Appreciative Inquiry Research Articles

Inovação na prática da Enfermagem em saúde comunitária brasileira durante a pandemia: uma revisão rápida

Abstract Objective to describe the innovations introduced in Brazilian community health nursing during the COVID-19 pandemic. Method rapid literature review with a conceptual framework of innovation in organizations and ideas underlying the method of appreciative inquiry. The databases were limited to Google Scholar (English) and SciELO (Portuguese) (November–December 2022). A total of 52 articles were identified in Portuguese, 11 of which met the eligibility criteria. Results the majority (n=10; 91%) addressed the “discovery” factor, highlighting the favorable conditions for innovation. Contents about “imagining what could be” (n=6; 55%) projected innovation as a permanent practice. In relation to “co-constructing the ideal condition” 55% (n=6), innovation was reported as a joint action and in practice. Regarding the “sustainability of innovation,” only five interventions (45%) indicated paths for continuity. Conclusions and implication to the practice the connection between primary health care, academia, and organizations produced simple solutions to unknown, complex, and unpredictable situations. However, the idea of innovation as something unprecedented, untested, and structurally revolutionary, was not extensively identified by this rapid review, due to the conceptual and theoretical fragility of the interventions and projects reported.

Meta-Analysis of Appreciative Inquiry into Timely Completion of Research Work at PhD Level

Completing research work at the PhD level is a significant milestone in academic and professional growth, contributing to the advancement of knowledge and societal development. This Appreciative Inquiry systematically examined the factors that influenced delays in research work at the PhD level in higher education institutions. Ten research articles published between 2020 and 2023 were analyzed to synthesize the findings. The study identified key factors that contributed to delays, including inadequate research guidance experiences, challenges in postgraduate research supervision, and barriers at the institutional level. Additionally, the impact of research topic selection and distance learning on research progress was explored. The analysis highlighted the significance of effective research guidance, supportive supervision practices, and adequate resources in minimizing delays. Furthermore, implications for institutional policies and recommendations for fostering a conducive research environment were discussed. Overall, this Appreciative Inquiry offered valuable insights for policymakers, educational institutions, and researchers to address delays in research work at the PhD level. Our findings suggested the need to foster a conducive research environment, provide adequate resources, and promote effective communication between students and supervisors. By implementing evidence-based interventions, we could enhance the research experiences of doctoral candidates, promote timely completion of research work, and advance the quality of research in higher education.

An Appreciative Journey to the Formulation of a Business School Credo

This paper narrates how a community outreach initiative to interview local leaders on organizational adaptation to COVID morphed into a systematic reflection on Emirati-expatriate leadership relations in the UAE with an eclectic mix of thinkers serving as guides along the journey. Influenced by Cooperrider’s call for an appreciative inquiry into the tragic as well as the ordinary and extraordinary, a deep dive is undertaken into the following questions:
 
 Why and for whom do Emiratis and expatriates sustain their pursuit of excellence?
 Why and how do Emiratis seek to engage expatriates in this pursuit?
 Why are expatriates initially charmed but often prematurely ‘exit’ as this engagement runs its course?
 Where in some of the stories told about Sheikh Zayed can be found a more life-giving purpose?
 
 The journey eventually returns home by discussing how it influenced the formulation of a philosophy to guide the strategic process in my business school and could be relevant to other academic ‘place shapers’ seeking cross-cultural enrichment.

How important is integration to the successful ‘roll out’ of specialist hospital discharge schemes for people who are homeless?

