Action research from the inside: issues and challenges in doing action research in your own hospital

Implementing Oncologic Nursing Care Plans in Electronic Health Records With Two Taxonomies: A Pilot Study

BACKGROUND

Nursing care plans document the nursing process, displaying actions, and illustrating expected outcomes. Their integration into electronic health records (EHRs) is critical for accurate documentation, enhanced by standardized nursing terminologies that promote communication, critical reasoning, and patient safety through consistent language for information.

OBJECTIVE

This study aimed to identify appropriate standardized nursing terminology tailored to the context of a Northern Italian Cancer Center and research facility for developing nursing care plans and starting their integration into institutional EHRs.

METHODS

Participatory action research was conducted to select proper terminology respecting the oncological setting, develop nursing care plans, and start their implementation in EHRs. The nursing team of a pilot ward collaborated closely with the researchers as coresearchers. Care plan samples were presented using the North American Nursing Diagnosis Association-International Nursing Intervention Classification, Nursing Outcomes Classification, and International Classification for Nursing Practice (ICNP) in the test section of the EHRs to gather nurses' preferences. Quantitative data collection, focus groups, and survey analyses were conducted.

RESULTS

Nurses chose the ICNP for its flexibility but sought better methods to define patient severity in assessments and outcomes. They suggested incorporating the Common Terminology Criteria for Adverse Events to enable context-sensitive care plans.

CONCLUSIONS

End-user involvement is essential for developing EHRs, enhancing system usability, and reducing implementation resistance. Including nurses in management decisions empowers them, and improves care quality.

Ready, Set, Sort! A User-Guide to Card Sorts for Community-Engaged Empirical Bioethics

We demonstrate the fruitfulness of using card sort activities as an engagement method by detailing community consultation for ethical, legal, and social implications of sociogenomics. Readers are provided with a user-guide for card sort engagement through: (1) an overview of the card sort activity and its merits for engagement, (2) detailed methods of sorting for values-elicitation and prioritization goals, and (3) strategies to design this approach for other participatory research designs. Our intent is to add to meaningful exchanges between community engaged researchers and empirical bioethicists.

Starting continuous improvement; creating a common understanding of stroke care delivery in a general hospital

BACKGROUND

Continuous improvement is based on fostering practitioners' suggestions to modify their own work processes This improvement strategy is widely applied in healthcare but difficult to maintain. The cross-disciplinary nature of many care processes constitutes an extra impediment.

METHODS

The study had an explorative design with a qualitative single-case approach. The case presents a project to improve the treatment of patients with thrombotic stroke. Data was obtained via hands on involvement, documents, observations, and interviews with participants in a cross-functional improvement group. A thematic analysis method was employed.

RESULTS

Through learning how tasks were carried out in other disciplines, the participants developed a common understanding of why it took so long to provide treatment to stroke patients. These insights were used to implement practical changes, leading to immediate improvements in stroke care delivery. The results were fed back so that successes became visible. Participants' understandings of the local context enabled them to convince peers of the rationale of changes, setting in motion a permanent improvement structure. The participants considered that mapping and then assessing the entire workflow across disciplines were relevant methods for improving the quality of patient care.

CONCLUSION

Starting an improvement project in a cross disciplinary environment requires deep engagement on the part of professionals. A quintessential prerequisite is therefore the realization that the quality of care depends on cross-disciplinary cooperation. A facilitated learning arena needs to (1) create insights into each other's colleagues' tasks and process interdependencies, (2) increase understanding of how the distribution of tasks among specialist units affects the quality of care, and (3) frequently report and provide feedback on results to keep the process going.

Picking the "Proper Hat?" Emerging Ethical Dilemmas while Juggling Nursing and Research Roles

AIMS

To explore ethical dilemmas inherent in two potentially conflicting roles: practicing nurse and researcher.

BACKGROUND

Ethical guidelines for practice and research in nursing have been widely discussed. Yet examining ethical dilemmas that emerge from engaging in the dual role of nurse-researcher is rare.

METHOD

A qualitative approach was employed, using semi structured interviews with 15 nurse-researchers. Data were analyzed using thematic analysis.

RESULTS

One theme emerged with three subthemes of nurse-researcher role definitions: primarily nurse, primarily researcher, and combined nurse-researcher. Each subtheme had three dimensions: (a) how ethical dilemmas were expressed in encounters with role colleagues, (b) coping strategies, and (3) implications for nurse-researchers.

CONCLUSION

Primarily nurses or primarily researchers experienced conflict in encounters with role colleagues, developed less effective coping strategies, and reported impaired well-being. Conversely, combined nurse-researchers said each role nourished the other.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing policymakers and managers should support the nurse-researcher role by developing a code of ethics that acknowledges the dual role's inherent dilemmas, assimilate organizational routines and roles that support nursing research, and encourage forums for discussing staff dilemmas.

