international practice development in nursing and...

P1: SFK/RPW P2: SFK/RPW QC: SFK/RPW T1: SFK

BLUK149-Manley March 13, 2008 10:4

International Practice Developmentin Nursing and Healthcare

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International Practice Developmentin Nursing and Healthcare

Edited by

Kim ManleyBrendan McCormackVal Wilson

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This edition first published 2008C© 2008 by Blackwell Publishing Ltd

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Library of Congress Cataloging-in-Publication Data

International practice development in nursing and healthcare / edited by Kim Manley, BrendanMcCormack, Val Wilson.p. ; cm.

Includes bibliographical references and index.ISBN-13: 978-1-4051-5676-9 (pbk. : alk. paper)ISBN-10: 1-4051-5676-7 (pbk. : alk. paper) 1. Nursing. 2. Nurse practitioners.

3. Nursing–International cooperation. I. Manley, Kim, MN. II. McCormack, Brendan.III. Wilson, Val.

[DNLM: 1. Nursing Research. 2. Clinical Competence. 3. Evidence-Based Medicine.4. International Cooperation. 5. Nurse’s Role. 6. Patient-Centered Care. WY 20.5 I6185 2008]

RT82.8.I56 2008610.73–dc22

2007039587

A catalogue record for this book is available from the British Library.

Set in 9.5/11.5pt Palatino by Aptara Inc., New Delhi, IndiaPrinted in Singapore by C.O.S. Printers Pte Ltd

1 2008

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Contents

List of contributors viiPreface xixAcknowledgements xxi

1. Introduction 1Kim Manley, Brendan McCormack and Val Wilson

2. Person-Centred Systems and Processes 17Brendan McCormack, Kim Manley and Ken Walsh

3. The Ever-Changing Discourse of Practice Development: Can WeAll Keep Afloat? 42Lucienne Hoogwerf, Donna Frost and Tanya McCance

4. A Methodological Walk in the Forest: Critical Creativity andHuman Flourishing 59Angie Titchen and Brendan McCormack

5. Evidence Use and Evidence Generation in Practice Development 84Tracey Bucknall, Bridie Kent and Kim Manley

6. Learning – The Heart of Practice Development 105Charlotte L. Clarke and Val Wilson

7. An Exploration of Practice Development Evaluation:Unearthing Praxis 126Val Wilson, Sally Hardy and Bob Brown

8. Enabling Practice Development: Delving into the Concept ofFacilitation from a Practitioner Perspective 147Theresa Shaw, Jan Dewing, Roz Young, Margaret Devlin,Christine Boomer and Marja Legius

9. Being Culturally Sensitive in Development Work 170Cheryle Moss and Jane Chittenden

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Contents

10. Person-Centred Outcomes and Cultural Change 189Brendan McCormack, Tanya McCance, Paul Slater, Joanna McCormick,Charlotte McArdle and Jan Dewing

11. Changing the Culture and Context of Practice: Evaluating theJourney Towards Family-Centred Care 215Val Wilson and Raelene Walsh

12. Becoming a Facilitator – The Journey 241Jacqueline Clarke, Helen O’Neal and Shirley Burke

13. Leadership Support 260Annette Solman and Mary FitzGerald

14. Becoming and Being Active Learners and Creating ActiveLearning Workplaces: The Value of Active Learning inPractice Development 273Jan Dewing

15. Evidence Use in Practice Development 295Rob McSherry and Karen Cox

16. Using Practice Development Approaches in the Developmentof a Managed Clinical Network 319Liz Henderson and Sandra McKillop

17. Accrediting Practice Development Activity: An Approach forAchieving Person-Centred and Evidence-Based Care 349Kim Manley, Jane Canny, Jill Down, Jane-Marie Hamill,Elaine Manderson, Natalie Moroney, Jenny Newton,Alyce A. Schultz and Helen Young

18. The Future Contribution of Practice Development in aChanging Healthcare Context 379Kim Manley, Brendan McCormack, Val Wilson and Debra Thoms

Index 396

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Contributors

Christine Boomer, Research Officer, Belfast Health and Social Care Trust, The RoyalHospitals Nursing Development Centre, Belfast, Northern Ireland, UK

Christine’s clinical experience has been in Neurosciences Nursing, holding a vari-ety of positions within the field. Within the last 7 years Christine has been activelyinvolved in a variety of practice development (PD) roles and programmes of work.In her current role Christine is involved in both the research evaluation of PD ac-tivity within the organisation and the facilitation of PD programmes, including thedevelopment of facilitation skills within the trust’s nursing community. She is alsoa member of the International Practice Development Colloquium and is involvedin national and international research and PD activity.

Bob Brown, Assistant Director of Nursing, Southern Eastern Health and SocialCare Trust, Trust HQ Thompson House Hospital, Lisburn, Northern Ireland, UK

Bob has extensive experience as a practice development facilitator throughoutNI and internationally. He is an accredited RCN Facilitator and is a member ofthe International Practice Development Colloquium. Bob has held a number ofpositions during the last 10 years; firstly in a joint appointment between Universityof Ulster and Newry and Mourne Trust, then as an Intermediate Care Facilitatorand Nurse Commissioner. Recently, he has been a Senior Professional Officer at theNorthern Ireland Practice and Education Council for Nursing and Midwifery. Bob’smain research interest is in the field of palliative, supportive and end-of-life care.

Tracey Bucknall, Professor of Nursing, Deakin University, Head, Cabrini-DeakinCentre for Nursing Research, Cabrini Health, Malvern, Australia

Prior to her appointment at Cabrini Health and Deakin University, Tracey wasan Associate Professor at the University of Melbourne and Director of NursingResearch and Development at Western Health. Tracey has held a variety of clini-cal, educational and research appointments in both private and public hospitals,and in the tertiary sector. Her primary research interests have been clinical deci-sion making and research implementation. Tracey has obtained research fundingfrom NHMRC, State and Federal Health Departments, and private and profes-sional organisations. She has published and presented her research nationally andinternationally and is an Associate Editor for Worldviews on Evidence Based Nursing.

