A pluralistic evaluation of nursing/practice development units

Developing a theory of change model for a learning and innovation network: A qualitative study

AIM

The aim of this study is to further develop a preliminary framework into a model that can translate mechanisms into output and impact, based on the views of those working in practice and the relations between the mechanisms: a model that can inform practitioners and organizations on what has to be in place to shape a learning and innovating environment in nursing.

BACKGROUND

A Learning and Innovation Network (LIN) is a network of healthcare professionals, students and education representatives who come together to be part of a nursing community to integrate education, research and practice to contribute to quality of care. In a previous study a preliminary framework was developed through a concept analysis based on publications. The preliminary framework describes input, throughput and output factors in a linear model that does not explain what the components entail in practice and how the components work together.

DESIGN

Focus groups.

METHODS

We designed a Theory of Change (ToC) in four phases. This was based on a focus group interview with lecturer practitioners (Phase 1); a first concept ToC based on thematic analysis of the focus group interview (Phase 2); three paired interviews where the ToC was presented to other lecturer practitioners to complement and verify the ToC model (Phase 3); and adjustment of the model based on the feedback of phase 3 (Phase 4).

RESULTS

The developed ToC model describes important preconditions that have to be in place to start a LIN: a shared vision, a facilitating support system and a diversity of participants who are open to change. It describes the mechanisms by which a wide range of activities can lead to an improvement of the quality of care through collaboration between practice, education and research by working, learning, performing practice based research and implementing new methods together.

CONCLUSION

This study gives a comprehensive overview of the concept of the 'Learning and Innovation Network' (LIN); how the activities in the LIN can lead to impact; and under what conditions. Previously published findings supported elements of the ToC model. The overarching ToC model and the detailed appendix offer a theoretical and practice-based model for practitioners, managers and policy makers.

Bridging the gap between research and clinical care: strategies to increase staff awareness and engagement in clinical research

Background

Research active hospitals have better patient outcomes and improvements in healthcare are associated with greater staff engagement in research. However, barriers to research activity include inadequate knowledge/training and perceptions that research is a specialist activity. Nursing is an academic discipline but the infrastructure supporting nursing research worldwide is variable and sustaining clinical academic careers remains challenging. The National Institute of Health Research 70@70 Senior Nurse Research Leader programme provides dedicated time to increase clinical academic opportunities and foster a research culture across England; we describe initiatives developed by one National Institute of Health Research 70@70 leader to increase clinical staff engagement in research.

Aim

The purpose of this work was to develop initiatives to facilitate clinical research opportunities and bridge the gap between clinical care and research.

Methods

New strategies were developed in one health service to increase clinical staff engagement in research activity. This included: (a) Chief Nurse Research Fellows: clinical staff undertaking bespoke research training to identify local clinical research priorities, (b) an exemplar nurse-led Embedding Research In Care unit to pioneer innovation, evaluation and research participation supported by a research facilitator and (c) a Clinical Academic Network for nursing, midwifery and allied healthcare professionals to aid collaborative working.

Results

The first cohort of Chief Nurse Research Fellows have successfully completed a bespoke training programme and, with mentoring, developed projects to tackle clinical problems. The Embedding Research In Care unit initiative was configured and the first Embedding Research In Care unit has been awarded. A Clinical Academic Network group of 25+ nurses, midwives and allied health professionals was established and provides peer support and mentoring.

Conclusions

This multi-faceted approach has successfully supported research training/engagement, enabled career development and identified nurses/midwives with potential to undertake clinical academic careers. A range of strategies, such as those described in this paper, are required to successfully bridge the gap between clinical care and research and provide additional opportunities for clinical staff to become engaged in a research active career.

Managing the resource allocation for the COVID-19 pandemic in healthcare institutions: a pluralistic perspective

Purpose

As COVID-19 outbreak has created a global crisis, treating patients with minimum resources and traditional methods has become a hectic task. In this technological era, the rapid growth of coronavirus has affected the countries in lightspeed manner. Therefore, the present study proposes a model to analyse the resource allocation for the COVID-19 pandemic from a pluralistic perspective.

Design/methodology/approach

The present study has combined data analytics with the K-mean clustering and probability queueing theory (PQT) and analysed the evolution of COVID-19 all over the world from the data obtained from public repositories. By using K-mean clustering, partitioning of patients’ records along with their status of hospitalization can be mapped and clustered. After K-mean analysis, cluster functions are trained and modelled along with eigen vectors and eigen functions.