Knowing-in-action that centres humanising relationships on stroke units: an appreciative action research study

Background:

Equal, collaborative and therapeutic relationships centred on the person affected by stroke are important for supporting recovery and adjustment. However, realising these relationships in hospital practice is challenging when there is increasing focus on biomedical needs and organisational pressures. Despite a body of evidence advocating for quality relationships, there remains limited research describing how to achieve this in clinical practice. This appreciative action research (AAR) study aimed to describe the processes involved in co-creating meaningful relationships on stroke units.

Design and methods:

An AAR approach was used to develop humanising relationship-centred care (RCC) within two hospital stroke units. Participants were staff (n = 65), patients (n = 17) and relatives (n = 7). Data generation comprised of interviews, observations and discussion groups. Data were analysed collaboratively with participants using sense-making as part of the AAR cyclical process. Further in-depth analysis using immersion crystallisation confirmed and broadened the original themes.

Findings:

All participants valued similar relational experiences around human connections to support existential well-being. The AAR process supported changes in self, and the culture on the stroke units, towards increased value being placed on human relationships. The processes supporting human connections in practice were: (i) sensitising to humanising relational knowing; (ii) valuing, reflecting and sharing relational experiences with others that co-created a relational discourse; and (iii) having the freedom to act, enabling human connections. The outcomes from this study build on existing lifeworld-led care theories through developing orientations for practice that support relational knowing and propose the development of RCC to include humanising values.

A Little Less Conversation, a Little More Action: Participatory Insider Action Research in an Executive Team

In this paper, we describe a Participatory Insider Action Research (PIAR) intervention within the Executive Committee (EC) of a large publicly funded service for people with intellectual disabilities. I was a member of this EC and had been for 20 years. The intervention ran over a two-year period and comprised three cycles of PIAR. We addressed two specific organisational issues but our work did not deliver change in these areas in a substantial sense. We identify power dynamics and role duality challenges as the core factors that contributed to this outcome and describe their effects in this under-researched domain. We finish by offering some advice for future researchers undertaking initiatives of this nature.

A model six-month workshop for developing systematic review protocols at teaching hospitals: action research and scholarly productivity

BACKGROUND

Research engagement contributes to the improvement of patient care. A systematic review is a suitable first scholarly activity because it entails summarization of publicly available data and usually requires neither rigorous ethical review nor research funding.

METHODS

This study aimed to develop a model workshop for healthcare staff to acquire skills in creating systematic review protocols based on their own clinical questions at teaching hospitals. We used an action research method to create a model workshop at four hospitals in Japan from April 2015 to March 2017. To improve the program, we solicited reflections using participant questionnaires for each lecture and examined the quality of homework submitted by participants after each lecture. We administered a revised final version of the workshop at five hospitals from April 2016 to March 2017. We evaluated the participants' scholarly productivity related to these workshops. The observation period was a minimum of 2 years following the workshops.

RESULTS

Most participants had never developed a formal clinical research protocol and voluntarily participated in the workshop. The action research was developed and implemented at nine teaching hospitals in Japan, including one university hospital. The study developed a model nine-step workshop curriculum: 1) Research question development, 2) Search strategy development, 3) Search strategy brush-up, 4) Exclusion and inclusion criteria development, 5) Risk of bias assessment planning, 6) Meta-analysis planning, 7) Subgroup and sensitivity analysis planning, 8) Planning the presentation of results, and 9) Presentation protocols. A total of 233 participants, including medical doctors and other health professionals, produced 414 research questions. Seventy-nine participants (34%) completed the workshop, and 47 review teams accomplished systematic review protocols. The participants published 13 peer-reviewed articles as a result of the workshop.

CONCLUSIONS

We developed a structured scholarly productive model workshop for healthcare staff working at hospitals. We found healthcare staff with clinical subspecialties were able to develop an unexpectedly high number of research questions through this workshop. Medical teachers at hospitals with prior systematic review experience could teach how to develop systematic review protocols using this model. Further research is needed to increase the academic productivity of such workshops.

TRIAL REGISTRATION

UMIN (https://www.umin.ac.jp/ctr/), UMIN000017107 (4/15/2015), UMIN000025580 (1/10/2017).

"Starting from a higher place": linking Habermas to teaching and learning clinical reasoning in the emergency medicine context

Teaching clinical reasoning in emergency medicine requires educators to foster diagnostic accuracy and judicious decision-making amidst chaotic ambient factors including clinician fatigue, high cognitive load, and diverse patient expectations. The current study applies the early work of Jurgen Habermas and his knowledge-constitutive interests as a lens to explore an educational approach where physician-educators were asked to make their expert reasoning visible to emergency medicine trainees, to more deliberately make visible and accessible the context-specific thinking that emergency physicians routinely use. An action research methodology was used. The 'making thinking visible' teaching approach was introduced to five emergency medicine educators working in large public hospital emergency departments. Participants were asked to trial this teaching method and document its impact on student learning over two reporting cycles. Based on written reports of trialing the teaching approach, participants identified a need to change from: (1) introducing thinking structures to cultivating enquiry; and, (2) providing explanations based on cognitive thinking routines towards encouraging the learner to see the relevance of the clinical context. Educators described how they developed a more diagnostic and reflexive approach to learners, recognized the need to cultivate independent thinking, and valued the opportunity to reflect on their usual teaching. Teaching clinical reasoning using the 'making thinking visible' approach prompted educators to decrease the emphasis on providing technical information to assisting learners to understand the purposes and meanings behind clinical reasoning in emergency medicine. The knowledge-constitutive interests work of Jurgen Habermas was found to provide a robust framework supporting this emancipatory teaching approach.

