Practice Development Approach Research Articles

Listening to the family's voice: evaluation of a tool to improve symptom control and communication.

Acute hospitals provide a high proportion of end-of-life care but some families experience poor communication with clinical staff. To evaluate the use of the Family's Voice diary communication tool across nine healthcare settings. A mixed method practice development approach was used incorporating: an audit of the usage of Family's Voice; collation and analysis of written comments; and collation of written feedback from the principal investigators at data collection sites. There were 112 completed diaries. Families rated pain and vomiting as well controlled, but agitation and breathlessness were difficult to control. Families were positive about care provided to the patients and themselves. Ten themes were identified from analysis of the families' written comments that echoed national concerns. Evidence for the utility of the diary is building. Future work could focus on strategies for embedding the diary into routine care for all end-of-life patients.

Developing Specialist Leaders of Education: a research engagement approach

ABSTRACTThere has been little research to date on the continuing professional development needs of the several thousand Specialist Leaders of Education (SLE) now designated by the National College for Teaching and Leadership in England to work across schools as consultants on school-to-school support. This case study reports on the second and third stages of a four-stage research process designed to address these needs. The first stage reported on the creation of a professional development framework for SLE’s using consultancy research. These middle stages test out this framework with a stakeholder group of SLEs, headteachers and broker in a Teaching Schools Alliance. The fourth stage will track the implementation of professional development activities arising from these findings. Apart from the specific needs of SLE, this study will have wider relevance for all practitioners and researchers working in and with schools on leadership development using Research Engagement strategies and Joint Practice Development approaches in a so-called ‘self- improving’ school system.Abbreviation: NCTL: National College for Teaching and Leadership; HEI: Higher Education Institution; SAT: is Standard Assessment Task; CPD: Continuing Professional Development.

Overcoming synecdoche: why practice development and quality improvement approaches should be better integrated

Commentary on: Lavery, G. (2016) Quality improvement – rival or ally of practice development? International Practice Development Journal. Vol. 6. No. 1. Article 15

The advantages of using impact resonance test in dynamic modulus master curve construction through the abbreviated test protocol

Asphalt concrete behavior is heavily dependent on temperature and loading rate. Hence, the material is typically tested at a range of temperatures and loading frequencies to capture its properties. Results are then used to develop a master curve exhibiting material behavior at the full spectrum of loading frequencies. An abbreviated testing protocol, under AASHTO PP 61-13, proposes a practical approach for development of this master curve. In this practice, the low temperature asymptote of the master curve is dominated by the limiting maximum modulus estimated through the Hirsch model. In this study, the dynamic modulus (DM) testing coupled with impact resonance (IR) test was used to evaluate the effect of this limiting maximum modulus on construction of the asphalt concrete master curve. Three different asphalt mixtures prepared with the same gradation and binder content, but different grades of stiffness were tested. The DM testing was performed at multiple temperatures and loading frequencies. The IR tests were conducted on the same specimens at the same temperatures. Two sigmoid functions (MEPDG and Richards models), and three shift factors (Arrhenius, Williams–Landel–Ferry, and polynomial) were utilized in the analysis. Richards sigmoid function coupled with polynomial shift factor provided the best fitting accuracy to the measured data. It was observed that the limiting maximum modulus obtained from experimental data was underpredicted by that obtained from the Hirsch model. The results indicated potential benefits of the IR test as a complementary testing tool to the abbreviated DM testing protocol to reliably characterize asphalt concrete.

Refinement of the theoretical solubility model and prediction of solute solubility in mixed solvent systems

We have refined the non-polar (van der Waalls) and hydrogen bonding interaction term of STMIPE-AC (statistical thermodynamic molar intermolecular potential energy activity coefficient) model, which reduces the average error of the model in correlating the molar internal energy change on vaporization of pure liquids (62 solvents, 10 temperature points for each solvent) from 6.6% to 3.1%. The binary interaction parameters kij are fitted to the solubility data of solid solutes in pure solvents or estimated from a semi-empirical equation using a similar local composition method, and then they are used to predict the solute solubility in mixed solvents. The overall average relative error (ARE) in predicted solubility (15 solutes, 64 systems, 1091 data points) is 11.24%, which makes this model a practical approach for crystallization process development.

Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach

Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners.Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings.Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders.

P168 Learning disabilities and palliative care: Building bridges – supporting care

Palliative care for people with learning disabilities (PWLD) is often complex but it is vital that these challenges are faced. It is also important to recognise that life limiting illness...

The development and evaluation of a preceptorship program using a practice development approach

Objective: The aim of the research was to evaluate a Preceptorship Workshop for nurses and midwives structured using a Practice Development framework. The workshop was underpinned by an exploration of nurses and midwives attitudes, perceptions and concerns about being a preceptor. Design: Emancipatory Practice Development guided this study. Setting: The study was conducted in a 400-bed tertiary referral hospital in an Australian state. Subjects: Ninety three nurses and midwives participated in the study. Main outcome measures: Data collection was undertaken from July – December 2009. Participants’ completed a self-assessment of six identified learning outcomes on a five point Likert scale pre and post workshop. Findings were further informed by qualitative data collected during and following the workshops. Results: A paired samples t-test was used to compare pre and post workshop participant self ratings of knowledge, understanding and ability to apply preceptor skills. Statement four: ‘My knowledge of the requirements of my role as a preceptor in relation to the structure of a range of nursing programs’ demonstrates the highest shift in self assessment. There was a significant difference in the scores pre test (M= 3.04, SD=.751) and post test (M=3.99, SD=.617). Statistically significant changes occurred across all six learning outcomes, confirmed by qualitative findings from participant input on the day. Conclusion: Findings support the use of a Practice Development approach in the provision of a preceptor workshop, with clinicians indicating high acceptability that resulted in achievement of key learning outcomes.

A new approach to improving hand hygiene practice in an inner city acute hospital in Australia

Abstract Background Healthcare-associated infections occur in 5–15% of hospitalised patients, with 30–50% preventable. Hand hygiene is a basic and essential but poorly conducted method to limit infection in hospitals. This practice development approach to implementing the ‘5 Moments for Hand Hygiene' national initiative aimed to increase compliance with the recommended hand hygiene practices, anticipating this outcome would be reflected in lower rates of healthcare-associated infections. Methods Multiple methods were employed during October 2009–October 2010 within a multi-disciplinary initiative, although nurses were mainly recruited. Three medical wards, four surgical wards and the Intensive Care Unit were targeted. Project activities were informed by principles of practice development, solution-focussed coaching and models of behaviour change. Activities included active learning sessions, coaching, audit and feedback, competitions, creativity and fun. Outcomes were observations of hand hygiene compliance and routinely collected rates of Staphylococcus aureus bacteraemia. Results Overall hand hygiene audits showed statistically significant improvement in compliance, from 62 to 75% in quarterly audits. Compliance rates among nurses and medical staff increased significantly from 70 to 80% and from 43 to 63%, respectively, while changes for allied health practitioners, from 61 to 65% compliance, did not achieve significance. Recorded rates of Staphylococcus aureus bacteraemia reduced from between 0.6 and 2.55 infections per 10 000 occupied bed days pre-project to between 0 and 0.65 infections per 10 000 occupied bed days during the project period. Conclusions Multiple methods using a practice development framework can be successful in effecting changes in hand hygiene behaviouramong all health care workers. Study methods took planning andcommitment but were highly rewarding, particularly considering the magnitude of the issue for patient and clinician safety.

The senses in practice: enhancing the quality of care for residents with dementia in care homes

The study aimed to develop, deliver, and evaluate a training programme in care homes to enhance the quality of care for people living with dementia based on the principles of relationship-centred care expressed through the Senses Framework. There are increasing numbers of people living with dementia worldwide with a growing proportion requiring residential long-term care. This makes the quest for enhancing the quality of care and quality of life for people with dementia ever more pressing. A mixed-methods design was used adopting a Practice Development approach. The findings from one care home in the North West of England are reported. Eight facilitated workshops based on the principles of relationship-centred care were completed and evaluated in 2010, using pre- and postintervention design. A focus group was undertaken with staff on completion of the study to gain a more comprehensive understanding of the practice/training context, augmented by case examples of changes in practice identified from the study workshops. Structured questionnaires were used to profile the care home before and after the training. Following the workshops, staff felt more able to collect and use biographical information. In particular, staff reported how this information supported them to initiate meaningful conversations with the person with dementia as part of everyday care routines, thus improving overall feelings of well-being. Using a biographical approach to care planning structured through the Senses Framework helped staff to develop a greater understanding of the person with dementia.