Findings

After successful iterative training, the model is programmed using R functions and given as input to Bayesian filter for predictive model analysis. Through the proposed model, disposal rate; PPE (personal protective equipment) utilization and recycle rate for different countries were calculated.

Research limitations/implications

Using probabilistic queueing theory and clustering, the study was able to predict the resource allocation for patients. Also, the study has tried to model the failure quotient ratio upon unsuccessful delivery rate in crisis condition.

Practical implications

The study has gathered epidemiological and clinical data from various government websites and research laboratories. Using these data, the study has identified the COVID-19 impact in various countries. Further, effective decision-making for resource allocation in pluralistic setting has being evaluated for the practitioner's reference.

Originality/value

Further, the proposed model is a two-stage approach for vulnerability mapping in a pandemic situation in a healthcare setting for resource allocation and utilization.

Learning and innovation network in nursing: A concept analysis

BACKGROUND

Approximately 4 years ago a new concept of learning in practice called the 'Learning and Innovation Network (LIN)' was introduced in The Netherlands. To develop a definition of the LIN, to identify working elements of the LIN in order to provide a preliminary framework for evaluation, a concept analysis was conducted.

METHOD

For the concept analysis, we adopted the method of Walker and Avant. We searched for relevant publications in the EBSCO host portal, grey literature and snowball searches, as well as Google internet searches and dictionary consults.

RESULTS

Compared to other forms of workplace learning, the LIN is in the centre of the research, education and practice triangle. The most important attributes of the LIN are social learning, innovation, daily practice, reflection and co-production. Often described antecedents are societal developments, such as increasing complexity of work, and time and space to learn. Frequently identified consequences are an attractive workplace, advancements of expertise of care professionals, innovations that endorse daily practice, improvement of quality of care and the integration of education and practice.

CONCLUSIONS

Based on the results of the concept analysis, we describe the LIN as 'a group of care professionals, students and an education representatives who come together in clinical practice and are all part of a learning and innovation community in nursing. They work together on practice-based projects in which they combine best practices, research evidence and client perspectives in order to innovate and improve quality of care and in which an integration of education, research and practice takes place'. We transferred the outcomes of the concept analysis to an input-throughput-output model that can be used as a preliminary framework for future research.

Service Evaluation and the Service User: A Pluralistic Solution

User involvement is a key pillar in the temple of clinical governance. There are many potential ways in which the service users of health and social care may act in order to achieve positive and constructive change. Service evaluation, however, has not historically been one of these. This paper looks at a model of service evaluation that can offer an empowered voice to service users, enabling participation in service-level evaluation and development.

The pluralistic model for evaluation has a subjectivist epistemology, which stands in contrast to the scientific evaluation methods normally seen in health and social care organisations. It attempts to give all the stakeholders of a service equal authority and explores all perspectives to create a measure of success that is relevant and meaningful at the local level. This paper evaluates the theory behind this model and explores the pros and cons of this approach through recent examples found in the literature. It is hoped that this article will generate further thought and debate on this important and timely subject.

Practice development: a concept analysis

Exploration of the term `practice development' is required for the discipline of infection control nursing. Improved understanding of the term would allow practitioners to approach practice development in a more constructive and measurable fashion. A concept analysis based on the model of Walker and Avant is therefore presented. The analysis includes the definition of the term `practice development' and discussion of how it is presented in the literature. Illustrative cases are used to achieve clarification of the concept, culminating in identification of the empirical referents, these being: (1) identified patient need and (2) a change in nursing practice and demonstrably improved care.

A concept analysis of practice development

The term 'practice development' is widely but inconsistently used in British nursing, addressing a broad range of educational, research, and audit activity, but there appears to be little consensus as to what practice development actually involves. Such lack of clarity means that the increasing number of nurses whose work involves addressing practice development issues can have difficulty in focusing their efforts.

To try to clarify the concept of practice development and to describe the focuses of practice development work and the approaches used, a concept analysis was conducted. Both primary and secondary data were gathered and analysed in the study. One hundred and seventy seven items of published literature were gathered and analysed. Focus group interviews were carried out involving 60 practice developers. In addition, 25 clinical nurses were interviewed about their experiences of being involved in practice development.

