What is action research and can it promote change in primary care?

Improving the quality of health care is an international priority. However, research has shown that methods of altering clinician's behaviour or implementing organizational change are often ineffective. Action research has been used successfully to facilitate change and improve service provision in industry, education and more recently in health care. In this paper, action research methodology and why it should be successful in promoting change are outlined. Recently published studies using action research in the primary health care team setting in the UK are discussed. They demonstrate that action research improves clinical care, teamwork, communication and administration. It also encourages practice teams to audit their work and identify their educational needs. The main problems encountered were the amount of time and effort required to maintain collaboration with participants, staff turnover and completing the research process in a short time scale. Action research should be a useful means of improving quality in health care and could be used more widely. In the UK, government strategy has called for individual- and team-based development plans based on individual learning needs. Action research could be a useful method of transforming these from theory to practice.     

Action learning enhances professional development of research supervisors: an Australian health science exemplar

The worldwide academic workforce is ageing. At the same time, health and human services workforces are expanding. The preparation of educators to fill gaps in expertise and to position the health sciences for future growth is an urgent need. The findings from a recent action learning project that aimed to enhance the professional growth and development of higher degree researcher student supervisors in a School of Health and Human Sciences are presented. Seven early career researchers and the facilitator met for two hours every two to three weeks over 4 months between April and July 2010, in a rural and regional university in New South Wales, Australia. The processes initiated were a combination of experiential knowledge, referral to relevant published reports, use of an effective supervision checklist, and critical conversations. Learning outcomes centered on higher degree management and supervision pedagogy, communities of practice, knowledge translation, and the establishment of a research culture. The contextual barriers and implications of the methodology and learning outcomes for the professional development of health and human science practitioners, researchers and educators is also discussed.     

Value of implementation science and hybrid implementation research designs for nursing education research: A discussion paper

IntroductionNursing education research is complex and contextualized. The evaluation and impact of educational innovations on students, educators, and educational outcomes are influenced by the complexity of environments. Most interventional research in nursing is designed and implemented without considering the behavioral and contextual issues affecting educational innovations, uptake and change processes, and outcomes. Implementation science has emerged as a valuable methodology for designing and conducting interventional research that has the potential to translate evidence and innovations quickly into practice.PurposeThis paper aims to explore the value of implementation science theories, models, and frameworks and hybrid designs for interventional nursing education research and illustrate how these can be used in nursing education research.MethodsA brief overview of implementation science, the various types of theories, models and frameworks and Hybrid designs are provided. Illustrative examples demonstrating the incorporation of these methodologies in interventional nursing education research are provided.ResultsA brief overview of implementation and its key concepts namely context, implementation strategies, fidelity, outcomes, adaptation, and sustainability is provided. Three types of hybrid designs are discussed with examples in nursing education research.DiscussionThe implications of implementation science for nursing education research are: a) Accelerating uptake of innovations to improve educational outcomes, b) targeting systematic change in individual and organizational behaviour and c) ensuring the sustainability of teaching and learning innovations.ConclusionIncorporating implementation science in nursing education research can optimize the uptake of educational innovations in practice in a sustainable manner. Nurse educators should equip themselves with implementation science skills and develop competencies to enhance the delivery of effective and quality nursing education.     

