action research in action: reflections on a project to introduce clinical practice facilitators to...

METHODOLOGICAL ISSUES IN NURSING RESEARCH2

Action research in action: re¯ections on a project to introduce

Clinical Practice Facilitators to an acute hospital setting

Daniel Kelly BSc MSc RN NDN Cert Onc Cert PGCE RNT

Senior Nurse (Research and Development), Nursing and Governance, University College London Hospitals, London, UK

and Susan Simpson BA MSc RN PGCE RNT

Senior Lecturer, Faculty of Health, South Bank University, London, UK

Submitted for publication 17 November 1999

Accepted for publication 9 November 2000

Introduction

Action research has become increasingly popular in nursing

(Webb 1989, Greenwood 1994). This paper aims to clarify

the philosophy and principles of action research, and to

compare these with our experiences of facilitating such a

project in an inner city National Health service (NHS)

Trust in the United Kingdom (UK) (Simpson & Kelly

1999). The aims of the project were to introduce, develop

and evaluate Clinical Practice Facilitator (CPF) posts,

whose remit was to work alongside newly quali®ed nurses

and health care assistants (HCAs) to enhance their clinical

skills.

It has been known for some time that newly registered

nurses require support to develop their professional compet-

ence and knowledge (Kramer 1974, Acharya 19944 , Boxer &

Kluge 2000). Such support is necessary to meet a range of

needs including professional requirements for practice, career

development and the delivery of service objectives (Charnley

1999). To date, preceptorship has been promoted in the UK

and has gone some way in addressing these issues (Bain

1996). With increasing demands being placed on clinical

652 Ó 2001 Blackwell Science Ltd

Correspondence:

Daniel Kelly,

Senior Nurse (Research and Development),

Nursing and Governance,

University College London Hospitals,

Mortimer Street,

London W1N 8AA,

UK.

E-mail: [email protected]

K E L L YK E L L Y DD. && S I MP S O NS I M P S O N SS . (2 0 01 )( 20 01 ) Journal of Advanced Nursing 33(5), 652±659

Action research in action: re¯ections on a project to introduce Clinical Practice

Facilitators to an acute hospital setting

Aims of the paper. The process and philosophical basis of action research are

discussed in this article by reviewing the insights that were gained from a study

designed to enhance the support available to junior nursing staff in an acute hospital

setting.

Rationale. It has been well documented that newly quali®ed nurses require help to

develop professional competencies. With this in mind, the role of Clinical Practice

Facilitator was established within a National Health Service (NHS) Trust to

enhance clinical skill acquisition and the professional development of newly

registered nurses and health care assistants.

Design. In order to facilitate the inception, development and subsequent evaluation

of these new roles, an action research approach was adopted. Strategies used to

encourage collaboration and ¯exibility during the project are also discussed.

Results. The primary aims of the project were achieved and the authors suggest that

the choice of action research was signi®cant to the successful outcome. However, a

number of issues arose which deserve more attention including the importance of

the interpersonal skills of the action researcher and the value of action research to

facilitate change which is relevant at both an individual and organizational level.

Keywords: action research, organizational change, nursing competencies, collabor-

ation, research ethics

nursing staff, however, it was anticipated that the introduc-

tion of CPFs might be effective in emphasizing skill acqui-

sition in clinical settings (Nicol & Glen 1999), as well as

addressing the professional development needs of junior

nursing staff. The clinical specialities involved in the project

included medicine and elderly care, neuromedicine, neuro-

surgery, acute surgery, private patients (mixed medicine and

surgery) and accident and emergency. One CPF was recruited

to each area at the start of this project which was completed

over a period of 1 year. Before discussing our re¯ections on

the project, the following section summarizes the philosoph-

ical basis of action research.

The philosophical basis of action research

Action research originated, in part, from the Frankfurt

School, where the concept of critical social theory was

developed after the Second World War. At this time there

was a growing belief that positivism was failing to provide

solutions to all social or scienti®c questions; mainly because of

its reductionist viewpoint and a perception that research had

become a technical and depersonalized activity. The Frankfurt

School challenged this view by suggesting that individuals

possess the capacity to re¯ect upon a situation and effect

change during the process of research (Carr & Kemmis 19865 ).

Action research therefore drew upon Aristotelian concepts

of `praxis'; essentially doing; and `phronesis', an under-

standing of what should be carried out in practical situations.

