Managerial coaches' enacted behaviors and the beliefs that guide them: perspectives from managers and their coachees

Introduction

Managerial coaching is considered a powerful developmental intervention in the workplace that has gained tremendous popularity in recent years. A growing base of scholarship examining the efficacy of this form of coaching has identified numerous benefits, primarily for employees receiving this form of coaching, and some limited attention has focused on benefits for managers who coach. However, an important topic related to managerial coaching that has gone under-explored is the beliefs that managers have about coaching. Since beliefs often guide behaviors, obtaining a more robust understanding of the beliefs that guide managers who serve as coaches is warranted and several scholars have called for more research on this aspect of managerial coaching. Therefore, the study reported here presents a subset of findings that relate to the coaching behaviors that managers enact along with a comprehensive understanding of their guiding beliefs.

Methods

These specific findings are drawn from a larger qualitative multi-case study employing an adaptation of the critical incident technique that was designed to examine the beliefs, behaviors, and learning and development outcomes for both managers who coach and their respective coachees. This larger study obtained perspectives about these aspects of managerial coaching from both the coaches and coachees which also reflects an approach seldom taken when researching managerial coaching.

Results and Discussion

Four research questions are addressed here: 1) What are the behaviors enacted by managers who coach (facilitate the learning of) their employees from the perspective of managers; 2), what are the behaviors enacted by managers who coach (facilitate the learning of) their employees from the perspective of employees; 3) What are the beliefs held by managers who coach (facilitate the learning of) their employees from the perspective of managers; and, 4) What are the beliefs held by managers who coach (facilitate the learning of) their employees from the perspective of their employees (coachees)? In addition to thick rich descriptions that illustrate these findings, implications for theory, research, and practice are also discussed.

Perceptions of Urban Father Support in Early Parenthood: A Critical Incident Analysis

Becoming a father is a common transitional event, however men are often not adequately prepared for their fathering role. The United States (U.S.) health care system does little to support fathers' parenting needs during the postnatal and infancy period. Moreover, father's support needs are often perceived as secondary to the mother's needs in the maternal-child system. It is important that fathers' social support needs be investigated in the first year of his newborn's life, especially in diverse populations. Therefore, the purpose of this study was to determine the social support needs of urban, African American fathers during early parenthood. Using the Critical Incident Technique (CIT), a descriptive, qualitative design was used to interview 35 fathers about their social support at 2-12 months after the birth of their baby. Using a semi-structured interview guide, fathers were asked to describe helpful and unhelpful events they experienced since the birth of their baby. Fathers reported 36 helpful events and 32 unhelpful events for an overall total of 68 events. Data was analyzed using House's Social Support Theory and the four social support categories: instrumental, informational, emotional, and appraisal. Using the CIT, main categories and subcategories were developed. The helpful categories included: 1) Helping father with infant care, 2) Providing information on infant care, 3) Receiving HCP assistance, 4) Managing relationships, and 5) Becoming a father. The unhelpful categories included: 1) Receiving unhelpful assistance, 2) Receiving unreliable or unwanted assistance, 3) Offering bad advice, 4) Conflicting relationships, 5) Conflicts with friends, 6) Unsatisfying HCP experience, and 7) Receiving no support from family/organizations. The results of the study validated House's Social Support Theory and served as an excellent framework for exploring social support needs in fathers. More research needs to be conducted on the social support needs of fathers during the first year of their infants' lives, especially with experienced African American fathers and nonresidential fathers, and how health care professionals (HCPs), specifically postnatal and child health nurses, can better support fathers during the infancy period.

Developing a competency framework for extracorporeal membrane oxygenation nurses: A qualitative study

AIM

To develop a competency framework applicable to Chinese extracorporeal membrane oxygenation (ECMO) nurses.

DESIGN

A qualitative study was performed following the consolidated criteria for reporting qualitative research.

METHODS

Semi-structured interviews based on the critical incident technique were conducted among 21 ECMO care providers recruited from five well-known ECMO centres in Guangzhou, China. Interview transcripts were coded and analysed using the constant comparative method. The data collection period lasted from November 2021 to April 2022.