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List of contributors

Shirley Burke, Practice Development Lead, Royal Children’s Hospital, Melbourne,Australia. Honorary Lecturer, School of Nursing and Midwifery, Monash Univer-sity, Victoria, Australia

Shirley is a paediatric nurse with significant experience in paediatric nursing ed-ucation. She has been involved in utilising practice development facilitation prin-ciples in her work since 2003. Her present role is a new position at the RoyalChildren’s Hospital, Melbourne and she has been in this position for 1 year. Thisyear has been spent developing the new role and working with healthcare teamsto raise awareness about practice development, and to contribute to developing astrategic plan for practice development within the organization.

Jane Canny, Head of Patient Quality, Barts and The London NHS Trust, The RoyalLondon Hospital, Whitechapel, London, UK

Jane has been working at Barts and London Trust since 1993 and held a number ofsenior nursing positions. She specialised in HIV/AIDS nursing and held posts man-aging nursing services in in-patient, out-patient and day care environments anddeveloping services to meet the changing healthcare needs of an increasingly di-verse patient population. As the trust Senior Nurse, Practice Development, she hasworked collaboratively with the Royal College of Nursing in developing and im-plementing a practice development strategy for the trust. Her current role focuseson patient and public involvement and feedback – including the corporate com-plaints service, together with coordinating clinical effectiveness and audit activity.

Charlotte L. Clarke, Professor of Nursing, Practice Development Research, As-sociate Dean (Research), School of Health, Community and Education Studies,Northumbria University, Newcastle upon Tyne, UK

Charlotte Clarke works at Northumbria University as Professor of Nursing Prac-tice Development Research and Associate Dean for Research. She worked witholder people and people with dementia since qualifying as a nurse in the late1980s. After several years working clinically, she has concentrated on teaching andmulti-disciplinary applied research. Among many research projects, her PhD studyfocused on carers of people with dementia and a more recent study focused on theways in which risk is constructed and managed in dementia care. Charlotte haspublished widely in this field, the most recent edited book on community-basedcare for people with dementia having been published by the Open University inJuly 2007.

Jane Chittenden, Registered New Zealand Nurse, Bachelor Health Science. Man-ager, Tokoroa Hospital and Family Health Team, Tokoroa Hospital, Waikato DistrictHealth Board, Tokoroa, New Zealand

Jane has been involved with nursing and health delivery professionally for 20 years.Her clinical history of generalist practice in rural hospitals and urban settingshas enabled a broad understanding of health issues and systems. She currentlymanages a rural hospital that provides both community and hospital services. Her

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passion is quality patient care and supporting, enabling and challenging staff toprovide that quality care.

Jacqueline Clarke, Practice Development Facilitator, Southern Health and SocialCare Trust, Newry, Northern Ireland, UK

Following qualification as a Registered General Nurse, Jacqueline has mainlyworked in cardiology. She then completed her Midwifery and Health VisitingTraining. She completed her academic studies through the University of Ulsterachieving a BSc (Hons) Professional Development in Nursing with the Communityoption in Health Visiting. Presently, Jacqueline is working as a Practice Develop-ment Facilitator within the Southern Health and Social Care Trust.

Karen Cox, Clinical Chair, the Knowledge Centre for Evidence Based Practice,Faculty of Nursing, Fontys University of Applied Science, Eindhoven, The Nether-lands

Karen holds a Clinical Chair at the Knowledge Centre for Evidence Based Practiceat Fontys University School of Nursing. The vision of this Knowledge Centre is towork with patients and key stakeholders to achieve effective, person-centred andevidence-based care. Karen facilitates staff members of the Knowledge Centre in arange of projects. Among these projects are practice development projects (e.g. de-veloping lecturer–practitioner roles), education projects (e.g. Masters of AdvancedNursing Practice) and several international collaborations (e.g. International Prac-tice Development Collaborative).

Margaret Devlin, RN, PG Cert BSc [Hons] Dip Nursing. Nurse Education Coor-dinator, Belfast Health and Social Care Trust, The Royal Hospital Nursing Devel-opment Centre, Belfast, Northern Ireland, UK

Margaret’s background was in cardiac nursing before moving into the area ofclinical education and practice development, where she led a major project todevelop a new Clinical Career Framework (REACH ) for nursing in the trust. Inher current post, she is responsible for pre- and post-registration nurse educationon site, but still continues her involvement in practice development.

Jan Dewing, Independent Consultant Nurse, Honorary Research Fellow, Univer-sity of Ulster and Visiting Fellow, Northumbria University, Newcastle upon Tyne,UK

Jan works on a range of emancipatory and transformational practice developmentinitiatives mainly in the United Kingdom and Ireland, particularly in services forolder people. She is especially interested in how practice developers enable ac-tive learning, learning in the work place and ultimately learning cultures to bedeveloped.

Jill Down, Senior Nurse, Nursing Project Office, Addenbrooke’s Hospital, Cam-bridge University Hospitals, NHS Foundation Trust, Cambridge, UK

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Jill has held clinical and leadership posts in critical care, workforce developmentand acute medicine that have informed and developed a passion for helping staffto improve patient care. She has worked in partnership with the Royal Collegeof Nursing to deliver and evaluate practice development activities in an acutetrust. She is particularly interested in working with staff to develop a cultureof effectiveness and achieve sustainable change within the realities of everydaypractice.

Mary FitzGerald, Professor of Nursing, James Cook University, Cairns, Australia

Mary worked in Oxford in the 1980s where she was able to work with a talentedteam of nurses to develop practice on a general medical ward. Since leaving theUnited Kingdom to study and work in Australia she has maintained her interestin practice development. As Professor of Nursing at Central Coast Health in NewSouth Wales, she facilitated the development of an area wide practice developmentstrategy. Currently, she is Director of Research at James Cook University in FarNorth Queensland.

Donna Frost, Quality and Innovation Manager, WZH Nieuw Berkendael NursingHome, Den Haag, The Netherlands

Donna gained her nursing registration in New Zealand. She believes in the trans-forming power of practice development and participative research methods. Sincebeginning work in The Netherlands in 2003 She has been involved with nurses andmanagers who are working to develop nursing practice in long-term care settings.

Jane-Marie Hamill, Clinical Nurse Leader, Chelsea and Westminster IntensiveCare Nursing Development Unit, Chelsea and Westminster Foundation Hospital,London, UK

Jane-Marie has worked in intensive care for the last 17 years and her current roleinvolves the operational and clinical management of the unit. The unit is a chartermark holder. She has a particular interest in quality initiatives, especially find-ing out about users, experiences through focus groups and developing ways toimprove the service delivered to patients and their significant others.