Proponents of this view sought to replace the techniques of

positivism with the more ancient concept of reason. Further,

it was suggested that some of the questionable ethical

consequences of positivist research might be addressed more

openly if questions were posed about whether a given course

of action should be encouraged, rather than simply ques-

tioning whether it was effective (Carr & Kemmis 1986).

Action research was also considered a more empowering

experience for the researcher as personal insights and critical

evaluations of complex situations can result; including an

appreciation of the role which researchers themselves have

played (Elliott 1991).

This is a particularly relevant point when action research is

applied to health care organizations as the methodology is

grounded in maintaining the focus on the `real world', rather

than controlled environments. It acknowledges the struggles

which social actors negotiate each day, and attempts to

confront complex organizational processes. Various typolo-

gies of action research have been put forward to help to

clarify how the aims of action research might best be matched

by the approach taken by researchers, however, the inherent

¯exibility within action research requires such typologies to

be applied with caution. The following section explores this

issue in relation to our own experience.

Classi®cations of action research

Hart and Bond (1996) explore the limitations of classifying

action research projects using predetermined typologies such

as those proposed by Holter and Schwartz-Barcott (19936 ).

Essentially they argue that rigid classi®cations do not allow

for the fact that action research projects can be expected to

alter in focus over time. Our own experience con®rmed the

importance of ¯exibility by both participants and researchers.

Attempts to delineate action research into speci®c categories

or types may therefore prove problematic for action

researchers. When applying Hart and Bond's (1996) criteria

to the CPF project, for instance, the primary focus could have

been considered organizational in nature. As the work

progressed, however, it became necessary to shift towards a

more professionalizing or empowering approach to support

the individuals concerned to establish the role. It also became

clear that signi®cant change could only be achieved in the

organization by developing the individuals themselves.

Another group of individuals might also have concentrated

on different issues during this project. For example, a choice

could have been made to emphasize managerial initiatives to

secure resources for the role. In fact, the participants chose to

focus on developing personal objectives and to gauge success

in terms of how far they had in¯uenced local colleagues, in a

general sense, rather than focusing only on quanti®able

outcomes that might have been gained from an experimental

approach (Hart & Bond 1996). As the focus of the project

shifted in this way it was important to document, explain and

justify such changes. This degree of ¯exibility, whilst highly

relevant and appropriate in action research, should be

explicit within action research proposals and may require

to be emphasized to funding bodies so as to minimize

subsequent misunderstandings; especially if somewhat

different research outcomes are eventually produced to those

originally anticipated. Re¯ections on the process of the CPF

project highlight other issues which arose for the researchers,

participants and the organization involved.

Overview of the action research process

Assessment

In line with the spirit of action research, the ®rst phase

involved an assessment of the current situation (Holter &

Schwartz-Barcott 1993). Lewin (1946) ®rst suggested that the

action research cycle begins with an awareness of the need for

change to improve aspects of a speci®c situation. The need for

2Methodological issues in nursing research Action research in action

Ó 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 33(5), 652±659 653

a CPF role, for example, stemmed from the perception that

newly quali®ed staff nurses and HCAs were requiring support

to develop clinical skills (however, this was not yet based on

any formal evaluation). Funding was eventually secured to

establish and evaluate the contribution of the CPF role.

Following approval by the research ethics committee, a

range of baseline data were gathered prior to planning any

changes or interventions (Carr & Kemmis 1986). To begin

this process, the views of all nursing staff on the project areas

were sought using the Ward Culture Questionnaire (Adams

et al. 1995). This assesses organizational features of hospital

settings including job satisfaction and skill mix. Findings

from this phase were later examined by the CPFs to help them

plan the initial focus of their new role.

The researchers simultaneously facilitated a personal

development review to help the postholders to identify their

personal strengths and weaknesses, as well as clarifying their

immediate and longer-term goals. An analysis of information

from previous educational audits, as well as centrally held

data regarding staff retention and development (such as the

percentage turnover of each staff grade and the number of

HCAs currently undertaking training for National Voca-

tional Quali®cation (NVQ) in health care), was also carried

out in the assessment phase.

Action

As the work progressed into the action phase and the CPFs

entered the clinical settings, it became increasingly impor-

tant for the researchers to support them in the establishment

of these new roles, each of which was evolving somewhat

differently in response to local circumstances. In addition,

help was needed to respond to a number of organizational

issues (such as negotiating and modifying elements of the

original role description with managers). The personal goals

identi®ed in the assessment phase were also used to help the

CPFs establish their individual mode of practice in each

area.

Re¯ective diaries, detailing the process of establishing the

role, were written by the CPFs and key incidents were used as

a basis for discussion during the monthly project meetings.

