Advancing ophthalmic nursing practice through action research.

Aim: This paper reports an action research project that promoted posturing face down following macular hole surgery and aimed to enhance patient outcomes. This paper gives an overview of the process and outcomes of the first three of four phases of the project: problem identification, planning and action. The fourth phase, which was an evaluation of the project, is reported in another paper.

Background: Surgical repair for macular hole is common procedure carried out worldwide, and patients are required to posture face down for several weeks after this surgery. There is anecdotal evidence that many patients find this difficult to carry out. In the context of increasing medical specialization, nursing practice must be developed to meet the needs of patients being treated. This study will, therefore, be relevant beyond the particular specialty and geographical location described.

Method: The methodology was participative and cyclical. Initially, a fact-finding exercise was undertaken, using qualitative interviews with 18 members of staff to elicit their perspectives on the posturing of patients. Based on the fact-finding exercise, seven action objectives were set. While these were being implemented, three further research projects were identified and undertaken. Two were qualitative studies: one investigated patients' experiences of the surgery and posturing, and the second concerned nurses' developing working theories on the promotion of posturing and effects of nursing care on patient outcomes. Another pilot study was a randomized controlled trial to consider the effect of two different posturing regimes on patient outcomes. In addition to regular action research group meetings, these studies served to inform and monitor the changes as they were put into practice. The work was carried out from 1998 to 2002.

Findings: Several factors appeared to influence whether patients postured after surgery, namely: education of staff and patients, appropriately timed services, clear lines of responsibility for patient care, good communication and availability of equipment.

Conclusion: The research suggests that an approach to care is required that appreciates and deals with the multiple factors that influence whether patients carry out the posturing.