Showing papers in "Journal of Research in Nursing in 2010"
TL;DR: Findings from a novel randomised controlled trial conducted in mental health settings in Queensland, Australia are reported on to assist in both conceptualising and operationalising CS research, education, management, policy and clinical practice development decision making in the future.
Abstract: This paper reports on selected findings from a novel randomised controlled trial (RCT) conducted in mental health settings in Queensland, Australia. Several national and state reports recently revealed the sub-optimal state of Australian mental health service provision which have direct implications for mental health nursing, including the privately experienced cost of working and coping in these settings. Clinical supervision (CS), a structured staff support arrangement, has shown promise as a positive contribution to the clinical practice development agenda and is now found reflected in health policy themes elsewhere in the world. However, CS is underdeveloped in Australia and the empirical evidence base for the informed implementation of CS, per se, has remained elusive. Within the overall context of a RCT design, therefore, and supplemented by other data collection methods, this large and generously funded study attempted to make an incremental contribution to better understanding this demanding subst...
133 citations
TL;DR: The concept of social exclusion was originally developed in Europe as discussed by the authors, and has spread rapidly around the world partly due to its adoption by powerful organisations such as the World Bank and the United Nations.
Abstract: More than 300 million Indigenous Peoples around the world experience systematic racism and oppression including Europe’s Roma people.Millions of people including asylum seekers in the UK are ‘Citizens of Nowhere, forgotten by governments, ignored by census takers, amongst the World’s poorest and most disenfranchised.’ (Mydans, 2007). In 2001, 1% of the World’s population owned 40% of the World’s wealth whilst 50% of the population owned 1% of the wealth. Globally, around a billion people are living on less than US$1 a day including half of the population of Sub-Saharan Africa. In the UK in 2004/5, 3.4 million children were living in relative poverty. Are these the contours of social exclusion? Disadvantaged groups are an important part of the problem but this approach to understanding may be a significant barrier to effective action to address social exclusion. The concept of social exclusion was originally developed in Europe. Despite resistance in places such as Sub-Saharan Africa, where concepts such as human rights, sustainable development, poverty and basic needs have greater salience, the concept has spread rapidly around the world partly due to its adoption by powerful organisations such as the World Bank. There are two broad approaches to defining social exclusion and different actions flow from each. The most common is the shopping list approach in which exclusion describes a ‘state’ experienced by particular groups, for example, indigenous peoples, the poor, the homeless, the mentally ill, people with disabilities, who are excluded from a never-ending shopping list of things including:
118 citations
TL;DR: The experiences of using the method of emotional touchpoints to learn about compassionate care in hospital settings are described and its ability to help practitioners to see in a more balanced way both the positive and negative aspects of an experience is described.
Abstract: Improving the patient and family experience in hospital and supporting people to deliver compassionate dignified care is a priority on the policy agenda in the UK. The purpose of this paper is to d...
106 citations
TL;DR: The paper examines the different levels of complexity within healthcare interventions and the problems this poses in determining effectiveness and concludes that the use of realist strategies in combination with randomised controlled trials provides the most coherent solution to this quandary.
Abstract: In the perceived hierarchy of research designs, the results from randomised controlled trials are considered to provide the highest level of evidence. Indeed, these trials have been upheld as the gold standard in research. The benefits and limitations of the randomised controlled trial as a method of evaluating the effectiveness of healthcare interventions are presented. The paper then examines the different levels of complexity within healthcare interventions and the problems this poses in determining effectiveness. In an effort to provide a solution to this problem, the Medical Research Council produced a framework to assist investigators to develop and evaluate complex healthcare interventions. The framework is described with reference to an example of implementing and evaluating protocols for weaning patients in the intensive care unit. The framework is critiqued on the basis that it involves an ambiguous or contradictory ontology, which fails to articulate the relationship between the positivism of r...
93 citations
TL;DR: The study indicated that student satisfaction is increased when there is an ongoing student involvement, that is, in the words of Lave and Wenger (1991), when they become an integral part of the ‘community of practice’ in their clinical nursing placement.
Abstract: Learning in the clinical environment has traditionally formed an integral part of nursing education programs in Australia. In tertiary-based nursing courses today, students can spend equal or more ...
91 citations
TL;DR: A recent report by the Patients Association has fuelled public concern with a report documenting "dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment elderly patients had experienced at the hands of NHS nurses".
