Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice
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Abstract
BACKGROUND: Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. METHODS: A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. RESULTS: Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. CONCLUSIONS: Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study.
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Some factors were more important than others in providing the conditions for, and influencing the effect of, implementation interventions, including inter-professional team working (including communication), decision-making authority (mediated by inter-professional tensions), and organizational buy-in.
“Findings from this study show that some factors were more important than others in providing the conditions for, and influencing the effect of implementation interventions, which included inter-professional team working (including communication), decision-making authority (mediated by inter-professional tensions), and organizational buy-in, issues evident in others' work [e.g., [34,35].”
From The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework (2013) · cites this paper as [35]
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- Authors
- Kavanagh, T., Stevens, B., Seers, K., Sidani, S., & Watt-Watson, J.
- Affiliations
- University of Toronto (CA)
- University of Warwick (GB)
- Toronto Metropolitan University (CA)
- Corresponding author
- Kavanagh, Tricia
- Stevens, Bonnie
- Venue
- Implementation Science
- Published
- 2010-11-20
- Volume
- 5
- Issue
- 1
- Pages
- 90-90
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3000375
- OpenAlex
- W2098044024
- Cited by
- 35
- References
- 48
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 3 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 3 · 2012: 5
- FWCI
- 5.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- TSpace (University of Toronto) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Registered Nurses' Association of Ontario
- Sigma Theta Tau International
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Appreciative Inquiry and Organizational Change
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- appreciative inquiry, knowledge translation, pediatric pain management, evidence-based practice, PARIHS framework, nursing leadership, surgical wards, implementation fidelity, acceptability, feasibility, barriers to change, pediatric hospital care
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