RESULTS

A competency framework for ECMO nurses was identified. It included four domains: knowledge, skills, behaviours and attitudes, containing 33 subcompetencies and 66 items.

RELEVANCE TO CLINICAL PRACTICE

This framework can be a reference for the assessment and training of ECMO nurses.

A critical incident study of ICU nurses during the COVID-19 pandemic

Background:

Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses’ sources of distress is important when planning interventions to support them.

Purpose:

To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic.

Design:

Qualitative descriptive component within a larger mixed-methods study.

Participants and research context:

Participants were invited to write down their experiences of a critical incident, which distressed them when providing nursing care. Thematic analysis was used to analyze the data.

Ethical considerations:

The study was approved by the ethics committee at the researchers’ university in eastern Canada.

Results:

A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families’ grief, (3) our safety, and (4) futility of care. Many nurses’ stories also focused on the organizational preparedness of their institutions and concerns over their own safety.

Discussion:

Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed.

Conclusion:

Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses’ well-being.

Parents' strategies and advice for creating a positive sleep situation in the family

AIM

The aim of this study was to describe the experience-based knowledge of parents of children aged 0-3 years for creating a positive sleep situation in the family.

DESIGN

This study has a qualitative design. Data were collected using an online survey and analysed using the critical incident technique.

METHODS

The study participants were recruited through an announcement posted in parenting groups on a social media platform in September 2018. A total of 93 parents answered the questionnaire; 76 of the parents matched the study's selection criteria, and their responses were included in the analysis.

RESULTS

The results are presented from the two main questions in the survey: "Strategies for creating a positive sleep situation" and "Advice to new parents regarding sleep". Having routines and reading the child's signals were important strategies, as were creating good conditions for sleep and making sure the child was well-fed and content at bedtime. Winding down and giving the child closeness and touch was described as important, and some parents would co-sleep to soothe the child quickly and create a sense of security and belonging. Parents' most frequent advice to other parents was to accept the situation and to let go of the idea that the child should sleep without waking up in a separate bed or room.

CONCLUSION

Personal preferences and needs are likely to vary among individuals, and it is important that nurses tailor sleep advice in accordance with families' preferences and needs, taking individual variations and views into account.

Comparing Antecedents of Chinese Consumers' Trust and Distrust

To help retailers gain consumers’ trust, many studies have investigated antecedents of consumer trust. However, distrust, a concept closely related to trust, has attracted only sporadic research attention. As a result, whether factors that increase consumer trust can eliminate consumer distrust is unclear. To deepen understanding of trust and distrust, this study applies the critical incident technique to identify and compare the antecedents of trust and distrust of Chinese consumers. The results show that the antecedents of distrust differ from those of trust, indicating different formulation mechanisms of both. Therefore, on the one hand, retailers should pay attention to increasing consumer trust, and on the other hand, they should develop marketing activities to reduce consumer distrust.

How occupational therapy practitioners use virtual communities on the Facebook social media platform for professional learning: A critical incident study

BACKGROUND

As the use of social media to mediate learning in the occupational therapy profession gains increasing recognition, calls for tangible guidance with concrete and platform-specific examples have also become prominent.

AIMS

This study aims to describe and analyse the various learning activities qualified occupational therapy practitioners engage with in professional communities known as 'groups' on the Facebook social media platform.

METHOD

Forty-nine (n = 49) practitioners eligible for registration with the Health and Care Professions Council in the United Kingdom completed online questionnaires to produce one-hundred and ten (n = 110) critical incident reports. Data were thematically analysed.

RESULTS

Six learning activities were inductively identified: (1) Acquisition of New Ideas; (2) Reinforcement of Existing Knowledge; (3) Adjustments to Existing Knowledge; (4) Learning about Resources; (5) Learning related to Career Advancement; (6) Learning related to Hidden Curriculum.

CONCLUSION

This study showcases the varied ways occupational therapy practitioners learn through Facebook Groups, evidencing the utility of this professional learning environment.

SIGNIFICANCE

Findings enable occupational therapy practitioners to better evaluate which activities to engage in on Facebook Groups for learning and development of higher-quality professional practice. Further research examining the utility of Facebook Groups for professional learning in contrast to other social media platforms is recommended.