In 2021, we published research funded by the UK National Institute for Health Research that demonstrated the effectiveness and cost effectiveness of specialist hospital discharge schemes for people who are homeless. A key finding of the research was that areas that had a specialist homeless hospital discharge scheme had fewer delayed discharges and could reduce their emergency readmissions among homeless patients by 14%. This positive outcome attracted the attention of national health policy makers who allocated £16 million funding to 17 local authority areas to “roll out” new schemes. This paper reports the preliminary findings of an implementation evaluation. We assess how important integration was in those areas that successfully translated the evidence about “what works’ into practice. This presentation is targeted at academics and commissioners of integrated care.
 The evaluation employed a positive deviance (appreciative enquiry) methodology. This approach seeks out exceptionally performing sites, investigates the underlying factors contributing to the successful behaviours and strategies, and plans an appropriate means to replicate these with the aim to effect a change. The rationale behind appreciative inquiry is that solutions to common problems mostly exist within clinical/practice communities rather than externally with policy makers or managers.
 The first step of the evaluation was to collect audit (performance) data from the 17 local authorities taking part in the programme. Audit data was then used to select three case studies sites that demonstrated high performance against key metrics such as having a shorter length of stay in ‘step-down’ services (longer stays being indicative of housing shortages and difficulties maintaining flow through the system). In the case study sites, reflective interviews and focus groups then sought to establish what factors underpinned this successful implementation. This included interviews with a range of key stakeholders including people with lived experience of homelessness and transitions out-of-hospital (over sixty stakeholders in total).
 Integration was found to be a key factor in understanding successful implementation at many different levels - from building the initial strategic vision to delivering quality in frontline service delivery. Often this was ‘relational’ integration where building social networks in strategic places was the main factor in determining routinization and sustainability. Often boundary spanning was key where ‘homeless commissioners’ needed to cross the divide into the unfamiliar world of health service commissioning. Relational working required a dedicated project manager with highly developed skills in business planning, evaluation and policy literacy to negotiate the many hurdles that stood in the way of the routinization of specialist care. Successful sites also involved people with lived experience of homeless in meaningful rather than tokenistic activities, integrating their knowledge of services and practice to ensure compassion was at the forefront of practice. Taking an in-depth qualitative perspective on successful implementation is important as very few of the 17 test sites managed to sustain their new services once the initial programme funding had run out.

The Covid-19 pandemic as a driver towards integrated health care-learning from the experiences of UK community hospitals

Introduction: Many changes occurred in the UK National Health Service (NHS) during the COVID-19 pandemic-some positive and some negative. We were interested in how the pandemic drove integration of health care in small community hospitals in the UK.
 Method: Appreciative inquiry was used to understand staff perspectives of how community hospitals responded. A total of 20 organisations participated, representing 168 (34%) of community hospitals in the UK. Qualitative interviews were conducted, with a total of 85 staff members, using an online video platform. Community representation was featured through the membership of our project board and advisory group which includes Hospital Leagues of Friends. 30 case studies were developed from these interviews.
 Results: From our case studies we examine 4 types of integrated care: Multi-Disciplinary Team Working, Community Hospital and Primary Care, Community Hospital and Acute Care, Community Hospital and Local Community. In the interviews staff gave accounts of improved collaborations and partnerships across the local health and care system, and the consequent impact on patients, families, staff and the community. Many staff said that in many cases teamworking and partnerships were already established, so the trust was there to build on even closer joint working.
 Case studies demonstrating enhanced integration of health care at the micro, meso and macro level are described. Examples of micro changes were small but significant local improvements which impacted positively on the patient experience. Examples of meso changes were those that were across a community hospital or hospitals, with partnerships and joint working supporting improved services. We focus particularly on the macro level, where system-wide changes were implemented to embed innovations and integrated working. 
 We pay particular reference to factors that are known to be associated with successful integration as shown in a recently published systematic review, namely: organisational culture, workforce management, inter-organisational collaboration, leadership ability of staff, economic factors and political factors.
 Discussion: We discuss the learning from the case studies that in order to make the most of our community hospitals we need to be: making decisions locally, benefiting from excellent leadership, recognising community hospitals as community assets and looking after our staff. In particular locally devolved decision-making appropriate to local context was viewed as a critical success factor in swiftly making changes and improvements for the benefit of patients and families, and also for staff. Where this was supported by strong leadership, staff reported successful quality improvements. We continue to work with staff in online discussion groups in our Community Hospital Q Community Special Interest Group to build on this learning and share widely across the community hospital network.
 Conclusion: This study shows how the pandemic accelerated integrated care between staff, services and systems, and the improved recognition of the vital role of community hospitals as community services in the local health and care system.
 
 

SIN-BARRSS – Developing a mnemonic to support nurses’ participation in interprofessional ward rounds in intensive care: An appreciative inquiry for quality improvement

ObjectivesTo develop and pilot a mnemonic to increase the willingness and ability of bedside nurses to contribute to patient reviews in the daily interprofessional ward round. Research methodology/designAppreciative inquiry quality improvement study, using ethnographic observations and appreciative inquiry discussions, augmented by quantitative data collection of basic facts. SettingLarge (44 beds) critical care unit in the United Kingdom. Main outcome measuresInterprofessional development and acceptance of mnemonic; successful preparation for pilot; use and usability of mnemonic; improvements in bedside nurses’ contributions to ward round discussions (frequency and focus). Result/findingsInterprofessional development of a usable and useful mnemonic was successful, pilot implementation showed promising levels of take up and acceptance. Compared to before the quality improvement project bedside nurses were more willing and able to participate in ward round discussions, did so more often, and used the mnemonic script with insight and flexibility. ConclusionsThe implementation of a mnemonic supported bedside nurses’ contributions to the ward round. This could provide a framework for introducing similar programmes to other intensive care units. Appreciative inquiry methodology could be replicated in other settings to aid the improvement of interprofessional ward rounds, or to address other quality improvement priorities. Implications for clinical practiceA mnemonic can provide a structure which supports bedside nurses’ contributions in ways that make good use of bedside nurses’ professional expertise and most up to date knowledge of patients’ clinical state. Furthermore, a well-designed mnemonic can be used flexibly and provides an outline script that supports less experienced and less confident nurses to make well-focused and well received contributions to rapid interprofessional discussions. In turn, this can increase these nurses’ confidence and capability. More experienced and confident nurses, and ward round leaders, can use the same mnemonic flexibly as an aide memoir that guards against missing information and insights that could affect the quality and safety of patient care.