Reducing medication errors using lean six sigma methodology in a Thai hospital: an action research study

Purpose

The purpose of this paper is to illustrate the use of Lean Six Sigma (LSS) and its associated tools to reduce dispensing errors in an inpatient pharmacy of a teaching hospital in Thailand.

Design/methodology/approach

The action research methodology was used to illustrate the implementation of Lean Six Sigma through the collaboration between the researcher and participants. The project team followed the Lean Six Sigma Define, Measure, Analyze, Improve, Control (DMAIC) methodology and applied its tools in various phases of the methodology.

Findings

The number of dispensing errors decreased from 6 to 2 incidents per 20,000 inpatient days per month between April 2018 and August 2019 representing a 66.66% reduction. The project has improved the dispensing process performance resulting in dispensing error reduction and improved patient safety. The communication channels between the hospital pharmacy and the pharmacy technicians have also been improved.

Research limitations/implications

This study was conducted in an inpatient pharmacy of a teaching hospital in Thailand. Therefore, the findings from this study cannot be generalized beyond the specific setting. However, the findings are applicable in the case of similar contexts and/or situations.

Originality/value

This is the first study that employs a continuous improvement methodology for the purpose of improving the dispensing process and the quality of care in a hospital. This study contributes to an understanding of how the application of action research can save patients' lives, improve patient safety and increase work satisfaction in the pharmacy service.

Resilience enhancement among student nurses during clinical practices: A participatory action research study

BACKGROUND

Clinical practice is an essential component of nursing students' preparation for applying theoretical knowledge in a real-life setting. However, students often experience clinical practice as extremely stressful, which may disrupt their clinical performance, impact the quality of patient care they provide as well as their own physical and psychological health, and hinder their continuation into nursing careers. Resilience, understood as the capability to overcome challenges, is critical for these students.

PURPOSE

To develop and implement a resilience enhancement (RE)-based project for Taiwanese nursing students during their Last Mile practicum.

DESIGN AND METHODS

A participatory action research (PAR) approach was used in which ongoing planning, action, and reflection informed real-time progress. Twenty-eight nursing students in clinical practice participated in the study. A six-workshop RE project was completed over the course of two months. Evaluation methods involved group discussion, individual interviews, and reflective diaries. Content analysis was applied to the data.

RESULTS

Through a PAR-based project, participants achieved positive results. Three outcome themes were identified: Increasing self-exploration, Furthering confidence and competency, and Constructing resilience.

CONCLUSIONS

The PAR-based RE project helped students to develop resilience by enhancing their nursing knowledge and skills and practicing positive thinking and behavior.

CLINICAL RELEVANCE

The findings can be a reference for nursing educators in designing RE programs for students during clinical practice to increase their professional competence and provide psychological supports.

Application in the World of Understanding: Researchers' Experiences of Participation in Reflective Dialogues

The aim of this study was to describe researchers’ experiences of participation in reflective dialogues through a hermeneutic application research approach. The aim was also to describe their perspectives on application, that is, the inner appropriation and application of theory into practice and vice versa. Twenty-one clinical coresearchers and four scientific researchers participated in reflective dialogues in a project on ethical sustainable caring cultures, in which an application research approach was used. The study included questionnaires, a focus group interview, and conversations. The findings show that participation in the reflective dialogues required that the participants are present, open for dialogue, share a common interest in the thematics of the dialogue, and are given space to express themselves. The participants described their experiences of the dual meaning underlying application. Application research strengthened the relationship between research and clinical practice and it contributed to the development of theory.

The catalytic role of Mystery Patient tools in shaping patient experience: A method to facilitate value co-creation using action research

Improving patients’ experience in hospitals necessitates the improvement of service quality. Using mystery patients as a tool for assessing and improving patients’ experience is praised for its comprehensiveness. However, such programs are costly, difficult to design and may cause unintended negative consequences if poorly implemented. Following an Action Research theoretical framework, the aim of this study is to utilize the Mystery Patient (MP) for engaging the patient in co-creating valuable non-clinical services and producing guidance about future managerial interventions. This was operationalized at the Outpatient Clinics at a large Academic Hospital in the Middle East region whereby 18 Mystery Patients conducted 66 visits to clinics and filled out 159 questionnaires. The results indicated higher scores on hard criteria or skills (technical), such as personal image and professionalism, and lower scores on soft criteria (interpersonal), including “compassion” and “courtesy”. The data also demonstrated how the MP tool could provide targeted information that can point to future interventions at any one of the patient experience core pillars, namely: process, setting, and employees. This paves the way for another cycle of spiral learning, and consequently, a continuous process of organizational learning and development around service provision. The MP tool can play the role of the catalyst that accelerates the value co-creation process of patient experience by directing management to necessary interventions at the three pillars of patient experience: employees, processes, and setting.