Abstract: Compassion, in its original meaning in Latin, means ‘with suffering’. Compassion is usually expressed towards others when we experience their suffering, being there with them in some way that makes their pain more bearable (Firth-Cozens and Cornwell, 2009). A simple definition is that it is ‘a deep awareness of the suffering of another coupled with the wish to relieve it’ (Chochinov, 2007). The casual reader of recent reports might be forgiven for thinking that nurses have no interest in compassion. The mainstream media have interpreted the regulator’s shocking and disturbing reports about the quality of care in hospitals in Mid Staffordshire and Maidstone and Tunbridge Wells as poor nursing delivered by insensitive, even bad, nurses. More recently, the Patients Association has fuelled public concern with a report documenting ‘dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment elderly patients had experienced at the hands of NHS nurses’ (Patients Association, 2009). A great many practising nurses share the concern. Nurses’ and ex-nurses’ own accounts of poor experiences of care feature regularly in the nursing press. In interviews and evidence (Dawoud and Maben, 2008; Maben and Griffiths, 2008) over and over again a wide range of nurses suggested that the essence of nursing, being with patients, performing essential but intimate care, where relationships are forged and built has been passed over to health care assistants. The broad consensus seems to hold: compassion once seen as ‘the essence of caring and therefore the essence of nursing’ is no longer ‘always the central focus of nursing practice’ (Chambers and Ryder, 2009).
62 citations
TL;DR: In this article, the nature and construct of evidence and its relation to qualitative research are discussed using a post-modern lens, signifying the importance of context, and showing how evidence can be used for qualitative research.
Abstract: This paper is about the nature and construct of evidence and its relation to qualitative research. Using a post-modern lens, we begin by defining evidence, signifying the importance of context, and...
56 citations
TL;DR: In this article, a model of the multidimensional aspects of lesbian, gay, bisexual, and trans social exclusion is proposed, drawing on research evidence of the social, political and global inequalities experienced by lesbian, Gay, bisexual and trans people.
Abstract: Since the early 1980s, there has been increasing recognition that the health of individuals and communities is affected by social disadvantage. Following the election of the New Labour Government in 1997, social exclusion became a key concept in UK policymaking. Social exclusion approaches consider health outcomes to be linked to living and working conditions rather than, primarily, to healthcare interventions. Social exclusion is thus an important concept for nursing scholarship for understanding how people’s life circumstances may have an impact on their health. This paper analyses some of the theoretical underpinnings which may lead to recognition of the concept of lesbian, gay, bisexual and trans (LGBT) social exclusion. The paper goes on to propose a model of the multidimensional aspects of lesbian, gay, bisexual and trans social exclusion drawing on research evidence of the social, political and global inequalities experienced by lesbian, gay, bisexual and trans people. In conclusion, it considers t...
55 citations
TL;DR: The paper looks at where to start in order to build improvement skills at every level of the healthcare system and empower frontline staff to make changes that will deliver results.
Abstract: Across the world, healthcare organisations are implementing radical change strategies in the face of unprecedented financial challenge. In this context, a focus on building capacity and capability ...
49 citations
TL;DR: The long-term health impact associated with a history of persecution, social pathologisation and social exclusion of Gypsies and Travellers is explored and nurses are identified as needing to play a key part as role models in challenging prejudice and discrimination.
Abstract: There are striking inequalities in the health of Gypsies and Travellers, even when compared with people from otherethnic minorities or from socio-economically deprivedWhite UK groups. In this paper we explore the long-term health impact associated with a history of persecution, social pathologisation and social exclusion of Gypsies and Travellers. A society that has demonstrated entrenched and widespread hostility towards Gypsies and Travellers has contributed to wariness about trust in outsiders and contributes to the communication barriers with health staff that are implicated in their poor access to healthcare. Many of the problems identified by health staff mirrored those identified by Gypsies and Travellers, particularly with regards to mismatched expectations and resulting conflicts. Whilst the Department of Health has recognised the extreme health inequalities experienced by Gypsies and Travellers and the need for specific action to reduce them and improve access to health care, this paper emphasises the need for an associated improved effort at all levels to seriously tackle the wider determinants of health, including societal attitudes towards Gypsies and Travellers, as well as focusing on delivery of health services. Nurses are identified as needing to play a key part as role models in challenging prejudice and discrimination.
43 citations
TL;DR: Results indicated the positive effect of co-workers support on job performance, and it was shown that demographic variables and co- workers support explained 20% of the variation in job performance.
