Abstract
BackgroundThis paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice. While the intention of the project was to identify and change factors in the practice context that inhibit effective person-centred pain management practices with older people (65 years or older), reflective critical engagement with the findings identified that enhancing pain management practices with older people was dependent on cultural change in the unit as a whole.MethodsAn EAR approach was utilised. The project was undertaken in a surgical unit that conducted complex abdominal surgery. Eighty-five percent (n = 48) of nursing staff participated in the two-year project (05/NIR02/107). Data were obtained through the use of facilitated critical reflection with nursing staff.ResultsThree key themes (psychological safety, leadership, oppression) and four subthemes (power, horizontal violence, distorted perceptions, autonomy) were found to influence the way in which effective nursing practice was realised. Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice.ConclusionsWhilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature. Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments.
Highlights
This paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice
In a climate of cost-driven health services, many hospitals have in recent years achieved important improvements in postoperative pain management [4]
Patient interviews and observation of nursing practice revealed that holistic pain assessment with older people appeared deficient within the surgical environment, with nurses seemingly unaware of the importance of addressing the particular pain needs of older patients (Table 1)
Summary
Emancipatory Action Research (EAR) offers an approach that aims to improve practitioners’ self-understandings and critique of their work settings [37]. Adopting a critical theoretical philosophy, this approach encourages participants to explore assumptions made in and about practice through systematic reflection and critique, making change the main interest of critical reflection [38]. EAR involves practitioner researchers in developing practice by introducing change in response to a need or problem [39]. This method was chosen because it enabled systematic working with ward-based practitioners to answer the research question: What effect would a programme of action research have on the practice of evidence-based pain management with older people following abdominal surgery?
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