The model of the Best Practice Unit (BPU) is a specific form of practice based research. It is a variation of the Community of Practice (CoP) as developed by Wenger, McDermott and Snyder (2002) with the specific aim to innovate a professional practice by combining learning, development and research. We have applied the model over the past 10 years in the domain of care and social welfare in the Netherlands. Characteristics of the model are: the interaction between individual and collective learning processes, the development of (new or better) working methods, and the implementation of these methods in daily practice. Multiple knowledge sources are being used: experiential knowledge, professional knowledge and scientific knowledge. Research is serving diverse purposes: articulating tacit knowledge, documenting the learning and innovation process, systematically describing the revealed or developed ways of working, and evaluating the efficacy of new methods. An analysis of 10 different research projects shows that the BPU is an effective model.
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This thesis describes an Action Research (AR) project aimed at the implementation of Evidence Based Practice in a mental health nursing setting in the Netherlands. The main research question addressed in this thesis is: In what way is Action Research with an empowering appropriate to implement Evidence Based Practice in a mental health nursing setting in the Netherlands and what is the effect of this implementation on the care experienced by the client, the nursing interventions and the context in this setting compared to a comparative setting? To answer this main research question, the following questions derived from it were addressed: What is Evidence Based Practice? What is known about implementing evidence-based practice in nursing through Action Research? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be more successful? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be successful? How is EBP implemented through AR with an empowering intent and what are the outcomes for the use of evidence, the context and the facilitation in the setting? What is the effect of the implementation of EBP in mental health nursing using AR with an empowering intent on the care experienced by the client, the nursing interventions and the context compared to a comparison setting? The first two questions were answered by a search of the literature while the remaining questions were answered during the AR study conducted in two mental health organisations in the Netherlands.
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The extent to which action research has a democratising influence - and the ethical pitfalls involved in the practice of action research. The conduct of action research within the organisational context and the practice community receives attention.
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Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action research. Method: The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. Results: A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of EBP were that nurses had little knowledge of EBP and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of EBP was adapted. Nurses worked according to the EBP discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Conclusions: Action research provides an opportunity to empower nurses and to tailor EBP to the practice context. Applying and implementing EBP is difficult for front-line nurses with limited EBP competencies. Relevance to clinical practice: Adaptation of the academic model of EBP to a more pragmatic approach seems necessary to introduce EBP into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice, it seems relevant to integrate scientific evidence with clinical expertise and patient values in nurses’ clinical decision making at the individual patient level.
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Background: On two Care Innovation Units in the Netherlands, staff, students and Lecturer Practitioners work intensively together to provide care, create a rich learning environment, and to foster innovation and research. In striving to advance the quality of care and to develop person centred cultures a preference is given to participative forms of research in which diverse experiences and different types of knowledge are valued. Aims and Objectives: The research described here had two overarching aims: the improvement of practice situations and the encouragement of the integration of work and learning. This article focuses on our actions and learning with respect to fostering participation during this project. Design and methods: Within the action research methodology used, participative work-forms and research methods were chosen. For example, a responsive approach to evaluation of practice, use of narratives and the stimulation and use of creativity to help in exploring and sharing feelings, values and different forms of knowledge. In this article we use Arnstein's ladder of citizen participation to frame our reflection on enabling participation within this project. Results Participation took various forms and vacillated throughout the project. In addition to particular facilitation strategies, four factors emerged as influential in enabling or inhibiting aspects of participation among stakeholders: individual motivations and interests, the make-up of and atmosphere within the group, and the time made available to engage in research activities. Conclusions Participation in research is both more complex and dynamic than Arnstein's typology suggests. Moving 'up' the ladder may not be appropriate as a goal in and of itself. Instead, meeting and responding to each other's situations, as stakeholders, seems a more appropriate focus. Taking responsibility, as facilitator, for certain research activities, can free other participants to focus on elements which interest them and from which they derive satisfaction.