Abstract: The purpose of this study was to investigate the effect of social support from co-workers on job performance among Jordanian hospital nurses. A correlational descriptive survey was used to investigate this relationship among a convenience sample of 365 Jordanian hospital nurses. Data were collected using a structured questionnaire, which included the Schwirian Six Dimension Scale of Nursing Performance, the McCain and Marklin Social Integration Scale, and the demographic form. Perceived social support from co-workers enhanced the level of reported job performance (r ¼0.40; p <0.001). The analysis also showed that demographic variables and co-workers support explained 20% of the variation in job performance. Results indicated the positive effect of co-workers support on job performance.
TL;DR: A significant development in the evolution of the Cochrane intervention review is reported and an evolving role for qualitative evidence is outlined, including an emerging and developing evidence base with a range of qualitative synthesis approaches for different contexts.
Abstract: Whilst the Cochrane intervention review remains the gold standard, the previous focus on randomised controlled trials and exclusion of other types of evidence limited their utility for some users —...
TL;DR: In this paper, the authors explore how the oldest humans exhibit high resilience, characterised by qualities of equanimity, perseverance, self-reliance, meaningfulness and existential aloneness.
Abstract: High resilience is characterised by qualities of equanimity, perseverance, self-reliance, meaningfulness and existential aloneness. The aims of the present study were both to explore how the oldest ...
TL;DR: Findings are details from part of the evaluation of the Royal College of Nursing dignity campaign, which used a qualitative case study design across seven UK sites and data was analysed using thematic analysis.
Abstract: Dignity in care has become a key policy, practice and political priority. This development has become more pressing as media, anecdotal and research reports have highlighted dignity deficits in care. In response to such reports and to concerns of the membership and general public, the Royal College of Nursing initiated a high-profile campaign (Dignity: at the heart of everything we do) involving engagement with stakeholders, a survey of members and the development and dissemination of educational and practice development materials. This article details findings from part of the evaluation of the Royal College of Nursing dignity campaign, which used a qualitative case study design across seven UK sites. The study used interviews with 51 staff members, direct observation of the physical care environment and document analysis, and data were analysed using thematic analysis. The article focuses on two areas: enablers (staff receptivity and creativity; organisational support and leadership; and campaign educat...
TL;DR: Insight is given into the students’ perceptions of the importance and value of practice placements and the perceived need for students to be part of the ‘community of practice’ and the way in which the respondents rate task orientation and involvement as important actual and preferred clinical learning experiences.
Abstract: The concept of practice-based learning for nursing students is, as this paper suggests, integral to nursing education – and is often highlighted from an educational perspective. It is, therefore, appropriate and interesting to have insight into the students’ perceptions of the importance and value of practice placements. An interesting aspect in this educational discussion is the perceived need for students to be part of the ‘community of practice’ and the way in which the respondents rate task orientation and involvement as important actual and preferred clinical learning experiences. While seemingly obvious that clarity of tasks and responsibilities within the work setting and activity as a ‘full’ member of the team would appeal to students learning from practice, this does, potentially, have a darker side. The power and urge to socialise (read adapt) to a team in order to be accepted is strong and has often been described in terms of horizontal violence, bullying and coercion (Hutchinson et al, 2006; Randle, 2003; Farrell, 2001; Freshwater, 2000). The effect of this pressure to adapt/socialise into a ward culture and the attitude of registered nurses and ward-based mentors can lead to attrition, burn-out, and psychological and emotional trauma among student nurses (Esterhuizen, 2009). So from an educational perspective it is imperative to understand where student enthusiasm to learn from practice becomes overshadowed by group pressure to adapt to group dynamics and perhaps achieve anonymity and a form of status through acceptance within the team. Another interesting finding in this research is the student expectation of the clinical teacher in supporting learning in clinical areas. Developing registered staff to provide educational support is not simply a matter of offering a form of continual and continuing education, but a case needs to be made to develop the reflective potential of the individual within the clinical setting. The ‘I/Thou’ relationship (Buber, 2004) is not limited to the nurse–patient relationship, but is also pertinent to nurse–nurse and nurse–student interactions. Clinical supervision in relation to educational support is vital and can provide the opportunity to develop the educational prowess of registered staff and improve patient care (Esterhuizen & Freshwater, 2008a,b; Freshwater et al, 2007;
TL;DR: A conceptual framework of stress and compromise in relation to caring and a methodology for developing an intervention that would consider how compromise itself may be utilised and adapted to both alleviate stress and inform individual and professional development are proposed.
