Evaluation of an action research project in ophthalmic nursing practice.

Aim: This paper reports the evaluation phase of an action research project that promoted face-down posturing of patients following vitreo-retinal surgery for macular hole to enhance patient outcomes. The evaluation phase identified areas of practice needing further development from the perspectives of those involved with the care of patients.

Background: To achieve best results following surgical repair of macular hole, patients are required to posture face down for several weeks. As a consequence, patients complain of severe back and neck ache and find it difficult to persist with the posturing. Work to advance nursing practice as surgical developments occur has relevance beyond ophthalmology and the particular context of this project.

Method: The first three phases of this action research--problem identification, planning and action--have been reported in another paper. Throughout the project an action research group comprising of representatives of key stakeholders were actively involved in researching and changing practice. During the evaluation phase, a qualitative methodology was chosen. Interviews with 17 members of staff from the inpatient area were carried out to elicit their perspectives on the posturing of patients. Qualitative interviews were selected to facilitate comparison with interview data from Phase 1. Data analysis ran concurrently with data collection, so that one could inform the other.

Findings: Overall, nurses and healthcare support workers felt that patients were more agreeable to posturing and after surgery began to posture more quickly. Communication was still an issue in some instances, and patients having urgent as opposed to planned surgery were found to be more difficult to prepare and the psychological care of patients still posed problems for nursing staff.

Conclusions: The evaluation suggests that improvements in the care of this group of patients have occurred. A 10-point plan to promote face-down posturing has been developed which will be of use to practitioners in other settings. Some aspects of practice remain less well-understood, for example, the psychological care of patients.