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Several models have been developed to predict prolonged stay in the intensive care unit (ICU) after cardiac surgery. However, no extensive quantitative validation of these models has yet been conducted. This study sought to identify and validate existing prediction models for prolonged ICU length of stay after cardiac surgery.
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The Best Practice Unit (BPU) model constitutes a unique form of practice-based research. A variant of the Community of Practice model developed by Wenger, McDermott and Snyder (2002), the BPU has the specific aim of improving professional practice by combining innovation and research. The model is used as a way of working by a group of professionals, researchers and other relevant individuals, who over a period of one to two years, work together towards a desired improvement. The model is characterized by interaction between individual and collective learning processes, the development of new or improved working methods, and the implementation of these methods in daily practice. Multiple knowledge resources are used, including experiential knowledge, professional knowledge and scientific knowledge. The research serves diverse purposes: articulating tacit knowledge, documenting learning and innovation processes, systematically describing the working methods that have been revealed or developed, and evaluating the efficacy of the new methods. Each BPU is supported by a facilitator, whose main task is to optimize learning processes. An analysis of ten different BPUs in different professional fields shows that this is a successful model. The article describes the methodology and results of this study.
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Narratives are being increasingly used in nursing and action research. In this participatory action research study, nurse leaders of an acute care of the older person unit collectively, critically and creatively reflected on lived experiences in order to explore the concept of person-centred leadership within their own practice. This paper describes a critical and creative reflective inquiry (CCRI) structure and processes, as well as participant evaluations. CCRI has a threephased structure: descriptive, reflective, critical/emancipatory. Reflectivity moves from 'consciousness' to 'critical consciousness' as participants critique and gain insight into their being within context. In the descriptive phase one participant shares a narrative, supported by group members applying the principles of narrative interviewing. As the narrator distances self from the narrative the reflective phase opens, where individuals creatively express their interpretation of the narrative shared. Collective and critical reflection begins as group members dialogue interpretations. As mutual understandings emerge, these are further contested and theorised in the critical/emancipatory phase. Both perspective and practice transformations were expressed within the CCRI space and observed outside it. The CCRI method created a communicative space for leaders to critically reflect, feel supported and develop knowledge and skills that they could immediately apply to daily leadership practice. Skilled facilitation was found to be essential for enabling learning and efficacy and the use of creative expression enriched the inquiry, offering new and unexpected insights. In conclusion, CCRI offers action researchers and participants a new method to explore (new) concepts relevant, and intended, to improve practice.
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Aims: Prescribing medication is a complex process that, when done inappropriately, can lead to adverse drug events, resulting in patient harm and hospital admissions. Worldwide cost is estimated at 42 billion USD each year. Despite several efforts in the past years, medication-related harm has not declined. The aim was to determine whether a prescriber-focussed participatory action intervention, initiated by a multidisciplinary pharmacotherapy team, is able to reduce the number of in-hospital prescriptions containing ≥1 prescribing error (PE), by identifying and reducing challenges in appropriate prescribing. Methods: A prospective single-centre before- and after study was conducted in an academic hospital in the Netherlands. Twelve clinical wards (medical, surgical, mixed and paediatric) were recruited. Results: Overall, 321 patients with a total of 2978 prescriptions at baseline were compared with 201 patients with 2438 prescriptions postintervention. Of these, m456 prescriptions contained ≥1 PE (15.3%) at baseline and 357 prescriptions contained ≥1 PEs (14.6%) postintervention. PEs were determined in multidisciplinary consensus. On some study wards, a trend toward a decreasing number of PEs was observed. The intervention was associated with a nonsignificant difference in PEs (incidence rate ratio 0.96, 95% confidence interval 0.83–1.10), which was unaltered after correction. The most important identified challenges were insufficient knowledge beyond own expertise, unawareness of guidelines and a heavy workload. Conclusion: The tailored interventions developed with and implemented by stakeholders led to a statistically nonsignificant reduction in inappropriate in-hospital prescribing after a 6-month intervention period. Our prescriber-focussed participatory action intervention identified challenges in appropriate in-hospital prescribing on prescriber- and organizational level.
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