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.

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 clinical development unit in cardiology: The way forward

The clinical development unit (CDU) has been recognized as an effective strategy to progress creativity and resourcefulness in nursing practice to improve patient outcomes. Clinical development units, through transformational leadership, promote staff development, the use of research evidence and dissemination of research findings through publication and presentations. The aim of this paper is to clearly articulate the processes (in particular, research and education initiatives) related to the development of staff that address issues in the everyday workplace and, accordingly, have been instrumental in the success of the creation of a CDU in cardiology. These units aim to achieve and promote excellence in an identifiable area of nursing using a systematic, transparent and defensible approach. A review of acute coronary syndrome informed the needs and direction of staff activities in the cardiology unit of a tertiary referral hospital. Through a collaborative staff approach, evidence was carefully examined to plan its appropriate adoption into the clinical area. Nursing practice and education resulting from this review was scheduled into staff career progression. These initiatives have been incorporated into staff development learning, enabling the integration of research into practice, which ultimately has a positive impact on patient outcomes.

'Working from the inside': an infrastructure for the continuing development of nurses' professional clinical practice

AIM

This paper describes how the nursing executive of a tertiary referral facility revisited their management structures and responsibilities to create a new, sustainable infrastructure that supports research and education at the core of nursing practice and not at the periphery.

BACKGROUND

Nursing executive and senior management groups are charged with the ultimate responsibility of ensuring the highest possible quality nursing care within their facility. In the current health care climate the aim for best practice conflates with evidence-based practice that can be notoriously difficult to achieve due to the many barriers to integrating research findings into practice.

KEY ISSUES

Research and education activities have been established as fundamental to core business under a simple evidence-based practice model.

CONCLUSION

The value of a synthesis between the clinical areas with the nursing education and research division has been recognized to better achieve the goal of improved services.