Clinical application research through reflection, interpretation and new understanding - a hermeneutic design

The implementation of theoretical knowledge in clinical practice and the implementation of good clinical practice into theory have been of interest in caring science for the last 30 years. The aim of this article was to elaborate and discuss a methodology named clinical application research. The method is grounded in a hermeneutical design inspired by Gadamer's philosophy. The methodology, clinical application research, has been used in a research project A life in dignity and experiences from the researchers forms the bases for the elaboration and discussion. The project was performed in collaboration with residents, family caregivers and healthcare providers at six nursing homes in Scandinavia. The material for this article is based on the previous research, that is the results from 10 different articles showing the meaning of dignity and indignity in daily life in nursing homes. Data were generated from 56 individual interviews and 18 focus-group interviews with a total of 40 staff members with five to eight participants at every interview session. By reflection, interpretation and new understanding our results provide knowledge about dignity and how to preserve dignity for older people in an appropriate ethical way. The methodology was relevant for the research project A life in dignity and relevant to caring practice in nursing homes as it opens new possibilities and new ways of thinking when performing dignified care to older people.

Unpacking action research and implementation science: Implications for nursing

AIM

The aim of this study was to unpack the key concepts of action research and implementation science thereby enabling appropriate use of these methods in nursing.

BACKGROUND

A key issue in action research is not so much the methodology employed to gather data/evidence but who decides the research agenda and who benefits from it. Implementation science is a way to ensure that evidence is translated into practice. The question arises as to how action research and implementation may be understood in relation to one another in nursing.

DESIGN

Discussion Paper DATA SOURCES: This discussion paper is based on our own experiences and offers an exploration of action research and implementation science with the aim of clarifying what each involves and what synergies, if any, exist between them.

IMPLICATIONS FOR NURSING

Using action research to secure the voice of patients in their own care is essential to delivering quality nursing care. Using implementation science frameworks to get research evidence into practice is effective. Familiarity with both these concepts may enable their improved use and have a positive impact on quality of care.

CONCLUSION

There is a tension between action researchers and the protagonists of implementation science related to perceived "trade offs" between what constitutes "science" and the necessity of community participation. Nevertheless, the use of an implementation science framework in an action research approach can reduce the research practice time lag and action research provides sound theoretical and philosophical underpinnings that can be used by those in the implementation science field.

[Training and action research in a short-stay geriatric oncology unit]

A participative action research project was undertaken in a geriatric oncology hospital unit. It resulted in the training of paramedical staff regarding the specific care to be provided to elderly people with cancer.

A qualitative examination of physiotherapist led community-based yoga for individuals with Huntington's disease

PURPOSE

The purpose of this study is to examine community-based yoga, led by a physiotherapist, for individuals affected by Huntington's disease (HD).

METHODS

Qualitative case study methodology was used to examine the Hatha yoga led by a certified yoga instructor who was a neurologic physiotherapist. Data collection included participant observations, semi-structured interviews with the instructor, and structured participant surveys. Data were coded and thematically analyzed. Strategies for rigor included field engagement, triangulation, member checks, and reflexivity.

OUTCOMES

Five major themes emerged regarding the value and role of yoga for individuals affected by HD: [1] Emphasis on mindfulness, [2] Yoga is modifiable and accessible, [3] Precise communication, [4] Yoga fosters a sense of community, and [5] Poses tailored to HD-specific deficits.

CONCLUSIONS

Yoga led by a physiotherapist can be tailored to enable participation by those affected by HD, addresses HD-specific deficits, and promotes a sense of community to supplement traditional physiotherapy.

Developing a framework for community-based sexual health interventions for youth in the rural setting: protocol for a participatory action research study

INTRODUCTION

There is limited research examining community-based or multilevel interventions that address the sexual health of young people in the rural Australian context. This paper describes the Participatory Action Research (PAR) project that will develop and validate a framework that is effective for planning, implementing and evaluating multilevel community-based sexual health interventions for young people aged 16-24 years in the Australian rural setting.

METHODS AND ANALYSIS

To develop a framework for sexual health interventions with stakeholders, PAR will be used. Three PAR cycles will be conducted, using semistructured one-on-one interviews, focus groups, community mapping and photovoice to inform the development of a draft framework. Cycle 2 and Cycle 3 will use targeted Delphi studies to gather evaluation and feedback on the developed draft framework. All data collected will be reviewed and analysed in detail and coded as concepts become apparent at each stage of the process.

ETHICS AND DISSEMINATION

This protocol describes a supervised doctoral research project. This project seeks to contribute to the literature regarding PAR in the rural setting and the use of the Delphi technique within PAR projects. The developed framework as a result of the project will provide a foundation for further research testing the application of the framework in other settings and health areas. This research has received ethics approval from the Curtin University Human Research and Ethics Committee (HR96/2015).

