256 research outputs found
Kelly + Jones In Conversation with Seers in Residence Artists for The Glass Tank
No full textThis research event took place online during lockdown so that Kelly + Jones could share insights and learnings of the exhibition process with the seers. Kelly + Jones invited the seers to consider the geographical site(s) of chalk deposit, the original residency site of a Victorian school staircase and our own bodies as a site. In addition to this Kelly + Jones extend an invitation to the seers to create site-specific responses to the exhibiting context. The conversation was hosted by Kelly + Jones with Seers researchers:
Janice Howard BFA (Oxon), MA, SFHEA. Senior Lecturer in Fine Art.
Professor Helen Walkington BSc, PGCE, MSc. PhD, FRGS, NTF, PFHEA. Department of Social Sciences
Deborah Pills BA Fine Art, Year 3
Kate Mohony Associate Lecturer Fine Art
The outcome of this sharing event is a series of further research questions relating to the female form, marine life and performativity of the body. It also addressed the effectiveness and problematics of using practice as research as both a curatorial method for installing and working as an artist live in the context of a gallery setting, and the use of micro residencies as a methodology for practice as research. These discussions and reflections are now the basis for a series of essays and performative gestures that will form a new publication for late 2020/early 2021
Kelly + Jones : The Glass Tank Seers in Residence CaCO3
No full textKelly + Jones' research explores a decentralised and phenomenological methodology for approaching shared research dynamics. The Kelly + Jones: The Glass Tank Seers in Residence CaCO3 project approaches investigation as a non-hierarchical, non-linear series of happenings that privilege knowledge as a mingling and arrangement of rhythms and textures in anticipation of the appearing of the not-yet-seen. The Seers in Residence research model was first developed by Traci Kelly (2012). Kelly + Jones proposed that this model should form part of their practice as research exhibition at The Glass Tank, Oxford Brookes University, 2020 with an expanded scope to create a research opportunity not only across disciplines as previously but and also across generations of researchers. A key component of creating a research ecology lay in inviting others to pursue their own research through the lens of the exhibition. A micro-residency research model ”Seers-in-Residence” developed by Traci Kelly in 2012 as an open resource for creative practices provided the structure.
Each invited researcher spent a continuous three hours engaging with Kelly + Jones’ exhibition material through the prism of their own discipline and research interests. The contingent research-in-action expands, renews and shifts the territory of artworks and practices, providing a ground for each ”Seer” to further mobilise their investigations through the process.
The innovative intervention into exhibiting-as-research, created an inter-departmental, cross-disciplinary and inter-university research opportunity for four female researchers.
The intergenerational grouping of researchers was also key to the process and included a management/senior researcher, a lecturer/ researcher, a PhD candidate and a third year B.A. Fine Art student.
The result was the process built an intergenerational experience to benefit all participants by allowing integrated critical futures to develop within the Oxford Brookes University environment. Feedback from the residencies has been highly positive with students and staff commenting that they don’t normally get to witness their lecturers in active practice-as-research. The residencies also keep a static exhibition enlivened throughout its duration.
The methodology:
*The three-hour micro residencies were dependent upon a commitment by Oxford Brookes University to a resulting integrated publication on the different research areas and responses in order to disseminate the research. The micro–residencies took place once a week or twice a week depending on the duration of the exhibition.
The invited seers were:
Janice Howard BFA (Oxon), MA, SFHEA. Senior Lecturer in Fine Art
Professor Helen Walkington BSc, PGCE, MSc. PhD, FRGS, NTF, PFHEA. Department of Social Sciences
Deborah Pills BA Fine Art, Year 3
Kate Mohony Associate Lecturer Fine Art
Through this unique method by Kelly + Jones they worked in depth with an appropriate and coherent process of practice as research. The context of creating and inviting other researchers to have a micro-residency and to site their occupations within the Kelly + Jones exhibition at The Glass Tank established practical reflection points through our own research and the trajectories of the seers own research interests - working in parallel.