Sally Hardy, Director of Research and Practice Development, The Royal Children’sHospital, Melbourne, Australia

Sally trained as a general nurse, then moved into mental health nursing. Her desireto inform practice led her towards education and research and is currently workingwith the Royal Children’s Hospital in Melbourne utilizing PD to support, prepareand enable practitioners for contemporary practice. She is an Honorary AssociateProfessor with Monash University in promoting a new Masters in PD, engagementin a PD round table and in sharing her experience of PD with practitioners of alllevels to bring about transformation through human-flourishing.

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Liz Henderson, Network Nurse Director, Northern Ireland Cancer Network(NICaN), UK

Liz has worked in cancer nursing for the past 25 years. In her current role sheprovides nursing leadership in the strategic development of cancer services acrossNorthern Ireland. In partnership with colleagues in the network team she con-tributed to the establishment and development of the Cancer Network. Her par-ticular focus is around improving the patient experience. She serves on a numberof regional committees and has been involved in a series of practice developmentprogrammes.

Lucienne Hoogwerf, Head of Department, Fontys University of Applied ScienceFaculty of Nursing, Eindhoven, The Netherlands

Lucienne became an RN in 1980. She specialised in gerontology nursing. In thisinteresting nursing speciality she held several positions such as clinical nurse man-ager, educator and consultant. She obtained her PhD in 2002 at the University ofUtrecht. She now holds the position of Head of Department, Faculty of Nursing,at Fontys University of Applied science. Her research interests are patient partici-pation, relocation and dementia.

Bridie Kent, Associate Professor, Director of Clinical Nurse Research, School ofNursing, Faculty of Medical and Health Sciences, University of Auckland, Auck-land, New Zealand

Bridie is a clinically focused nurse academic who specialised in adult critical carenursing. I gained a PhD in 1998. She has extensive experience in health servicespractice, education and research in the United Kingdom and New Zealand, whereShe is also the Director of the Centre of Evidence Based Nursing Aotearoa (CEBNA).

Marja Legius, Senior Lecturer, Fontys University of Professional Education, Eind-hoven, The Netherlands

Marja has been a senior lecturer at Fontys University of Professional Education(Eindhoven, The Netherlands), Nursing Faculty, since 1996. She has also been amember of the Knowledge Center ‘Evaluation and Implementation of EvidenceBased Practice’ for the last 2 years. In the early 1980s she graduated as a paedi-atric nurse, and is still passionate about children and paediatric nursing. She isan active advisory board member of the National Paediatric Nursing Association,and National Nursing Association in The Netherlands. After several studies ineducation, paediatrics and nursing science, she now enjoys working with students(just grown up children really). She has recently completed a project entitled ‘Carein dialogue’, about patient-centred care. As a member of the Knowledge Centreshe co-facilitates the PD and EBP courses run within the faculty. The courses havebeen held in English and Dutch. In January 2006 she started the first phase of herPhD study. The subject matter being ‘facilitation’ and in particular the ‘CriticalCompanionship model’.

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Elaine Manderson, Clinical Nurse Specialist, Intensive Care, Chelsea and West-minster Hospital NHS Foundation Trust, London, UK

Elaine has worked in the field of intensive care for the past 13 years in a varietyof settings including general, liver and cardiothoracic. Her interests lie with thedevelopment of nursing language in critical care, the experience of weaning fromventilation for nurses and patients and the development of an evidence-based,patient-centred culture.

Kim Manley, Learning and Development Manager, Resources for Learning andImproving, Royal College of Nursing, UK

Kim, previously Head of Practice Development at the Royal College of Nursing,has a long history of working in practice, with practitioners and practice teamsnationally and internationally to help them become more person centred and ef-fective in their work. Her particular interests are approaches to research, inquiry,learning and development that are transformational and make a difference to thecare experienced by users and patients. Developing workplace cultures where thepatient is at the centre, staff are clinically effective, shared governance principlesare realised and services continually improved is her passion. Kim is Visiting Pro-fessor, Bournemouth University, and Visiting Fellow, Brighton University. She wasthe founding co-editor of Nursing in Critical Care.

Charlotte McArdle, Director of Primary Care and Older People, Executive Directorof Nursing, South Eastern Health and Social Services Trust, Northern Ireland, UK

Charlotte joined South Eastern Trust from the Royal Hospitals Trust, Belfast, whereshe was the Acting Director of Nursing having been the Deputy Director of Nurs-ing for 2 years. Her current responsibilities include the professional leadership ofnursing and midwifery, training and development for nurses and the provision ofservices for Primary Care and Older People. Charlotte has extensive experience innursing clinical leadership, practice development and senior nursing management.

Tanya McCance, Co-Director for Nursing R&D, Belfast Trust/Mona Grey Profes-sor for Nursing R&D, University of Ulster, Northern Ireland, UK

Tanya currently holds a joint appointment between the University of Ulster andthe Belfast Health and Social Care Trust. She has been a registered nurse since 1990and throughout her career has gained experience in a range of posts within highereducation and the health service that have focused on practice, education andresearch. Tanya has been involved in a variety of research and practice developmentprojects, but her main areas of interest are the development of person-centredpractice and the use of practice development to promote this concept within clinicalsettings, and also the strategic development of nursing and midwifery R&D.

Brendan McCormack, Professor of Nursing Research, Institute of Nursing Re-search/School of Nursing, University of Ulster, Newtownabbey, Belfast, NorthernIreland, UK

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Brendan leads a variety of practice development and research projects in Ireland,the United Kingdom, Europe and Australia that focus on the development ofperson-centred practice. In addition, he is the leader of the Institute of NursingResearch ‘Working with Older People’ Recognised Research Group, coordinatingresearch and development activity in this area. He has a particular focus on the useof arts and creativity in healthcare research and development. He is the co-editorof the International Journal of Older People Nursing.