EFL Pre-service Teachers’ Leadership Project Practices in Indonesia's Teacher Professional Development Program

Indonesia's Ministry of Education has integrated the Leadership Project course into the Pendidikan Profesi Guru (PPG) program, emphasizing the development of professional qualifications and leadership skills among EFL pre-service teachers. This study scrutinizes the influence of both conceptual and practical frameworks of the course on cultivating leadership competencies. It poses two pivotal questions: Firstly, how do pre-service EFL teachers perceive these frameworks within leadership projects? Secondly, what challenges do they face in executing these projects effectively? Utilizing an explanatory mixed-methods design, the study collated and analyzed data from 31 participants through surveys and inductive thematic coding. It revealed that while EFL pre-service teachers have a positive reception of leadership involving collective knowledge and change initiation, they also report significant hurdles. Implementing complex frameworks like Sustainability NEWS (Nature, Economy, Well-being, Society) and Appreciative Inquiry presented difficulties, predominantly due to time limitations and communication barriers with target groups. Furthermore, a gap in understanding the conceptual underpinnings led to complications in the planning and sustainable implementation of projects, exacerbated by tight schedules and financial restrictions. Feedback from participants highlighted a need for program enhancements, suggesting refined policies, more rigorous consultation processes, and an enriched focus on reflective practices. The study offers valuable insights into the perceptions of EFL pre-service teachers regarding leadership programs.

Academic Language Development and Linguistic Discrimination

Language use within Canadian postsecondary institutions reflects ongoing neocolonialism and the privileging of European and North American English varieties. This article shares student perspectives of interactions with faculty on themes of language development and linguistic discrimination, discovered in qualitative interviews using Appreciative Inquiry methodology. Participants’ stories reveal both appreciation for supportive practices that facilitate the development of academic language skills and frustration with linguistic discrimination. Practices valued by participants include using simple and clear language, creating a comfortable environment for non-native English speakers, honouring multilingualism, and providing supportive instruction in discipline-specific language. Students also identified experiences of linguistic discrimination that resulted in academic and personal harm. In students’ stories, a tension between encouraging academic language development while avoiding discriminatory practices emerges. Paths forward in navigating this tension while challenging colonial language hierarchies may include integrating pedagogies using an academic literacies framework while also creating space for translingual practices in classrooms and institutions.

Opportunities for tackling sexual harassment in Zimbabwe: Lessons from the Global North

This article employs content analysis to explore lessons that can be drawn from the Global North to confront sexual harassment in higher education (HE) in Africa and Zimbabwe in particular. The slow progress in both the formulation and implementation of policies directed at mitigating sexual harassment in Zimbabwe’s tertiary institutions is a slow and worrisome journey despite a well-crafted roadmap. This article, using appreciative inquiry (AI) as a lens, presents what developed countries have put in place to deal with sexual harassment. Proposals show that policies and guidelines on sexual harassment remain paper exercise in the developing countries, and are not backed by fair reporting mechanisms and education on how to deal with sexual abuse. The study suggests that policies must not remain paper exercise and therefore have to be implemented. Universities in the Global South may partner with those from the Global North and share notes and best practices on how sexual harassment can be mitigated.Contribution: The article provides insights on how universities can improve sexual harassment policy frameworks and practices to create safe and inclusive campus environments for females so as to protect students’ well-being for sustainable development.

AN INTERGENERATIONAL TRAINING PROGRAM TO SUPPORT LATINE ELDERS: LESSONS LEARNED

Abstract Cultural adaptation and tailoring of caregiving interventions has garnered greater attention in part due to high levels of unmet need and poor intervention outcomes among dementia caregivers from racial and cultural groups. Additionally, there is a growing interest in understanding intervention mechanisms. We conducted a formative analysis of the process employed in the design of an intergenerational training program to support elders within the Latine community. A content analysis of memos and stakeholder listening sessions and document review guided this analysis. Framed within a discussion on the continuum of cultural adaptation, we report on lessons learned. Lessons include: 1) embracing community-led design, 2) demonstration of partnership commitment to facilitate trust-building, 3) consistent appreciative inquiry, and 4) demonstration of cultural centeredness within the partnership.