Telling our stories: writing for publication to enhance reflective and contextualised family and community practice.

Health care provision is an area in which constant innovation and improvement is needed, with nurses and others involved in service planning and delivery being called upon to do more with less, and to meet the needs of individuals and communities facing ever more complex health challenges and disease processes (Jackson & Saltman, 2011). In addition, health care is delivered within a culture of increasing performativity, accountability and demand for evidence (Jackson, 2009; Taylor, Lyon, & Harris, 2005). These two factors create a need for innovation in service design and delivery as well as for focused and considered dissemination of such innovations and how they are applied, through stories of practice - reflective and contextualised accounts of what has worked well, what has not worked so well, where improvements have been made and where further improvements are necessary.Necessity is the mother of invention, and right from Nightingale's time (Stanley, 2007), nurses have shown themselves to be inventive and able to adapt to various settings and situations in order to provide the best possible care in all manner of circumstances (Biedermann, Usher, Williams, & Hayes, 2001; Hegney, McCarthy, Rogers-Clark, & Gorman, 2002; O'Brien & Jackson, 2007; Rewi, 2007). But, when working with families and communities there are various persuasive cultural and social imperatives that will exert a strong, even decisive influence on openness and adherence to education, intervention and treatment (Mohan, Wilkes, & Jackson, 2006; Ogunsiji, Wilkes, & Jackson, 2007; Wade, Jackson, & Daly, 2003). The strength of these factors may be such that they cannot be ignored and quite possibly accounts, at least in part, for the poorer health status of some minority community groups.In establishing trusting and respectful relationships with patients, clients and families, there is much that can be learned. In this issue we are pleased to present a range of papers that portray perspectives from consumers, and cover diverse issues such as the meaning of childbirth for African women in Canada (Etowa, 2012), experiential accounts of Muslim people with diabetes, and how they manage this in the context of Ramadan (Peterson, Nayda, & Hill, 2012), the meaning of smoking from the perspective of older women (Treloar & Gunn, 2012), and older New Zealand women's perspectives of factors that impact on their quality of life while living with chronic illness (Lowe & McBride-Henry, 2012). These papers all contribute insights that can inform practice and services so as to make them more appropriate and sensitive to a wider range of health consumers.However, there are many innovative approaches to practice and service delivery that are potentially very useful to others, but that are never adequately disseminated (Cleary, Walter, & Luscombe, 2007). This means that other nurses, patients, clients and communities may not ever benefit from the knowledge that has been generated. There is a disconnect between doing and writing and it may be that we are more comfortable with talking than writing, as some information about innovations in practice development and novel approaches to care can only be found in the form of conference abstracts, which, while of some use, tend to lack the contextual and other detail necessary to make full and informed decisions about their efficacy, benefits and potential for further development or application.It is known that there are all sorts of reasons why writing is an activity that can cause avoidance and procrastination in many people (Jackson, 2009). Even where there is a high level of commitment and desire to write, in today's highly pressured organisational environments, it can still be very difficult to find the time to write. So how can we approach writing to facilitate targeted and focused, rather than informal and unplanned, dissemination?Given that there are a limited number of hours in a day, and ever-increasing demand, simple and realistic goal setting is essential. …

Blending critical realist and emancipatory practice development methodologies: making critical realism work in nursing research

This paper examines the efficacy of facilitation as a practice development intervention in changing practice within an Older Person setting and in implementing evidence into practice. It outlines the influences exerted by the critical realist paradigm in guiding emancipatory practice development activities and, in particular, how the former may be employed within an emancipatory practice development study to elucidate and increase understanding pertinent to causation and outcomes. The methodology is based upon an emancipatory practice development approach set within a realistic evaluation framework. This allows for systematic analysis of the social and contextual elements that influence the explication of outcomes associated with facilitation. The study is concentrated upon five practice development cycles, within which a sequence of iterative processes is integrated. The authors assert that combining critical realist and emancipatory processes offers a robust and practical method for translating evidence and implementing changes in practice, as the former affirms or falsifies the influence that emancipatory processes exert on attaining culture shift, and enabling transformation towards effective clinical practice. A new framework for practice development is proposed that establishes methodological coherency between emancipatory practice development and realistic evaluation. This augments the existing theoretical bases for both these approaches by contributing new theoretical and methodological understandings of causation.

