Facilitating Implementation of Research Evidence (FIRE): an international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework.

Background: Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice.

A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar.

Background: Facilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice.

Designing and implementing two facilitation interventions within the 'Facilitating Implementation of Research Evidence (FIRE)' study: a qualitative analysis from an external facilitators' perspective.

Background: The 'Facilitating Implementation of Research Evidence' study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators' ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation.

A Kaleidoscope of Hope: Exploring Experiences of Hope Among Service Users and Informal Carers in Health Care Contexts.

Background: There is a large and diverse literature on the concept of hope in health care. This literature covers a broad spectrum of perspectives, from philosophical, conceptual, and theoretical analysis through to attempts at measuring the concept of hope with differing health care users.

Aims: To explore the concept of hope through the secondary analysis of existing data sets, with the intention of understanding hope in the context of person-centeredness.

FIRE (Facilitating Implementation of Research Evidence): a study protocol.

Background: Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy.

Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges.

Background: The PARiHS framework (Promoting Action on Research Implementation in Health Services) has proved to be a useful practical and conceptual heuristic for many researchers and practitioners in framing their research or knowledge translation endeavours. However, as a conceptual framework it still remains untested and therefore its contribution to the overall development and testing of theory in the field of implementation science is largely unquantified.

Discussion: This being the case, the paper provides an integrated summary of our conceptual and theoretical thinking so far and introduces a typology (derived from social policy analysis) used to distinguish between the terms conceptual framework, theory and model - important definitional and conceptual issues in trying to refine theoretical and methodological approaches to knowledge translation.

Developing a qualitative approach to 360-degree feedback to aid understanding and development of clinical expertise.

Aim: This paper presents one aspect of a 5-year multicentre action research study to develop an accreditation process for clinical nursing expertise. Part of the process consisted of the exploration, critique and refinement of qualitative 360-degree feedback as a tool for peer review.

Background: Three hundred and sixty-degree feedback is widely used as a personal and professional development strategy.

Patient narratives in the investigation and development of nursing practice expertise: a potential for transformation.

This paper is a review of the experiences gained whilst working with the 'expertise in practice project'. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice-based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others.

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.

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.

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.

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.

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.

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.

Ingredients for change: revisiting a conceptual framework.

Finding ways to deliver care based on the best possible evidence remains an ongoing challenge. Further theoretical developments of a conceptual framework are presented which influence the uptake of evidence into practice. A concept analysis has been conducted on the key elements of the framework--evidence, context, and facilitation--leading to refinement of the framework.

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).

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.

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.

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.

Towards practice development--a vision in reality or a reality without vision?

This paper describes the development of a conceptual framework for practice development. Drawing on the authors' combined experiences of facilitating developments in practice, a conceptual framework is proposed. It is argued that much practice development in health care today lacks a systematic approach and is often undertaken by individual practitioners who are poorly prepared for their roles.

Using a supervisory framework to support and evaluate a multiproject practice development programme.

The paper describes a multiproject practice development programme undertaken over a period of 1 year. The background and development of the programme are outlined, whilst attention is paid to the innovatory nature of the work, particularly the use of inductive, deductive and integrated approaches to both change implementation and project supervision. The programme was monitored throughout using different data sources and the paper uses evaluative material retrospectively to provide answers to organizational and professional difficulties which arose during the course of the programme.

The art of clinical supervision.

Helping nurses to become effective and confident as primary nurses involves developing their interpersonal skills, sharpening their decision-making and nurturing their creativity. In our action research study, we found that traditional methods of ward teaching did not help to promote this kind of professional growth. We therefore developed, tested and refined three distinct strategies for clinical supervision which specifically aimed to foster more thoughtful and more sensitive nursing practice.

Action research: a strategy for theory generation and testing.

We define action research and relate it conceptually to other research strategies. The inadequacy of some action research methodologies for theory generation and testing is discussed. We describe the way we re-dressed this deficiency in our study of the journey from traditional nursing to patient-centered nursing.

What am I meant to be doing? Putting practice into theory and back again in new nursing roles.

This two-part paper is based on some of the findings from an action research study of the development of patient-centred nursing in an acute medical unit. In the first part, Angie Titchen presents findings from a case study of a ward undergoing the initial changes from traditional nursing to primary nursing. She documents and reflects upon the complexity of establishing new nursing roles, the devolution of authority and the shift in power relationships within the ward team, and the confusion and pain caused by role ambiguity.