Action Research in Healthcare: judging value and impact Dr Annetta Smith

Overview Summary of action research characteristics Overview of two action research projects 1.Transfer of pain knowledge from a continuing education course into practice 2.Development of case management models in community nursing practice Judging value and impact Research-led, Practice-driven, People-focussed 2

Action Research Characteristics Main tenets of inquiry: focus on practice improvement and the premise that practitioners responsible for practice should be involved in that improvement. Participatory character Investigation into social practices Contribution to practice change Development of theory Research-led, Practice-driven, People-focussed 3 Value and impact ?

Participatory character 1.Collaborative endeavour between researchers and participants 2.Shared interests advanced through a process of dialogue and co-operation 3.Participants locate their inquiry in their social world - and in doing so may involve others in aspects of the research 4

Investigation into social practices Access to practical theories (Kemmis 1993) Participants investigate their practice, the context in which practice occurs, formulate accounts of their situation and devise appropriate plans (informed action) which reflect their practice situation Research-led, Practice-driven, People-focussed 5

Contribution to practice change Expressed as the commitment to improve practice Participants are encouraged to search for solutions to problems and then apply these within their practice settings Research-led, Practice-driven, People-focussed 6

Development of theory Practical knowledge –What practitioners do in practice / how practitioners apply theory in practice Propositional knowledge –The conditions under which practical actions are carried out Research-led, Practice-driven, People-focussed 7

Project 1 An action research inquiry exploring the transfer of pain knowledge from a continuing education course into practice Research aims: –To explore the transfer of pain knowledge from a continuing education course into practice. –To investigate the impact that nurses’ participation in action research has on their ability to improve aspects of their pain practice. Research question: –How does engagement in action research affect nurses’ capacity to influence pain assessment and management practices? Research-led, Practice-driven, People-focussed 8

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Project 1 – value and impact Participatory character “We ended up on the same wave length because of what we had done together. We struggled together, helped each other out…and we have built a rapport. We can help each other in a non-judgemental way.” Investigation into social practice “On a busy ward it is really hard I think to assess someone’s pain properly unless you spend time with them…it’s a bit of a lottery sometimes.” Research-led, Practice-driven, People-focussed 10

Project 1 – value and impact Contribution to practice change “I thought I was going to be able to help get the message across and I am doing that in a small way…you have to share your knowledge”. Development of theory Practical knowledge – e.g. negotiations for changing practice when transferring theatre patients Propositional knowledge- e.g. need for collective, interdisciplinary, organisational effort to change practice. Research-led, Practice-driven, People-focussed 11

Project 2: Case Management in Community Nursing – Model Development Research Aim To contribute to the development of a case model approach to support Community Nursing practice. Research Questions Which aspects of case management models do nurses identify as contributing to the effectiveness of Community Nursing? What is required to promote the integration of case management into the Community Nursing service? Research-led, Practice-driven, People-focussed 12

Phases of Inquiry: Based on action research principles community nurses a) reviewed and analysed their current practice and b) identified and evaluated approaches to case management that could be tested in practice Research-led, Practice-driven, People-focussed 13 Fact finding: established community nurses understanding of case management approaches & implementation in practice Planning: established preliminary recommendations by CN of processes & structures that can support case management implementation Action: CN reviewed findings that emerged from fact finding stages Evaluation: CN nurses focused on recommendations for practice development that would support implementation of case management Reflection

Project 2 – value and impact Participatory character “One of the most successful features of case management would be the building of relationships – like this” Investigation into social practice “But there’s countless patients who come home, who are already at home when it is the GP that phones or the nurse because there is now a crisis” Research-led, Practice-driven, People-focussed 14

Project 2 – value and impact Contribution to practice change Value of reflective discourse Research recommendations to funders – education requirements and organisational change Development of theory Practical knowledge – e.g. Using SPARRA data Propositional knowledge- e.g. need for shared understandings of philosophy of care, underpinning principles, roles and responsibilities. Research-led, Practice-driven, People-focussed 15

Final thoughts: Value and impact If action research has a focus on practice improvement with the premise that practitioners responsible for practice should be involved in that improvement, it may be useful to have a framework to help evaluate the extent to which these goals have been achieved. Research-led, Practice-driven, People-focussed 16