'People with intellectual disabilities living in the communities is bad enough let alone…having sex': Exploring societal influence on social care workers' attitudes, beliefs and behaviours towards support for personal and sexual relationship needs

BACKGROUND

Services have a duty to uphold the personal and sexual relationship (P&SR) rights of adults with intellectual disability. However, little is known about how social care workers' (SCWs) perceptions of public views of intellectual disability and sexuality might affect their attitudes, believes and behaviours towards supporting P&SR needs. This exploratory study addresses this gap in knowledge.

MATERIALS AND METHODS

Qualitative interviews using critical incident technique were conducted with 18 SCWs. Data were transcribed and thematically analysed.

RESULTS

Four dominant themes were identified; socio-cultural, practice-policy gaps, fear and safety needs. These highlights how perceptions of public attitudes impact on SCWs' attitudes towards supporting development of P&SR both directly and through perceptions of organisational policies. This leads to prioritisation of safety needs over support for P&SR.

CONCLUSIONS

Public expectations strongly influenced SCWs' interpretation of organisational policy, emphasising a need for practice-based support to manage public expectations and reduce fear.

Dyadic teams and nursing care: A critical incident study of nurses in the emergency medical service

AIM AND OBJECTIVES

The aim of the study was to describe Emergency Medical Services (EMS) nurses' experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team.

BACKGROUND

Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient's suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering.

DESIGN

The study has an inductive descriptive qualitative design, in adherence to the COREQ-checklist.

METHODS

A critical incident technique was used. Thirty-five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub-categories.

RESULTS

The experiences of critical incidents emerged to form two main areas: "Functional co-operation" and "Dysfunctional co-operation," comprising seven categories and sixteen sub-categories. Their coping with critical incidents encompassed two main areas: "Adapting oneself" and "Adapting nursing care and the colleague," comprising four categories and eight sub-categories.

CONCLUSIONS

Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles.

RELEVANCE TO CLINICAL PRACTICE

This study underlines the importance of strengthening the dyadic EMS team's ability to co-operate using common goals and knowledge within clinical nursing care. The individual team members' different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.

Difficulties and Problem-Solving Strategies in Wayfinding Among Adults With Cognitive Disabilities: A Look at the Bigger Picture

Many people with cognitive disabilities avoid outside activities, apparently for fear of getting lost. However, little is known about the nature of the difficulties encountered and the ways in which these individuals deal with them. None of the few studies on wayfinding by people with cognitive disabilities have explored the various specific difficulties they meet in everyday life. Using both a qualitative and quantitative methodology, this study aimed at profiling the types of difficulties encountered in urban mobility and the associated problem-solving strategies. In order to provide more direct evidence from the field, we conducted semi-structured interviews using the critical incident technique (Flanagan, 1954). Among the 66 participants interviewed, 44 had cognitive disabilities and 22 were matched controls. The analysis of the transcripts showed in particular an overall reduced autonomy in problem-solving strategies for people with a cognitive disability. The multiple correspondence analysis highlighted three main types of complex situations, covering a comprehensive range of complex situations that are met in everyday life by these individuals. Results also indicated that people with cognitive disabilities request assistance from another person more frequently when a complex event occurs. These situations are discussed as potential cues for improvements in navigational aids. Conclusions and perspectives are provided to improve wayfinding among people with cognitive disabilities.

Experiences among firefighters and police officers of responding to out-of-hospital cardiac arrest in a dual dispatch programme in Sweden: an interview study

OBJECTIVES

The objective of this study was to explore firefighters' and police officers' experiences of responding to out-of-hospital cardiac arrest (OHCA) in a dual dispatch programme.

DESIGN

A qualitative interview study with semi-structured, open-ended questions where critical incident technique (CIT) was used to collect recalled cardiac arrest situations from the participants' narratives. The interviews where transcribed verbatim and analysed with inductive content analysis.

SETTING

The County of Stockholm, Sweden.

PARTICIPANTS

Police officers (n=10) and firefighters (n=12) participating in a dual dispatch programme with emergency medical services in case of suspected OHCA of cardiac or non-cardiac origin.

