Nurse-managed clinics: issues in evaluation.
BACKGROUND: Nurse-managed clinics (NMCs) have been in existence for over 30 years. Evaluation of such clinics has been sparse and most have used entirely quantitative techniques. This article explores the importance of evaluation of NMCs using the Mana Health Clinic in Auckland, New Zealand as an example. DISCUSSION: Fourth generation evaluation is offered as an appropriate methodology for undertaking evaluation of NMCs. Fourth generation evaluation actively seeks involvement of clients in the process and outcome of the evaluation, resulting in participation and empowerment of stakeholders in the service - a precept often forgotten in traditional evaluation strategies and of vital importance in understanding why people use NMCs. The method proposed here also incorporates the need for quantitative data. CONCLUSION: The main argument proposed here is that a combination of qualitative and quantitative data sources is likely to give the greatest understanding of NMCs utilization. Evaluation of NMCs is vital to the continuation of this type of health service. However, evaluation must be appropriate to the service being studied. Fourth generation evaluation used to elicit client's perceptions of the clinic along with quantitative data is offered as an appropriate means of achieving this.