Joanna McCormick, Nurse Consultant, Critical Care, Belfast Health and SocialServices Trust, Royal Hospitals, Belfast, Northern Ireland, UK

Joanna has worked within critical care settings for the past 20 years and has beenin her current post for 5 years. Joanna’s work focuses on improving outcomesfor critically ill patients and staff caring for them through initiatives such as earlywarning scoring systems, critical care outreach services and organisation of patientcare. This work is carried out within a PD framework.

Sandra McKillop, Network Director, Northern Ireland Cancer Network (NICaN),UK

Sandra is the Network Director of the cancer network in Northern Ireland (NICaN).In partnership with clinical leads, she was responsible for establishing and devel-oping the Cancer Network, the first regional managed network within health andsocial care in Northern Ireland. Before joining the health service in 2004, Sandraworked for over 12 years in Queens University, Belfast, in both teaching and man-agement positions; her latter post setting up a network to support innovation inlearning for students across the further and higher education institutions in North-ern Ireland.

Rob McSherry, Principal Lecturer, Practice Development, School of Health andSocial Care, University of Teesside, Middlesbrough, UK

Rob holds an honorary contract for the post of Practice Development Advisorwithin the Division of Medicine, James Cook, University Hospital, Middlesbrough.Following nurse registration in 1988 Rob pursued a career in Care of the OlderPerson and Acute Medical Nursing until in 1994 when he became a Practice De-velopment Advisor/Lecturer in Medical Specialties for Chesterfield and NorthDerbyshire Royal Hospitals NHS Trust and the University of Sheffield. Rob joinedthe University of Teesside in 1999 as a Senior Lecturer in practice development,which has remained his focus of expertise since. Rob was the founder memberof the North East and Yorkshire Developing Practice Network and in June 2005was elected as the Chair of the Developing Practice Network United Kingdom. InMarch 2007 Rob was appointed Clinical Associate Professor with the AustralianCatholic University, Brisbane, Australia. Rob’s main interest is seeing research be-ing utilized at a clinical level where nurses, midwives, nurse specialists and otherallied health professionals are equipped with the essential skills and knowledgeto aid this process.

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Natalie Moroney, Previously Senior Sister, Colorectal Surgical Ward. Barts andThe London NHS Trust, The Royal London Hospital, Whitechapel, London, UK

Cheryle Moss, Associate Professor, Graduate School Nursing, Midwifery andHealth, Victoria University of Wellington, Wellington, New Zealand

Cheryle is interested in practice development and in how health profession-als learn and progress their practice in the context of workplace environments.Cheryle also has a role as a practice development facilitator at Thames Hospital inNew Zealand.

Jenny Newton, Post Doctoral Industry Fellow, Australian Research Council, Schoolof Nursing and Midwifery, Monash University, Melbourne, Australia

Jenny is the coordinator for the international Master’s of Practice Developmentoffered in partnership with the University of Ulster. She is a proactive researcherin the field of clinical nurse education and practice development and maintainsher clinical practice skills on a cardiothoracic/cardiology unit.

Helen O’Neal (Crisp), Practice Development Sister, Intensive Care, AddenbrookesNHS Trust, Cambridge, UK

Helen’s practice development and facilitation skills have developed since qualify-ing as a nurse in 1994. Whilst working in various clinical areas, but now specialisingin critical care, She has participated in advancing clinical practice through develop-ing staff skills and knowledge or promoting evidence-based practice. She becamean accredited facilitator as a result of learning and involvement as a researcherpractitioner in a trust-wide action research project supported by the Royal Collegeof Nursing.

Alyce A. Schultz, Clinical Professor, Phoenix Children’s Hospital, College of Nurs-ing and Healthcare Innovation, Arizona State University, Phoenix, AZ, USA

Alyce is a Clinical Professor at Arizona State University with a joint appointmentat Phoenix Children’s Hospital. For 12 years, she was the Director of the Centerfor Nursing Research and Quality Outcomes at Maine Medical Center, in Port-land, Maine. In collaboration with staff nurses, faculty, physicians, social workersand dietitians, she was funded by six external grants, three internal grants, andhas written over 25 peer-reviewed publications. She and her colleagues at MaineMedical Center have been honored national and internationally for their work inclinical research and evidence-based practice. She is currently a co-investigator ona Robert Wood Johnson study with an international team of researchers studyingthe characteristics in a work environment that promote and sustain evidence-basedpractice. She is a participant in the international interdisciplinary Knowledge Uti-lization colloquium that meets annually face-to-face with continual work duringthe year via the internet. Dr Schultz had been an appraiser for the American NursesAssociation Magnet Recognition Program since its inception in 1994. She is cur-rently Vice President on the Board of Directors for Sigma Theta Tau International.

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She was inducted as a Fellow into the American Academy of Nursing for her workin developing the Clinical Scholar Mentorship Model.

Theresa Shaw, Chief Executive, Foundation of Nursing Studies, London, UK

As CEO and PD facilitator at the FoNS, Theresa is committed to enabling practice-based development and research with the ultimate purpose of transforming patientcare and nursing practice. She has worked with a wide range of nursing and health-care teams and views facilitation as key to enabling transformation towards moreperson-centred thinking and practice.

Paul Slater, Research Fellow, Institute of Nursing Research, University of Ulster,Newtownabbey, Belfast, Northern Ireland, UK

Paul’s background is in psychology, having completed an undergraduate and Mas-ter’s degree in Applied Psychology at the University of Ulster. In 2006 he completedmy PhD with a focus on the development and psychometric testing of an instru-ment to measure nurse practice environment. He has worked as a researcher since1998 in the university, and conducted research on smoking behaviour, the assess-ment of older peoples’ capacities, person-centred nursing and measurement of thehealthcare work environment.

Annette Solman, Adjunct Professor, Director of Nursing, The Children’s Hospital,Westmead, Sydney, Australia

Annette has extensive experience and credentials in education and training withinnursing and the broader healthcare context. She has worked in senior roles withinhealth focusing on leadership development, organisational culture change andpractice development.

Debra Thoms, Adjunct Professor, Chief Nursing Officer, Department of Health,Sydney, Australia

Debra has worked in several states in Australia and held senior roles in nursingmanagement for a number of years. Her interests are in organisational change andthe creation of a culture that supports nursing and midwifery practice. Her cur-rent role is to provide statewide leadership and advice on nursing and midwiferyprofessional issues in NSW. She is also an Adjunct Professor of Nursing with theUniversity of Technology, Sydney.

