Realist evaluation: an immanent critique.

This paper critically analyses realist evaluation, focussing on its primary analytical concepts: mechanisms, contexts, and outcomes. Noting that nursing investigators have had difficulty in operationalizing the concepts of mechanism and context, it is argued that their confusion is at least partially the result of ambiguities, inconsistencies, and contradictions in the realist evaluation model. Problematic issues include the adoption of empiricist and idealist positions, oscillation between determinism and voluntarism, subsumption of agency under structure, and categorical confusion between context and mechanism. In relation to outcomes, it is argued that realist evaluation's adoption of the fact/value distinction prevents it from taking into account the concerns of those affected by interventions. The aim of the paper is to use these immanent critiques of realist evaluation to construct an internally consistent realist approach to evaluation that is more amenable to being operationalized by nursing researchers.