Understanding the Factors that Influence the Effectiveness of Learning Disability Nursing Interventions: A Realistic Evaluation

Background: Across the United Kingdom, a specific field of nursing is commissioned whose role and function is to work in partnership with individuals with learning disabilities and their supportive carers to enable and collaborate with health services, the third sector, and private and public agencies to meet the evolving needs of a growing population. People with learning disabilities experience higher levels and different patterns of health needs compared to the general population. Registered learning disability nurses deliver specialist healthcare and support to people of all ages with learning disabilities. Aim: The evaluation was informed by the Realistic Evaluation model (Pawson and Tilley, 1997) to increase understanding and generate new insights into the factors that influence the effectiveness of interventions delivered by registered learning disability nurses in day-to-day practice. Methods: The evaluation was conducted in three phases. In phase one, a documentary analysis, semi-structured interviews and a focus group were conducted with key informants—policymakers and senior registered learning disability nurses to elicit the programme theory. In phase two, this theory was tested and refined using semi-structured interviews conducted with key informants—community learning disability nurses and people with learning disabilities. Phase 3 is the comparison with previous literature. Setting and participants: The setting for the evaluation was four health boards in the National Health Service in Scotland. In phase one, three policymakers and six senior registered learning disability nurses participated. In phase two, 10 registered learning disability nurses and 12 people with learning disabilities participated; overall, 31 participants took part in interviews or focus groups. A literature review and separate documentary analysis of 52 key United Kingdom documents was undertaken. Findings: Suited to evaluating complex interventions, realistic evaluation sets out to identify three fundamental components of an intervention, namely, context, mechanism and outcome. Supportive programme mechanisms included reasonable adjustments, a positive values base, building resilience, the therapeutic bond and relationships. Supportive programme contexts included; trust, advocacy, policy and leadership, risk, support and protection and therapeutic optimism. Programme outcomes included choice and informed decision-making, control and self advocacy, improved health and continued education, and a contribution to the evidence base. These programme theories are discussed in light of how they can enable registered learning disability nurses to develop a clearer understanding of how interventions work (or not), to effectively support people with learning disabilities.