RESULTS

Analysis of 60 critical incidents was performed resulting in three consecutive time sequences (preparedness, managing the scene and the aftermath) with related categories, where first responders described the complexity of the cardiac arrest situation. Detailed information about the case and the location was crucial for the preparedness, and information deficits created stress, frustration and incorrect perceptions about the victim. The technical challenges of performing cardiopulmonary resuscitation and managing the airway was prominent and the need of regular team training and education in first aid was highlighted.

CONCLUSIONS

Participating in dual dispatch in case of suspected OHCA was described as a complex technical and emotional process by first responders. Providing case discussions and opportunities to give, and receive feedback about the case is a main task for the leadership in the organisations to diminish stress among personnel and to improve future OHCA missions.

Continuous glucose monitoring in adults with type 1 diabetes: A balance between benefits and barriers: A critical incident study

AIMS AND OBJECTIVES

To describe positively and negatively perceived situations experienced by adults with type 1 diabetes using continuous glucose monitoring and the actions they take to deal with these situations.

BACKGROUND

Real-time continuous glucose monitoring has been shown to improve glycaemic control and reduce hypoglycaemia. Although many patients with type 1 diabetes report great benefits when using continuous glucose monitoring, a substantial number discontinue using the device. Little is known about the different situations and experiences with the daily use of continuous glucose monitoring that contribute to such differences.

DESIGN

A descriptive design based on the critical incident technique was used. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) (see File S1).

METHODS

Individual interviews were conducted with a purposive sample of 23 adults with type 1 diabetes, including current and former users of continuous glucose monitoring from four different outpatient clinics.

RESULTS

The participants described that they felt that the use of continuous glucose monitoring was a balance between benefits and barriers, and how, through their actions, they tried to adapt their use of continuous glucose monitoring to fit their lifestyles. Various life events affected and altered the balance between benefits and barriers and thus affected their use of continuous glucose monitoring.

CONCLUSIONS

Continuous glucose monitoring is perceived as an effective and important tool in the self-management of diabetes type 1. It enables a better everyday life and increased satisfaction with treatment. At the same time, the use of continuous glucose monitoring can be both demanding and challenging.

RELEVANCE TO CLINICAL PRACTICE

Understanding the complex interplay between perceived benefits, treatment burden and adherence to continuous glucose monitoring use is important for nurses engaged in diabetes care. Education and support regarding the use of continuous glucose monitoring must be based on the understanding and perspectives of the patient to alleviate stress and barriers and enhance self-efficacy. As the use of continuous glucose monitoring can change over time, this must be a continuous process beyond initial training.

The Critical Incident Technique: Method or Methodology?

The critical incident technique (CIT) is a qualitative research tool that is frequently used in health services research to explore what helps or hinders in providing good quality care or achieving satisfaction with care provision. However, confusion currently exists on the nature of the CIT: Is it a method for data collection and analysis or a methodology? In this article, I explain why this distinction is important and I argue that the CIT is a methodology (and not a method) for the following reasons: Key methodological dimensions are described for the CIT; it has a clear focus; studies that apply this technique make use of various methods for data collection and analysis; it describes, explains, evaluates, and justifies the use of a specific format for those methods; it implies philosophical and practical assumptions; and studies that use the CIT cannot easily make use of additional methodologies simultaneously.

Key Factors for Successful General Anesthesia of Obese Adult Patients

PURPOSE

To study nurse anesthetists' experiences of key factors for successful airway management in general anesthesia of adult obese patients.

DESIGN

The study was a qualitative observational study with a descriptive approach.

METHODS

Eight semistructured interviews were conducted. Data were analyzed using the critical incident technique.

FINDINGS

Five key factors for successful general anesthesia of adult obese patients were identified. These factors were preparing and planning the anesthesia, optimizing patient position, optimizing ventilation through proper preoxygenation and increasing positive end-expiratory pressure, quickly securing the airway, and working in teams.

CONCLUSIONS

Knowledge of key factors that facilitate and improve the anesthesia care of obese patients is important to provide safe and quality anesthesia to this patient group as obese patients often have small margins and urgent situations can quickly arise. This knowledge enables the nurse anesthetist to be one step ahead and to be ready to take action if complications occur.