Exploring Interprofessional Education and Collaboration in the Midst of COVID-19

The COVID-19 pandemic and the inequities it uncovered highlighted the need for a rapid and coordinated response among different disciplines in medical settings. Interprofessional collaboration and education is necessary to provide culturally competent emergent care. However, there is still scarce evidence demonstrating the use of interprofessional education in emergent care settings. This paper explores the training and education of health care professionals in a primarily minority serving hospital located in New York City during the first phase of COVID-19. Guided by the appreciative inquiry framework, two focus groups were conducted with administrators and health care workers who provided care to COVID-19 patients in an emergent care setting. It was found that a positive work environment that emphasizes knowledge sharing, collaboration, communication, and continuous on-the-job training facilitates culturally competent care. The implementation of interprofessional education and collaboration has the potential to transform clinical practice and improve health outcomes for under-resourced communities.

Creative STEM Pathways - Supporting Pacific Learners through 3D Printing

The low participation of Pacific students in tertiary STEM studies has implications for schools as they consider how best to engage these learners in STEM subjects (Science, Technology, Engineering and Mathematics). This article reports on an innovative project that supports Pacific learners with STEM learning through 3D printing technology. Creative STEM Pathways is a university-led initiative which has successfully brought 3D technology to the classroom, providing culturally-sustaining, hands-on and relevant learning opportunities. We used an Appreciative Inquiry lens to help us explore how the programme could create positive learning experiences. In this article, we share experiences of its development and delivery. We highlight successes and challenges, offering practical insight to those considering similar innovation in the classroom.

Co-Creating a Health and Wellbeing Strategy for Students and Staff

This paper reports on the application of culture change methodology to co-design a whole-of-university health and wellbeing strategy. We outline considerations that necessitate a change in the way higher education contributes to student and staff mental health and wellbeing. We provide an overview of an Appreciative Inquiry culture change methodology; a map of the process followed; the benefits of applying Appreciative Inquiry principles; and a description of outcomes, which include funding for a new health and wellbeing strategy implementation team. We argue that by co-designing a strategy, with representatives of the whole system taking a strengths-based perspective, we enabled self-determined change. We also argue that the process of co-designing and co-developing a strategy can be a wellbeing intervention in and of itself.

Supporting an organizational change process with appreciative inquiry

AbstractThe author describes and analyzes the application of an Appreciative Inquiry initiative in a student success unit called University College, an academic unit with approximately 60 staff members. The article addresses the decision to adopt Appreciative Inquiry as part of the change process; the introduction of AI to the staff; the enactment of the process; and analytic reflections that could assist adoption of the AI process in other contexts.

Being an appreciative educator in today's world: Unknowingly and knowingly using appreciative frameworks in higher education

AbstractThe authors share their stories on how they moved from unknowingly using appreciative frameworks in their life and work in higher education to knowingly applying it as appreciative educators. They share a co‐created definition of being an appreciative educator and how appreciative inquiry can be used today in higher education.

Reimagining the future of a business education program using appreciative inquiry

<span lang="EN-US">Rethinking the future of education has fueled momentum for large-scale change after the significant effects of the global pandemic. This momentum for change may require large amounts of positive affect by affirming and appreciating what works well during difficult times rather than identifying and understanding problematic areas. This study made use of appreciative inquiry in reimagining the future of a Business Education program in a private tertiary institution in the Philippines. Using naturalistic approach, 35 business education students and three teachers were interviewed using positive questions that amplify the positive core of the college. The participants unleashed the strengths of the college such as the implemented flexible modular setup, availability of the repository of educational resources, efficient communication during online learning, empowered student council, and group collaborations. Through inquiry and dialogue, participants co-created the reimagined future of the College of Business Administration which is a more flexible and inclusive means of delivering the Business Education Curriculum and upgraded and holistic learning experiences for the learners. Through the use of appreciative inquiry, the participants collectively leveraged the best practices of the college and their envisioned future to design high-impact strategies that can move the college decisively to its reimagined future.</span>

Flipping the script: A model response to student conduct using appreciative inquiry

AbstractIn the traditional model of student conduct adjudication, a finding of responsibility often results in prescribed punitive and/or educational outcomes, which may not resonate with the student or evoke deeper learning. Following a student's acceptance of responsibility, the Appreciative Inquiry process provides a highly personal, forward‐thinking approach to future decision‐making and self‐authorship.