The challenge for basic science education in problem-based medical curricula

There has been intense debate about medical curriculum reform since the early 1950s. The last 25 years have seen a steady shift ward problem-based learning curriculum design in schools of medicine and allied health sciences. This trend has been less challenging for clinical departments than for departments of basic science, where it has often evoked anxiety, antipathy, lack of cooperation, and general mistrust. This appears paradoxical, as problem-based learning (PBL) is promoted as an improved method of integrating scientific concepts, and the advances that drive much of modern medical practice are advances in the basic sciences. While proponents of PBL argue that the approach promotes better integration and use of scientific concepts, the evidence, such as it is, is against this. As well, other evidence suggests that clinicians do not use basic science concepts extensively in their practice. This then questions the utility of scientific knowledge in a medical curriculum. This article examines this notion of utility (the quality or state of being useful), to establish some ground rules for what does, and does not, possess utility, and to present strategies to develop specific objectives from general statements concerning utility. Understanding of biologic and pathologic processes becomes of central importance and arguably possesses utility. If it is both required and evaluated, such understanding necessitates mastery of basic science concepts. Previously, the presentation of the basic sciences in medical curricula has emphasized the acquisition of knowledge rather than its use. Such learning has been perceived to lack utility; strategies to enhance the value of studying basic science concepts are suggested. If the importance of objectives in the basic medical sciences is accepted, these objectives should be achieved early in training, maintained at exit from medical school, and revisited in continuing medical education. The process of change in medical education initiated by Abraham Flexner early in this century remains incomplete. One reason why curricular changes have proved frustrating to basic scientists is that much of clinical medicine remains unnecessarily unscientific. Until clinical medicine itself changes, the utility of science in the training of a physician will remain difficult to demonstrate.     

Clinical education. Relating practical experiments to theory

Integrating theory into practice is not without its difficulties. Often concepts derived from the physical and behavioural sciences appear to be unrelated to nursing practice and although noted laboriously by student nurses no active learning occurs. As nurse education changes not only in curriculum content and teaching methodology but in who will do the teaching and in what venue, then the importance of ensuring the relevance of theoretical concepts to nursing practice will increase. This paper illustrates how physiological theory can be integrated into nursing practice by the use of ward-based practical experiments. Currently four such experiments have been introduced and are being evaluated. There is scope for developing further experiments and it is contended that this approach will enhance learning.     

Feminist-informed participatory action research: a methodology of choice for examining critical nursing issues

Identifying a methodology to guide a study that aims to enhance service delivery can be challenging. Participatory action research offers a solution to this challenge as it both informs and is informed by critical social theory. In addition, using a feminist lens helps acquiesce this approach as a suitable methodology for changing practice. This methodology embraces empowerment self-determination and the facilitation of agreed change as central tenets that guide the research process. Encouraged by the work of Foucault, Friere, Habermas, and Maguire, this paper explicates the philosophical assumptions underpinning critical social theory and outlines how feminist influences are complimentary in exploring the processes and applications of nursing research that seeks to embrace change.     

Nursing science and related sciences. Questions about centralization of nursing science and interdisciplinary relations

The thesis of this paper is that nursing science draws a lot of its innovative potential from the knowledge that has been gathered in related disciplines. This knowledge is specified and reformulated with regard to nursing practice. The thesis is developed on two levels: first under aspects of methodology and the philosophy of science, then under aspects of the adoption of interdisciplinary knowledge. The integration of various related sciences that takes place in nursing science will finally be demonstrated in an example. This example shows which qualifications the practitioners need to deal with patients who suffer from a stroke.     

A pilot evaluation of simulation-based interprofessional education for occupational therapy,speech pathology and dietetic students: improvements in attitudes and confidence

ABSTRACT

Many higher education institutions struggle to provide interprofessional practice opportunities for their pre-licensure students due to demanding workloads, difficulties with timetabling, and problems with sourcing suitable placements that provide appropriate practice opportunities. A series of complex unfolding video-based simulation scenarios involving a patient who had experienced a stroke was utilized as a case study for a three-hour interprofessional practice workshop. 69 occupational therapy (OT), speech pathology (SP) and dietetics (DT) students participated in a mixed-methods study comparing interprofessional attitudes before and after the workshop. Attitudes toward interprofessional practice improved pre- vs. post-workshop and overall. Students were highly satisfied with the workshops contribution toward learning, although OT and SP students were more satisfied than DT students. Focus groups confirmed students liked the format and structure of the workshop, suggested that students better understood the role of other professions and improved role clarification, increased their confidence to practice in interprofessional practice settings, but noted the experience could have been improved with the incorporation of nursing and smaller groups to better facilitate participation. There is widespread support for implementing interprofessional education (IPE) in the health sciences, yet widespread implementation is not yet a reality. This research suggests that a simulation-based, three-hour IPE workshop can have an immediate benefit on confidence and attitudes toward interprofessional practice for allied health students.     

