Table 3.
Example of how action cycles, key themes, and excerpts relate to one another.
| Themes | Examples of issues unearthed during reflections with nursing staff. | Post-project feedback |
|---|---|---|
| Communication Action cycle one | Ward Manager: 'Communication within the ward is deficient at times...we seem to repeat the same information.' | Ward Manager: 'I have learnt to be more professionally mature and communicate with MDT, as an adult. |
| Interruptions Action cycle two | A. Doctors (e.g., 'concurrent ward rounds,' 'doctors working one nurse off another to get what they want'). B. 'Multiple interruptions at handover time from other professionals.' | Ward manager: 'Interruptions are so difficult to manage.' |
| Pain assessment Action cycle three Older peoples' needs | Nurse: 'Older people don't tell you about their pain.' Support worker: 'You have to get a nurse to repeat what the doctor says, they don't seem to understand.' | Nurse: 'We discuss how we can improve practice and how we may better help older patients to understand their care.' |
| Power imbalance Horizontal violence | Nurse: 'I want the ground rules to say that there will be no recriminations for opinions....if someone doesn't agree with you, then they can't make your life difficult.' | Nurse: 'We discuss issues and how to move forward as a team.' |
| Value Support Trust Respect | Support Worker: 'It's like you don't exist until someone wants something.' | Nurse: 'Increased support has been invaluable. |
| Threat | Lead Nurse: 'It's frustrating when insufficient time is given for new initiatives to be established.' | Nurse: 'Things in the ward are generally better.' |
| Autonomy | Nurse: 'Why is it I'm allowed to make a decision to give a patient paracetamol today, but not tomorrow when the senior nurse is on duty?' | Nurse: 'It's better now we delegate and support each other.' |
| Distorted perceptions | Nurse: 'We are under more pressure than anyone else.' Ward manager: 'We always consult everyone about what we do.' | Nurse: Thinking things through with you (facilitator) permitted a more appropriate response and resulted seeing things differently.' |
| Leadership Support Value | Ward manager: 'I was avoiding conflict but now see that avoidance has led to an increase in issues.' Nurse: 'You need to know whose decisions count.' | Ward managers: 'I've developed insight into how important it is for me to be a strong leader.' |