The use of life story work with people with dementia to enhance person‐centred care

Person-centred care has been linked with quality of care but difficulties remain in person-centred care being implemented in care practice. This study explores the use of life story work to enhance person-centred care with people with dementia. The study investigates how life story work is: understood and developed in practice; experienced by all participants and affects the delivery and outcomes of care. The experience of older people with dementia, family carers and care staff in using life story work was explored within an NHS Health and Social Care Trust. A multiple case study design was adopted within a constructivist approach. Semi-structured interviews, observation, conversations were employed. Life story work has the potential to: enable care staff to see the person behind the patient; allow family carers to uphold their relatives' personhood; enable the voice of the person with dementia to be heard, verbally and non-verbally; be enjoyable for all concerned and enable the person with dementia to feel proud about themselves and their lives. Life story work has the potential to enhance person-centred care for older people with dementia and their families. Taking a practice development approach ensures that life story work can be implemented sensitively and is sustained in practice.

Prediction of Drug Solubility in Mixed Solvent Systems Using the COSMO-SAC Activity Coefficient Model

A simple method is proposed to improve the accuracy in prediction of drug solubility using the COSMO-SAC model. In this method, the data of solubility of drug in a pure solvent is used to determine any error in the COSMO-SAC model for the drug−solvent interactions. These values are then used to correct for the solubility in the mixture of solvents. We have examined this method for the solubility of 33 drug compounds in 127 different solvent mixtures (235 systems, 1955 data points) over a temperature range of 0−50 °C and a wide solubility range of 10−1−10−6 (mole fraction scale). The error in the predicted solubility reduces significantly from 442% (original COSMO-SAC) to only 88% (COSMO-SAC with corrections), making it a practical approach for drug development. The accuracy of this method found to be comparable to another predictive method, NRTL-SAC.

A Cooperative Inquiry Into Action Learning and Praxis Development in a Community Nursing Module

As nurse lecturers we investigated practice development and action learning approaches aimed at enabling postregistration bachelor's- and master's-level nursing students (Community Health Studies, Nursing in the Home) to advance practice in the context of policy and professional developments. A patchwork text was used to assess summatively what students achieved (practice change/development) and how this was informed critically, via an extended epistemology. First-person inquiry supplemented by cooperative inquiry postcourse completion (including reflective discussions with 16 students and 16 practice mentors) were used to assist coresearcher constructions of meaning. A relational, tripartite approach to learning and assessment (students', teachers', and practice mentors' collective contributions) depends on continuing reflective attention. Action learning enhances interrelation of experience with dialectic thinking. The patchwork text functions to promote creative writing, evaluative thinking, and praxis development. Role modeling by all, being genuine and not just "talking" genuine, is challenging yet crucial if people are to function as mutual resources for learning.

Development and validation of a prediction model with missing predictor data: a practical approach

Objective To illustrate the sequence of steps needed to develop and validate a clinical prediction model, when missing predictor values have been multiply imputed. Study Design and Setting We used data from consecutive primary care patients suspected of deep venous thrombosis (DVT) to develop and validate a diagnostic model for the presence of DVT. Missing values were imputed 10 times with the MICE conditional imputation method. After the selection of predictors and transformations for continuous predictors according to three different methods, we estimated regression coefficients and performance measures. Results The three methods to select predictors and transformations of continuous predictors showed similar results. Rubin's rules could easily be applied to estimate regression coefficients and performance measures, once predictors and transformations were selected. Conclusion We provide a practical approach for model development and validation with multiply imputed data.

‘Teaching an old dog new tricks’: A practice development approach to organizational change in mental health

AbstractPractice development is widely described as: ‘ways in which knowledge and skills development is used to provide better patient care’. This article will outline a mental health units approach and experience of implementing collaborative practice development processes which identify values and beliefs and enable the development of a framework of action to effect positive change. A qualitative participatory action research design was used to engage participants in exploring and critiquing relevant workplace culture issues. The project was divided into four chronological stages: values clarification; claims, concerns and issues; barriers, enablers and actions; and action planning. The results of this project highlight a number of issues for practice development approaches. We believe that these processes are easily transferable to other organizations within health care. Copyright © 2009 John Wiley & Sons, Ltd.