Using behavioral science theory to enhance public health nursing

The application of behavioral science theory is instrumental in advancing nursing research and practice. Nurses can benefit from a thorough understanding of theoretical perspectives related to health behavior change. Behavioral science theory can provide a conceptual context for understanding patient behavior, it can guide research on the determinants of health behavior and health service delivery, and it can offer alternative approaches to nursing practice that may improve the effectiveness of patient care. The aim of this paper is to provide some examples of behavioral theories that can be used in nursing research and practice, and provide an example of how one theory, Stages of Change (Transtheoretical Model), can be applied to older adult fall prevention. Given the critical role behavior plays in premature morbidity and mortality, public health nurses and researchers can benefit by broadening the use of theory in the design and implementation of interventions, using behavioral theory as their guide.     

Evidence-based management in clinical governance

The aim of this paper is to describe a strategy--a partnership between a clinician manager and nurse academic--developed for the purpose of utilizing clinical governance literature to enhance management practice. The partnership is an initiative that has been implemented to fill a growing need for more collaboration between the tertiary health education and health industry sectors. The paper provides a brief overview of clinical governance and evidence-based management, and describes the partnership between the clinician manager and nurse academic. For the purposes of this paper 'clinician manager' refers to a health professional who also has an extensive management role in a health care organization. The benefits of this partnership in terms of the application of clinical governance literature to improved management decision making and practice concern the ability of clinician managers to have access to the most up-to-date research findings in terms of good clinical governance, and to be able to apply them in their management practice. Information about clinical governance, linked with evidence-based management and the application of clinical governance literature in the management of a health service is also provided. The authors argue that this is a useful initiative which could be adopted by health care managers and academics--with the aim of enhancing evidence-based management policy and decision making.     

Integrating the creative arts into a midwifery curriculum: a teaching innovation report

The practice of midwifery has long been recognized as both art and science. However, educational programmes for midwifery are most often undertaken within an academic health sciences environment, and tend to be based on knowledge derived from the sciences (e.g. life sciences, biomedical sciences, behavioural sciences and social sciences). These scientific perspectives, while essential to the preparatory and on-going education of midwives, do not necessarily fully prepare midwives to fulfil their practice roles. This paper reports a teaching innovation aimed at facilitating student exploration of fundamental, complex and ethereal concepts which are essential to the effective and skillful practice of midwifery. Through the exploration of the arts and humanities, students were encouraged to engage with concepts such as 'caring', 'empathy', 'suffering', 'motherhood', 'pain', 'love', 'attachment', 'health' and 'illness'. Students were also encouraged to explore cultural and social symbols pertaining to parenthood and family life. Evaluation revealed that students valued the course, and that they gained insights which assisted them to develop understanding of key concepts. Implications for practice and education are drawn from this paper.     

Evaluation of email alerts in practice: part 1 – review of the literature on clinical emailing channels

Rationale Methods to systematically assess electronic knowledge resources by health professionals may enhance evaluation of these resources, knowledge exchange between information users and providers, and continuing professional development. We developed the Information Assessment Method (IAM) to document health professional perspectives on the relevance, cognitive impact, potential use and expected health outcomes of information delivered by (push) or retrieved from (pull) electronic knowledge resources. However, little is known about push communication in health sciences, and what we propose to call clinical emailing channels (CECs). CECs can be understood as a communication infrastructure that channels clinically relevant research knowledge, email alerts, from information providers to the inboxes of individual practitioners. Aims In two companion papers, our objectives are to (part 1) explore CEC evaluation in routine practice, and (part 2) examine the content validity of the cognitive component of IAM. Methods The present paper (part 1) critically reviews the literature in health sciences and four disciplines: communication, information studies, education and knowledge translation. Our review addresses the following questions. What are CECs? How are they assessed? Results The review contributes to better define CECs, and proposes a ‘push‐pull‐acquisition‐cognition‐application’ evaluation framework, which is operationalized by IAM. Conclusion Compared with existing evaluation tools, our review suggests IAM is comprehensive, generic and systematic.     

