ABSTRACT
Finding ways to deliver care based on the best possible evidence remains an ongoing challenge. Further theoretical developments of a conceptual framework are presented which influence the uptake of evidence into practice. A concept analysis has been conducted on the key elements of the framework--evidence, context, and facilitation--leading to refinement of the framework. While these three essential elements remain key to the process of implementation, changes have been made to their constituent sub-elements, enabling the detail of the framework to be revised. The concept analysis has shown that the relationship between the elements and sub-elements and their relative importance need to be better understood when implementing evidence based practice. Increased understanding of these relationships would help staff to plan more effective change strategies. Anecdotal reports suggest that the framework has a good level of validity. It is planned to develop it into a practical tool to aid those involved in planning, implementing, and evaluating the impact of changes in health care.
Subject(s)
Delivery of Health Care/organization & administration , Evidence-Based Medicine , Health Services Research/methods , Organizational Innovation , Delivery of Health Care/standards , Health Plan Implementation , Humans , Organizational Culture , Patient Satisfaction , Practice Patterns, Physicians' , Process Assessment, Health Care , Quality Assurance, Health Care , Reproducibility of Results , United KingdomABSTRACT
This paper describes the development of a conceptual framework for practice development. Drawing on the authors' combined experiences of facilitating developments in practice, a conceptual framework is proposed. It is argued that much practice development in health care today lacks a systematic approach and is often undertaken by individual practitioners who are poorly prepared for their roles. A short history of practice development is outlined to contextualize current development activities. The proposed framework is located in a critical social science philosophy and it is suggested that such a philosophy enables individual growth and development, empowerment of practitioners and the generation of cultural change that sustains continuous growth and innovation in practice. An example of the framework in use is described and recommendations proposed to enable organizations to embrace a systematic approach to practice development.
Subject(s)
Models, Nursing , Nursing Care/organization & administration , Nursing Research , Philosophy, Nursing , Professional Autonomy , Quality Assurance, Health Care/organization & administration , Social Sciences , Clinical Competence/standards , Humans , Nurse-Patient Relations , Nursing Process , Organizational Culture , United KingdomABSTRACT
The paper describes a multiproject practice development programme undertaken over a period of 1 year. The background and development of the programme are outlined, whilst attention is paid to the innovatory nature of the work, particularly the use of inductive, deductive and integrated approaches to both change implementation and project supervision. The programme was monitored throughout using different data sources and the paper uses evaluative material retrospectively to provide answers to organizational and professional difficulties which arose during the course of the programme. The authors conclude that the use of combinations of different models for practice development has potential, but requires careful supervision. They also recommend that those involved in practice development are made fully aware of its local or micropolitics, and develop strategies to deal with change before it occurs, not after it has taken place.
Subject(s)
Models, Nursing , Nursing Research/methods , Nursing, Supervisory/organization & administration , Program Evaluation/methods , Evidence-Based Medicine , HumansABSTRACT
Helping nurses to become effective and confident as primary nurses involves developing their interpersonal skills, sharpening their decision-making and nurturing their creativity. In our action research study, we found that traditional methods of ward teaching did not help to promote this kind of professional growth. We therefore developed, tested and refined three distinct strategies for clinical supervision which specifically aimed to foster more thoughtful and more sensitive nursing practice. Very importantly, we found that these approaches to supervision were feasible and practical to use in a busy hospital ward. In this paper, we describe the three supervision strategies, using a clinical story to illustrate what each demands from the supervisor and what it offers the nurse under supervision. We also suggest ways in which expert nurses can be helped to become effective clinical supervisors.
Subject(s)
Clinical Competence , Education, Nursing, Continuing/methods , Nursing Staff, Hospital/education , Nursing, Supervisory/organization & administration , Health Services Research , Humans , Nursing Methodology ResearchABSTRACT
We define action research and relate it conceptually to other research strategies. The inadequacy of some action research methodologies for theory generation and testing is discussed. We describe the way we re-dressed this deficiency in our study of the journey from traditional nursing to patient-centered nursing. The differences and tensions between "research-thinking" and "practice-thinking" are explored and we show how our research partnership balances the two ways of thinking. We suggest that operating within the research criteria, presented here, may help action researchers to conduct rigorous research, as well as to improve practice.
Subject(s)
Clinical Nursing Research/organization & administration , Nursing Theory , Nursing, Team/organization & administration , Thinking , Diffusion of Innovation , Humans , Models, Nursing , Organizational Innovation , Organizational Objectives , Research Design , Research Personnel/psychology , Role , Social ChangeABSTRACT
This two-part paper is based on some of the findings from an action research study of the development of patient-centred nursing in an acute medical unit. In the first part, Angie Titchen presents findings from a case study of a ward undergoing the initial changes from traditional nursing to primary nursing. She documents and reflects upon the complexity of establishing new nursing roles, the devolution of authority and the shift in power relationships within the ward team, and the confusion and pain caused by role ambiguity. In the second part, we show how we addressed these problems through the action research.
Subject(s)
Attitude of Health Personnel , Job Description , Nursing Staff, Hospital/psychology , Nursing Theory , Nursing, Team/organization & administration , Primary Nursing/organization & administration , Role , Decision Making, Organizational , Education, Nursing, Continuing , Models, Nursing , Negotiating , Nursing Methodology Research , Nursing Staff, Hospital/education , Nursing, Supervisory , Organizational InnovationABSTRACT
This methodological paper discusses and critiques the 'insider' and 'outsider' models of action research described in the nursing literature. It highlights tensions and problems with these models and demonstrates how the models developed by the authors--the 'double-act' and 'collaborative group' partnerships--overcome these difficulties. The success of this approach suggests that such partnerships of nurse practitioners and a researcher should be considered when practitioners want to introduce innovation and facilitate change in practice and generate and test theory which is relevant to practice. The paper is presented in the form of a commentary, interspersed with reflective conversations in which the authors illustrate and reflect upon their attempts to make the methodology described a reality.