Abstract: In this paper we argue that in the current global healthcare climate, practitioners’ ability to provide compassionate and high quality care is undermined on a daily basis, not least by the organisational priorities of cost containment, of science and technology and, paradoxically, innovations experienced as demands such as specialisation. It is not surprising that the financial and workforce constraints of the global healthcare system, now more than ever, affect the practitioners’ capacity to deliver the optimum level of care, care that is positively influenced by patient satisfaction, a current indicator of quality. Whilst the notions of quality and standards have increasingly become the concern of healthcare organizations, quality cannot be considered in isolation from the healthcare management and occupational health of the workforce. In this paper we argue that healthcare practitioners are especially vulnerable to stress because the very nature of caring as a profession demands high levels of emotiona...
TL;DR: Key among the findings was that older patients experienced a diminished sense of their individual significance, and interventions to enhance care delivery that promotes a sense of significance will need to target practitioners and the wider organisational culture.
Abstract: In this paper we report the role that a sense of significance plays in the experiences of older patients in urgent care settings, and explore the factors that influence these experiences. The paper draws on findings from a UK study in which 69 patients and 27 relatives from 31 English NHS Trusts were interviewed about their urgent care experiences using semi-structured qualitative interviews. Key among the findings was that older patients experienced a diminished sense of their individual significance. Some questioned the legitimacy of their presence in the urgent care setting and believed that they mattered little in relation to other patients and the other tasks which health professionals were undertaking. The three key features of this diminished sense of significance were: the primacy of technical, medical care; an imbalance of power; and the subordination of patients’ non-medical needs. These features suggest that interventions to enhance care delivery that promotes a sense of significance will need to target practitioners and the wider organisational culture
TL;DR: Evidence-based practice is the combination of individual clinical or professional expertise with the best available external evidence to produce practice that is most likely to lead to a positive outcome for a client or patient.
Abstract: Simply defined, evidence-based practice is the combination of individual clinical or professional expertise with the best available external evidence to produce practice that is most likely to lead to a positive outcome for a client or patient. Although medicine and nursing are the healthcare occupations most advanced in the evidence-based practice movement, the ideas and arguments underpinning them are common to all professionals who work in healthcare. Sackett et al. (1996) contend that evidence-based medicine had its philosophical origins in the mid-nineteenth century in Paris. They define it as being ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’ (p.71) The evidence-based approach is not without controversy. The most controversial issue relates to the current focus on evidence of effectiveness. The dominant approach to the systematic review of evidence favours the meta-analysis of the results of randomised controlled trials (RCTs); indeed, the RCT is conceptualised as the ‘gold standard’ in evidence of effectiveness, with other quantitative methods ranked as lower in quality in terms of evidence. The findings of interpretive and critical research are, by and large, have no real legitimacy in terms of being a source of evidence. The result is that qualitative research is rendered invisible in systematic reviews: the central methodology that underpins the evidence-based practice movement. Elsewhere I have argued (Pearson, 1998) that:
TL;DR: The research leadership of professors is highly valued, though the study recommends greater transparency of expectations in their role, as the challenges facing the higher education workforce in taking the lead to promote a research based culture for practice are limited.
Abstract: A qualitative study was undertaken to explore lecturers’ and professors’ views of their role in shaping attitudes to, and careers in, research for the nursing and allied health professional workforce. A purposive sample was used to identify key participants (n = 30), from four universities across southwest England, with 7—8 participants from each institution. Data were collected between October 2005 and January 2007. Data were managed, analysed and coded with the assistance of the qualitative data analysis software NVivo using a thematic content analysis. This paper reports the findings, which are limited to the challenges facing the higher education workforce in taking the lead to promote a research based culture for practice. Overall, participants see themselves as playing a significant and important role in shaping the research agenda in healthcare. However, with only 9% of the education workforce holding a doctoral qualification, capacity and capability need further investment, as well as the need to ...
TL;DR: The need to further develop and evolve the research evidence base on what works to improve the health of people with learning disabilities, enhance their experience of care and minimise the risk of harm is stressed.
Abstract: This paper contributes to the growing debate relating to meeting the health needs of people with learning disabilities when accessing general health services. It is set within the context of a popu...
