Biomedical subjects

Angie Titchen

Publications and source records attributed to Angie Titchen.

10 recordsLinked to original sources

PubMed2006

Re-defining nursing expertise in the United kingdom.

There is now international recognition of the importance of practice expertise in modern and effective health services. The Expertise in Practice Project in the United Kingdom began in May 1998 and continued to 2004. It included nurses working in all four countries of the United Kingdom, and it covered clinical specialists from pediatrics to palliative care. The project added to the current understanding of what nursing practice expertise is, through the identification and verification of attributes and factors which enable expert practice. The proposed framework offers a language for sharing what constitutes practice expertise and offers insight into what occurs between the expert practitioner and the people that experience their care. The Expertise in Practice Project demonstrates that nurses affect change and facilitate performance and organizational development.

Attitude of Health Personnel↗

PubMed2004

What counts as evidence in evidence-based practice?

BACKGROUND: Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice. AIM: This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care. DISCUSSION: Against a background of financial constraints, risk reduction, increased managerialism research evidence, and more specifically research about effectiveness, have assumed pre-eminence. However, the practice of effective nursing, which is mediated through the contact and relationship between individual practitioner and patient, can only be achieved by using several sources of evidence. This paper outlines the potential contribution of four types of evidence in the delivery of care, namely research, clinical experience, patient experience and information from the local context. Fundamentally, drawing on these four sources of evidence will require the bringing together of two approaches to care: the external, scientific and the internal, intuitive. CONCLUSION: Having described the characteristics of a broader evidence base for practice, the challenge remains to ensure that each is as robust as possible, and that they are melded coherently and sensibly in the real time of practice. Some of the ideas presented in this paper challenge more traditional approaches to evidence-based practice. The delivery of effective, evidence-based patient-centred care will only be realized when a broader definition of what counts as evidence is embraced.

Decision Making↗

PubMed2004

An exploration of the factors that influence the implementation of evidence into practice.

BACKGROUND: The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry. AIMS AND OBJECTIVES: The aim of the study was to address the following questions: * What factors do practitioners identify as the most important in enabling implementation of evidence into practice? * What are the factors practitioners identify that mediate the implementation of evidence into practice? * Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice? DESIGN AND METHODS: The study was conducted in two phases. Phase 1: Exploratory focus groups (n = 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites. Phase 2: Two sites with on-going or recent implementation projects were studied. Within sites semi-structured interviews were conducted (n = 17). RESULTS: A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi-professional relationships and collaboration, role of the project lead and resources. CONCLUSIONS: The results are discussed with reference to the wider literature and in relation to the on-going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence-based practice, such as skilling-up practitioners to appraise research evidence, will be ineffective by themselves. RELEVANCE TO CLINICAL PRACTICE: Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementation and evaluation projects.

Diffusion of Innovation↗

PubMed2003

Research into patients' perspectives: relevance and usefulness of phenomenological sociology.

BACKGROUND: The dominant epistemology underpinning much inquiry in the field of patient evaluation of health care is positivist, with categorization and quantification being high priorities, despite the highly personal and dynamic nature of people's responses to their health care experiences. The mis-match between underpinning theoretical assumptions and the nature of the subject under investigation has led to ineffectiveness in much current inquiry into patients' perspectives. More needs to be learnt about patients' processes of evaluation prior to any summary assessment of the quality of their care. AIMS: This paper documents the search for a close fit between a study's research questions and a theoretical perspective with which to underpin the research. It describes the benefits of identifying a specifically relevant perspective, in this case phenomenological sociology, and discusses the potential of that particular perspective to underpin research within health care. METHODS: Research questions relating to patients' processes of evaluation were established. The possible contribution of a range of interpretative methodologies was considered. While all were relevant to some degree, phenomenological sociology was identified as having considerable specific potential to illuminate the patient's process of evaluation. FINDINGS: The particular strengths of phenomenological sociology relevant to the investigation of patients' processes of reflection are in highlighting the importance of subjectivity; its insistence on a clear link from theoretical development right back to the raw data; its wealth of evocative ideas and concepts that support the investigation of the development of interpretation; and the relatively accessible language and style of its texts. CONCLUSION: Time spent evaluating the potential contribution of different theoretical perspectives to a study is worthwhile, as a good choice can not only support but also enhance the quality of the research. Phenomenological sociology has much potential to underpin research into patient evaluation of health care and in nursing research more widely.

Attitude to Health↗

PubMed2002

Getting evidence into practice: the role and function of facilitation.

