Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Practice Development: Realising Active Learning for Sustainable Change

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Practice Development: Realising Active Learning for Sustainable Change

Article excerpt

INTRODUCTION

Practice Development is a well established international movement. Over the past 10 years significant conceptual, theoretical and methodological advances have been made in the development of frameworks to guide practice development activities. During that period, the relationships between practice and professional development have been deliberated so that greater clarity can be achieved around their relationship with each other. In this paper, some background to practice development will be presented, including an overview of the key concepts within practice development and current evidence underpinning the methodology of emancipatory practice development. We will then use the processes and outcomes arising from the first year of a 2-year national practice development programme being undertaken in the Republic of Ireland to illustrate core practice development processes in action.

BACKGROUND TO PRACTICE DEVELOPMENT

All innovations have their roots in what has preceded them and practice development is no exception. Practice development (PD) is a systematic approach that aims to help practitioners and healthcare teams to look critically at their practice and identify how it can be improved. It not only works with concrete projects or initiatives but also seeks to first deconstruct and then reconstruct the different types of patterns within the workplace and enable staff to better understand and facilitate their workplace cultures. Thus, its purpose is to develop more effective workplace cultures that have embedded within them person-centred processes, systems and ways of working. Unique to practice development is its explicit person-centred focus. Person-centredness is about respecting and valuing each individual as a unique being with rights, and engaging with them in a way that promotes their dignity, sense of worth and independence. This is the essence of caring, fundamental to nursing, and core to health care business. The delivery of effective healthcare is significantly dependent on the staff who deliver the care. It is they who create and sustain the climate and culture within which patients are cared for and therefore the culture that is most directly experienced by patients and families. Corporate culture also plays a role in how practice development is viewed. Practice development facilitators help staff and managers to get underneath the surface and patterns of their immediate cultures, to critically reflect on the values and beliefs they hold about patient care and their workplace cultures. Teams are challenged to consider if the behaviours, systems and processes used in practice are consistent with person-centred values. They are enabled to identify what needs to change and the part they need to play in effecting continuous improvement. This needs staff to be able to reflect on and evaluate evidence from practice, enhance their ability to implement evidence into practice, to be consistent and sustain new initiatives. Processes that: (1) enable staff to learn about and take control of their own practice, (2) integrate work-based active learning, and (3) develop new knowledge, skills and ways of working are vital to achieving sustainable change.

Key concepts in practice development

There have been significant advances in our understanding of the key concepts underpinning practice development work irrespective of methodological perspectives being adopted. For example, workplace culture, person-centredness, facilitation; practice context; evidence, values and approaches to active learning (Bellman, Bywood, & Dale, 2003; Clarke & Wilcockson, 2002; Dewing, 2004, 2008a; Fink, 1999; Manley, 2004; McCormack, 2004; Rycroft-Malone et al., 2003; Titchen, 2004). In a concept analysis of practice development, Garbett and McCormack (2004, p. 29) articulated the interconnected and synergistic relationships between the continuous process of improvement; development of knowledge and skills; helping or facilitation and systematic, rigorous and continuous processes of emancipatory change in order to achieve the ultimate purpose of evidence-based and person-centred care that reflects the perspectives of users. …

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