These meetings also included the opportunity to provide peer

support and the collection of qualitative insights to enable the

role development to be described later. The re¯exive critique

undertaken included discussions of practical problems and

the identi®cation of possible solutions. Ethical re¯ections

were also encouraged to gain a sound understanding of the

various aspects of particular situations (Elliott 1991). These

activities together became a form of personal development

review and also acted as a form of `organizational diagnosis'

(Harrison 1994).

Winter (1989) argues that it is vital in collaborative studies

such as this that the opinions of each participant are

considered along the way, and that no one person has more

authority than another. Shumsky (1958) also stressed the

importance of constructive criticism as a vital component

within the action research process. However, this also

requires the creation of a safe and supportive environment

to encourage dialogue between researchers and participants.

During the action phase, open discussion was encouraged to

explore emerging issues (including successes and obstacles) as

they were encountered. Participants were also invited to

verify the written notes of meetings and to reach a consensus

on progress to the next stage. From the outset, it was

emphasized that our aim was to ensure that trust and

integrity were to be the guiding principles for the project.

The dialogue which took place remained con®dential,

except when otherwise agreed. Each section of the project

report was veri®ed by participants as it was produced, and

alterations were made at their suggestion. This paper was

also circulated prior to its submission to ensure that all views

were included, as far as possible.

Evaluation

The CPF role was evaluated in the ®nal phase by the use of a

questionnaire, speci®cally designed and piloted for this study,

which was sent to the nursing staff and managers of the areas

involved. This asked three questions; whether the staff

member had contact with the CPF during the period of the

project; what the purpose of that contact had been; and to

what extent the CPF had been perceived as useful. Evaluation

data were also gathered from the postholders themselves in

the form of re¯ective records and notes gathered during the

project meetings facilitated by the researchers.

In action research, data can be obtained from both

qualitative and quantitative sources. Triangulation of data

is suggested as being particularly desirable as it overcomes the

limitations within a single approach (Winter 1989). In this

case, the researchers gathered qualitative accounts of the

CPFs experiences, supplemented with quantitative data from

the assessment and evaluation questionnaires.

In relation to the primary focus of the project (more

detailed ®ndings will be published in a separate paper), we

received positive feedback regarding the bene®ts of these

roles; in fact, 95% of clinical staff who responded to the

evaluation questionnaire (response rate 80%) were `satis®ed'

or `very satis®ed' with the CPF's input to the clinical setting.

Organizational issues also remained important. For instance,

variations in the responsibilities of each CPF continued to

emerge; such as covering only one unit (in accident and

emergency), or up to seven individual clinical areas (in acute

D. Kelly and S. Simpson

654 Ó 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 33(5), 652±659

medicine). These differences impacted signi®cantly on how

each individual CPF functioned, and also in¯uenced what

they could be expected to achieve.

On re¯ection, action research, with its emphasis of colla-

boration and awareness of the change process itself, was

appropriate to the aim of this project. Collaboration, ¯exi-

bility and the relationship between the researchers and

participants emerged as crucial in each of the assessment,

action and evaluation phases.

Action research and new learning

Winter (1989) explores whether particular methods are most

applicable for action research whereas Meyer (1993) argues

that this research process places more emphasis on personal

and interpersonal issues than the choice of methods per se.

However, Winter (1989) suggests that there is an important

distinction to be made between merely gaining experience,

and learning from it. This supports the view that when we

learn signi®cantly from our experience, we use skills (which

can be improved), and methods (which can be described).

The insights gained from action research can result in deeper

understandings of previously taken-for-granted situations, as

well as learning more bene®cial ways of working to achieve

both individual and organizational goals.

Habermas (1972) also suggested that critical social science

should be motivated by the quest for greater understanding of

our world. He accepted certain tenets of historicism within

this de®nition; such as knowledge being shaped by what has

gone before. However, he also moved beyond pure histori-

cism to emphasize the need to discover what factors may

shape people's needs and goals in the present, in order to

diminish the in¯uence of `repressive in¯uences' and encou-

rage èmancipation'.

In this instance, the researcher's `learning' began when we

discovered that the CPFs, as a group, had a varied and

inconsistent range of experience as clinical nurses. As a result,

one of our ®rst aims was to offer guidance and support to

facilitate their move away from the familiarity of working

within a structured clinical team (with its own rules and

expectations), and develop as autonomous practitioners; able

to cope with the dif®culties inherent in these new and less

well-de®ned roles. We also employed a facilitative style of

working, which we hoped they would mirror and adopt in

the CPF role.

