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Developing the practice context to enable more effective pain management with older people: an action research approach.

Brown D, McCormack BG - Implement Sci (2011)

Bottom Line: Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice.Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature.Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Nursing Research/School of Nursing, University of Ulster, Shore Road, Newtownabbey, Co. Antrim, Northern Ireland. bg.mccormack@ulster.ac.uk

ABSTRACT

Background: This paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice. While the intention of the project was to identify and change factors in the practice context that inhibit effective person-centred pain management practices with older people (65 years or older), reflective critical engagement with the findings identified that enhancing pain management practices with older people was dependent on cultural change in the unit as a whole.

Methods: An EAR approach was utilised. The project was undertaken in a surgical unit that conducted complex abdominal surgery. Eighty-five percent (n = 48) of nursing staff participated in the two-year project (05/NIR02/107). Data were obtained through the use of facilitated critical reflection with nursing staff.

Results: Three key themes (psychological safety, leadership, oppression) and four subthemes (power, horizontal violence, distorted perceptions, autonomy) were found to influence the way in which effective nursing practice was realised. Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice.

Conclusions: Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature. Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments.

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Related in: MedlinePlus

Capacities of the U movement in relation to the project (adapted from Senge et al. 2005, p219) [49].
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Figure 2: Capacities of the U movement in relation to the project (adapted from Senge et al. 2005, p219) [49].

Mentions: Senge et al. [49] argue that we need to use our intuition and emotions, rather than objective analytical rationalism, if we are to unlock the future we seek through presencing. Hence, it is argued that the data arising from this project fit with and possibly shed light on what may occur at the bottom of the 'U' (Figure 2). Working closely with nursing staff in the surgical unit offered the opportunity to reflect and raise consciousness of habitual ways of seeing things (Tables 3 and 4). Reflective sessions, critical companionship, and reflexivity revealed a whole range of underlying interlinked and interconnected issues (Figure 1) that needed to be addressed before changes to pain management practices with older people could begin. This process was, at times, emotional and difficult for those who participated in the project. As nursing staff unpicked the issues and reflected upon them, often they were uncomfortable with where it was taking them; nevertheless, they needed to explore the issues fully if they were to transform the self, let go and identify meaningful actions.


Developing the practice context to enable more effective pain management with older people: an action research approach.

Brown D, McCormack BG - Implement Sci (2011)

Capacities of the U movement in relation to the project (adapted from Senge et al. 2005, p219) [49].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3037913&req=5

Figure 2: Capacities of the U movement in relation to the project (adapted from Senge et al. 2005, p219) [49].
Mentions: Senge et al. [49] argue that we need to use our intuition and emotions, rather than objective analytical rationalism, if we are to unlock the future we seek through presencing. Hence, it is argued that the data arising from this project fit with and possibly shed light on what may occur at the bottom of the 'U' (Figure 2). Working closely with nursing staff in the surgical unit offered the opportunity to reflect and raise consciousness of habitual ways of seeing things (Tables 3 and 4). Reflective sessions, critical companionship, and reflexivity revealed a whole range of underlying interlinked and interconnected issues (Figure 1) that needed to be addressed before changes to pain management practices with older people could begin. This process was, at times, emotional and difficult for those who participated in the project. As nursing staff unpicked the issues and reflected upon them, often they were uncomfortable with where it was taking them; nevertheless, they needed to explore the issues fully if they were to transform the self, let go and identify meaningful actions.

Bottom Line: Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice.Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature.Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Nursing Research/School of Nursing, University of Ulster, Shore Road, Newtownabbey, Co. Antrim, Northern Ireland. bg.mccormack@ulster.ac.uk

ABSTRACT

Background: This paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice. While the intention of the project was to identify and change factors in the practice context that inhibit effective person-centred pain management practices with older people (65 years or older), reflective critical engagement with the findings identified that enhancing pain management practices with older people was dependent on cultural change in the unit as a whole.

Methods: An EAR approach was utilised. The project was undertaken in a surgical unit that conducted complex abdominal surgery. Eighty-five percent (n = 48) of nursing staff participated in the two-year project (05/NIR02/107). Data were obtained through the use of facilitated critical reflection with nursing staff.

Results: Three key themes (psychological safety, leadership, oppression) and four subthemes (power, horizontal violence, distorted perceptions, autonomy) were found to influence the way in which effective nursing practice was realised. Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice.

Conclusions: Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature. Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments.

Show MeSH
Related in: MedlinePlus