TL;DR: Being non-judgemental is an aspiration, acknowledging that judgement occurs may be more appropriate for clinical nurses in order for them to devise strategies to conceal judgements in a considered manner.
Abstract: This study aimed to elicit some of the affective attributes in nurses and midwives involved in caring for those undergoing abortion and explore how they may affect the care given. Nurses and midwives face challenges in caring for women during abortion. Recent advances have resulted in more nursing/midwifery input into abortions. Impending legislation is also likely to increase nursing involvement and yet little is known of the likely impact on those involved. Twelve nurses and midwives working in termination of pregnancy services throughout Wales were interviewed using a grounded theory approach. An early affective attribute was being non-judgemental, but the core category derived from comparative analysis revealed that nurses and midwives conceded judging the women, but then concealed their judgements. To help them conceal their judgements maxims were used such as ‘there but for the grace of God go I’. Goffman’s work on stigma was used to challenge and integrate the grounded theory into the literature. A...
TL;DR: It is argued that evidence-based medicine is a social movement as well as a scientific enterprise, and that as such it requires qualitative investigation of its various activities to understand its impact and take-up.
Abstract: In this paper it is argued that evidence-based medicine (EBM) is a social movement as well as a scientific enterprise, and that as such it requires qualitative investigation of its various activities to understand its impact and take-up. Randomised controlled trials (RCTs) are a blunt instrument of assessing whether interventions achieve intended or unintended outcomes, or whether they are acceptable to those they are aimed at. To understand the success or failure of evidence-based interventions, it is necessary to investigate practitioners’ acceptance of, or resistance to, EBM. This involves exploration of the perceived relationships between practical clinical knowledge derived from everyday practice and scientific knowledge. The implementation of best evidence also requires the acknowledgement of local contextual factors. The goals of EBM will not be achieved if patients do not accept the advice and prescriptions they are given by professionals. One of the reasons that some professionals find it difficu...
TL;DR: Research insights are shared on an approach that shows promise for engaging across the spectrum of health services to foster access to services and supports for child development to reduce child health inequities.
Abstract: In recent years understanding and addressing child health inequities has become a priority for research and practice. In this paper we share research insights on an approach that shows promise for engaging across the spectrum of health services to foster access to services and supports for child development to reduce child health inequities. As pathways of influence on children’s health and development extend beyond the biomedical domain new approaches to practice are needed to foster health care access and to mobilise needed supports. The Social Paediatrics Initiative has been introduced in one of Canada’s poorest inner city neighbourhoods where a disproportionate number of children experience adverse childhood events and enter school developmentally delayed. The research was undertaken in partnership with practitioners, community based organisations and the formal health services sector. The study gathered data from parents, community members and clinicians to understand the range of conditions that int...
TL;DR: Investment in research infrastructure presents considerable opportunities for nursing to develop capacity and capability to undertake research and knowledge translation activity and support clinical academic careers.
Abstract: Nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCS) were established by the National Institute of Health Research in 2008 with the remit to undertake high quality applied health research and support the translation of research findings into practice within the National Health Service in England. Each CLAHRC represents a collaborative partnership between one or more universities and their neighbouring NHS organisations. This investment in research infrastructure presents considerable opportunities for nursing to develop capacity and capability to undertake research and knowledge translation activity and support clinical academic careers. However, in order for the potential of CLAHRCs to be realised investment in nursing leadership is required.
TL;DR: Nurses are provided with the basics on structural equation modeling so they can assimilate evidence from studies that use this statistical tool and be able to incorporate such findings into practice.
Abstract: Structural equation modeling is a statistical technique that allows researchers to examine multiple hypotheses while simultaneously controlling for error. It can consist of a variety of observed and latent independent, mediator, and dependent variables. Owing to it being confirmatory in nature, this statistical approach can be used quite readily to test theoretical models. Likewise, it provides overall fit indices that determine whether the model tested actually fits the observed data. This article provides nurses with the basics on structural equation modeling so they can assimilate evidence from studies that use this statistical tool and be able to incorporate such findings into practice.
TL;DR: Results suggest that the model has good predictive utility in this area and could usefully be employed in interventions with school nurses with the aim of modifying their behaviour.
