An analysis of policy to practice developments in nursing, midwifery and allied health professions within Scotland from 2005 to 2010.
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In the new millennium the Scottish government has been seeking effective practice developments in Nursing, Midwifery and Allied Health Professions (NMAHPs) through setting up numerous policy initiatives to improve patient care both directly and indirectly. Despite the fact that many of these initiatives have been subject to individual commissioned evaluations, to date, no systematic integrative study has been carried out in Scotland. This thesis addresses this deficit with the aim of constructing better understanding of key lessons and issues in regard to policy contexts, processes and outcomes. Based on a constructivist approach and case study methodology, this study consists of: critical review of literature in relevant cognate areas; critical review of selected commissioned reports and other documentary analysis; case studies of four selected policy initiatives using twenty four in-depth semi-structured interviews; and integrative analysis and synthesis featuring framework analysis and application of relevant theoretical perspectives to enable explanation. At micro level this has provided insight into how and why selected policy initiatives were developed and implemented, based mainly on the perspectives of the various participants involved in the policy initiatives. At macro-level, cross case study enabled identification of key generic lessons such as policy internal and external alignment, good leadership at all levels and effective communication. In doing so the thesis also illuminates relationships between clusters of policy initiatives and their continuous development. In particular, a new explanatory model of policy to practice change has also been developed in this thesis, building from relevant theoretical perspectives and empirical research. The thesis suggests that the new model will be useful for the analysis of policy through to practice both from ‘top down’ and ‘bottom up’ perspectives. Finally, the findings have significant implications for future policy, education, practice and research. The thesis concludes with a summary of its contributions and related recommendations.