Action Research in Nursing

“There is no research without action; and there is no action without research”
-Kurt Levin
Action research is a process of gaining information about a situation through a deliberate process of:
  • Making explicit assumptions about how and why things work
  •  Planning to act to improve
  • Carrying out the intervention that has been planned
  • Observing what happens as a result of the intervention
  • Reflecting on the observations
  • Planning another intervention based on the reformulated hypothesis
“Action research is not merely research which it is hoped will be followed by action! It is action which is intentionally researched and modified leading to the next stage of action which is then again intentionally examined for further change and soon as part of there search itself”. -Yoland Wadsworth. 
Action research is a reflective process of progressive problem solving led by individuals working with others in teams or as part of a "community of practice" to improve the way they address issues and solve problems. Action research can also be undertaken by larger organizations or institutions, assisted or guided by professional researchers, with the aim of improving their strategies, practices, and knowledge of the environments within which they practice.
Kurt Lewin, a professor at MIT, first coined the term “action research” in about 1944. He described action research as “a comparative research on the conditions and effects of various forms of social action and research leading to social action” that uses “a spiral of steps, each of which is composed of a circle of planning, action, and fact-finding about the result of the action”.

Action Research and Nursing
Action research has gained popularity in Nursing and Health Care Research offering a way of developing practice-based knowledge, which can assist in changing practice and democratising inquiry. Modern health practice expects individual practitioners to develop patient focused, accessible, evidenced based services in diverse organisational settings. These situations occurs where the shifting boundaries between and within the nursing profession demands the need for practitioners to demonstrate their capacity as knowledgeable actors as they meet service delivery needs and empower their patients
Aim of action research is to build the capability of individuals and organizations to move beyond current conditions and practice. Recognized as a powerful tool for improving practice and the health of the organization.

Principles of Action Research
1. Reflection
2. Dialogue
3. Collaboration
4. Risk
5. Multiple action and interpretation
6. Transformation (Theory and Practice)
Types of Action Research
  • Traditional action research
  • Contextual action research
  • Radical action research
  • Educational action research
Role of the Action Researcher
  • Planner Designer
  • Leader Observer
  • Catalyser Reporter
  • Teacher Listener
  • Synthesizer Facilitator
The systematic process of inquiry available through action research extend the professional capacities of health practitioners, providing methods that improve the effectiveness and intervention that augment professional practice in ways that enhance outcome for clients.
Acton Research involves:
  • Real situation, rather than contrived or experimental studies
  • Primary focus is solving real problems
  • Circumstances require flexibility
  • Change must take place quickly or holistically
  • People who wish to improve understanding of their practice
A multidimensional Model of Action Research