Getting the Evidence into Practice: The Challenges and Successes of Action Research

In health and social care, occupational therapists are acknowledging the importance of being evidence-based practitioners. The challenge is not only how to find the evidence but also how to implement research findings or best evidence in clinical practice. Furthermore, the pressure for more effective implementation of research findings is likely to increase. This paper discusses the issues and challenges that occupational therapists may face and must overcome when doing action research from the inside. Action research can be used to improve clinical practice by identifying and solving practical problems.

The paper demonstrates the use of action research to change practice by implementing a new interprofessional discharge model with fractured neck of femur patients in an inner-London teaching hospital. The strategies used to help to overcome the challenges of action research are discussed. The main problems encountered were the difficulties in reaching amicable solutions and in empowering health care professionals who often had little or no influence on decision making. While the aims of the research project were not met, it did highlight further areas that needed to be resolved in order to enhance interprofessional working.

Delivering an infection control link nurse programme: implementation and evaluation of a flexible teaching approach

Infection control nurses work to ensure practice is evidence-based, thereby minimising infection risks. There is, however, a gap between theory and practice in infection control at clinical level. Link nurse groups have been used in an attempt to ensure practice is evidence-based.

This article describes a research study that examined the efficacy of an infection control link nurse programme, which had an educational programme based upon adult learning theory, delivered using an action-research approach. Results of the study are described in subsequent articles.

The perceptions and experiences of nurses undertaking research in the clinical setting

Nursing research activity by clinicians has increased in volume in the last few years, due to an increased awareness of the importance of evidence-based practice, the shift of nurse education into higher education establishments and the emergence of new nursing roles which demand research activity as a central domain of the role. This paper will report on the results of a study examining nursing research activity in the UK National Health Service and will present data examining the perceptions and experiences of nurses undertaking research. Forty-eight research-active nurses in five NHS organisations were interviewed. Data were analysed using the Framework approach. Four main themes emerged: perceptions of nursing research, NHS influences, support systems and individual influences. Many factors were identified by nurses that influenced their experiences and perceptions, and nurses frequently reported difficulties in being able to conduct research in the clinical area. Dissemination via publication was rare. Personal sacrifices were common and nurses felt that these were not recognised by managers. Nurses undertaking research need more structured support systems and recognition of the value of nursing research. Individualised help from more experienced researchers for support and to disseminate findings is recommended.

"Care or control?": a qualitative study of staff experiences with outpatient commitment orders

PURPOSE

Outpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals' experiences with the scheme. The purpose of this study was to examine health professionals' experiences with patients subject to outpatient commitment.

METHODS

This was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis.

RESULTS

The study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients' lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient.

CONCLUSION

Health professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients' need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients' autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion.

Gaining access to a research site and participants in medical and nursing research: a synthesis of accounts

OBJECTIVES

The literature contains few accounts of how access to a research site and participants in medical and nursing research is gained, and few efforts to synthesise the existing accounts. Therefore, this article has two main goals: (i) to synthesise our own account of access with others in the medical and nursing literature, and (ii) to derive from this synthesis considerations of access and implications for health professions education.

METHODS

Based on field notes from a study conducted in an orthopaedic surgical section of a Norwegian university hospital, we provide an account of how access to the operating theatre (research site) and surgical teams (participants) was achieved. We synthesise the findings by comparing our account with existing accounts on access.

RESULTS

Our synthesis translates into a number of considerations related to the gaining of access to a research site and participants in medical and nursing research. These include conducting continuous negotiations to ensure the agreement and consent of participants and gatekeepers, and demonstrating transparency regarding the researcher's identity and the nature of the particular project and findings. These considerations can raise awareness and preparedness for the process of gaining access, which will benefit health professions education researchers planning or undertaking studies in educational or clinical settings. Health professions educators can also include the considerations in structured educational programmes, specifically methods courses, to instil similar awareness and preparedness in students.

CONCLUSIONS

We suggest that future medical and nursing research should emphasise a detailed, unvarnished documentation of the access process that incorporates existing accounts of the process.

Aktivnosti za preprečevanje padcev v rehabilitaciji pacientov po možganski kapi in njihov učinek na incidenco padcev

