Appreciative Inquiry as an intervention to change nursing practice in in-patient settings: An integrative review

BackgroundHigh profile accounts of failures in patient care reflect an urgent need for transformational development in healthcare. Appreciative Inquiry is promoted as an approach to exploring and bringing about change in social systems. Appreciative Inquiry has been used extensively in North American business since the late 1980s. The application of Appreciative Inquiry may have merit in the complex world of human health experiences.ObjectivesTo identify, evaluate and synthesise the evidence about the impact of Appreciative Inquiry on changing clinical nursing practice in in-patient settings.DesignAn integrative review and narrative synthesis.SettingIn-patient settings including paediatrics, maternity and mental health.ParticipantsNurses of all grades, patients, carers, relatives, other healthcare professionals including allied healthcare staff, management and students.Data sourcesAn electronic search of the following electronic databases was performed in January 2015 and updated in July 2015: MEDLINE, EMBASE, Cochrane Library (Cochrane database of systematic reviews), Cumulative Index of Nursing and Allied Health Literature, PsychINFO, PsychARTICLES, Amed, Assia, Scopus and Web of Science. Hand searching of reference lists of included studies was undertaken. Limits were set to include literature published in English only and publications from 1990 to July 2015.Review methodsThree reviewers independently assessed eligibility for inclusion and extracted data. Full text articles were systematically appraised using a standardised data extraction instrument in conjunction with criteria to assess whether change using Appreciative Inquiry is transformational.ResultsEight studies (reported in 11 papers) met the inclusion criteria. Overall, these studies demonstrate poor application of Appreciative Inquiry criteria in a nursing context. This makes judgement of the impact difficult. One study achieved transformation against agreed criteria for Appreciative Inquiry. Other included studies demonstrated that Appreciative Inquiry is being perceived as a gateway to knowledge translation rather than transformative change in practice.ConclusionsAppreciative Inquiry offers potential for nurse practice development and change but not without cognisance of the pivotal components. If Appreciative Inquiry is to be perceived as a legitimate research endeavour, there must be engagement and attention to rigour. Findings suggest caution is required against the choreography of Appreciative Inquiry where participant experiences are moulded to fit a previously drafted master plan. Further research is needed to explore the role of expert facilitation in securing and sustaining successful outcomes of Appreciative Inquiry.     

概述美国的药学服务实践流程变迁

摘 要 目的： 概述美国的药学服务实践流程变迁,为我国开展药学服务工作提供借鉴。方法: 查阅文献,对美国医院药学相关学会组织提出的药学服务实践流程进行总结、分析。结果与结论:美国药学从业者联合委员会提出的以患者为中心的药学服务完整总结了其实践流程,包括采集-评估-计划-实施-随访等步骤,强调与团队的沟通、合作、资源共享,适合任何工作环境对患者提供的药学服务。     

Prevalence and reliability of treatment-based classification for subgrouping patients with low back pain

Objectives: To observe the distribution of patients who presented with low back pain (LBP) and to determine the between therapists’ interrater reliability of assessments in a private outpatient setting using treatment-based classification (TBC) subgroups.

Methods: An observational and methodological study was conducted. Four hundred and twenty-nine patients (231 male; 198 female) presenting LBP symptoms and referred to conservative treatment were assessed by 13 physical therapists who conducted a 60-min examination process utilizing TBC subgroups. Interrater reliability analyses from six raters were assessed using Fleiss’ kappa and previously recorded data (n = 30).

Results: In this study, 65.74% of patients were classified in only one subgroup, the most prevalent being stabilization (21.91%), followed by extension (15.38%), traction (11.89%), flexion (10.96%), manipulation (5.13%), and lateral shift (0.47%). Approximately 20.98% of patients were classified in two subgroups, where the most frequent overlaps were flexion + stabilization (7.46%), extension + stabilization (6.06%), flexion + traction (4.20%), extension + manipulation (1.86%), and 13.29% of patients were not classified in any TBC subgroup. Analysis of interrater reliability showed a kappa value of 0.62 and an overall agreement of 66% between raters.

Discussion: LBP is a heterogeneous clinical condition and several classification methods are proposed in the attempt to observe better outcomes for patients. Eighty-five percent of patients assessed were able to be classified when using the TBC assessment and reliability analysis showed a substantial agreement between raters.

Level of Evidence: 2c.     

上海市二、三级医疗机构儿科护理从业人员执业环境调查研究

目的 调查上海市二、三级医疗机构儿科护理从业人员执业环境现况。方法 采用《护士执业环境量表》,选取上海市三级甲等儿科专科医院、三级甲等综合医院儿科、二级甲等综合医院儿科及二、三级妇幼保健院儿科1610名儿科护理从业人员参与网络问卷调查。结果 《护士执业环境量表》各维度得分排序由高到低分别为有提供高质量护理服务的基础、护理管理者的能力及领导方式、医护合作、护士参与医院事物、充足的人力和物力。四类参研单位儿科护士执业环境得分比较差异无统计学意义。结论 各单位护理理念、制度、流程及领导力较完善,儿科护士参与医院事务管理较少、人力物力不足,医护合作有待更紧密,MDT建设需加强,儿科医联体为儿科护理质量同质化提供保障。管理者需在更高的平台为儿科护理人员进行呼吁,稳定儿科护理队伍。     

A scoping review of the progress of the evolution of the Doctor of Nursing Practice in the USA to inform consideration of future transformation of Nurse Practitioner education in Australia

Background

In 2004 a consensus was reached through a vote of membership of the American Association of Colleges of Nursing to move Nurse Practitioner education from the masters to the doctoral level by 2015.