Angie Titchen, Clinical Chair, Knowledge Centre for Evidence-Based Practice,Fontys University of Applied Science, Eindhoven, The Netherlands; Visiting Pro-fessor, University of Ulster, Belfast, Northern Ireland, UK

Nationally and internationally Angie collaborates with nursing, health profes-sional and higher education colleagues to investigate person-centred healthcare,evidence-based practice, professional artistry and practitioner research. She un-dertakes philosophical, theoretical and methodological development in qualitative

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research and practice development, including processes, outcomes and evaluationthrough research that is creative, person centred and action orientated. Angie de-signs, delivers and evaluates work-based programmes for practice development,specifically facilitation programmes. She can be contacted at [email protected]

Ken Walsh, Clinical Professor of Nursing, Graduate School of Nursing, Midwiferyand Health, Victoria University of Wellington, Wellington, New Zealand; Director,Nursing Research and Development Unit, Waikato District Health Board, Hamil-ton, New Zealand

Ken has extensive nursing experience as both a clinician and academic. His re-search activities and interests revolve around clinical practice research, with aparticular focus on nurse–patient interactions and the implementation and evalu-ation of practice development initiatives. Ken has developed a large portfolio ofwork related to clinical practice change and quality improvement in the healthcareenvironment. His fresh, innovative and dynamic approach to nursing research anddevelopment is well respected and recognised at an international level.

Raelene Walsh, Nurse Unit Manager, Special Care Nursery, Dandenong Hospital,Melbourne, Australia

Raelene completed her Bachelor of Nursing at Latrobe University. She gained ex-perience on an adult medical ward, a cardiothoracic surgical ward, then workedas a Clinical Nurse Educator. Completed her Neonatal Intensive Care course atMonash University and then travelled overseas for 12 months, which includedworking as a Neonatal Nurse in London. She left nursing for 3 years and workedfor a large insurance firm as a claims assessor and Training Manager. She returnedto nursing as a Nurse Unit Manager of the Special Care Nursery and has been inthis position for 5 years. It was during this time that she was involved with prac-tice development and also completed studies in Business Management. She hascurrently on maternity leave and have an 11-month-old son, Oliver.

Val Wilson, Director of Nursing, Research and Practice Development, The Chil-dren’s Hospital, Westmead, Australia; Professor of Nursing, Research and PracticeDevelopment, The University of Technology, Sydney, Australia

Val works with clinicians and practice developers to develop person-centred ap-proaches to care, which are both evidenced based and take into account the needsof patients and families. The evaluation of this work, together with a number oflocal, state and international projects form the basis of her research work.

Helen Young, Clinical Manager Neurological Rehabilitation, Bedfordshire PrimaryCare Trust, UK

Helen qualified in Swindon in 1994 and has since held a variety of nursing po-sitions in general medicine, orthopaedics, research, care of older people and re-habilitation (both neurological and general), working up to holding managementpositions. Within management positions held, Helen has led on service redesign

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and implementation of new projects to benefit patients. Helen is passionate abouther job and a firm believer in lifelong learning, especially the role of practice devel-opment within nursing. Helen became involved in an RCN expert practice pilotproject whilst working as a nurse manager on the Stroke and Neurological Reha-bilitation Unit at Addenbrookes Hospital, Cambridge.

Roz Young, Senior Nurse, Emergency Assessment Unit, Northampton GeneralHospital Trust, Northampton, MA, USA

Roz trained in Manchester, and since qualifying She has predominantly worked inEmergency Care and Medicine. After her children were born she became a PracticeDevelopment (PD) Nurse. Though she is now back in practice she strongly believesthat you can take the girl out of PD, but you can’t take PD out of the girl.

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Preface

At a time when healthcare is undergoing major transformation, it is a privilege tobe involved with this book with its focus on changing the workplace cultures ofhealthcare systems. Practice Development in Nursing (2004, edited by McCormack,Manley & Garbett) presented a first attempt at bringing together a variety of per-spectives on practice development (PD). Contributors to the book came from avariety of UK nursing specialities and with a diverse range of views and perspec-tives about PD. This book (like all books) represented the perspectives of the dayand an articulation of the collective knowledge about PD at that time. The editorswere conscious of their responsibility to faithfully represent the empirical, experi-ential, creative and tacit knowledge of PD and to do so in a way that representedthe culture of healthcare of the period. Practice Development in Nursing has been ahighly successful book and is used internationally to inform a variety of initiativesunder the umbrella term of PD. A significant focus of the book was the articula-tion of two distinct methodologies for PD – technical and emancipatory – and toarticulate these methodologies in action as well as their evaluation.

Four years later, it is fair to say that our thinking about PD has developed sub-stantially and PD has established itself on an international platform. The body ofpublished literature has grown enormously and we have greater clarity about theoverall direction of travel – we could even suggest that PD has come of age! Thiscoming of age is happening at a time when the discourse of person centrednessdominates in healthcare and when clinical redesign is the order of the day. PDis at the heart of this agenda. With its focus on developing person-centred andevidence-based workplaces and enabling human-flourishing, it offers a coherentapproach to unravelling the complexity of workplaces and enabling person cen-tredness to be realised. A distinct shift in thinking in this volume is less emphasison arguing the differences between technical and emancipatory approaches to thedevelopment of practice. Instead, the book offers a coherency in thinking aboutmethodological perspectives that are considered to be effective in transformingthe cultures of workplaces in healthcare services. Centred on a new and contem-porary definition of PD, each chapter provides a rigorous articulation and critiqueof theoretical, methodological, strategic and practical frameworks and approachesto PD. Because of this approach, the book provides a valuable source of infor-mation for academics, managers, researchers and clinicians alike. It challenges ourthinking about PD, unravels assumptions, exposes blind spots, and offers practicalsolutions to changing workplace cultures.

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Preface

Part 1 of International Practice Development in Nursing explores the knowledgebase for PD encompassing the following: using and generating evidence in PDwork; collaborative working to enable effective PD work; the role of PD in themodernisation of healthcare services; the theory and practice of facilitation; criticalcreativity and active learning; and approaches to evaluating PD.