Uvod: Preprečevanje padcev je pomemben del rehabilitacijske obravnave. S timsko obravnavo in sistematičnim izvajanjem aktivnosti pri za padec visoko ogroženih pacientih se število padcev lahko zmanjša. Metode: V raziskavo je bilo vključenih 1.634 pacientov na rehabilitaciji po možganski kapi v Univerzitetnem rehabilitacijskem inštitutu Republike Slovenije – Soča (URI – Soča) od 1. 1. 2007 do 31. 12. 2012. Za ugotavljanje učinkovitosti aktivnosti za preprečevanje padcev pacientov je bila izvedena retrospektivna opazovalna raziskava z elementi akcijskega raziskovanja. Uspešnost izvedenih aktivnosti za preprečevanje padcev se je ugotavljala na podlagi incidence padcev. Rezultati: V primerjavi z obdobjem 2007 do 2010, ko so se izvajale splošne aktivnosti za preprečevanje padcev in je incidenca padcev npr. leta 2007 znašala 4,5/1000 bolnišničnooskrbnih dni, se je le-ta v letih 2011 in 2012 po uvedbi lestvice za oceno tveganja za padec ter sistematičnega delovanja celotnega rehabilitacijskega tima pomembno zmanjšala, tako da je leta 2012 znašala 2,8/1000 bolnišničnooskrbnih dni. Učinkovitost sistematičnega delovanja pri preprečevanju padcev se kaže v manjšem številu pacientov, ki so padli enkrat (p = 0,025). Diskusija in zaključek: S sistematičnim delovanjem multidisciplinarnega rehabilitacijskega tima lahko učinkovito zmanjšamo število padcev pacientov po možganski kapi na rehabilitacijskem oddelku. Vpliv teh aktivnosti na preprečevanje padcev pacientov v domačem okolju po zaključeni rehabilitaciji odpira tudi možnosti za nadaljnje raziskovalno delo.

Embracing a culture in conducting research requires more than nurses' enthusiasm

AIMS

This study explored the perceptions of clinical nurses about their research knowledge and experiences to highlight any gaps in nurse education in supporting research activities in healthcare organisations.

BACKGROUND

Nurses' research activities have been encouraged by moving hospital-based nurse education into higher education institutions whereby there is a stronger emphasis on teaching and developing nursing research at both undergraduate and post graduate levels. They were further encouraged by the introduction of advanced nurse practitioner roles, in the hope to increase opportunities for research participation. Whilst nurses' research activities have been explored in many countries, nurses in Singapore where there is a strong emphasis on evidence-based practice have not been investigated.

METHODS

A mixed-methods exploratory descriptive design, using a questionnaire based on open and closed questions was employed to obtain the views of clinical nurses about their capacity and organisational support in conducting research. The questionnaires were distributed to convenient samples who attended one of the 4 research seminars held on separate occasions between July and August 2011 in Singapore.

RESULTS

A total of 146 nurses were recruited. Whilst nurses demonstrated strong enthusiasm in conducting research, this characteristic feature was not adequate for them to embrace a research culture in organisations. Active participation as co-investigators was not possible in healthcare organisations where skewed distribution of resources towards medical and nurse researchers was perceived.

CONCLUSIONS

The results suggest a need for a significant shift in focus on educational training from imparting research contents to providing opportunities to experience the research process. Organisational support in terms of protected time and financial support ought to be in place for nursing research experience. The findings also demonstrated that in places where organisational support was available, awareness of research opportunities such as educational and organisational support needed to be strengthened. This in turn would enable more nurses particularly those who provide direct patient care to conduct research within the context of the competing nursing practice demands.

Development of a practical toolkit using participatory action research to address health inequalities through NGOs in the UK: Challenges and lessons learned

This study aimed to develop a practical toolkit to support non-government organizations (NGOs) in tackling health inequalities in the UK and to highlight the challenges and lessons learned. A mixed qualitative methodology within an action research framework was conducted. Semi-structured questionnaires, focus group interviews and discussions with an expert reference group aimed to identify the important themes and produce the toolkit content. A practical guide of information materials for NGOs working on addressing health inequalities was subsequently developed and successfully piloted. The experience of using participatory action research revealed a number of lessons and challenges. The key challenges were lack of training and experience in conducting action research, costs and insufficient resources, slow and time-consuming process, lack of commitment from marginalized groups, and differences in emphasis of goals and vision among participants. The main lessons learned were importance of effective leadership and project management skills, importance of integrating researchers and the researched as equal partners, creation and nurturing of trust, importance of evaluating and piloting processes, importance of engaging with marginalized groups, and use of evidence base in decision making. The lessons and challenges enumerating herein are of value to researchers aiming to implement participatory action research in developing checklists, tools, practical guidance and frameworks, and they offer important areas to consider before starting such projects. In addition, this offers an insight into how the dynamics of participatory action research methodology evolved in the development of the toolkit. Future research and initiatives in this area should focus on ways to improve the toolkit and make it more relevant to a wider community, and methods for evaluating the impact of the toolkit on practice.

An action research study to explore the nature of the nurse consultant role in the care of children and young people

AIMS AND OBJECTIVES

An action research study was undertaken to explore the development of the nurse consultant role when caring for children and young people.

BACKGROUND

Five nurse consultants in different areas of specialist care in a tertiary paediatric hospital undertook the study when implementing the new role of nurse consultant into the hospital.

METHODS

Action research meetings took place over a year. The nurse consultants then collated and analysed data using thematic analysis during the second year. A research fellow facilitated meetings, carried out participant observation, and coordinated the action research project.