A paradigm for the production of practice-based knowledge

Aim  The aim of this paper was to explore trends, arguments and issues surrounding knowledge production and nursing practice, and to propose a paradigm of practice-based knowledge along with strategies to promote theory-based knowledge development in practice.
Background  Practice-based knowledge has been marginalized in the current practice and research paradigms. Several reasons for this are presented, some of which may be addressed to facilitate a more inclusive approach to knowledge that can potentially advance patient care and the discipline.
Evaluation  Classic and contemporary scholarly sources in nursing, philosophy, education, social sciences and other areas were critically reviewed and applied to support the argument and propose a paradigm of practice-based knowledge production.
Key issues  A key point identified in the paper is that theory, meaning conceptualizations at all levels of abstraction, is an important tool of knowledge development in nursing practice as it is in traditional research.
Conclusions  Various strategies exist that can be employed to promote development and use of practice-based knowledge in the clinical setting. The strategies are innovative yet practical, and require the support and encouragement of nursing management for their successful implementation.
Implications for Nursing Management  Nursing managers can influence if not facilitate all of the strategies to promote practice-based knowledge development identified in the paper. These efforts could give voice to the caregiver's knowledge and, in turn, enhance patient care and the satisfaction and retention of nurses.     

Appreciating and developing compassionate care in an acute hospital setting caring for older people

dewar b. & MacKay R. (2010) Appreciating and developing compassionate care in an acute hospital setting caring for older people. International Journal of Older People Nursing
5 , 299–308
doi: 10.1111/j.1748-3743.2010.00251.x Background. There is increasing emphasis in policy, research and practice on the importance of caring in health care. Indeed there is much debate about how to enhance the caring cultures within which health care is provided. This paper argues that a proper systematic analysis of caring practice that works well in care environments may help us to move towards a realistic model for the future which supports staff, patients and families to give and receive compassionate care. Aim. The aim of the project was to explore, develop and articulate strategies that enhanced compassionate relationship centred care in an acute hospital setting, caring for older people. Methods. Appreciative action research informed the development and evaluation of the project. A range of data generation activities were used to examine what worked well. Following detailed analysis key processes emerged as being central to delivery of compassionate care. Specific action projects were implemented and evaluated to enhance these processes necessary for compassionate caring. Findings. Data from the project helped to articulate the special and often hidden acts that make up compassionate care. In relation to the process of ‘knowing who I am and what matters to me’ data provided evidence of the value of this process and the potential impact to care. In addition data about the process of doing appreciative action research helped to realise its application and relevance in the health care setting. Conclusions. Findings from this work suggest that there are a number of significant processes that help people to deliver compassionate care. These need to be articulated, shared more widely across practice, policy and education so that we can build on this excellent practice. Implications for practice. Appreciative action research adopted in this project is an important methodology to supporting practitioners to identify what it is they do well and develop practice to try to make the best caring practice happen most of the time. Academics, policy makers and practitioners should consider the approach of appreciative action research as key to supporting developments in care.     

Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team's reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team-working in primary health care.     