The outcome of the seers residency programme and its engagement with the Kelly + Jones exhibition as part of the research enquiry was that we were able to decentralise the research by opening it up to other researchers at various stages in their career without hierarchy. We have moved outside of the Fine Art community to gain fresh insight into our theory framework and site knowledge; this as evidenced by seer and geographer Professor Helen Walkington who brought new insight about the presence of flint within chalk beds and their significance around human activity
A realistic evaluation : the case of protocol-based care
No full textBackground
'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways.
Methods
Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances.
Results
In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs).
Conclusions
As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice
Implementing evidence-based practice in clinical situations
No full textMany nurses in a variety of clinical settings are facing the challenges posed by incorporating evidence-based practice in health care. Some of the steps involved in implementing evidence-based care in clinical practice are discussed and a two-step framework to assist practitioners in implementing evidence-based practice is outlined. Factors such as the relevance of specific guidelines or research, generalisability of research findings, the strength of the evidence relative to the risks and benefits of treatment, and patient preferences are discussed in terms of evidence-based decision making.Elizabeth McInnes, Gill Harvey, Lesley Duff, Gabby Fennessy, Kate Seers, and Elizabeth Clar
A pragmatic cluster randomised trial evaluating three implementation interventions
No full textBackground
Implementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice. Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience. The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting.
Methods
A pragmatic cluster randomised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis. Hospitals were randomised to one of three interventions: standard dissemination (SD) of a guideline package, SD plus a web-based resource championed by an opinion leader, and SD plus plan-do-study-act (PDSA). The primary outcome was duration of fluid fast prior to induction of anaesthesia. Secondary outcomes included duration of food fast, patients' experiences, and stakeholders' experiences of implementation, including influences. ANOVA was used to test differences over time and interventions.
Results
Nineteen acute NHS hospitals participated. Across timepoints, 3,505 duration of fasting observations were recorded. No significant effect of the interventions was observed for either fluid or food fasting times. The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone. The process evaluation showed different types of impact, including changes to practices, policies, and attitudes. A rich picture of the implementation challenges emerged, including inter-professional tensions and a lack of clarity for decision-making authority and responsibility.
Conclusions
This was a large, complex study and one of the first national randomised controlled trials conducted within acute care in implementation research. The evidence base for fasting practice was accepted by those participating in this study and the messages from it simple; however, implementation and practical challenges influenced the interventions' impact. A set of conditions for implementation emerges from the findings of this study, which are presented as theoretically transferable propositions that have international relevance. Trial registration ISRCTN18046709 - Peri-operative Implementation Study Evaluation (POISE
What counts as evidence in evidence-based practice?
No full textBackground: 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.Jo Rycroft-Malone, Kate Seers, Angie Titchen, Gill Harvey BNursing, Alison Kitson and Brendan McCormac
Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice
No full textBackground
Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management.
Methods
A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion.
Results
Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up.
Conclusions
Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study
Qualitative systematic reviews : their importance for our understanding of research relevant to pain
No full textThis article outlines what a qualitative systematic review is and explores what it can contribute to our understanding of pain. Many of us use evidence of effectiveness for various interventions when working with people in pain. A good systematic review can be invaluable in bringing together research evidence to help inform our practice and help us understand what works. In addition to evidence of effectiveness, understanding how people with pain experience both their pain and their care can help us when we are working with them to provide care that meets their needs. A rigorous qualitative systematic review can also uncover new understandings, often helping illuminate ‘why’ and can help build theory. Such a review can answer the question ‘What is it like to have chronic pain?’ This article presents the different stages of meta-ethnography, which is the most common methodology used for qualitative systematic reviews. It presents evidence from four meta-ethnographies relevant to pain to illustrate the types of findings that can emerge from this approach. It shows how new understandings may emerge and gives an example of chronic musculoskeletal pain being experienced as ‘an adversarial struggle’ across many aspects of the person’s life. This article concludes that evidence from qualitative systematic reviews has its place alongside or integrated with evidence from more quantitative approaches
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