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Chapter 6 Phase Two
Reflection Excerpt no. 3
It is a difficult time for staff to focus on any type of change to practice at the
moment because the national health-service provider has imposed a recruitment
freeze on the service and this has really taken its toll on staff morale. Maternity
leave and sick leave are not being replaced and vacant posts are not being filled.
Needless to say the research unit is also feeling the pinch. However the clinical
nurse manager remains passionate about the change and is definitely one the
“champions” for keeping this going. Getting time with the staff for facilitation is
difficult due to the staff shortages and time constraints. The inclusion of the
resident in the care plan is essential due to its design. This should enhance their
autonomy and I hope that the critical companionship can help the staff to
develop their negotiation skills. I think wearing my uniform when I visit the unit
has really helped and I feel the staff no longer see me as an outsider - the
academic removed from reality who doesn’t understand but a nurse who
understands what the working day is like and what frustrations and time
constraints exist with trying to introduce changes in practice. I overheard one
staff participant comment that “she is doing research but she works too”. Not
only have I gained an insiders perspective but I have also identified how
individuals as well the whole team can be helped to develop. I think that the
critical companionship has been essential in role modelling to the staff how they
can meaningfully engage the residents in asking them what they would like and
in finding out about their interests and who they are as a person. We have
designed care plan templates which are deliberately open and simple as the staff
care plan skills are only developing and therefore we must begin the process
slowly. The staff seem to have enjoyed picking out the new care plan folders,
trolleys and equipment especially because this was a time when other resources
are cut.
6.5 Step 4: Evaluating: Studying the consequences of the action
Step four of an action research cycle requires the researchers to evaluate whether
or not the action has actually changed practice. Hence once all of the care plans
had been implemented for all residents, the documentary analysis from phase one
of the research study was repeated to examine the extent to which the new
approach to care planning had impacted upon resident autonomy. It was never
the intention to repeat the data collection methods from phase one of this study
on completion of phase two of this study however the nature of the intervention
in phase two lended itself well to using the documentary analysis audit tool from
phase one. The documentary analysis audit tool had been developed from the
elements of resident autonomy and hence could be used to examine whether or
not the newly implemented approach to care planning had impacted positively on
resident autonomy. The findings revealed that all of the elements of resident
autonomy which were originally examined in the documentary analysis in phase