Practice development units: progress update

The reality of practice development for nurses working in an inpatient service for people with severe and enduring mental health problems

Nursing practice development is a growing priority for the British National Health Service. However, the nature of practice development remains poorly articulated. Despite the growing number of papers on practice development in nursing, there is insufficient guidance in the literature for the practical day-to-day management of the role, particularly in the inpatient environment. This paper explores the tensions experienced by practitioners engaged in practice development within a service for people mainly with a diagnosis of psychosis. The entrenched culture of the environment is described, which was resistant to change therefore did not easily embrace practice development. Within such a culture it is important to balance effective management with team development and support. Although this balance is essential for positive change, it is the maintenance of the balance that often leads to the tensions experienced by practice development practitioners. The paper describes numerous tensions including the competing agendas, influencing 'hearts and minds' rather than forcing change and working where people are at. Each tension is explored alongside possible survival strategies. The material presented aims to be realistic and although it may not be generalizable to other settings and staff groups, the authors hope to stimulate debate about similar or contrasting experiences of practice development.

A pluralistic evaluation of nursing/practice development units

Nursing/practice development units (N/PDU) are perceived as centres for pioneering, evaluating and disseminating innovative practice development and facilitating the professional development of practitioners. This paper reports on a pluralistic evaluation research study of the nursing/ practice development unit accreditation programme provided by the University of Leeds, UK. Individual and focus group interviews were undertaken with key stakeholders involved in six nursing/practice development units. These included: clinical leaders, team members, executive nurses, trust board members, general medical practitioners, nursing/practice development unit steering group members, and accreditation panel members. Stakeholder perceptions of what constituted a successful nursing/practice development unit were elicited and then used to judge the success of the programme. Seven criteria for judging the success of nursing/practice development units were identified. These were: achieving optimum practice; providing a patient-orientated service; disseminating innovative practice; team working; enabling practitioners to develop their full potential; adopting a strategic approach to change and autonomous functioning. The findings highlighted differences between the rhetoric of a successful nursing/practice development unit and the reality in which they function. Whereas all the units were actively involved in innovative practice development, evaluation, dissemination and networking activities, several factors influenced the success of the units, in particular, the role of the clinical leader, the motivation and commitment of nursing/practice development unit members, financial resources, and the nature of support from managers, medical staff and education institutions. Although the nursing/practice development units had made significant progress in developing both healthcare practice and practitioners, there is still a need to consider how the claim that nursing/practice development units benefit patients can be substantiated.