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Waterman H Harker R MacDonald H McLaughlan R Waterman C 《Journal of advanced nursing》2005,52(4):389-398
AIM: This paper reports the evaluation phase of an action research project that promoted face-down posturing of patients following vitreo-retinal surgery for macular hole to enhance patient outcomes. The evaluation phase identified areas of practice needing further development from the perspectives of those involved with the care of patients. BACKGROUND: To achieve best results following surgical repair of macular hole, patients are required to posture face down for several weeks. As a consequence, patients complain of severe back and neck ache and find it difficult to persist with the posturing. Work to advance nursing practice as surgical developments occur has relevance beyond ophthalmology and the particular context of this project. METHOD: The first three phases of this action research--problem identification, planning and action--have been reported in another paper. Throughout the project an action research group comprising of representatives of key stakeholders were actively involved in researching and changing practice. During the evaluation phase, a qualitative methodology was chosen. Interviews with 17 members of staff from the inpatient area were carried out to elicit their perspectives on the posturing of patients. Qualitative interviews were selected to facilitate comparison with interview data from Phase 1. Data analysis ran concurrently with data collection, so that one could inform the other. FINDINGS: Overall, nurses and healthcare support workers felt that patients were more agreeable to posturing and after surgery began to posture more quickly. Communication was still an issue in some instances, and patients having urgent as opposed to planned surgery were found to be more difficult to prepare and the psychological care of patients still posed problems for nursing staff. CONCLUSIONS: The evaluation suggests that improvements in the care of this group of patients have occurred. A 10-point plan to promote face-down posturing has been developed which will be of use to practitioners in other settings. Some aspects of practice remain less well-understood, for example, the psychological care of patients. 相似文献
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Waterman H Harker R MacDonald H McLaughlan R Waterman C 《Journal of advanced nursing》2005,52(3):281-290
AIM: This paper reports an action research project that promoted posturing face down following macular hole surgery and aimed to enhance patient outcomes. This paper gives an overview of the process and outcomes of the first three of four phases of the project: problem identification, planning and action. The fourth phase, which was an evaluation of the project, is reported in another paper. BACKGROUND: Surgical repair for macular hole is common procedure carried out worldwide, and patients are required to posture face down for several weeks after this surgery. There is anecdotal evidence that many patients find this difficult to carry out. In the context of increasing medical specialization, nursing practice must be developed to meet the needs of patients being treated. This study will, therefore, be relevant beyond the particular specialty and geographical location described. METHOD: The methodology was participative and cyclical. Initially, a fact-finding exercise was undertaken, using qualitative interviews with 18 members of staff to elicit their perspectives on the posturing of patients. Based on the fact-finding exercise, seven action objectives were set. While these were being implemented, three further research projects were identified and undertaken. Two were qualitative studies: one investigated patients' experiences of the surgery and posturing, and the second concerned nurses' developing working theories on the promotion of posturing and effects of nursing care on patient outcomes. Another pilot study was a randomized controlled trial to consider the effect of two different posturing regimes on patient outcomes. In addition to regular action research group meetings, these studies served to inform and monitor the changes as they were put into practice. The work was carried out from 1998 to 2002. FINDINGS: Several factors appeared to influence whether patients postured after surgery, namely: education of staff and patients, appropriately timed services, clear lines of responsibility for patient care, good communication and availability of equipment. CONCLUSION: The research suggests that an approach to care is required that appreciates and deals with the multiple factors that influence whether patients carry out the posturing. 相似文献
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This paper is a review of the experiences gained whilst working with the 'expertise in practice project'. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice-based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to the process of engaging people who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners' concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient-participants' role as a sophisticated evaluator of health-care. As a result, we present a case for transformational qualitative research. Such research is values-driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its 'ends' (i.e. research products) but also, intentionally, through its 'means' (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self-reflection) to examine and critique their personal values. 相似文献
