Fighting falls with action research : a practice development project
- Publication Type:
- Thesis
- Issue Date:
- 2005
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Nurses espouse a caring ethic and demonstrate effectiveness in prevention of patient falls
but are often observed taking risks with patients’ safety. These actions reflect poor
congruence between espoused values and behaviours. Attitudes, values and involvement in
decision- making are factors that influence work behaviours. Nurses’ attitudes are held to
be a definitive factor in prevention work; however, few studies have focused on adherence
with best practice principles of fall prevention. Yet nurses claim no authority to change
their work. It was assumed that increased adherence would be achieved by improving
nurses’ attitudes through participation in decision- making surrounding fall prevention
practice. This study aimed to tes t this assumption by empowering nurses working in two
medical wards with high numbers of patient falls to improve their ownership of practice by
utilising critical social theory and action research. Nurses’ attitudes, including self-esteem,
professional values and work satisfaction were established before and after a practice
development project using action research. Mixed methods were employed by praxis
groups meeting fortnightly for a year reflecting on, and re-engineering practice. Action
research occurred in cycles focusing on assessment, communication, everyday work, and
performance. Nurses’ work was re-organised to gain time to spend in prevention work.
Patients’ environments were made safer and more patient-centred. New and effective ways
of assessing risk to fall, communication of risk and monitoring nurses’ performance of
prevention work were created and evaluated. Analysis demonstrated that nurses had good
self-esteem and professional values but were not satisfied with their work. Self-esteem and
professional values were unaffected by participation in work-related decisions however,
nurses expressed increased sense of ownership, more satisfaction and were observed to
engage in more prevention work. In conclusion, manipulation of attitudes and values is not
warranted if attitudes and values are good. However, participation in work-related
decision- making engages practitioners and leads to greater congruence between values and
behaviour. The “unspoken rules” constraining practice that were exposed in the action
research oblige nurses to assume authority, confronting and dispelling these constraints to
enable more therapeutic care to emerge. Recommendations include promoting practice
development as the preferred means for cultural change and improving person-centred care
whilst recognising its fragile nature and dependence on clinical leadership.
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