Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: perspectives of doctors, nurses and optometrists

Read, Simon, Morgan, James ORCID: https://orcid.org/0000-0002-8920-1065, Gillespie, David ORCID: https://orcid.org/0000-0002-6934-2928, Nollett, Claire ORCID: https://orcid.org/0000-0001-6676-4933, Weiss, Majorie ORCID: https://orcid.org/0000-0001-8065-4108, Allen, Davina ORCID: https://orcid.org/0000-0002-6729-7502, Anderson, Pippa and Waterman, Heather ORCID: https://orcid.org/0000-0001-7052-2734 2021. Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: perspectives of doctors, nurses and optometrists. PLoS ONE 16 (8) , e0255564. 10.1371/journal.pone.0255564

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Abstract

Background Normalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that ‘plasticity’ of intervention components and ‘elasticity’ of an intended setting contribute. We report on the introduction of a clinical pathway assessing patient non-responsiveness to treatment for glaucoma and ocular hypertension. The aim of this study was to assess the feasibility of implementing the Cardiff Model of Glaucoma Care into hospital eye services, identifying any issues of acceptability for staff through the filter of normalisation process theory. Methods A prospective observational study was undertaken in four hospital eye services. This incorporated detailed qualitative semi-structured interviews with staff (n = 8) to gather their perceptions on the intervention’s usefulness and practicality. In addition, observational field notes of patient and staff consultations (n = 88) were collected, as well as broader organisational observations from within the research sites (n = 52). Data collection and analysis was informed by the normalisation process theory framework. Results Staff reported the pathway led to beneficial knowledge on managing patient treatment, but the model was sometimes perceived as overly prescriptive. This perception varied significantly based on the composition of clinics in relation to staff experience, staff availability and pre-existing clinical structures. The most commonly recounted barrier came in contextually integrating into sites where wider administrative systems were inflexible to intervention components.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Healthcare Sciences Optometry and Vision Sciences Pharmacy Centre for Trials Research (CNTRR)
Subjects:	H Social Sciences > H Social Sciences (General) H Social Sciences > HM Sociology R Medicine > R Medicine (General) R Medicine > RE Ophthalmology
Publisher:	Public Library of Science
ISSN:	1932-6203
Funders:	Health and Care Research Wales
Related URLs:	Publisher
Date of First Compliant Deposit:	9 August 2021
Date of Acceptance:	20 July 2021
Last Modified:	23 May 2023 17:45
URI:	https://orca.cardiff.ac.uk/id/eprint/143107

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