RESULTS

Data analysis revealed 22 subthemes grouped into four overarching themes: shaping the role; shaping child-centred care through consultancy; taking responsibility for practice; and leadership. These roles and their ease and complexity within the nurse consultant role are examined in further detail in this paper. Balancing the four key components in a newly developing role was initially complex and required support. Over time the nurse consultants developed the necessary skills to perform fully in all areas. A major challenge was developing the research role, a key function of the nurse consultant role. By the end of the study, all nurse consultants were actively embarking upon their own research either in preparation for or as part of Doctoral studies.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

While there are many similarities with nurse consultants in adult practice, one major difference was the nurse consultant role in supporting families when caring for children and young people. This meant having a three-way communication style: with the family, the child/young person, and other healthcare professionals. This communication style was observed by the research fellow in participant observation of the nurse consultants undertaking clinical care and is described further in the analysis of the role.

An action research approach for developing research and innovation in nursing and midwifery practice: building research capacity in one NHS foundation trust

The National Health Service in the United Kingdom is committed to a process of reform centred on quality care and innovative practice. Central to this process is the need for research capacity building within the workforce. The aim of this study was to develop an infrastructure for research capacity building within one National Health Service Foundation Trust. Using an Action Research methodology, sixteen individuals were purposefully selected from a population of nurses and midwives to participate in the study. This nonprobability sampling method enabled the researchers to select participants on the basis of who would be most informative about existing research capacity building structures and processes within the Trust. Data were collected in the form of semi-structured individual interviews with each participant. The main findings were that research activity was not embedded in the culture of the organisation, and initiating and undertaking change was a complex process. As a result, a range of structures and processes which were considered necessary to enable the Trust move forward in developing capacity and capability for research were developed and implemented. This paper reports the first two stages of this process, namely: the findings from the pre-step and an outline of how these findings were used to create an infrastructure to support research capacity building within one NHS Foundation Trust Hospital in the United Kingdom.

Interorganisational partnership arrangements: a new model for nursing and midwifery education

INTRODUCTION

This paper describes a framework to facilitate collaboration between hospitals and third level universities and colleges in Ireland. The move to higher education for nurses and midwives in Europe heralded the development of partnership between organisations that provide nursing education. There is an increased risk of exacerbation of the 'theory-practice gap' phenomenon. Hence the need for greater unity between education and practice is paramount.

METHODS

The study included five organisations involved in nursing and midwifery education. An action research case study approach was used. This paper reports on the cooperative inquiry element of the study.

RESULTS

Seven key elements of a framework for interorganisatinal partnership emerged; Context, Environment, Inputs, Processes, Skills, Outcomes, Role of Coordinator. The framework was found to have a key role to integrating nursing education.

DISCUSSION

Leading and managing nursing education for the future requires support from clinical and academic partners. These knowledge domains need to move forward together to ensure success.

CONCLUSIONS

Responsibility for leading and managing nursing education requires a framework to engage the support of the clinical and academic partners. Implementation of partnership frameworks is critical to ensuring responsiveness of nursing and midwifery education to students' learning and patient care.

Using Community-based Participatory Research (CBPR) To Target Health Disparities in Families

Community-based participatory research (CBPR) is an action research approach that emphasizes collaborative partnerships between community members, community organizations, health care providers, and researchers to generate knowledge and solve local problems. Although relatively new to the field of family social science, family and health researchers have been using CBPR for over a decade. This paper will introduce CBPR methods, illustrate the usefulness of CBPR methods in families and health research, describe two CBPR projects related to diabetes, and conclude with lessons learned and strengths and weaknesses of CBPR.

Relationships, trust, decision-making and quality of care in a paediatric intensive care unit

OBJECTIVE

To assess the care-giving practices of health-care practitioners in the paediatric intensive care unit (PICU) through their qualitative insights, reflections and experience in participatory action research.

DESIGN AND METHODS

Qualitative research in the form of 'participatory action research' was used to gather data from three sources within the unit: focus groups within disciplines, observations within the PICU, and semi-structured interviews. All staff members were active collaborators and equal stakeholders in the decision-making process, research and feedback.

SETTING

The paediatric intensive care unit (PICU) of the Red Cross War Memorial Children's Hospital (RCWMCH).

PARTICIPANTS

All staff members from various disciplines working in the PICU.

RESULTS

Staff members described problems with respect to relationships, trust and decision-making within care-giving practices.

CONCLUSION

The study qualitatively describes how poor communication amongst staff members in respect of relationships and decision-making impacted on trust and how this tended to compromise care-giving practices in the PICU. The data suggested that this was more evident in informal rather than formal clinical decision-making procedures. The strength of the study was that the participatory action design in the research allowed staff members to address the very dynamics that they themselves cited as problematic.