The Action Research sequence focuses on:
  • 1. Change: Improving practices and behaviours by changing them.
  • 2. Reflection: People’s thinking and reflecting, theorizing about their practices, behaviours and situation.
  • 3. Participation: People change their own practices and behaviours, not those of others.
  • 4. Inclusion: Starting with agenda’s and perspectives of the least powerful, widening the circle to include all those affected by the problem.
  • 5. Sharing: People sharing their perspectives with others.
  • 6. Understanding: Achieving clarity of understanding of the different perspectives and experiences of all involved.
  • 7. Repetition: repeating cycles of research activity leading towards solution to a problem.
  • 8. Practice: Testing emerging understanding by using them as the basis for constructing new practice.
  • 9. Community: Working towards the development/building of a learning community.
Action research is a collaborative approach
Through its participatory process it enables the participants to
  • Investigate systematically their problems and issues
  • Formulate powerful and sophisticated accounts of their situation and
  • Devise plans to deal with the problems at hand
  • Reflecting on the current situation
  • Planning a change to improve the situation
  • Acting and observing the process and consequences of the change
  • Reflection and preplanning the same
Action Research Cycle
Action Research is cyclical in nature since research participants continuously through processes of investigation as they work towards effective solutions to their research problem.
The Look- Think-Act cycle signals that research participants will use new understandings emerging from data analysis to enhance or change their work practices- to take appropriate “action”. The act phase of the Look-Think-Act cycle of action research applies the knowledge and understandings emerging from research inquiry.
Benefits of Action Research
  • Creates a system wide mindset for improvement –a professional problem-solving process.
  • Enhances decision making –greater feelings of competence in solving problems and making instructional decisions. In other words, action research provides for an intelligent way of making decisions.
  • Promotes reflection and self-assessment
  • Instils a commitment to continuous improvement
  • Impacts directly on practice
  • Empowers those who participate in the process
  • Qualitative
  • Quantitative
  • An inquiry process that explores a social or human problem, the researcher builds a complex, holistic picture, analyses words, reports detailed views of informants and conducts the study in natural setting-Creswell,1998
  • combines the scientific and artistic natures of nursing to enhance the understanding of human health experience.
  • Involves broadly stated questions about human experiences and realities studied through sustained contact with people in their natural environment
  • Are concerned with answering questions such as what is ‘X’ ? and
  • how does ‘X’ vary in different circumstances ? and
  • why rather than how many X’s are there?
Qualitative research answers
  •  what has happened here rather than what is happening generally
  • Ethnography
  • Case study
  • Grounded theory
  • Phenomenological studies
1.  Ethnography
  • An ethnography is a description and interpretation of a cultural or social group or system. The research examines the group’s observable and learned patterns of behaviour, customs, and ways of life.
  • Leininger (1985) defined ethnography as the systematic process of observing, detailing, describing, documenting and analyzing the life ways or particular patterns of a culture
2. Case study
  • A case study is an exploration of a ‘bounded system’ … over time through detailed, in-depth data collection involving multiple sources of information rich in context. This bounded system is bounded by time and place, and it is the case being studied –a program, an event, an activity, or individuals
3. Grounded theory
  • Grounded theory studies are studies in which data are collected, analyzed and then a theory is developed that is grounded in the data.
  • Grounded theory is an important research method for the study of nursing phenomenon. The method explores the richness and diversity of the human experience and contributes to the development of middle range theories in nursing. It is an excellent method for understanding the processes through which patients learn to manage new or chronic health problems.
  • “Constructs and concepts are grounded in the data and hypotheses are tested as they arise from the research.” –(Field & Morse, 1985)
  • Systematic technique and process of analyzing the data through constant compression of data to identify pertinent concepts and interpret the data through intuitive process. –(Glaser & Strauss, 1967)
4. Phenomenological studies
  • Respondents are asked to describe their experiences as they perceive them.
  •  Their description can be either in written form or spoken form.
  • First person account of the experiences of people who survived the terrible Tsunami disaster is an example.
  • In-depth Interviews
  • Focus groups
  • Participant observation
  • Video
  • Document review, field notes
  • Document review provides relevant background or information for a report or study.
  • Field notes typically include a field diary which provides a record of the chronological events and development of research as well as the researchers own reaction to feelings about and opinions of the research process.
  • Takes place in the natural setting
  • Uses multiple methods that are interpretive
  • Is emergent rather than tightly prefigured
  • Fundamentally interpretive (role of researcher as interpreter)
  • Researcher views social phenomena holistically
  • Researcher adopts and uses one or more strategies of inquiry
  • Sampling technique is purposive
  • Data analysis is non statistical-Data can be in the form of notes, ideas, photographs etc.
  • Analyzed by identifying significant categories and classification of information
Action Research Tools (Common to Qualitative Research)
  • keeping a research journal
  • data document collection and analysis
  • participant observation recordings
  • questionnaire surveys
  • structured and unstructured interviews
  • case studies
Ethical Considerations
  • Relevant people, authorities and committees are consulted and principles are accepted
  • All participants must be allowed to influence work and given the choice of opting out
  • The work must be visible and open to suggestion from others
  • Permission is obtained before observing or examining documents
  • Must accept responsibility of maintaining confidentiality
  • Action research has gained popularity in nursing and healthcare research, offering a way of developing practice-based knowledge, which can assist in changing practice and democratizing inquiry. (Reed J, 2005)
  • Action research has also been utilized in three domains of  education: teacher education and professional development; research on science learning; and curriculum development and implementation.
  • Reed J. in a paper suggested some of the principles of action research appear to offer much towards the development of a practice-rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric.
Action Research Articles
Reed J. Using action research in nursing practice with older people: democratizing knowledge.J Clin Nurs. 2005 May;14(5):594-600.
This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research.
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