Reflective Learning Outcomes of Community-Based Experiences: A Qualitative Study

The aim of this study was to explore the meaning of community-based experiences for senior dental and dental hygiene students through the use of critical incident essays. A total of 108 senior dental students and 22 senior dental hygiene students were invited to participate in the study. Each student was required to write about one critical incident that occurred at one of four community clinic rotation sites during the 2012-13 school year. The participation rate was 78% of the students. Professional responsibility, a willingness to volunteer, and an understanding of the importance of oral health education were the main themes that emerged from analysis of the essays. These results suggest that community-based learning, with reflection, challenged how these students perceived oral health disparities and expanded the meaning of professional responsibility for them.

A qualitative study of assistant nurses' experiences of palliative care in residential care

AIM

To explore assistant nurses' experiences and perceptions of both positive and negative aspects of providing palliative care for older people in residential care facilities.

DESIGN

A qualitative explorative study.

METHODS

Critical incidents were collected through semi-structured face-to-face interviews and analysed by performing a qualitative content analysis.

RESULTS

A total of 40 critical incidents from daily work was described by assistant nurses. The results showed that close cooperation between unlicensed and licensed professionals was crucial to provide good care but was sometimes negatively affected by the organizational structure. The availability of professionals was identified as a critical factor in providing good care at the end of life in a consultative organization. The most prominent findings were those that indicated that, especially in a consultative organization, there seems to be a need for clear roles, comprehensive and clear care plans and a solid support structure to ensure continuity of care.

Viewing Focus Groups Through a Critical Incident Lens

Scholars often do not describe in detail the complex process of conducting focus groups, including what happens when they take unexpected turns. A critical incident lens provides a framework for better analyzing and understanding what actually happens during focus group sessions. Using a critical incident approach, we examine our experiences of carrying out focus groups about the human papillomavirus (HPV) vaccine with vaccine-eligible adolescent girls and parents/caregivers of vaccine-eligible adolescent girls in New Mexico. The critical incident lens allowed us to productively explore the context and interactional dynamics of our focus groups and ultimately pushed us to talk through the challenges of conducting and analyzing them. We hope this serves as a call to qualitative researchers to be attentive to the critical incidents in your own research to enrich your analysis and contribute to a broader discussion of the realities of focus group conduct.

Healthcare professionals' descriptions of care experiences and actions when assessing postoperative pain - a critical incident technique analysis

BACKGROUND

Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments.

OBJECTIVES

The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain.

METHODS

An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience.

FINDINGS

In pain assessments, patient-related facilitators were patients' verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients' pain manifestations and adapting to patients' communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain.

CONCLUSIONS

Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals' dissimilar responsibilities when collecting patients' and relatives' perspectives on current pain.

Exploring the causes of junior doctors' prescribing mistakes: a qualitative study

AIMS

Prescribing errors are common and can be detrimental to patient care and costly. Junior doctors are more likely than consultants to make a prescribing error, yet there is only limited research into the causes of errors. The aim of this study was to explore the causes of prescribing mistakes made by doctors in their first year post graduation.

METHODS

As part of the EQUIP study, interviews using the critical incident technique were carried out with 30 newly qualified doctors. Participants were asked to discuss in detail any prescribing errors they had made. Participants were purposely sampled across a range of medical schools (18) and hospitals (15). A constant comparison approach was taken to analysis and Reason's model of accident causation was used to present the data.

RESULTS

More than half the errors discussed were prescribing mistakes (errors due to the correct execution of an incorrect plan). Knowledge-based mistakes (KBMs) appeared to arise from poor knowledge of practical aspects of prescribing such as dosing, whereas rule-based mistakes (RBMs) resulted from inappropriate application of knowledge. Multiple error-producing and latent conditions were described by participants for RBMs and KBMs. Poor/absent senior support and a fear of appearing incompetent occurred with KBMs. Following erroneous routines or seniors' orders were major contributory factors in RBMs.