Part 2 focuses on the critical application of PD in practice exploring the following:the development of facilitation expertise and knowledge; using and generatingevidence; changing the culture and context of practice; leadership development;active learning; person-centred outcomes; cultural change; and frameworks foraccrediting PD.

International Practice Development in Nursing challenges perceptual boundariesof what counts as valid evidence from a variety of perspectives and worldviews.It advances new understandings of PD concepts and theories in order to informthe international development of rigorous frameworks that will further developknowledge and understanding. This is not without its challenges however. It re-mains the case that PD is poorly understood outside of the nursing profession andthat critics of PD regard it as a ‘nurse-centric’ approach that has little relevanceoutside of nursing practice per se. We cannot afford for this view to dominate ata time when our evidence of effectiveness in undertaking PD is greater than ever.We have for the first time a body of evidence underpinning our work and a varietyof international scholarly outputs that demonstrate the imagination, creativity andrigour of the work undertaken. This book makes an important contribution to thisagenda and it demonstrates the impact of PD on healthcare practice generally.

Brendan McCormackKim Manley

Val Wilson

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Acknowledgements

This book would not have happened without considerable support and help froma variety of people. We would like to sincerely thank the following:� All those who have contributed to each of the chapters. Each of the authors ac-

cepted the challenge of writing complex chapters that in many cases are breakingnew ground in the theory and practice of PD. We are grateful for their commit-ment to working with challenging deadlines and for accepting critique withgrace and thoughtfulness.� Sinead Kelly, Administrative Assistant, Royal Hospitals, Belfast, and TriciaBerhardt, Administrative Assistant, Royal College of Nursing, London, whoprovided us with administrative support, maintained systems, organised meet-ings and maintained contact with authors. We could not have worked so effec-tively without them.� Anne-Marie Davis, Nursing and Practice Development Unit, The Children’sHospital, at Westmead, Sydney, who undertook a final critique of the completedchapters. Her attention to detail in critiquing the final manuscript and giving sogenerously her time to do so is greatly appreciated.� Beth Knight and Adam Burbage at Wiley-Blackwell whose commitment tospreading the word about PD has enabled this project to be brought to fruition.� Our respective partners, families, friends and colleagues who tolerated ourburning of the midnight oil and supplied endless support in the final stagesof the project.

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BLUK149-Manley February 29, 2008 1:19

1. Introduction

Kim Manley, Brendan McCormack and Val Wilson

Introduction

For more than 20 years, practice development (PD) has been used as a term todescribe a variety of methods for developing healthcare practice. In particular,the term has been used in the context of nursing development. Over the past10 years significant conceptual, theoretical and methodological advances havebeen made in the development of frameworks to guide PD activities. Of mostsignificance has been our increased understanding of key concepts underpinningPD work irrespective of the methodological perspective being adopted – for ex-ample, workplace culture (Manley, 2004), person centredness (McCormack, 2004;Dewing, 2004; Titchen, 2000; Nolan et al., 2004), practice context (McCormack et al.,2002), evidence (Rycroft-Malone et al., 2003), evidence implementation (Rycroft-Malone, 2004), values (Manley, 2001; Wilson et al., 2005; Wilson, 2005) and ap-proaches to learning for sustainable practice (Dewar et al., 2003; Wilson et al., 2005;Wilson et al., 2006; Hardy et al., 2006). A number of researchers have explored themeaning of PD through conceptual analysis (Garbett & McCormack, 2002, 2004;Unsworth, 2000), action inquiry (Binnie & Titchen, 1999; Manley, 1997; Clarke et al.,2004; Clarke & Wilcockson, 2001; Gerrish, 2001) and evaluation (McCormack et al.,2004; Wilson & McCormack, 2006; Tolson, 1999).

In a concept analysis of PD, Garbett and McCormack (2004) articulated the inter-connected and synergistic relationships between the development of knowledgeand skills, enablement strategies, facilitation and systematic, rigorous and contin-uous processes of emancipatory change in order to achieve the ultimate purposeof evidence-based person-centred care. Manley and McCormack (2004) articulatedthese elements of PD in a model called ‘emancipatory PD’, drawing on previoustheoretical developments in action research (Grundy, 1982). Emancipatory PD ex-plicitly uses critical social scientific concepts on the basis that the emphasis on thedevelopment of individual practitioners, cultures and contexts within which theywork, will result in sustainable change. Whilst one of the key distinctions betweenaction research and emancipatory PD has been the explicit intent of developingtransferable knowledge in action research, this increased PD literature also articu-lates transferable principles for action and thus demonstrates the ‘coming of age’of PD and its potential as a systematic process of transformative action. In a recent

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International Practice Development in Nursing and Healthcare

systematic review of the evidence underpinning PD, McCormack et al. (2007a)identified a range of outcomes that have been achieved from systematic PD work,including the following:� Implementation of patient care knowledge utilisation projects.� Development of research knowledge and skills of participating staff.� Development of facilitation skills among staff.� Development of new services.� Increased effectiveness of existing services or expansion of more effective ser-

vices.� Changing workplace cultures to ones that are more person centred.� Developing learning cultures.� Increased empowerment of staff.� Role clarity and shared understanding of role contributions.� Development of greater team capacity.� Development of frameworks to guide ongoing development (e.g. competencyframeworks, integrated care pathways).

Whilst these outcomes are evident in the published literature, it is also evident thatmuch work is needed to develop strategic level evaluation frameworks that reflectthe complex and multi-faceted nature of PD interventions.

International collaborations are emerging that will enable these advances to hap-pen. Take for example this book; each chapter has a number of authors who aredrawn from across the world with differing workplace contexts and cultures, witha multiplicity of professional roles from a diverse range of clinical and academicbackgrounds. This of itself has been a major achievement in crossing internationalboundaries with PD. The issue of language is of course at times confusing acrossinternational boundaries; to ensure consistency throughout this text we have usedthe universal term practitioner, which in the Australia and New Zealand contextdenotes a clinician.

To date a number of collaboration endeavours have developed across differentcontexts, providing wider and more sophisticated understandings of PD to be de-veloped. An example of this work can be drawn from the International PracticeDevelopment Colloquium (IPDC), a group of practice developers from the UnitedKingdom, The Netherlands New Zealand, and Australia that meet and work to-gether to develop PD, theory and practice. The IPDC have established a numberof focus areas in which they wish to advance PD. Three of these groups have con-tributed to work within this book (Chapters 4, 7 and 8). Each of these chapters isa collaborative endeavour to unpick, understand and advance our thinking aboutPD.

