Table 1 Overview of the action research project, including timeframes for the different phases, the primary content of the different parts of the action research cycles in each phase, and data sources utilized when exploring the process
Project Phase | Time | Content of the Action Research Cyclesa | Data Sourceb | |||
|---|---|---|---|---|---|---|
Observing and reflecting | Planning | Acting | ||||
Developing activities | Implementing activities | |||||
1. Initiating and defining the improvement work | November 2011–March 2012 | Problem identified inter alia by review of health records. Need for change acknowledged. | Initial planning for a clinical pathway project. Researcher contact established. | Core project group and external facilitators assigned. Patient group chosen for the first pathway. Necessary permits obtained. | Project information provided in nursing and anesthesiologist staff meetings and by e-mail. | Logbooks. Field notes. One FG with the core project group. |
2. Exploring and initial drafting | March–November 2012 | Current practice and existing guidelines scrutinized and reflected upon. | Planning for developing the pathway and for the need to create new or revise existing guidelines. | External searches and reviews of pathways in other ICUs. Evidence search with librarian assistance. Initial drafting of a pathway and some guidelines. | Pathway methodology lectures (with only nursing staff attending). Involving specialized staff to find evidence for guidelines. Involving staff outside the core group in reviewing drafts. | Logbooks. Field notes. Two core group FGs. One physiotherapist and two manager interviews. Six staff FGs. |
3. Revising, completing and implementing | November 2012–October 2014 | Perspectives from staff and managers on the drafts were collected and considered. | Perspectives were prioritized, and plans were constructed for revised models of the guidelines and pathway. | Revision and successive intranet publication of guidelines. Composition, clinical testing, and intranet publication of the pathway. | Repeated information in nursing staff meetings. Each guideline e-mailed to all staff. Strategically placed reading copies and sign-up lists. An external lecturer discussed change in sedation regime (reaching all staff categories). | Logbooks. Field notes. Two core group FGs. |
4. Enforcing and evaluating | October 2014–September 2016 | Use and perceptions of the pathway were evaluated, and the results were reviewed. | Planning for enhanced utilization. | Repeated information and reminders to staff. Feedback from data analysis to managers and staff. | Field notes. Two manager interviews. Four core group interviews. Five staff FGs. Questionnaire. Monthly health record screening. | |