Lewin's (1946) seminal work suggested that the aim of

action research is not only to improve modes of practice in

isolation, but also to encourage the practitioner's under-

standing of their practice, as well as the social context in

which it takes place. Shumsky (1958) later argued that action

research should go beyond the production of `research

®ndings' to include a nuanced consideration of the process

and signi®cance of the research act itself. This approach

proved congruent with an essential facet of the CPF project as

we sought to document and simultaneously explain the

development of this new role, as it was evolving within this

particular setting.

Habermas (1972) also supported the use of self-re¯ection

to enable individuals to conceptualize what frustrates them as

social beings, and to identify actions or changes which might

be taken to effect change in their situation. The desire to

achieve a more enlightened approach to nursing is mirrored

in the recent interest in re¯ective practice as a means of

enhancing personal and professional development (Schon

1983). During the course of this project, it became clear that

self-re¯ection was a philosophy central to our ethos. By

providing the participants with the opportunity for re¯ection

on the development of the CPF role, they appeared to grow

more insightful and con®dent that they could identify strat-

egies to deal with challenges more effectively as they arose.

Flexibility and progress in action research

A fundamental difference between action research and posi-

tivistic approaches is that the former is often conducted by

ìnsiders' whose aim is to investigate and facilitate change in a

social setting. In contrast, positivistic research is characterized

by the use of objective, detached òutsiders' (Bowling 1999).

The individual or group undertaking action research is

therefore encouraged to eschew the notion of the elitist

academic researcher, and to move towards an acceptance that

no-one can ever provide the answer to a particular problem.

Instead, action researchers are expected to synthesize ®ndings

as they emerge and to consider them in context before offering

conclusions (Chisolm & Elden 1993). This challenges action

researchers to adopt a more open epistemological stance in

their work and con®rms the point made earlier that they

should be willing to negotiate changes and suggestions as the

work progresses (Shumsky 1958). In reality, however, this

means that extra demands can emerge as the con¯icting

pressures and deadlines impact on the action research process.

In order to ensure progress as well as ¯exibility, we

included the opportunity for data to be shared with the CPFs

as they became available. This ensured that their views were

sought before progressing further. When the researchers

re¯ected on their role at this time it became clear that we

succeeded in remaining open to the participant's suggestions

as well as guiding the project towards completion. As a result,

as issues emerged which required a more practical response,

the researchers had to become directly involved in negotiating



the most appropriate way forward. Examples of this included

lobbying for computer equipment on the participants' behalf,

or clarifying the scope and progress of the project with

managers.

The remainder of this paper explores other key issues

related to action research which, we suggest, merit further

discussion in the light of our experience.

Collaboration in action research

Cohen and Manion (1989) suggest that although collabor-

ation is desirable within action research various levels of

collaboration are likely to be encountered in reality.

However, a minimal expectation is that participants have a

clear understanding of the research and their role within it.

Holter and Schwartz-Barcott (1993) propose two levels of

collaboration which might exist between researchers and

participants in action research. First, the `technically colla-

borative' approach involves the researcher translating an

intervention from accepted theory to a speci®c situation.

Collaboration between researcher and practitioner in this

instance will be required to the extent that practitioners are

willing to implement and evaluate the proposed intervention.

The technically collaborative approach can result in imme-

diate change; although it may only prove to be of short

duration. Examples of this include work by Hunt (1987) who

encouraged nurses to implement research based practice;

Webb (1990) who implemented team nursing, and Hyrkas

(1997) who developed clinical teaching in an acute setting.

Conversely, the `mutually collaborative' approach sets out

to achieve a more equal involvement between the parties

involved, with `local theory' being developed to plan change

(Holter & Schwartz-Barcott 1993). This may produce more

durable change, and can also result in the development of

new theory. Titchen and Binnie (1993), for example, imple-

mented primary nursing using what they described as a

mutually collaborative approach. On closer examination,

however, they appear to have identi®ed both the research

question and the interventions, which may have detracted

from the level of participation of all of those involved.

Manley (1997) is one of the few examples in the nursing

literature who demonstrates a mutually collaborative method

being adopted to develop a framework for advanced nursing

practice; with the suggestion for such practice emerging from

the nursing team themselves.