Collaborative research links have also been established to provide a platformfor systematic studies that not only evaluate complex interventions, but also do soacross borders and contexts. An example of this work is a project titled ‘The de-velopment of person-centred cultures through an integrated practice developmentand work-based learning program’. This project takes place in number of clinicalunits in four area health services across two countries (UK and Australia) and

2



Introduction

involves a partnership with two universities. Interventions are multi-faceted andare developed within particular contexts. Data are collected and analysed withineach area health service and cross-comparisons will take place between these sites.The project is layered in such a way as to establish a range of outcomes for patients,staff, units and organisations in each context (area health service) as well as to de-velop outcomes for the overall project. Through a strategic evaluation frameworkthe investigators hope to make explicit the transformations that are occurring forindividuals (patients, families and staff), teams, and organisations as a result of PDinterventions.

The conceptual, theoretical and methodological advances that are being opera-tionalised through national and international collaborations are reflected through-out this book, demonstrating advancements in PD since the first volume of workpresented in Practice Development in Nursing (2004, edited by McCormack, Manley& Garbett). Since 2004 these advances have contributed to the development of a PDknowledge base and helped in articulating the key principles underpinning PD.

Practice development principles

With this increasing advancement in our understanding of PD come both increasingcomplexity with regard to the theoretical ideas surrounding it, and at the same timeincreasing clarity about how these theoretical ideas inform PD activity as a specificapproach in the workplace. This paradox leads to the need for a set of principlesthat articulate the practical activity involved in PD in a way that also integrates thetheoretical and philosophical ideas that are emerging.

Nine key principles are proposed as identifying the primary elements of PDactivity. They are particularly intended to help other stakeholders (in particularcommissioners, research funders, policy makers) to be clear about what PD is andwhat it is not. These principles provide the criteria or standards by which anyactivity presented as PD could be judged as such and differentiated from anyother activity that may be similar or different. Similarities and differences with,for example, service development are cogently illustrated in Chapter 16, wherePD is articulated as an approach that focuses on changing people and practicerather than just systems and processes, although both are integrated as illustratedin Chapter 3.

Whilst there are demonstrable outcomes from PD as illustrated above, there isan urgent need for articulating the outcomes of PD in a way that� matches current and future healthcare needs in the context of global health-

care trends that will become the future driver for policy makers and healthcarecommissioners, and� is recognised by policymakers and commissioners as an approach that is worthinvesting in because it can assist with addressing the above in a sustainable way.

The outcomes of PD therefore need to be constructed in messages that importantstakeholders can not only recognise but also need to be linked to a specific set ofprinciples that encompass and guide the methods and activity used.

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Nine PD principles are identified that inform all PD activity, themed in relationto the following:� Purpose� Level� Learning� Evidence use and evidence development� Creativity� Methodology and methods

The principles (Box 1.1) are described overleaf, and whilst every principle maybe reflected implicitly in each chapter, those chapters that illustrate the principlesmost clearly are identified.

Purpose

Principle 1. PD aims to achieve person-centred and evidence-based care that is manifestedthrough human-flourishing and a workplace culture of effectiveness in all healthcare settingsand situations.

The aim of PD is to develop effective workplace cultures that have embeddedwithin them person-centred processes, systems and ways of working. Chapter 2of this book explores person-centred systems and processes and the impact thesehold for care delivery as well as for patients, families and staff. Person-centredprocesses take into account the individual’s cultural perspective as well as theprevailing workplace culture that exists and the impact this may hold for peopleexperiencing this culture. The relevance of this for PD is explored in detail inChapter 9, which takes us on a cultural journey through the authors’ engagementwith the broader cultural context of living and working within New Zealand. Thischapter helps the reader explore the importance of being culturally sensitive in PDwork.

A manifestation of effective workplace cultures is the use of evidence to in-form decision-making and the development of practice in context. Within PD evi-dence this includes a broader scope than is often found within the evidence-basedcare movement and is sourced from four key areas: research; clinical experience;patients, clients and carers; and local context and environment (Rycroft-Maloneet al., 2004). A broader discussion of evidence and its relevance to decision-makingis captured in Chapter 5 of this book.

Understanding the relationship between the delivery of person-centred care andthe resultant outcomes is an integral component of PD work. We are interested notonly in the outcomes for patients, families and staff, but also the impact that person-centred care has on the evolving workplace culture. Chapters 10 and 11 explorethrough evaluations of PD initiatives the relationship between PD, person-centred

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Introduction

Box 1.1 Principles of practice development

PrinciplesPractice development Focus Chapter(s)

1. It aims to achieve person-centred andevidence-based care that is manifestedthrough human-flourishing and aworkplace culture of effectiveness in allhealthcare settings and situations.

Purpose 2, 5, 9, 10, 11

2. It directs its attention at the micro-systemslevel – the level at which most healthcareis experienced and provided, but requirescoherent support from interrelated mezzo-and macro-systems levels.

Level 2, 3, 16

3. It integrates work-based learning with itsfocus on active learning and formalsystems for enabling learning in theworkplace to transform care.

Learning 6, 14

4. It integrates and enables both thedevelopment of evidence from practiceand the use of evidence in practice.

Evidence use anddevelopment

5, 15

5 It integrates creativity with cognition inorder to blend mind, heart and soulenergies, enabling practitioners to freetheir thinking and allow opportunities forhuman-flourishing to emerge.

Creativity 4

6. It is a complex methodology that can beused across healthcare teams andinterfaces to involve all internal andexternal stakeholders.

Methodologyand methods

2, 17

7. It uses key methods that are utilisedaccording to the methodologicalprinciples being operationalised and thecontextual characteristics of the PDprogramme of work.

All

8. It is associated with a set of processesincluding skilled facilitation that can betranslated into a specific skill-set requiredas near to the interface of care as possible.

8, 12, 13

9. It integrates evaluation approaches thatare always inclusive, participative andcollaborative.

7

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practice, changes in workplace culture and the potential for human-flourishing tooccur. It is through this type of exploration that we can hope to understand morefully the potential we have in achieving the stated purpose of PD.