医学服务、科研和教育中的伦理原则、监管与公共监督

医学承载人类健康责任。技术能力、服务标准、职业道德和社会责任心共同构成这个行业的灵魂。不伤害和有利原则、尊重和公正原则,是建立良好医患关系和规范医疗服务行为的职业伦理体系,已被国际、国内行业规范所认定。医学科研的发展,要求在保证真实性、有效性、安全性的基础上,确保受试者自主选择、风险最小化和社会公正,并建立起与之配套的各项程序。现代医学教育肩负为医学行业提供适任的人力资源的责任,直接影响卫生服务的可及性与健康结果,其目标、运作和评估日益成形。面临当前医疗公平问题突出且医患关系日益恶化、医学科研领域丑闻和伦理争议层出不穷、医学教育未能完全匹配社会需求的诸多问题,循证医学方法学向政策和社会科学领域延伸,以期为获得高质量科学证据提高决策质量提供助力。     

内科护理学实践教学大纲编制的研究

实践教学大纲是指导实践教学的纲领性文件,决定着教学质量和人才培养质量。因此,本文通过调查法、文献法、访谈法等研究方法,以"护理职业能力"为核心,制定切实可行的、科学的研究路线,对《内科护理学》实践教学大纲的编制进行研究,提高对护理学生职业能力的培养。     

The untapped potential of behaviour analysis and interprofessional care

ABSTRACT

Interprofessional collaboration has become a sought-after component of quality mental health care. Higher education institutions and mental health organizations seek to equip clinicians with the ability to provide cohesive clinical services while working collaboratively with a diverse group of professionals. Although research suggests that there may be benefits of interprofessional collaboration in mental health settings, collaborative practice initiatives have struggled with conceptual and methodological limitations. A behaviour analytic contribution to interprofessional care provides a philosophical position with an analytical goal distinguished by the prediction and influence of events, theoretical clarity, and methodological rigour that are needed within interprofessional research and practice. At the philosophical level, the extension of functional contextualism to interprofessional care research may provide a framework to achieve the valued ends of improving interprofessional collaboration and ultimately improving health-related outcomes for service users. Interprofessional collaboration can be conceptualized as metacontingency, a behaviour analytic concept that allows for a group level analysis of contributing social components. This paper uses the example of mental health care to guide a conceptual analysis of the potential application of behaviour analytic methodology within interprofessional practice, research, and education.     

Ethnography and nursing research

Ethnography, a qualitative research method developed within the field of anthropology, has been increasingly applied to a variety of fields, including sociology, education, and nursing. Ethnography works to understand the behavior and views of a particular cultural group from that group's own perspective. Traditionally, ethnography has been differentiated into classic ethnography, systematic ethnography, interpretive ethnography, and critical ethnography. A recently developed focused ethnography studies specific issues within a single culture or social situation among a limited number of people within a specific period of time. Focused ethnography is particularly relevant to the field of health sciences and holds significant potential to contribute to nursing knowledge and to help improve nursing practice. A search of Medline, CINAHL, Eric, PsycINFO, and the Index to Chinese Periodical Literature database found that ethnography has seldom been applied or discussed in the nursing literature in Taiwan. Therefore, the aim of this article is focused on introducing ethnography and understanding the applications of ethnography in nursing research. Relevant nursing literature published between 2000 and 2005 is summarized and the authors hope that this paper will give Taiwanese nursing professionals a better appreciation of this methodology and encourage its wider application in nursing research.     

Mentoring in Health Sciences Education: A Review of the Literature

Mentoring is a concept that has been around for many years, but has only gained popularity in health science education programs over the past 20 years. Nursing, in particular, has recognized the short- and long-term benefits of mentoring students. The primary benefits are career and psychosocial development, which enables students to be successful in their educational programs. Mentoring also assists with easing the transition from student to graduate in a shorter period. In this literature review, the authors examined mentoring programs from nursing, medical school, pharmacy, and occupational therapy educational programs. Each of these health science programs reported favourable outcomes for their students involved in mentoring relationships, such as decreased stress and anxiety about their education, increased feelings of belonging to their programs and professions, and increased self-confidence and self-esteem.These studies help to confirm that mentoring can have a dramatic influence on the success and retention of students enrolled in health science programs. Unfortunately, no recent literature is available that specifically addresses mentoring practices in the medical radiation sciences. This article will attempt to show that results from current research in other health science educational programs could be used in forming medical radiation sciences mentoring programs. Developing these programs could have the same positive effects on recruitment and retention as they have in related disciplines.