Action Research Outline

Sharon Andrews RN, BN (Hons) & Andrew Robinson RN, PhD

Action Research - background

Action research (AR) is primarily concerned with changing “peoples’ practices, their understandings of their practices and the conditions under which they practice” (Kemmis, S. 2007). There are a number of distinguishing features of AR these being:

  • A cyclical process: AR is operationalised through a cyclical process consisting of problem identification, planning, taking action and collecting data, evaluation and reflection which may lead to the identification of new problems or a different focus on existing problems and subsequent planning, action and evaluation, reflection and so on (Waterman et al. 2001) (see Diagram 1 below)
  • Partnership: AR is carried out between the researcher(s) and practitioners (i.e. RNs, ENs, PCAs, allied health etc) who have interest in the area of practice under investigation. Practitioners are understood as “co-investigators” (Waterman et al. 2001).
  • Participatory and collaborative: participation and collaboration in ARemphasizes equity so that everyone engaged in the particular area of practice has an equal opportunity to be part of the research process. Participation of the co-investigators occurs at all points in the research, from problem identification, to action planning, taking action, data collection and evaluation (Kemmis, S. & McTaggart 1988; Waterman et al. 2001).
  • Conducted locally: problems that are identified by co-investigators in collaboration with the researcher are significant to the practitioners in the setting, therefore, planning and change processes are locally specific, to meet the needs of those in the setting (Greenwood & Levin 1998; Kemmis, S. & McTaggart 1988).
  • Reflective: AR engages all participants to candidly look at their practice and investigate what they say they do compared to what is currently being done. Reflection provides an impetus for change as practitioners come to identify gaps in their practice that they wish to address.

A recent systematic review of action research, undertaken in the UK offers the following generic description of action research as follows (Waterman et al. 2001, p. 12):

Action research is a period of inquiry, which describes, interprets and explains social situations while executing a change intervention aimed at improvement and involvement. It is problem-focused, context-specific and future-oriented. Action research is a group activity with an explicit critical value basis and is founded on a partnership between action researchers and participants all of whom are involved in the change process. The participatory process is educative and empowering, involving a dynamic approach in which problem identification, planning, action and evaluation are interlinked. Knowledge may be advanced through reflection and research, and qualitative and quantitative research methods may be employed to collect data. Different types of knowledge may be produced by action research, including practical and propositional. Theory may be generated and refined, and its general application explored through the cycles of the action research process.

The action research process:

Diagram 1

Adapted from Street A. & Robinson A. 1995 ‘Advanced clinical roles: investigating dilemmas and changing practice through action research’. Journal of Clinical Nursing: 4: 349-57

Getting Started

Establishment of a project team

As highlighted elsewhere in the STAR resource guide, the establishment of a project team that includes partnership with a research institute or university department (with a falls prevention focus) has numerous benefits for facilitating the translation of evidence into practice. Partnership with a university/research institute will facilitate:

  • ready access to the latest research evidence and falls prevention strategies;
  • training, data collection and analysis and evaluation of falls prevention activities; and
  • the acquisition of skills amongst Residential Aged Care Facility (RACF) staff establishing action research.

A project team should include people with skills that traverse a range of skills sets appropriate for the project. For example in the STAR project the project team included people with skills in research, aged care, falls and project management. A project officer liaised with RACFs and the university/research institute based members of the project team.

Management support and establishment of a steering committee

As a first step, it is essential to obtain management support for the project. It is important to not only discuss with management the aims and purpose of the project, but perhaps more importantly it is essential to seek support for the use of an action research approach so that managers are fully supportive of involvement by their staff.

The establishment of a steering committee is also important to provide the members of the action research group with access to support, guidance and advice throughout the course of the project from key stakeholders in the field. The committee should compromise stakeholders associated with the area of investigation with the capacity to provide advice and feedback on the research direction and progress.

Terms of reference for a steering committee could include:

  1. To monitor research activities and provide feedback where appropriate.
  2. To be a resource to the research group by promoting access to information networks and key respondents.
  3. To promote access to key decision making committees to facilitate the planning and implementation of action.
  4. To make recommendations on issues of concern related to the research.

The steering committee should meet at regular points during the project, ideally these meeting should be scheduled that committee members can provide feedback on progress (results, action plans) and outcomes: Below are some suggested meeting times:

Commencement of the project – introduction, terms of reference, establish mechanisms of contact and dissemination of information (e.g. meeting minutes and other research information);

Completion of preliminary data collection and problem identification;

Completion of 1st round of action planning;

Completion of first action cycle and development of subsequent action plans; and

At completion of the project to review project outcomes and recommendations.