CONCLUSIONS

Although individual factors such as knowledge and expertise played a role in prescribing mistakes, there were many perceived interrelated factors contributing to error. We conclude that multiple interventions are necessary to address these and further research is essential.

Dilemmas of participation in everyday life in early rheumatoid arthritis: a qualitative interview study (The Swedish TIRA Project)

PURPOSE

To explore the experiences of today's patients with early rheumatoid arthritis (RA) with respect to dilemmas of everyday life, especially regarding patterns of participation restrictions in valued life activities.

METHODS

A total of 48 patients, aged 20-63, three years post-RA diagnosis were interviewed using the Critical Incident Technique. Transcribed interviews were condensed into meaningful units describing actions/situations. These descriptions were linked to ICF participation codes according to the International Classification of Functioning, Disability and Health (ICF) linking rules.

RESULTS

Dilemmas in everyday life were experienced in domestic life, interpersonal interactions and relationships, community, social and civic life. Most dilemmas were experienced in domestic life, including participation restrictions in, e.g. gardening, repairing houses, shovelling snow, watering pot plants, sewing or walking the dog. Also many dilemmas were experienced related to recreation and leisure within the domain community, social and civic life. The different dilemmas were often related to each other. For instance, dilemmas related to community life were combined with dilemmas within mobility, such as lifting and carrying objects.

CONCLUSIONS

Participation restrictions in today's RA patients are complex. Our results underline that the health care needs to be aware of the patients' own preferences and goals to support the early multi-professional interventions in clinical practice. Implications of Rehabilitation Today's rheumatoid arthritis (RA) patients experience participation restrictions in activities not included in International Classification of Functioning, Disability and Health (ICF) core set for RA or in traditionally questionnaires with predefined activities. The health care need to be aware of the patients' own preferences and goals to meet the individual needs and optimize the rehabilitation in early RA in clinical practice.

National critical incident reporting systems relevant to anaesthesia: a European survey

BACKGROUND

Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia.

METHODS

We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure.

RESULTS

Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national co-ordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed.

CONCLUSIONS

We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

Health professionals' beliefs about domestic abuse and the issue of disclosure: a critical incident technique study

Domestic abuse is increasingly recognised as a serious, worldwide public health concern. There is a significant body of literature regarding domestic abuse, but little is known about health professionals' beliefs about domestic abuse disclosure. In addition, the intersection between health professionals' beliefs and abused women's views remains uninvestigated. We report on a two-phase, qualitative study using Critical Incident Technique (CIT) that aimed to explore community health professionals' beliefs about domestic abuse and the issue of disclosure. We investigated this from the perspectives of both health professionals and abused women. The study took place in Scotland during 2011. The study was informed theoretically by the Common Sense Model of Self-Regulation of Health and Illness (CSM). This model is typically used in disease-orientated research. In our innovative use, however, CSM was used to study the social phenomenon, domestic abuse. The study involved semi-structured, individual CIT interviews with health professionals and focus groups with women who had experienced domestic abuse. Twenty-nine health professionals (Midwives, Health Visitors and General Practitioners) participated in the first phase of the study. In the second phase, three focus groups were conducted with a total of 14 women. Data were analysed using a combination of an inductive classification and framework analysis. Findings highlight the points of convergence and divergence between abused women's and health professionals' beliefs about abuse. Although there was some agreement, they do not always share the same views. For example, women want to be asked about abuse, but many health professionals do not feel confident or comfortable discussing the issue. Overall, the study shows the dynamic interaction between women's and health professionals' beliefs about domestic abuse and readiness to discuss and respond to it. Understanding these complex dynamics assists in the employment of appropriate strategies to support women post-disclosure.

Turning knowledge into action at the point-of-care: the collective experience of nurses facilitating the implementation of evidence-based practice

BACKGROUND

Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America.

AIM

To describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice.

METHODS

Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses' facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison.

RESULTS

A number of factors emerged at various levels associated with the successes and failures of participants' efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability.

CONCLUSIONS

Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence-based practice in real situations at the point-of-care. With a greater understanding of factors contributing to successful or unsuccessful facilitation, future research should focus on analyzing facilitation interventions tailored to address barriers and enhance facilitators of evidence uptake.