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Systematic implementation of evidence‐based practice in a clinical nursing setting: a participatory action research project
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Jolanda HHM Friesen‐Storms MSc RN Albine Moser PhD MPH RN Sandra van der Loo RN Anna JHM Beurskens PhD MSc Gerrie JJW Bours PhD MSc RN 《Journal of clinical nursing》2015,24(1-2):57-68
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Creating effective nursing partnerships: relating community development to participatory action research 总被引:1,自引:0,他引:1
Elizabeth Lindsey RN PhD Laurene Sheilds RN PhD & Kelli Stajduhar RN MN 《Journal of advanced nursing》1999,29(5):1238-1245
The purpose of this article is to demonstrate the importance of creating effective partnerships between nurses practising community development (CD) and nurses engaged in participatory action research (PAR). To that end, an overview of the theoretical principles of CD and PAR is provided and the central tenets of each methodology explored. This is followed by a discussion of the similarities and differences inherent in CD and PAR which derive from the same theoretical and philosophical foundation; that of critical social theory. Examples of two research projects highlight the relationship between CD and PAR and demonstrate the value of creating effective practitioner/researcher partnerships. Finally, some of the lessons learned in creating these important partnerships will be presented. Although this call for practitioner/researcher alliance is not new, what is new is the central role the practising nurse could take in research. Creating partnerships between practising nurses and nurse researchers advances the opportunity to actualize responsive and effective PAR and to fulfill nursing's social contract. 相似文献
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This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings. 相似文献
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Understanding the challenges of palliative care in everyday clinical practice: an example from a COPD action research project
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Geralyn Hynes Fiona Kavanagh Christine Hogan Kitty Ryan Linda Rogers David Coghlan 《Nursing inquiry》2015,22(3):249-260
Palliative care seeks to improve the quality of life for patients suffering from the impact of life‐limiting illnesses. Palliative care encompasses but is more than end‐of‐life care, which is defined as care during the final hours/days/weeks of life. Although palliative care policies increasingly require all healthcare professionals to have at least basic or non‐specialist skills in palliative care, international evidence suggests there are difficulties in realising such policies. This study reports on an action research project aimed at developing respiratory nursing practice to address the palliative care needs of patients with advanced chronic obstructive pulmonary disease (COPD). The findings suggest that interlevel dynamics at individual, team, interdepartmental and organisational levels are an important factor in the capacity of respiratory nurses to embed non‐specialist palliative care in their practice. At best, current efforts to embed palliative care in everyday practice may improve end‐of‐life care in the final hours/days/weeks of life. However, embedding palliative care in everyday practice requires a more fundamental shift in the organisation of care. 相似文献
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Aim. This paper explores the development of a low‐cost, involving methodology for constructing nursing‐focused evidence‐based national care guidance, known as Best Practice Statements, the intended users of which are gerontological nurses practising throughout Scotland. Design. The Best Practice Statement construction methodology forms one cycle in a five‐year longitudinal action research study that aims to achieve evidence‐based nursing, facilitate professional networking to support practice development and promote the principles and practice of gerontological nursing. Achieving these aims involved designing a virtual Practice Development College. Methods. A Community of Practice comprising practising gerontological nurses, expert advisors, academic teaching and research nurses collaborated in face‐to‐face meetings and in the virtual Practice Development College to delineate and refine the procedural model for Best Practice Statement construction. Focus groups, telephone interviews, analysis of on‐line archives and documentary outputs formed the analytic dataset. Results. Qualitative analysis indicated that, from the perspective of the community of practice, the emerging methodology facilitated the melding of knowledge sources reflecting the dominant evidence hierarchy with other forms of evidence valued by gerontological nurses, in the Best Practice Statement. Relevance to clinical practice. Current methods of care guidance construction rarely address the concerns of nurses and the evidence from which guidelines are developed is narrowly defined with regard to inclusion and acceptability. In contrast this model focuses on nursing issues, embraces a wider definition of evidence and ensures that the published Best Practice Statements are credible and achievable in gerontological practice, where they are tested and refined as an inherent aspect of the development process. 相似文献