Introducing peer-group clinical supervision: an action research project

Clinical supervision (CS) has been found to be beneficial in the role development of nurses and can contribute to increased job satisfaction and reduced burnout. However, implementing CS can be resource intensive, and there are few accounts of it being implemented in developing countries. Ten psychiatric nurses in Trinidad engaged in an action research project over a 5-month period to develop, implement, and undertake an initial evaluation of a model of peer-group CS for use in routine practice. The participants were involved in undertaking peer-group CS and contributing to monthly focus groups to reflect on the practices and further refine the model. This inexpensive form of CS was perceived by participants to have positive effects on the way they viewed and practiced nursing. An outline of the model and initial evaluation is presented, but further research is necessary to establish the sustainability of the model in practice.

Evolving the theory and praxis of knowledge translation through social interaction: a social phenomenological study

Background

As an inherently human process fraught with subjectivity, dynamic interaction, and change, social interaction knowledge translation (KT) invites implementation scientists to explore what might be learned from adopting the academic tradition of social constructivism and an interpretive research approach. This paper presents phenomenological investigation of the second cycle of a participatory action KT intervention in the home care sector to answer the question: What is the nature of the process of implementing KT through social interaction?

Methods

Social phenomenology was selected to capture how the social processes of the KT intervention were experienced, with the aim of representing these as typical socially-constituted patterns. Participants (n = 203), including service providers, case managers, administrators, and researchers organized into nine geographically-determined multi-disciplinary action groups, purposefully selected and audiotaped three meetings per group to capture their enactment of the KT process at early, middle, and end-of-cycle timeframes. Data, comprised of 36 hours of transcribed audiotapes augmented by researchers' field notes, were analyzed using social phenomenology strategies and authenticated through member checking and peer review.

Results

Four patterns of social interaction representing organization, team, and individual interests were identified: overcoming barriers and optimizing facilitators; integrating 'science push' and 'demand pull' approaches within the social interaction process; synthesizing the research evidence with tacit professional craft and experiential knowledge; and integrating knowledge creation, transfer, and uptake throughout everyday work. Achieved through relational transformative leadership constituted simultaneously by both structure and agency, in keeping with social phenomenology analysis approaches, these four patterns are represented holistically in a typical construction, specifically, a participatory action KT (PAKT) model.

Conclusion

Study findings suggest the relevance of principles and foci from the field of process evaluation related to intervention implementation, further illuminating KT as a structuration process facilitated by evolving transformative leadership in an active and integrated context. The model provides guidance for proactively constructing a 'fit' between content, context, and facilitation in the translation of evidence informing professional craft knowledge.

Evaluating evidence-based practice within critical care

BACKGROUND AND AIMS

Between 2002-2005 the Trust undertook an action research project to evaluate a corporate practice development strategy. During this period clinicians became practitioner-researchers utilising a variety of methods to evaluate the influence of practice development. One aspect of this focused upon evaluation of evidence based guidelines. This article concentrates upon this process and the learning from this within critical care.

METHOD

Within critical care it was recognised that the standard of guidelines and protocols varied in terms of the amount of evidence used to underpin decision making. A group was set up to evaluate and appraise these using a structured format such as the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument.

FINDINGS

The initial evaluation (cycle 1) highlighted learning associated with the process of using the instrument within critical care, as well as where the quality of the guidelines could be improved. The second cycle of evaluation demonstrated that implementation of the action plans as a consequence of cycle 1 resulted in an improvement in the quality of the guidelines. It also resulted in streamlining the process of undertaking guideline appraisal across a Trust.

DISCUSSION AND CONCLUSIONS

Action resulting from analysis of the findings of cycle 1 led to a cultural change in which the structure of a tool such as the AGREE instrument could be beneficial in the development of future guidelines. This has been sustained both within critical care and Trust wide with various initiatives such as the establishment of critical care multidisciplinary guideline development groups and a Trust wide electronic library management system.

The Learning Practice Inventory: diagnosing and developing Learning Practices in the UK

BACKGROUND AND SETTING

This paper outlines the development of a diagnostic tool to help Primary Care general practitioner (GP) Practices diagnose the extent to which they are developing effective techniques for collective learning and if their Practice culture supports innovation. This project is undertaken by the University of St Andrews and NHS Education for Scotland.

METHODS

Based on Learning Organization and Organizational Learning theory, and using a modified Behaviourally Anchored Rating Scale, the Learning Practice Inventory (LPI) identifies attitudes, behaviours, processes, systems and organizational arrangements associated with being a Learning Practice. The LPI is a self-assessment, fixed-choice, survey-feedback tool that surveys all Practice members.

RESULTS

The survey-feedback tool empowers Practice members to view, assess and prioritize the developments they wish to make collectively to Practice life. The LPI assumes complexity and non-linearity in change processes, used longitudinally it tracks the impact of change on Practice life through time. Practitioners and Practices involved in its development give favourable feedback on the tool, and its potential usefulness.

DISCUSSION

This contributes to our wider understanding in three main ways: first, it applies the ideas of Learning Organizations and Organizational Learning to health care settings. Second, as a practical advance, the tool assumes complexity, non-linearity and systemic knock-on effects during change in Primary Care. Third, it offers practitioners who work together the opportunity to share knowledge and learning in practical ways helping them to change by themselves and for themselves and their patients.