood from a wider perspective that includes aspects related to the context where they are implemented. CONCLUSIONS: Social and organizational aspects need to be considered in evaluation studies and realistic evaluation can provide a framework for the evaluation of information systems in nursing. RELEVANCE TO CLINICAL PRACTICE: The rapid introduction of IT systems for clinical practice urges evaluation of already implemented systems examining how and in what circumstances they work to guide effective further development and implementation of IT systems to enhance clinical practice. Evaluation involves more factors than just involving technologies such as changing attitudes, cultures and healthcare practices. Realistic evaluation could provide configurations of context-mechanism-outcomes that explain the underlying relationships to understand why and how a programme or intervention works.