Establish a falls action research group (ARG)

In the STAR project each RACF had a falls ARG that was integral to driving change within the RACFs. The falls ARG comprised various staff from the RACFs and a falls champion.

Find a Falls Champion

Prior to recruiting ARGs in each facility for the STAR project, a “falls champion” was recruited at each RACF. This person was an integral member of the project team at their RACF and in the ARG. The falls champion is a key driver of falls prevention project activities in the RACF and a key liaison between management and the ARG.

Requirements for setting up a champion position:

  • Enthusiastic and willing participant;
  • A position description that outlines the key responsibilities of the Champion (see Box 1 for an example of information that could be included in the position description);
  • Dedicated time allocated for the Champion to engage in project activities every week;
  • Training for the champion to undertake their role.

TIPS from our experience:

In the STAR project falls champions held positions as RNs, ENs and PCAs. Our experience across the various RACFs demonstrated that ideally a falls champion should be a staff member with a reasonable level of seniority in the facility. While PCAs who were falls champions were enthusiastic and committed, without significant management support they found it more difficult to drive change in their facilities’ compared to RNs that occupied more senior positions (e.g. supervisor, equivalent level 2 or level 3 RN).

Box 1

Establish the Action Research Group

The ARG will meet regularity during the course of the project to discuss issues of concern relevant to the areas of investigation. Key questions to consider when establishing an ARG are:

  • Who will comprise the ARG? – a diversity of members will better equip the group to share a range of perspectives, identify problems for different stakeholder groups and share knowledge and skills to develop innovative solutions.
  • How will members of the ARG be recruited? Potential members of the ARG should to be provided with an opportunity to engage in the project at their own discretion. While potential members can be accessed in a variety of different ways (e.g. on recommendation from management, participants in interest groups and other committees) it is essential that potential participants have a desire to be involved. If staff feel like they have no choice but to be involved, it is less likely that they will be committed to the process. Invitation flyers/posters, highlights in newsletters, public invitations in staff meetings are some suggested methods of alerting staff about the project and their opportunity to be a member of the ARG.
  • Who would be suitable members of the ARG? Participants should have an interest in the area of investigation and be open and enthusiastic to exploring ways that their practices can be changed and improved.
  • What do participants need to know prior to making a decision to be involved? AR is an iterative and interactive process that at times can involve intense periods of work by group members. Potential participants need to be informed about the level of commitment that their participation will involve and a realistic idea of the workload associated with the project over time,
  • How can participation in the ARG meeting be facilitated?Once the members of the ARG have been recruited, rosters may need to be reviewed to ensure that meeting times can be established to ensure maximum participation. Ideally modification of rostering should be done in consultation with management to ensure ongoing support for ARG members’ participation.
  • Preparation is critical: Taking the time to prepare ARG members to undertake their role is a cornerstone to a successful action research project (Gibbon 2002; Kelly & Simpson 2001; Morton-Cooper 2000; O'Conner 1987; Waterman et al. 2005). There are a variety of strategies that can be used to prepare ARG members. Box 2 (below) provides examples from our experience that may be useful for RACF staff.

Box 2

TIPS from our experience:

The STAR project had at least two RACFs involved in each participating state (TAS, VIC, QLD). Action research training workshops were conducted in each state. Members of the ARGs from the respective facilities attended the training workshop together (where geographically possible). Feedback from the ARG members indicated that meeting with their peers was invaluable as it facilitated networking that they may have otherwise not had access to. Enabling RACF staff to share ideas about and experiences form practice was important in reducing their sense of professional isolation and establishing state based networks around falls prevention.

Actually undertaking action research requires an organised and systematic approach. The next section of this resource will provide information about how to operationalise action research according to it’s key stages of problem identification, planning, taking action and collecting data, analysis/evaluation and reflection. While the stages are presented below as being discrete, in reality they often overlap (Kemmis, S. & Wilkinson 1998, p. 21). For example the stages of reflection and re-planning often overlap, given that knowledge from the reflection on previous action will inform the next round of problem identification and planning.

Operationalising action research

Problem Identification

A reconnaissance or preliminary investigation will enable members of the action research group to share and collect information about current practices and identify problems in relation to falls prevention and management in their RACFs. During this phase the ARGs meet regularly and reflect on their practices and consider:

the history of the problem

the context of their practices – organizational, economic, social

the culture of the RACF in terms of falls management and evidence based practice

what has previously been done to try and improve falls prevention; and

what sort of data should be collected to better understand falls prevention and management in their facility (e.g. what data sources are available, who else would be useful to collect data from.)