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Reed J 《Journal of clinical nursing》2005,14(5):594-600
Aim. This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. Background. Action research has gained popularity in nursing and healthcare research, offering a way of developing practice‐based knowledge, which can assist in changing practice and democratizing inquiry. Methods. There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. Conclusion. While the principles of action research appear to offer much towards the development of a practice‐rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. Relevance to clinical practice. If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies. 相似文献
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Kirkevold M 《International journal of older people nursing》2008,3(4):282-286
Background. In the mid-1990s, there was persistent critique of the quality of care provided in residential aged care facilities in Norway, in line with similar concerns expressed in many other countries. Difficulties recruiting qualified staff and high turnover led to difficult working conditions. Little prestige was associated with providing geriatric care. Collaboration between educational institutions, universities and elderly care institutions with the purpose of strengthening education, competence development, practice development and research within elderly care was poorly developed. The Norwegian teaching nursing home (NTNH) program was launched to address these issues. Aim. The purpose of the NTNH was to contribute to the quality of care of frail older persons by improving the competence of staff, improving the prestige of working with older people, stimulating development of services, facilitating research into the care of older persons, and developing good learning environments for students. Methods. The NTNH-program was developed over a period of seven years, applying a participatory action research design. Progressing through four phases, it involved a number of people and institutions across Norway. Results. Formal and informal competence of staff was increased. A large number of practice development projects contributed to increased quality of care in selected problem areas. Models of competence development were disseminated to other institutions, thereby improving the level of competence beyond the NTNHs. Learning conditions for students were improved. Following a formal evaluation of the program, teaching nursing homes (TNHs) were established on a permanent basis in 2004, with financial support from the Department of Health and Social Services. In 2008, a total of 20 TNHs are part of the NTNH program. Conclusions. The NTNH program led to permanent establishment of a series of TNHs responsible for contributing to competence development, practice development and research on a continuous basis in order to secure high levels of care to the Norwegian nursing home population. The program has created substantial enthusiasm within the nursing home sector and has increased the prestige of these institutions. 相似文献
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KIM MANLEY 《Journal of clinical nursing》1997,6(3):179-190
- ? A preliminary conceptual framework for an advanced practice/consultant nurse role is presented which links the role to its context and outcomes.
- ? The conceptual framework was developed in the process of analysing data from a 3-year action research study involving the operationalization of an advanced practice/consultant nurse role in a Nursing Development Unit.
- ? The skills and knowledge base of consultancy, underpinned by a strong nursing foundation, augmented by strong leadership and combined with the educator and researcher functions, are presented as the attributes of the advanced practitioner/consultant nurse.
- ? The facilitation of a transformational culture is highlighted as central to the skills and processes used within the role.
- ? Implications for the preparation and accreditation of the advanced practitioner/ consultant nurse are highlighted.
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目的:构建精神科专科护士核心能力评价指标体系。方法:采用德尔菲法对18名专家进行两轮函询。结果:专家的权威系数、意见集中程度和协调程度均较高;最终确立的指标体系包括7项一级指标,34项二级指标。结论:精神科专科护士核心能力评价指标体系的研究结果可靠性高,可为精神科专科护士的培养提供参考依据。 相似文献
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Björnsdottir K 《Journal of advanced nursing》2001,33(2):159-166
AIM OF THE PAPER: This paper highlights the centrality of language in constructing knowledge. It aims at making us sensitive to the political nature of knowledge production and the complex power relationships that may emerge as a result of our efforts to create new knowledge. BACKGROUND: Science, as understood here, is a linguistic construction, rather than a mirror reflection of reality. A number of examples are presented, demonstrating the complex ways in which language is central in shaping all our attempts to know, science included, and nursing practice. CONCLUSION: Based on the analysis presented in this paper an argument is made for a substantial re-thinking of nursing research and its relationship to nursing practice. Research needs to be an integral part of everyday nursing practice, a way of posing questions and reflecting on answers. Further, nurses need to be aware of the potentially coercive nature of knowledge as well as its liberating effect. 相似文献