Innovation and change in a rehabilitation unit for the elderly : Through action research

This report describes an eighteen-month action research project in an assessment, treatment and rehabilitation ward for older people in a large metropolitan hospital in New Zealand. The study aimed at developing participative care and the clinical nurse consultant role, and advancing nursing practice. Initially, nurses and patients worked together towards establishing a relationship in which patients were viewed as valid members of the interdisciplinary team. In the reconnaissance phase, nursing practice was critically examined. One-to-one guided interviews with nurses, patients and their families, and group discussions were used to develop an understanding of current nursing practice. This led to the transformative action in which action plans, based on the feedback from patients, nurses and allied health workers, were implemented and reflected upon. The action plans consisted of environmental changes, alteration of the admission procedure, implementation of group (patient) education sessions, and patient guided care plans. The positive outcome of this phase was the impetus for the interdisciplinary phase, in which patients became active participants in interdisciplinary participative goal-setting meetings. Interdisciplinary assessment forms and care plans were also piloted at this stage. The qualitative evaluation suggests that patient participation in the planning and evaluation of care came to be regarded as valuable by patients and health professionals. In conclusion, by critically examining nursing practice, the nurses were able to gain an insight into their practice, take informed action to transform practice, and initiate change in a ward environment