The reconnaissance phase assists the action research group to “cement” why they are concerned about the issue of falls in their facility and should enable them to articulate problems in their practices.

Meeting Frequency:

During the STAR project ARGs met on a fortnightly basis during the problem identification phase. If meetings are too far apart, the group will not gain momentum, they may forget what they have talked about and not have the opportunity to explore a range of issues in any detail.

Considerations Around Data Management:

Ideally, it is best to conduct a project that involves collecting multiple data sources from a various stakeholders under an ethics framework (could be an organizational ethics community or a university based committee), as this will ensure that there are measures to protect people’s anonymity and confidentiality. In the course of discussions ARG members may disclose sensitive data (e.g. related to organizational processes, facility management, resident care processes). It is essential that the group members feel safe to disclose this information if it is useful to the project. Therefore:

  • all members of the ARG will be given a pseudonym and this will be used in all information arising from the group meetings (e.g. minutes, case notes),
  • group members will be asked not to disclose the content of any discussions or research related data to anyone outside the ARG, unless specifically advised by the project officer and the action research group members. This will ensure confidentiality of research data.
  • Guidelines around communication will be established with the group in the initial meetings (e.g. how meetings will be recorded and how information will be distributed e.g. via email, in person).

TIPS from our experience:

Obviously, group members will be aware of the thematic concern of the research i.e. falls prevention. So you would assume that discussions amongst the group would occur in relation to this issue. Initially this may or may not be the case. If group members have previously had little involvement with research and limited opportunities for professional engagement with their peers, then for the first few meetings the group may feel it necessary to “air their frustrations”. This may the first time that they have been asked to share their concerns about practice!! While their discussions may occur in the context of falls prevention and management, dialogue could centre on issues that have, from the group’s perspective, the greatest impact on their practice (e.g. staffing issues, workloads, excessive documentation etc). So for the first few meetings consider asking the group broad questions in relation to the research area and allow them space to voice their grievances. This will develop a common understanding amongst the group members that they share similar problems and concerns, hopefully contributing to the development of cohesive group relations. The issues that the group raises will also help you understand the context of the group’s practice.

Action research Cycle– Plan, act, observe, reflect…

From the reconnaissance phase the action research group will have identified a number of concerns/problems related to falls management. At this stage the first action cycle will be put into place. This will consist of planning action to address an identified need, taking action, observing the results of the action and reflecting on the outcome (was the action successful or not?). Usually the researcher/project officer has a key role in guiding the first action research cycle. This is when the group will learn the practicalities of conducting action research. In later phases of the project the action research group will be better equipped to direct and manage their own action plans. It is important to remember that action research is RESEARCH so it is imperative that the process reflects a high level of rigor in the way it is undertaken.

Plan:

Planning action is a prospective process and needs to be done systematically. When planning action the ARG needs to consider:

what they wish to achieve from the action and have these objectives been clearly stated so that all group members are aware of what they are working towards.

Why is this intervention important/how is it going to make a difference? What do you think will be the outcome of the intervention?

the risks involved with taking the action and why the action might not be successful – identify the potential barriers to the action. This would include resource issues, political/cultural issues.

What could go wrong/ What are the risks?

how the action will be monitored while it is underway. What methods will the ARG members use to observe how the action is progressing and if there are any problems and how it has initially been received?

how change will be indicated. How will the impact of the action be evaluated and what data sources will be collected?

Consider the roles of various group members in the action. Who’s responsible? (Street 1995).

Meeting Frequency:

The planning phase is usually a busy time and requires the ARG members to carefully consider a range of issues prior to deciding on action. During this phase it is useful to meet weekly and depending on the amount of time that it takes the ARG to plan actions, you may need to extend the meeting times. For example, some groups work best when they have a block of time to tackle issues, rather than having to stop their work at the end of an hour meeting. Therefore, it is advisable to consider whether your group will require a block of 2-3 hours for action planning, across a few weeks. This may provide the time needed to workshop ideas and systematically plan what action will be implemented, how it will be conducted, monitored and evaluated.

TIPS from our experience:

Encourage the group to consider actions that start small, are doable and have a good chance of success. If the initial action(s) of the group are too complex and the group encounters too many barriers, they risk becoming despondent and lose commitment and enthusiasm for the project. An early victory will boost their confidence.