Abstract: The aim of this paper was to ascertain how valuable the Theory of Reasoned Action (TRA) would be in the prediction of the sexual health education behaviour of school nurses. The current government in the United Kingdom has made a commitment to reducing the high rates of teenage conceptions and sexually transmitted infections and emphasise an increased public health role for school nurses. However, there appears to be no research to suggest that school nurses are the most appropriate healthcare professionals to competently assist with sexual health education in schools. In accordance with the TRA, a questionnaire was designed to measure the intention, attitude, subjective norm and behaviour of the group being surveyed. The purpose-designed questionnaire was distributed to all school nurses in a large geographical area in the United Kingdom. All 46 participants who responded were female (as there are currently no male school nurses in the United Kingdom). No demographic data were obtained as it is believed ...
TL;DR: Recently, the President of the Patients Association, Claire Raynor, reported an increasing number of calls on their helpline from people wanting to talk about the 'dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses.
Abstract: Recently, the President of the Patients Association, Claire Raynor (a high-profile nurse), reported an increasing number of calls on their helpline from people wanting to talk about the ‘dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses.’ (Patients Association, 2009, p. 1). She went on to suggest that she is:
TL;DR: The Journal of Research in Nursing (JRN) as discussed by the authors has published a survey on practice development in nursing, focusing on five papers, with a common focus on "practice development/ developing practice".
Abstract: The five papers presented here all have a common focus on ‘practice development/ developing practice’ and I welcome the fact that the Journal of Research in Nursing has chosen to focus on this topic and the opportunity to comment on the papers. In the past I have been accused of making practice development my own personal ‘cottage industry’ (Walker, 2009) and so it is a delight to see that industry become a ‘corporate’! At a time in global healthcare when practice development activity is under greatest threat, due to economic downturns that have impacted on health and social care services, the timing of these papers is significant in bringing practice development into the vistas of health and social care reform. Thinking about this commentary and having read the papers made me reflect on the life course of practice development, from its early inception in the UK in the 1980s to where it is now as an increasingly accepted global movement. The journey through this period has been turbulent and researchers such as me (and others) who have taken an active interest in practice development are labelled as the charlatans of the research world (see editorials by Walker (2009) and Thompson et al. (2008), for example). Despite such critique, practice development in its various guises (and disguises) has persisted through major health and social care reform, through professional nursing role development and through an interdisciplinary practice agenda that has at times appeared to be more about boundary management than service effectiveness. Through all of these changes, practice development has adopted and adapted in order to retain its central focus, that of the development of increased effectiveness in person-centred practice through the changing of workplace cultures (Manley et al., 2008). Methodologies have become more sophisticated in the way that models for enabling collaborative, inclusive and participative approaches to working with everyday nurses (and other team members) have become integrated and fine tuned. Evaluation frameworks are more sophisticated and approaches such as ‘Praxis Evaluation’ (Wilson et al., 2008) have been derived from systematic analysis and scholarly inquiry into practice development activity. So, in summary there is much to be celebrated about the achievements of practice development and its contribution to contemporary nursing and patient care, as evidenced in the first systematic review of practice development conducted by McCormack et al. (2006).
TL;DR: It is maintained that Action Research can be useful in harnessing and focussing the necessary commitment to bring about long-term changes in a hospital setting.
Abstract: In March 2004 we delivered a new module entitled ‘Fostering Dignity and Respect in Health Care Settings’. This was a collaborative venture between Anglia Ruskin University lecturers and Southend University Hospital Staff and was the first step in our Action Research project. We had expected the project to be a short-term one, terminating with the first three deliveries of the module. However, the education programme led to the formation of a Dignity and Respect Action Group within the hospital that continues to this day alongside deliveries of the module, and thus the Action Research project continues. In this paper we outline the achievements of the Action Research study and identifies some of the features that we believe have sustained it over a period of 5 years. These factors were not always the consequence of planned strategies but often arose as we responded to events during the trajectory of the project. Issues relating to dignity and respect are to be found in many large institutions and we maintain that Action Research can be useful in harnessing and focussing the necessary commitment to bring about long-term changes in a hospital setting.
TL;DR: A novel Australian attempt to establish the evidence base for causal relationships with quality of care and patient outcomes, as an informed contribution to mental health nursing practice development is established.
Abstract: controlled trial of clinical supervision: selected findings from a novel Australian attempt to establish the evidence base for causal relationships with quality of care and patient outcomes, as an informed contribution to mental health nursing practice development Journal of Research in Nursing 15(2) 169–172 ! The Author(s), 2010. Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1744987109357819 jrn.sagepub.com