‘For Want of a Nail’: developing a transparent approach to retroduction and early initial programme theory development in a realist evaluation of community end of life care services

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Change is an identifiable in: curative to palliative to EoL care dying into death and the stages of death (somatic-cellular-post-mortem) social death to bodily death (what Frogatt (2001) calls ‘sequestration’) transition of the space and place of ‘home’ over dying and death period change of caregiver/patient relationship/roles Managing these changes require differing resources: physical +/economical +/social +/cultural The Transitions Theory model includes two phases: 1. Understanding (the service user) and 2. Intervention (the programme design/strategy). Phase One- Understanding most appropriate to ‘theory gleaning’ and includes: change triggers – what kicks off the transition? properties – what are the commonalities of the transition period? conditions – what we are some of the identifiable contexts and resource mechanisms? patterns of response – what are potential reasoning mechanisms and outcomes?

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For Want of a Nail For want of a nail the shoe was lost. For want of a shoe the horse was lost. For want of a horse the rider was lost. For want of a rider the message was lost. For want of a message the battle was lost. For want of a battle the kingdom was lost. And all for the want of a horseshoe nail.

Frogatt, K. (2001). Life and death in English nursing homes: Sequestration or transition? Ageing and Society, 21(3), 319–332. https://doi.org/10.1017/S0144686100100825x

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