The Government’s communication: Diffusion Innovation or Participatory Approach towards Renewable Energy Development Project

This study focuses on development communication in supporting Government’s renewable energy project in Indonesia. Using a case study of the communication in the implementation of a micro-hydro power plant (MHPP) project by Indonesia government, this study examines whether the government’s communication aims to encourage community participation in the project or merely diffuse the innovation for community’s adoption, or combine both approaches. This project was chosen, since this requires more community participation to maintain it as well as sustained communication to facilitate meaningful engagement. Appreciative inquiry involving six focus group discussions and nine in-depth interviews were conducted to explore communities’ experiences in exploiting the MHPP and accompanying communication process. The findings show that project development is divided into five stages: pre-initiation, initiation, adoption, transition and sustainability. Compared to the diffusion and adoption process, this project cycle is comparable to the five stages of the diffusion and adoption process. The information sharing session to introduce the innovation is significant to build awareness among communities. Likewise, the ideas to choose and train communities’ representatives as pioneers to the adoption process help communities gain direct experiences about the use of technology. Nevertheless, the domination of diffusion innovation approach with mechanistic communication that prioritises technological change may lead to a lack of participation and empowerment. Participatory approach that acknowledges local values will likely empower communities and build ownership towards the project.

Abstract A076: Trial participation in pictures: Using photo elicitation to explore minority patients’ experiences on therapeutic cancer clinical trials

Abstract Background: Much has been published about barriers to research participation for under-represented minority (URM) yet we know little about the experiences, motivations, and decision-making of the URM patients who were successfully treated on clinical trial (CT). The purpose of this study is to draw on the experiences of URM patients as insiders of practical knowledge of CT through photo elicitation to comprehensively understand the current state of recruitment and treatment of URM patients on interventional cancer CTs across the Mayo Clinic enterprise with a short-term goal of informing mechanisms to enrich CT participation and a long-term goal of building a patient-centered cancer practice and clinical trial patient population that is reflective of the diverse communities served by Mayo Clinic. Method: An Appreciative inquiry approach was adapted for this study which acknowledges that existing strengths and everyday experiences of URM patients has the potential to allow a more nuanced view as it pertains to our cancer populations. A total of 138 URM were invited to participate. Using photo elicitation technique, patients were asked to take photographs to portray factors that motivated them and/or facilitated their enrollment, barriers to enrollment and recommendations to improve the process for CT recruitment for other URM. Participant-generated photographs (59) and accompanying 13 interview narratives were analyzed using layered analysis. Results: A total of 13 patients (female =9) participated in the photo interviews. URM detailed their overall experiences around CT participation, motivations for participating in clinical trials; facilitators to clinical trial participation; and opportunities and considerations for increasing minority patients CT participation. Photo analyses provided symbolic representation of patients’ general experiences around CT including celebrating their “new identity”, finding peace in moments of nostalgia, their journey through the trial, lost times and finances and yet finding a new purpose to live through CT participation. Importantly patients described decision making in CT participation as a relational approach. Patients suggested opportunities and considerations for increasing minority patients trial participation, which included minimizing logistical barriers, decentralizing cancer clinical trials, increasing awareness via patient narratives, diversifying research staff, minimizing cost, and being clear on purpose and benefit of the trial. Conclusion: Our study highlights the potential to utilize visual data and narratives from URM in CT recruitment and education programming. It provided valuable insights from the URM community for the URM community on key issues on motivations of CT participation and decision-making in CT participation. Citation Format: Gladys B. Asiedu, Rahma Warsame, Mary O’Shea, Yong-hun Kim, Sara A. Ellingson, Katharine A. Price. Trial participation in pictures: Using photo elicitation to explore minority patients’ experiences on therapeutic cancer clinical trials [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A076.

Clinical and Organizational Nursing Innovations in Primary Care: Findings From a Stakeholders' Symposium.

Nursing innovations in primary care, based on interprofessional care models, could be better identified, recognized, and deployed. This article presents the results of a symposium discussing the implementation of nursing innovations in primary care in Quebec, Canada, in partnership with researchers and stakeholders. Built on the appreciative inquiry approach, 9 nursing innovations were described. To support the implementation of such nursing innovations responding to current primary care issues and population needs, 4 recommendations emerged: the need to implement strategies to achieve optimal scope of practice for primary care nurses; the importance to develop funding and organizational models that support primary care nursing innovation; the need to enhance a collaborative and democratic governance open to innovation; and the opportunity to create partnerships with the research community and teaching institutions.