Collaboration: ideals and realities

Within action research reports there are often claims that

collaboration and equity was successfully promoted

between researchers and participants. However, for

change to occur in organizations there must also be

some degree of leadership ± as well as creative con¯ict

(Beer et al. 1990). Garside (1998) also suggests that it is

important to question whether the available theoretical

constructions of organizational change are always helpful

in reality:

All improvements require change, and improving quality in health

care involves changing the way things are done, changes in processes

and in the behaviour of people and teams of people¼Much is said

and written in the ®eld of organizational behaviour¼but the jargon is

a barrier and the theory seems to be arcane (p. 8).

We would suggest that we achieved a degree of close

collaboration with our immediate participants (the CPFs).

In¯uential others from the wider organization (such as some

managers), however, were less inclined to become involved;

especially if they sensed a risk of increasing costs as a result of

the project. Whilst this was understandable, it supports the

assertion by Pettigrew et al. (1992) that change in organiza-

tions can be resisted for any number of reasons including self-

interest, resentment, differing perceptions of the value of

change, misunderstandings, lack of trust or a low tolerance

towards change in general.

We would claim therefore that we encouraged a mutually

collaborative approach during this project. Initially, this was

aided by the fact that the CPFs were appointed on the basis

that they agreed to be involved in the project, as well as

action research proving ¯exible enough to incorporate

changes as we progressed. Collaboration was enhanced

through regular re¯ective meetings, problem-focused discus-

sions and an action planning approach. The main research

question itself was only identi®ed after the researchers and

participants had completed the assessment phase.

Whilst the researchers continued to advise the CPFs about

establishing the role, they also encouraged them to identify

the most useful mode of working within each clinical setting.

This required them to adopt an effective process of negoti-

ation with fellow clinicians and managers.

Skills of the action researcher

Winter (1989) suggests that action research can be assisted by

the researcher not only having expertize and up-to-date

knowledge, but also by `having been around', and `knowing

the score' of the situation being explored. In this case both

researchers were experienced clinicians and educationalists

who were aware of some of the politics and potential pitfalls

which the project might encounter. This background, we

propose, equipped them with skills and credibility in situa-



tions which might otherwise might have proved dif®cult to

negotiate. On re¯ection this became an important factor in

helping to facilitate both the action research process and a

successful outcome for the project.

McNiff (19917 ) suggests that in situations such as this,

organizational politics will always intrude, and that practical

problems will present which need to be overcome. With the

insights gained from our experience we would concur

strongly with this view.

We would also argue that more attention should be paid to

the training and skills required of action researchers and the

dangers of recruiting inexperienced individuals to projects

such as this. The importance of interpersonal skills, primarily

those of collaboration, negotiation and assertiveness, which

could prove highly signi®cant to the process and eventual

outcomes of action research, is a topic which appears to have

received little attention in the literature.

Addressing validity and reliability in action research

Questions of validity and reliability in action research, as in

other methods, are concerned with how far can outcomes be

accepted as accurate re¯ections of reality. McNiff (19918 ) has

suggested three approaches to enhance the validity of educa-

tionally focused research such as this. They include self-

evaluation, peer validation, and learner validation. In the case

of the CPF project, we included all three dimensions; with

self- and peer-evaluation being undertaken at the monthly

meetings and the effectiveness of the role judged by clinicians

through the evaluation questionnaires.

When analysing and reporting on an action research

project Winter (1989) goes on to argue that an ìnsider'

practitioner/researcher might be inhibited from telling the

whole truth about their organization; a situation which may

not occur with a more disinterested òutsider'. However, the

same author also suggests that, as a result of closer

involvement, the action researcher who is also an ìnsider'

may have an added incentive to produce conclusions that

are more rigorous, balanced and grounded within the

shared perceptions of those who make up the setting in

question. The òutsider', on the other hand, may produce

more super®cial or less insightful conclusions as they do not

own or have any particular af®nity to the situation being

studied.

The external validity of an action research study can only

be judged by those who have access to the ®ndings, as the

researchers, even if they apply methods of veri®cation, can

normally only claim some degree of face validity; such as

ensuring that questionnaire items are presented in unambig-

uous and clear fashion (Bowling 1999). It is also implicit

within action research that a unique situation is being

studied, and that generalizability is not normally inferred.

In the CPF project, the researchers and practitioners had

little incentive to gloss over the less positive aspects of the

data, as this would have negated the whole purpose of the

study; namely to produce workable principles for CPF

practice. It could also be argued that the project was not

carried out merely for the purposes of academic enquiry, but

was grounded in the real (and messy) world of an organiza-

tion in a state of ¯ux. It could claim to be more meaningful to

this setting than one where a more positivistic or less context-

speci®c approach, such as a randomized trial, had been

employed (Susman & Evered 1978).

