Nicola J Spalding

Exploring the Use of Vignettes: From Validity to Trustworthiness

In this article one of the authors presents her experience of using vignettes in an action research case study, with particular emphasis on their trustworthiness. The research was carried out with a group of health care professionals who were working together to improve preoperative education for patients awaiting a hip replacement in one National Health Service Trust in the United Kingdom. The authors describe the exploration of three types of vignette—snapshots, portraits, and composites—as a means of collecting, analyzing, and representing data. They provide an example of each and briefly present their evaluative use by the health care professionals. The vignettes were constructed to provide one account of the truth that was representative of events. Within this representation was the writer, researcher, and reader feature. The vignettes stimulated reflection and analysis within the action research cycle and thus contributed to the improvement of practice.

The Skill Acquisition of Two Newly Qualified Occupational Therapists

This research was an investigation, using a case study approach, to gain an understanding of the professional development of two newly qualified occupational therapists. Six interviews were undertaken with each therapist between November 1997 and June 1998. A reflective assignment written in May 1997 by the subjects when they were students also added to the data collection. The progressive nature of their learning resembled the Dreyfus and Dreyfus (1986) model of skill acquisition, where advancement to proficiency level of many skills was evident. Their progression in such a short time was an important finding of this research. This suggested that the amount of exposure to clinical experience was not an indicator of skill acquisition. Instead, the individual merits of the learner, as evidenced by the skills that he or she demonstrated, was a better indicator of professional development. The progression through the stages was explained by reflection on experience. The rapid advancement to proficiency level by the two therapists was thought to be due to their good reflective skills, which facilitated their learning.

The informational needs of patients with ANCA-associated vasculitis—development of an informational needs questionnaire

OBJECTIVE The aim of the study was to compare the informational needs of patients with ANCA-associated vasculitis (AAV). METHODS We developed a Vasculitis Informational Needs Questionnaire that was distributed to members of Vasculitis UK (VUK) by mail and registrants of the Vasculitis Clinical Research Consortium (VCRC) online registry with self-reported AAV. Patients were asked to use a 5-point scale (1 = not important, 5 = extremely important) to rank aspects of information in the following domains: disease, investigations, medication, disease management and psychosocial care. The source and preferred method of educational delivery were recorded. RESULTS There were 314 VUK and 273 VCRC respondents. Respondents rated information on diagnosis, prognosis, investigations, treatment and side effects as extremely important. Information on patient support groups and psychosocial care was less important. There was no difference in the ratings of needs based on group, sex, age, disease duration, disease or method of questionnaire delivery. The most-preferred methods of providing information for both groups were by a doctor (with or without written material) or web based; educational courses and compact disc/digital video disc (CD/DVD) were the least-preferred methods. CONCLUSION This study demonstrates that people with AAV seek specific information concerning their disease, treatment regimes and side effects and the results of investigations. Individuals preferred to receive this information from a doctor. Patients with AAV should be treated in a similar manner to patients with other chronic illnesses in which patient education is a fundamental part of care.

Multidimensional collaboration: reflections on action research in a clinical context

This paper reflects on the challenges and benefits of multidimensional collaboration in an action research study to evaluate and improve preoperative education for patients awaiting colorectal surgery. Three cycles of planning, acting, observing and reflecting were designed to evaluate practice and implement change in this interactive setting, calling for specific and distinct collaborations. Data collection includes: observing educational interactions; administering patient evaluation questionnaires; interviewing healthcare staff, patients and carers; patient and carer focus groups; and examining written and audiovisual educational materials. The study revolves around and depends on multi-dimensional collaborations. Reflecting on these collaborations highlights the diversity of perspectives held by all those engaged in the study and enhances the action research lessons. Successfully maintaining the collaborations recognises the need for negotiation, inclusivity, comprehension, brokerage, and problem-solving. Managing the potential tensions is crucial to the successful implementation of changes introduced to practice and thus has important implications for patients’ well-being. This paper describes the experiences from an action research project involving new and specific collaborations, focusing on a particular healthcare setting. It exemplifies the challenges of the collaborative action research process and examines how both researchers and practitioners might reflect on the translation of theory into educational practices within a hospital colorectal department. Despite its context-specific features, the reflections on the types of challenges faced and lessons learned provide implications for action researchers in diverse healthcare settings across the world.

Developing patient education to enhance recovery after colorectal surgery through action research: a qualitative study

Objectives To understand the role of preoperative education for patients undergoing colorectal surgery by involving patients, carers and staff in: (1) identifying its perceived value and deficits for enhanced recovery; (2) modifying current education practices to address educational deficits; and (3) evaluating these changes for preparing patients to enhance their recovery. Design Qualitative study of three cycles of action research using mixed methods within a 24-month naturalistic enquiry to identify, implement and evaluate changes through observations, questionnaires, semistructured longitudinal interviews, focus groups and documentation review. Setting A UK 1200-bed National Health Service (NHS) hospital providing colorectal surgery in a small city in a rural county. Participants Ninety-sevenpatients having colorectal surgery, 19 carers and 22 clinical staff. Results Themes identified were: (1) knowledge and engagement; (2) situated understanding and confidence building; and (3) partnership and proactive involvement in enhancing recovery. All patients articulated needs to prepare mentally and physically to plan for colorectal surgery and rehabilitation. Patients and carers wanted to counter uncertainty about medical procedures: likely bodily changes, recovery timescales and future. They therefore sought as much personalised, relevant information as possible about their disease, planned surgery and recovery. Staff implemented preoperative education to more specifically inform and respond multimodally to individual needs. Conclusions Patients wanted to be proactively involved in managing their recovery to re-engage with their everyday lives. Preoperative education supported this through developing patients’ situated understanding of hospital and bodily processes related to colorectal surgery. Situated understanding was achieved through educational product to give knowledge and processes promoting engagement. Multimodal, comprehensive and timely preoperative education on the whole patient pathway facilitates active engagement. Situated understanding increased patients’ confidence to work in partnership with healthcare professionals and proactively self-manage recovery.

Addressing patients’ colorectal cancer needs in preoperative education

Purpose – The purpose of this paper is to understand and develop ways to enhance patients’ experiences of preoperative education received prior to surgery for colorectal cancer. Design/methodology/approach – Based in the UK, three-action research cycles were undertaken to evaluate preoperative education, identify changes seen by patients and staff as likely to improve the service and to re-evaluate such changes following implementation. Data in each cycle were collected from: observations of clinic interactions; patient questionnaires; individual semi-structured interviews with multidisciplinary colorectal unit staff; longitudinal semi-structured interviews with patients and carers pre-surgery, two weeks post-surgery and 12 weeks post-surgery; patient and carer focus groups post-surgery; and existing educational material. Findings – In total, 138 participants shared their experiences of either giving or receiving preoperative education. Findings were themed into why patients want preoperative education, a...

Autumn book review supplement

Brain Injury and Neuropsychological Rehabilitation: International Perspectives Fundamentals of Skeletal Radiology (2nd edn) Therapy in Practice 45: Spinal Cord Injury Rehabilitation HIV and AIDS: A Strategy for Nursing Care (4th edn) Body in Action Clinics in Physical Therapy: Temporomandibular Disorders (2nd edn) Radiology MGH Clinical Review Moving to Audit: an Education Package for Professionals Allied to Medicine Home at Last Working with Dysfluent Children: Practical Approaches to Assessment and Therapy Alzheimer’s (A Practical Guide to Carers to Help you Through the Day) Teaching Atlas of Hand Radiology: A Self-assessment Text