This paper describes the identified purposes, attributes and outcomes of practice development. Practice development activities are described as addressing the effectiveness of care through the transformation of care practices and cultures. Practice development is described as a systematic, rigorous activity underpinned by facilitation processes. The outcomes of practice development can be described in terms of changes in the behaviours, values and beliefs of staff involved. Parallels between practice development and current policy imperatives are outlined.

A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency

Background

Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why?

Methods

The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use.

Results

24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents’ function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches.

Conclusion

This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.

The Norwegian teaching home program: developing a model for systematic practice development in the nursing home sector

Background.  In the mid-1990s, there was persistent critique of the quality of care provided in residential aged care facilities in Norway, in line with similar concerns expressed in many other countries. Difficulties recruiting qualified staff and high turnover led to difficult working conditions. Little prestige was associated with providing geriatric care. Collaboration between educational institutions, universities and elderly care institutions with the purpose of strengthening education, competence development, practice development and research within elderly care was poorly developed. The Norwegian teaching nursing home (NTNH) program was launched to address these issues. Aim.  The purpose of the NTNH was to contribute to the quality of care of frail older persons by improving the competence of staff, improving the prestige of working with older people, stimulating development of services, facilitating research into the care of older persons, and developing good learning environments for students. Methods.  The NTNH-program was developed over a period of seven years, applying a participatory action research design. Progressing through four phases, it involved a number of people and institutions across Norway. Results.  Formal and informal competence of staff was increased. A large number of practice development projects contributed to increased quality of care in selected problem areas. Models of competence development were disseminated to other institutions, thereby improving the level of competence beyond the NTNHs. Learning conditions for students were improved. Following a formal evaluation of the program, teaching nursing homes (TNHs) were established on a permanent basis in 2004, with financial support from the Department of Health and Social Services. In 2008, a total of 20 TNHs are part of the NTNH program. Conclusions.  The NTNH program led to permanent establishment of a series of TNHs responsible for contributing to competence development, practice development and research on a continuous basis in order to secure high levels of care to the Norwegian nursing home population. The program has created substantial enthusiasm within the nursing home sector and has increased the prestige of these institutions.

Improving capacity in ethnicity and health research: report of a tailored programme for NHS Public Health practitioners

Aim

To determine whether an intervention designed to enhance research capacity among commissioners in the area of ethnicity and health was feasible and impactful, and to identify programme elements that might usefully be replicated elsewhere.

Background

How healthcare commissioners should be equipped to understand and address multiethnic needs has received little attention to-date. Being able to mobilise and apply evidence is a central element of the commissioning process that requires development. Researching ethnicity and health is widely recognised as challenging and several prior interventions have aimed to enhance competence in this area. These have, however, predominantly taken place in North America and have not been evaluated in detail.

Methods

An innovative research capacity development programme was delivered to public health staff within a large healthcare commissioning organisation in England. Evaluation methodology drew on ‘pluralistic’ evaluation principles and included formative and summative elements. Participant evaluation forms gave immediate feedback during the programme. Participants also provided feedback at two weeks and 12 months after the programme ended. In addition, one participant and one facilitator provided reflective accounts of the programme's strengths and weaknesses, and programme impact was traced through ongoing partnership work.

Findings

The programme was well received and had a tangible impact on knowledge, confidence and practice for most participants. Factors important to success included: embedding learning within the participants’ work context; ensuring a balance between theory and practical tips to enhance confidence; and having sustained interaction between trainers and participants. Despite positive signs, the challenging nature of the topic was highlighted, as were wider structural and cultural factors that impede progress in this area. Although it is unrealistic to expect such programmes to have a major impact on commissioning practices, they may well make an important contribution to raising the confidence and competence of staff to undertake work in this area.

Using practice development methodology to develop children's centre teams: ideas for the future

The Children's Centre Programme is a recent development in the UK and brings together multi-agency teams to work with disadvantaged families. Practice development methods enable teams to work together in new ways. Although the term practice development remains relatively poorly defined, its key properties suggest that it embraces engagement, empowerment, evaluation and evolution. This paper introduces the Children's Centre Programme and practice development methods and aims to discuss the relevance of using this method to develop teams in children's centres through considering the findings from an evaluation of a two-year project to develop inter-agency public health teams. The evaluation showed that practice development methods can enable successful team development and showed that through effective facilitation, teams can change their practice to focus on areas of local need. The team came up with their own process to develop a strategy for their locality.