Participants' consent in action research

Ensuring that informed consent is achieved for the partici-

pants of action research is a complex challenge. Meyer (1993)

suggests that consent rests on participants accepting the

researcher, and the project, as well as being willing to

contribute their views. Although the CPFs were appointed

to the posts on the understanding that they would be willing

to take part in the study, it was still a step into the unknown

for them, and it could be argued that `fully informed' consent

was compromised at best, or impossible to ever achieve, in

such a situation. It was essential therefore to ensure that

consent was renegotiated as the project progressed.

It is also possible that action research can place partici-

pants at greater risk of exploitation, betrayal and abandon-

ment than more positivistic methods (Meyer 1993);

particularly as the process involves exposure to real world

situations, and hence real risks for the individuals involved.

The change inherent within the action research process could

prove particular threatening to those who have a vested

interest in the status quo; making some individuals feel

particularly vulnerable. Certainly the research team encoun-

tered such issues during this project, and there was a

requirement to act tactfully to facilitate co-operation and

progress.

Kemmis and McTaggart (1982) are typical of those who

stress the importance of identifying relevant ethical principles

to guide action research. These include consultation with all

relevant authorities and the close inclusion of participants

throughout the project. Although the CPFs were included in

planning the stages of this project, it could be argued that the

clinical nursing staff found themselves involved rather more

unwittingly; especially as the CPFs were introduced into the

clinical settings with little time available for prior consulta-

tion. Clinical staff were informed of the nature of the project

in an explanatory letter which was circulated with the



assessment questionnaire to obtain the baseline information

(which they could have refused to return). However, it would

have been more dif®cult for individuals not to participate in

the study once the roles were actually established in the

clinical areas.

Meyer (1993) describes the dif®culties which the key

participants would have in withdrawing from a project of this

nature. Indeed, if the project had developed in a manner with

which an individual CPF had disagreed, despite further

negotiation, they would have had little option but to

withdraw.

From our experience of this process we would stress that it

is essential for action researchers to consider the ethical

dimensions of their work, and provide ways of ensuring that

the ethical issues which do arise are discussed as openly as

possible. Individual and organizational concerns should be

addressed promptly. Once again this may rely on the skill of

the researcher being sensitive to the circumstances in which

they are involved. This is a point which we wish to stress and

is particularly relevant in relation to the training and selection

of action researchers in the future; especially if this method is

to be more widely adopted in health care settings.

Conclusions and recommendations

Shumsky's (1958) stressed the value of action research to

social settings, with its emphasis on processes and personal

experiences as well as outcomes. Throughout the CPF project

participants demonstrated considerable growth and develop-

ment, especially in the ®eld of problem solving and the

successful establishment of this new role. The posts were

positively evaluated by both clinical staff and managers, with

over 95% responding that they were satis®ed or highly

satis®ed with their input.

Action research, with its explicit linking of theory

to practice, undoubtedly contributed towards the success

of this project and assisted the CPFs simultaneously to

develop personal con®dence and knowledge. Similarly, the

researchers developed insight into the practicalities of action

research as a result.

Applying this methodology to health care practice proved

both challenging and enlightening. Action research does,

however, have its limitations. One of these is relatively small

scale of projects such as this. The researchers also worked so

closely with participants that the traditional objectivity

expected of the researcher becomes blurred. Whilst this can

certainly be a positive experience, it could also limit the

reliability of ®ndings. It might now be useful to replicate the

work on a larger scale. The drawbacks of doing so, however,

may be that a less personalized mode of working would

probably result. Despite these limitations, a more positivistic

approach would not, we suggest, have yielded so much

insight or as many context-related outcomes.

This action research study demonstrated that Clinical

Practice Facilitator posts were positively evaluated by nursing

staff in this acute setting. This new role encouraged skill

acquisition and facilitated other activities such as clinical

teaching and HCA training. An outcome of equal import-

ance, for both the researchers and participants, were insights

gained into the process of change and con®rmation that

action research is an appropriate way to involve people more

directly in research and development activity.

Two years after the project ®rst began, CPF posts are now

established in other areas across the trust and have secured

ongoing funding. Most of the original post holders have since

moved on to promoted posts in related areas. A second phase

of the project to continue the evaluation and promote

evidence based practice has since been funded and will be

reported on subsequently.

Acknowledgements

We wish to acknowledge the contributions of the individual

CPFs and other colleagues who worked with us during this

project. Thanks are also owed to Pauline Brown and Ann

Tacket for their support. The project was funded by the

Central and East London Educational Consortium.

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