Practice development: providing benefits for both managers and older patients with delerium and dementia

This article describes the ways in which practice development can aid Nurse Managers to enhance both efficiency and effectiveness, focussing particularly on the care of older people with delerium and dementia. Practitioners caring for this group of patients in acute general hospitals need specialist skills, particularly skills in working with the unusual ('challenging') behaviours that these patients often exhibit. These skills are rarely present at the point of registration but practice development techniques can facilitate the acquisition of appropriate skills with resultant benefits for both patients and organization. The study contains an outline of the ways in which a practice development approach can be delivered and appraised: the theories are outlined, strategies for delivery of the techniques are described and methods of evaluation are suggested. These theories and techniques are being applied in a project in Portsmouth called 'Rise to the Challenge', which has the specific aim of improving the care of people with delerium and dementia in an acute hospital setting. This project is currently running and will be evaluated in the summer of 2008.

Critical creativity: melding, exploding, blending

In this article, the authors expose, for critical review and public scrutiny, their challenge to the critical paradigm as an adequate location for the transformational practice development and research approaches that they are developing in healthcare. Whilst they accept the fundamental assumptions of the critical paradigm, in their view it does not recognise the creativity required in their approaches. Neither does it explicitly acknowledge that creativity often requires moral and sacred dimensions as people push out the boundaries of the known within their own practices. In particular, the authors expose these gaps within Fay’s eight critical theories for practice. Over the last decade, the authors have addressed these gaps by combining the assumptions of the critical paradigm with their experiences of using creative imagination and expression in their practice development (PD) and action research work. Then through a critical review of their work, they have created a new paradigmatic synthesis to add to the critical paradigm. They call this synthesis ‘critical creativity’. In this article, the authors set out their reflexive journey that has led to the articulation of ‘critical creativity’ as a paradigmatic synthesis for action‐oriented development and research.

Admiral nursing competency project: practice development and action research

Admiral Nurses are specialist dementia care nurses working in the community with carers of those who have a dementia. The aim of the competency project (2000-2003) was threefold. Firstly to work collaboratively with these specialist nurses to facilitate the development a competency framework that reflects the needs of the Admiral Nursing Service. Secondly, to provide a way to structure evidence demonstrating evolving competency. Thirdly, to specifically enable the nurses to demonstrate evidence of achieving the UK Nursing and Midwifery Council's Higher Level Practice standard. The two complementary approaches of emancipatory action research and systematic practice development were adopted. Methods were taken from action research and systematic practice development approaches with an emphasis on promoting and enabling enlightenment, critical reflection, ownership and creating the best conditions for long-term commitment to the competency framework. The main outcome from this project was the development of a specialist nursing competency framework. The Admiral Nurses' Competency Framework is made up of a set of eight core competencies with three levels of competency statements, loosely structured around the Higher Level Practice standard, and guidance documentation to illustrate how work-based evidence can be generated to demonstrate competence. There were also process-derived outcomes associated with combining systematic practice development with emancipatory action research that had an impact on the culture. The main outcomes here were that practitioners engaged in and experienced learning about how to research their own practice and the consequences of doing this. They also learnt about specialist nursing practice more widely than Admiral Nursing. Finally, there was some increase in awareness about the culture within their teams and organizations. The final competency framework reflects the needs of the service, is owned by the majority of practitioners and project commissioners and this has had a positive impact on implementation. In this paper, we report on combining systematic practice development with action research to achieve immediate project aims. In addition we show how a project of this nature can contribute to developing skills in practitioners necessary for cultural changes in practice and contributes to wider issues of modernization within nursing and health care. This competency framework will enable Admiral Nurses to demonstrate their level of specialist practice, as individuals and collectively as a service and it also promotes the principles of nurses as life long learners. This may have relevance to other groups of specialist nurses. The project has widespread relevance for two reasons. Firstly, it shows that nurses can be involved in designing and testing a competency framework as collaborators. Secondly, that to achieve this within the spirit of approaches, such as systematic practice development and action research, can be testing for all collaborators even were there is a shared or espoused aim.