Reflections on a 'virtual' practice development unit: changing practice through identity development

AIMS

This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a 'virtual' practice development unit of clinical nurse specialists in the south of England.

BACKGROUND

This practice development unit is 'virtual' in that it is not constrained by physical or specialty boundaries. It became the first group of Trust-wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004.

DESIGN AND METHODS

The local university was asked to facilitate the accreditation process via 11 two-hour audio-recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed.

FINDINGS AND DISCUSSION

Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts' identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper.

CONCLUSIONS

These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change.

RELEVANCE TO CLINICAL PRACTICE

Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience.

Treatment of minor illness in primary care: a national survey of patient satisfaction, attitudes and preferences regarding a wider nursing role

BACKGROUND

This study investigated patient opinion about the provision of nurse-led vs. doctor-led primary health care in the treatment of minor illness.

DESIGN

A postal questionnaire survey including discrete choice experiment (DCE) of a national sample followed by telephone interviews with respondent volunteers.

SETTING AND PARTICIPANTS

A large random sample of the population of Scotland from a range of general practices including traditional and extended practice nursing roles was invited to participate.

MAIN OUTCOME MEASURES

Patient satisfaction with, opinion of and preference for practice nurse (PN) vs. doctor consultation in primary care in relation to gender, age, education and income.

RESULTS

Questionnaire response rate was 49% (1343 of 2740). Women, younger people, the less well-educated and those with higher income had a more positive attitude towards the PN. Older people had a more positive attitude to the doctor. Results from the DCE indicated that whilst most respondents would prefer a doctor consultation, many would be happy to consult with a nurse if other aspects of the consultation were improved. Forty-eight people were interviewed. The main perceived differences between doctors and nurses were academic ability and qualifications. Most respondents thought nurses could deal with relatively minor problems and should be able to prescribe some drugs.

CONCLUSION

Patients would always want their choice of health professional to be available at first contact. However, this study suggests that, in primary health-care practices, if nurses take on more roles previously the preserve of doctors, patients would accept them, particularly if patients receive information on nurses' capabilities.

Review of advanced nursing practice: the international literature and developing the generic features

AIM

The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features.

BACKGROUND

This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed.

METHODS

An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP.

FINDINGS

The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice.

CONCLUSION

Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP.

RELEVANCE TO CLINICAL PRACTICE

Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.

Practice development 'without walls' and the quandary of corporate practice

AIM

The context of this study is a group of clinical nurse specialists from across a Trust seeking accreditation as a practice development unit. The university was asked to facilitate the accreditation process via 11 2-hour learning sessions (including a one-hour focus group). During initial discussions between the university and practice development unit, the overarching research question for this study was set as: 'what are the main roles and responsibilities of clinical nurse specialists?'

BACKGROUND

Although there is no known study of a practice development unit based beyond a ward or speciality, the central tenet of the practice development unit literature is that units must demonstrate their worth if they are to survive and harness senior management support in doing so.

DESIGN AND METHODS

Data gleaned from the transcribed audio tape-recordings of the learning sessions were studied at least three times to ensure transcription accuracy and produce detailed charts. Ethical approval was granted by the appropriate Local Research Ethics Committee and written informed consent obtained from clinical nurse specialists. The study lasted 30 months and ended in October 2004.

RESULTS

The four crucial statements that give meaning to specialist practice are: quality care giver; expert; information giver and initiator of change. Further analysis reveals the area of corporate and political practice as being missing from this and other lists of clinical nurse specialist attributes found in the literature. Clinical nurse specialists characterize their relationship with the Trust in terms of dichotomy--differing agendas and perceptions of value.

CONCLUSIONS

The specialist role requires professional development in the areas of corporate and political acumen and professional business management. While the findings of this study relate to one Trust and a group of 16 clinical nurse specialists, with careful application they may be transferable to other settings and groups of senior nurses.

A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment

OBJECTIVES

The overall aim of this comprehensive systematic review was to identify the best available evidence on the effect of team characteristics, processes, structure and composition within the context of collaborative practice among nursing teams that create a healthy work environment.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished studies and papers written in the English language. An initial limited search of Medline and CINAHL databases was undertaken to identify optimal search terms. A second extensive search using all identified keywords and index terms was then undertaken.