AIM OF PAPER: This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice. BACKGROUND: In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context. It was proposed that facilitators had a key role in helping individuals and teams understand what they needed to change and how they needed to change it. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide theoretical and conceptual clarity. METHODS: The concept analysis approach was used as a framework to review critically the research literature and seminal texts in order to establish the conceptual clarity and maturity of facilitation in relation to its role in the implementation of evidence-based practice. FINDINGS: The concept of facilitation is partially developed and in need of delineation and comparison. Here, the purpose, role and skills and attributes of facilitators are explored in order to try and make distinctions between this role and other change agent roles such as educational outreach workers, academic detailers and opinion leaders. CONCLUSIONS: We propose that facilitation can be represented as a set of continua, with the purpose of facilitation ranging from a discrete task-focused activity to a more holistic process of enabling individuals, teams and organizations to change. A number of defining characteristics of facilitation are proposed. However, further research to clarify and evaluate different models of facilitation is required.

Diffusion of Innovation↗

PubMed2002

Getting evidence into practice: the meaning of 'context'.

AIM OF PAPER: This paper presents the findings of a concept analysis of 'context' in relation to the successful implementation of evidence into practice. BACKGROUND: In 1998, a conceptual framework was developed that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice [Kitson A., Harvey G. & McCormack B. (1998) Quality in Health Care 7, 149]. One of the key elements of the framework was 'context', that is, the setting in which evidence is implemented. It was proposed that key factors in the context of health care practice had a significant impact on the implementation and uptake of evidence. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide some theoretical and conceptual rigour to its content. METHODS: Morse's [Morse J.M. (1995) Advances in Nursing Science 17, 31; Morse J.M., Hupcey J.E. & Mitcham C. (1996) Scholarly Inquiry for Nursing Practice. An International Journal 10, 253] approach to concept analysis was used as a framework to review semi-nal texts critically and the supporting research literature in order to establish the conceptual clarity and maturity of 'context' in relation to its importance in the implementation of evidence-based practice. FINDINGS: Characteristics of the concept of context in terms of organizational culture, leadership and measurement are outlined. A main finding is that context specifically means 'the setting in which practice takes place', but that the term itself does little to reflect the complexity of the concept. Whilst the themes of culture and leadership are central characteristics of the concept, the theme of 'measurement' is better articulated through the broader term of 'evaluation'. CONCLUSIONS: There is inconsistency in the use of the term and this has an impact on claims of its importance. The concept of context lacks clarity because of the many issues that impact on the way it is characterized. Additionally, there is limited understanding of the consequences of working with different contexts. Thus, the implications of using context as a variable in research studies exploring research implementation are as yet largely unknown. The concept of context is partially developed but in need of further delineation and comparison.

Culture↗

PubMed2002

Exploring nursing expertise: nurses talk nursing.

It has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence-based practice. The material presented within this article has been interpreted drawing from discourse analysis1 to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise in Practice (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants' clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse-patient relationship, 'maverick' nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a 'catalyst' that alters treatment pathways and maximizes patient-centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non-conventional practice that in itself can be isolating and challenging to the status quo of contemporary health-care.

Clinical Competence↗

PubMedDate not supplied

Getting evidence into practice: ingredients for change.

Mounting pressure is being exerted to ensure that the delivery of care is evidence-based and clinically effective. However, the challenge this presents to practitioners is complex. The authors propose that successful implementation of evidence into practice is a function of three elements: the nature of the evidence; the context in which the change is to take place; and the way the process is managed. A framework has been developed to represent these factors. For those about to embark on implementation work, this article closes by highlighting a number of key questions for consideration, stimulated by the framework.

Delivery of Health Care↗

PubMedDate not supplied

Critical companionship. Part 2: Using the framework.

Part 1 presented the critical companionship framework for facilitating experiential learning, with exemplars of expertise. The development and testing of the framework were outlined. In Part 2, we show the framework being used by new critical companions, without educational backgrounds or previous facilitation of learning experience. The reflective accounts of the critical companions not only show how they analysed their work using the framework, but also reveal that these early experiences helped those they were facilitating to unravel their practice and look critically at how they, and others, practise. Some accounts hint at the outcomes for patients and relatives and show how critical companionship became integrated with leadership roles. We conclude that the framework can be useful in helping new critical companions to acquire effective critical companionship skills. In addition, we tentatively suggest that the development of expertise, as demonstrated in Part 1, is likely to take at least five years, unless the individual is already a skilled facilitator.

Clinical Competence↗

PubMedDate not supplied

Critical companionship: Part 1.

This article is the first of two presenting critical companionship as a metaphor and framework for learning from healthcare experiences. Critical companionship is a helping relationship in which an experienced facilitator (often, but not necessarily, a colleague) accompanies another on an experiential learning journey, using methods of 'high challenge' and 'high support' in a trusting relationship. The overall purpose of critical companionship is to enable others to practise in ways that are person centred and evidence based. Critical companionship is effective in a variety of one-to-one or group learning contexts, such as practice development projects, organisational change, practitioner research, work-based learning, clinical supervision and action learning. In this article, the development and testing of the critical companionship framework, through action research, are briefly described. The framework is then presented and illustrated with exemplars of critical-companionship expertise in an acute medical ward. Part 2 highlights how the framework was used in a practice development programme with NHS trusts for older people's services, to help nurses to become critical companions.

Attitude of Health Personnel↗