Level

Principle 2. PD directs its attention at the micro-systems level – the level at which mosthealthcare is experienced and provided, but requires coherent support from interrelatedmezzo- and macro-systems levels.

From its inception PD has long been recognised as needing to dovetail with sup-portive and enabling organisational frameworks for its potential to be fulfilled(McCormack et al., 1999). Subsequently, the importance of executive sign up andsupport has been recognised as essential for PD to achieve success (Manley &Webster, 2006). Whilst other approaches to developing quality services may empha-sise organisational approaches to achieving change and innovation, the primaryfocus of PD is at the level of healthcare practice. This level (the ‘micro-systemslevel’) is where healthcare services most closely interact with patients and usersthrough practitioners, practice teams and patient pathways. There are a numberof assumptions that drive this specific focus in PD:� Staff providing care and services to patients and users are most likely to be able

to recognise the barriers to change, where improvements can be made and theinnovations that can be introduced when supported to do so.� It is at this level that care is experienced by users and therefore positive changehas most potential for impacting on the user’s experience and outcome.� Involving, supporting and enabling practitioners and practice teams with usersto lead change will more likely achieve internalised and embedded change thatis self-sustaining.� Developing practitioners to think and work in a person-centred and evidence-based way will help them to work more smartly as well as be self-sustaining and self-sufficient in their own problem-solving and learning for thefuture.

PD is an approach that can help practitioners to work with patients, users andcolleagues in a person-centred way regardless of the issue or topic that may be invogue at any one time. These ideas are further developed in Chapter 2, where thecontribution of PD to developing person-centred systems that achieve integrationand continuity of care for patients and users through structures, processes andpatterns, manifested in behaviour, are explored in depth. Whilst the developmentof person-centred systems at the micro-systems level is the focus of PD, the needfor cultures of effectiveness at every level of the organisation is recognised throughthe integration necessary between micro-, mezzo- and macro-systems levels. Thesuccess of micro-systems rely on organisational systems that actively support

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Introduction

practitioners and practice teams to deliver on organisational values; somethingthat is seen very effectively in the Magnet Hospital Programme and subsequentlydemonstrated through its outcomes (Aiken et al., 2002) (see Chapter 17).

Learning

Principle 3. PD integrates work-based learning with its focus on active learning and formalsystems for enabling learning in the workplace to transform care.

Learning in and from practice is a major component of PD identified in the originalconcept analysis work (Garbett & McCormack, 2004). Since then our understand-ing has continued to grow about how work-based learning approaches enable thetransformation of individuals, teams and practice within workplaces (Dewar &Sharp, 2006; Wilson et al., 2006; Hardy et al., 2006). The role of skilled facilitationand formal systems for enabling learning as well as its assessment, implementationand evaluation in the workplace are gaining increasing recognition as being instru-mental, together with a genuine learning culture and other factors, in developingand maintaining individual, team and organisational effectiveness (Manley et al.,2007).

Work-based learning is integral to PD. Learning in PD arises from develop-ing self knowledge and awareness through structured and intentional reflectionabout the impact of our actions or inactions on others within the context of ourworkplace. Learning in PD is not only fostered through specific processes but alsothrough the implementation of systems such as mechanisms for clinical super-vision that sustain and transform it in the workplace (Hardy et al., 2006). Pro-cesses include critical analysis and reflection, which act as motivators for action,enabling practitioners to continue to be self-sufficient in their learning approachesfor life. The range of approaches used to support learning in PD, termed activelearning, are presented in Chapter 6. Active learning is a new but broader con-cept for approaches to learning that build on the formal approaches usually as-sociated with PD such as action learning and clinical supervision. Active learn-ing encompasses all the varied formal and informal approaches that enable andsustain learning in the workplace, learning that forms the basis of ongoing effec-tiveness in practice. Chapter 14 shares the experiences of practitioners involvedin active learning in the workplace as an integrated part of their PD. Chapter 17identifies the role of a masters programme using PD principles in developing PDexpertise.

Evidence use and evidence development

Principle 4. PD integrates and enables both the development of evidence from practice andthe use of evidence in practice.

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The original drivers for PD included the research implementation agenda, the sys-tematic implementation of practice change and innovation as well as the need toprovide a person-centred approach (McCormack et al., 1999). From the research im-plementation agenda grew the evidence-based practice movement (Chapter 5) andsubsequently now the growth in translation science defined as the ‘investigation ofmethods, interventions, and variables that influence adoption of evidence-basedpractices by individuals and organisations to improve clinical and operationaldecision-making in healthcare’ (Titler et al., in press).

The Promoting Action on Research Implementation in Health Services (PARIHS)framework (Rycroft-Malone, 2004), a key framework for guiding evidence-basedpractice, identified how pivotal� skilled facilitation and a context that includes effective cultures, enabling lead-

ership and evaluation are for successful research implementation in the work-place;� integration of research evidence with evidence from other sources such as pro-fessional expertise and the patients, own experience and expertise are for pro-viding effective care.

All the components of the PARIHS framework are integrated within the method-ology of PD, but PD is more than the PARIHS framework. This is because its aimis to achieve not just evidence use and the blending of different types of evidenceso that care is experienced by users as meeting healthcare needs, but also, the sys-tematic development of evidence from practice and the achievement of a specificculture that sustains these endeavours as well as enabling all to flourish. Chapter 5updates readers on the evidence-based practice movement as well as strategies forsystematically developing evidence from practice. Chapter 15 provides practicalexamples about how practitioners and practice teams have developed their prac-tice using evidence-based practice frameworks and Chapter 7 presents insightsinto how PD work can continue to be systematic in its inquiry processes so thatevidence for its impact can be further developed. Chapter 17 presents a scholars,programme for developing evidence based practice expertise in Magnet Hospitalsat the practice level.

As the translation science movement grows, it is vital that PD is recognised as amethodology for achieving evidence-based practice but one that not only achievesevidence implementation and development but also sustains a culture of ongoingevidence use and development at individual and team levels.

Creativity

Principle 5. PD integrates creativity with cognition in order to blend different energies, en-abling practitioners to free their thinking and allow opportunities for human-flourishing toemerge.

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