METHODOLOGICAL QUALITY

Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package.

RESULTS

The papers included in the review included nine experimental or quasi-experimental studies, 11 descriptive studies and four qualitative studies. A variety of different team structures such as interdisciplinary teams, primary nursing, team nursing, multidisciplinary models of care delivery and the use of a Partner in Patient Care model were investigated. Team characteristics should include accountability, commitment, enthusiasm and motivation. Social support within a team from a supervisor or colleague increased satisfaction levels of staff.

CONCLUSION

The results of the review lead to the development of a number of recommendations for practice that could assist with creating a health work environment.

Preventing hip fractures in care homes 2: role of the specialist nurse

This article is the second of a two-part series based upon a research project to evaluate the impact of a specialist nurse role in reducing the incidence of hip fracture within care homes. The first article (Vol 13 (21): 1242-48) described the background and methods of the study, and presented the findings relating to resident and staff experiences of using hip protectors as a preventive measure within the homes. This article focuses on staff experiences of hip fracture prevention strategies and implementing evidence-based practice in this area. Findings suggest that specialist nurses have the potential to encourage evidence-based practice within care homes, while also improving staff morale and job satisfaction.

Processes, outcomes and evaluation: challenges to practice development in gerontological nursing

When aligned to participants' needs, evaluation may be used to enhance practice developers' work. Process evaluation enables practice developers to evaluate as they develop; making evaluation an integral part of practice development rather than an 'add on task'. It is contended that beginning practice developers can discharge their need to evaluate their work through the practice development techniques of critical reflection, dialogue and action learning. These form the basis of iterative and formative evaluation activity. However other types of evaluation are important for different audiences in practice development. Consideration of the purpose and utility of evaluation in a range of contexts in which gerontological nursing occurs, brings some clarity regarding the scope of the evaluation required to sustain practice development initiatives. In addition, it helps to clarify the nature of the evaluation required to provide evidence of patient-centred outcomes from developments in the practice of gerontological nursing.

Developing best practice in critical care nursing: knowledge, evidence and practice

Because the current drive towards evidence-based critical care nursing practice is based firmly within the positivist paradigm, experimentally derived research tends to be regarded as 'high level' evidence, whereas other forms of evidence, for example qualitative research or personal knowing, carry less weight. This poses something of a problem for nursing, as the type of knowledge nurses use most in their practice is often at the so-called 'soft' end of science. Thus, the 'Catch 22' situation is that the evidence base for nursing practice is considered to be weak. Furthermore, it is argued in this paper that there are several forms of nursing knowledge, which critical care nurses employ, that are difficult to articulate. The way forward requires a pragmatic approach to evidence, in which all forms of knowledge are considered equal in abstract but are assigned value according to the context of a particular situation. It is proposed that this can be achieved by adopting an approach to nursing in which practice development is the driving force for change.

The meaning of practice development: evidence from the field

This paper sets out to explore the meaning of practice development. The data from which this exploration is derived is largely drawn from an empirical research project that set out to explore practice development through concept analysis. The paper argues for a model of practice development that is focused on achieving increased effectiveness in patient-centred care. It argues that one-off changes in practice are not the same as a sustained systematic development of practice that focuses on achieving cultural changes in practice settings, ie the context of practice. It will be argued that facilitation is a key concept underpinning practice development work, but that in itself, facilitation is a misunderstood and abused concept. Finally, the consequences of practice development activity will be outlined and the need for further research in this area highlighted.

Developing continuing care: towards a teaching nursing home

This article describes a partnership between staff, residents and relatives of a nursing home for older people with mental health problems, and lecturers within an academic department of nursing. The aim of the partnership is to develop practice and to improve the setting of the care home as an environment for living, working and learning. In our attempts to create a teaching nursing home, we recognize the need to ensure that all participants - residents, relative and staff - feel that they are valued members of the team. We describe our progress to date, together with some of the challenges of working together.

Stakeholder involvement in curriculum planning: responding to healthcare reform

Instead of nursing faculty deciding the kind of education needed for a new curriculum, views and suggestions were solicited from nurses, doctors, and policy makers to help shape the curriculum. When stakeholders are involved in curriculum planning, there is a greater likelihood that the needed education is delivered. The authors discuss the context, process, outcome, and pros and cons of stakeholder involvement.