An action research study with health care professionals aiming to improve preparation for childhood hospitalisation

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Preparation for hospitalisation is a right of all children and its practice requires improvement. Preparation benefits children and their families because it provides information and appropriate support known to be crucial for positive outcomes. Optimal preparation practice is both difficult to define and challenging to provide. This thesis reports on an action research study undertaken when the concerns of a group of health care professionals at one major children’s hospital presented me with an opportunity to work with these staff to improve preparation for childhood hospitalisation. Applying critical social theory as a model of change helped the action group to understand how to negotiate the bureaucratic structures that can inhibit but also enable change in a hospital setting. The processes of engaging as a group with a shared goal of improving preparation practice highlighted some important challenges and opportunities in relation to the realities of collaborative action within health care settings. A survey of children and their parent/guardian regarding preparation for childhood hospitalisation and an audit of hospital staff’s preparation practices helped to identify children’s and families’ preparation practice experiences and preparation practices occurring at the hospital. As a way of mobilising collective action for desired change the action group facilitated the reinstatement of an approved preparation for childhood hospitalisation booklet. The most important findings of this study fall into three broad areas: the need for inclusive models of collaboration in complex and dynamic health care settings, the need for transformational approaches to leadership that consistently and explicitly support the engagement of staff in collaborative processes of ongoing practice improvement; and the need for transformational approaches to facilitation, which enable person-centred ways of working together and shared professional power and responsibility. To enable sustainable, evidence-based change the workplace must explicitly support staff’s continued engagement in critical reflection on their practice and provide staff with opportunities for taking collaborative action on issues of concern. Collaborative, evolving workplace cultures need to be sustained by inspired leadership at all levels of the organisation. Training and support are critical factors for attaining the inspired leadership required to transform the health care setting into an effective, efficient and supportive workplace. Keywords: preparation for childhood hospitalisation, critical social theory, action research, inclusive models of collaboration, transformational leadership, transformational facilitation.
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