Nurse Education in Practice (2008) 8, 221–222

Nurse

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Educationin Practice

GUEST EDITORIAL

Practice development: What is it and whyshould we be doing it?

It is increasingly fashionable in nursing to refer topractice development (PD), a concept that is poorlydefined, little questioned and seems to have anevangelical following, especially in the UK and Aus-tralia. But what exactly is it and is it a legitimateacademic activity? According to the website of theRoyal College of Nursing (RCN) in the UK, PD is‘‘. . . an approach that helps you, your team andorganisation to provide care that patients feel isright for them’’. There is no indication on this siteas to whether this statement is based on opinionor on actual research findings. There are questionsabout the claims of this activity to contribute to pa-tient care and improve patient outcomes in a sus-tainable way (Atsalos et al., 2007). Another issuethat deserves professional attention is the questionof how this vague and ill defined activity links withthe multidisciplinary team, the shared languageused by the team and the explicit understandingof nursing’s contribution to patient care. In Austra-lia, for example, other disciplines have not heardthe term and do not fully understand its meaning.Given this, why do we continue to develop a profes-sional image involving our own nursing languagethat is not fully understood by patients or othersin the health care team? The 7th International Con-ference on PD entitled’Portraits, Panoramas andPalettes’ leaves us questioning whether the flam-boyant language serves the interests of a develop-ing discipline which has still not achieved the fullintegration of research into practice.

Within the UK context, the information on theRCN website is quite vague. It mentions that thereis a PD team of 16 people across the UK at immedi-ate disposal to help individual nurses, teams andorganisations to: ‘‘improve care; create a goodplace to work in; meet government targets; con-

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tribute to organisational innovation and serviceimprovement; and implement clinical, shared andresearch governance agendas’’. Not content withthat, the PD team is also involved in a range of na-tional projects and contributes to an internationalPD collaborative and the creation of an interna-tional theory of PD. PD sits comfortably with otherbuzz words cited on the RCN website: facilitation,clinical supervision and action learning, criticalcompanionship and transformational leadership.Laudable and important as such concepts may be,surely this work should fall under the remit of pro-fessional and organizational development and bethe responsibility of individual clinical staff andtheir employing health care organizations.

Whilst not attempting to denigrate the goodintentions and aspirations of PD, we have seriousconcerns that it is being seen as an easy substitutefor scholarship and academic enquiry. It certainlyhas appeal to practitioners, but is PD any businessof universities? We pose this question because someof our academic colleagues seem to be of the viewthat not only should it be part of academic life, itshould be the central part. Given that there is suchambiguity around thewhole PD concept, and nursingis already criticised for latching onto such termsand phrases (thereby alienating ourselves fromother disciplines in the process), it could be to ourdisadvantage to once again create a language ofour own. A paper by Wilson and McCormack(2006), which provides an excellent comparisonand contrast of critical realism with other researchparadigms, also explains the relationship of criticalrealism to PD. However, they argue that it is some-how ‘‘emancipatory’’ PD (ePD) and is a differentform of evaluation from others. The argumentshere are often mixed, the theory is drawn from

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222 Guest Editorial

several methodologies and yet somehow ePD ‘‘teststhe outcomes of the research’’ (Wilson and McCor-mack, 2006, p. 45). We are not convinced that someof the exponents of critical realism such as Pawsonand Tilley (1997) would recognise this ‘emancipa-tory’ element, even if they understood its meaning.

Another frequent commentator on nursing mat-ters is Rolfe and he has, for example, suggestedthat PD should be a major component of an aca-demic’s work. In a recent rebuttal to an editorialby us (Thompson and Watson, 2006), Rolfe (2007)argues that we have forgotten the teaching andPD aspect of scholarship. We have responded andquestioned why professors should feel obliged toengage with it. We (Watson and Thompson, 2007)argue that there are at least two dangers inherentin such a desire: first, that it endangers the profes-soriate and academic enquiry into nursing by pan-dering to the insatiable appetite of the NationalHealth Service (NHS) for ‘pairs of hands’; and sec-ond, that PD is a diversion from, and an alternativeto, academic activity. It is interesting to note thatthis phenomenon has moved ‘‘down under’’ and inAustralia, the interest around PD has culminated inone university there partnering with one in the UKto develop an international Masters programme inPD. The curriculum appears non-specific and todraw from practice development methodologiesand philosophies, although it is not clear whatthese actually are. Does PD have its own uniquetheoretical base or is it simply repackaging existingtheories and presenting it as a unique phenome-non? Does the development of a Masters programin PD legitimise an otherwise nebulous concept?

PD may complement scholarly enquiry but we doquestion its legitimacy as an academic pursuit;especially if it is viewed as what we really oughtto be doing as nursing academics. It appears thatonce again we feel the need to add another typeof theory or methodology (that is not used in anyother discipline) to try and distinguish ourselvesas different; however in the process of trying todo this we may once again be alienating ourselves.Given that UK and Australian universities are aboutto go through a research assessment exercise, thiswill have ramifications not only as how we stand asa discipline but it could also affect how we collab-orate given that no-one understands what we aresaying or doing when we talk about PD.

We need to be acutely aware that nursing is veryquick to adopt fads and fashions – witness the

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nursing process, nursing models, team nursing, pri-mary nursing, to name a few – which have a prettyshort shelf life. PD has outlasted some and mayoutlive us. That is fine, but let us recognise PDfor what it is and what it is not and let us have adebate – which we hope this paper stimulates –on whether it serves nursing’s interests as a devel-oping profession and academic subject.

References

Atsalos, C., O’Brien, L., Jackson, D., 2007. Against the odds:experiences of nurse leaders in Clinical Development Units(Nursing) in Australia. Journal of Advanced Nursing 58, 576–584.

Pawson, R., Tilley, N., 1997. Realistic Evaluation. Sage, London.Rolfe, R., 2007. Nursing scholarship and the asymmetrical

professor. Nurse Education in Practice 7, 123–127.Thompson, D.R., Watson, R., 2006. Professors of nursing: what

do they profess? Nurse Education in Practice 6, 123–126.Watson, R., Thompson, D.R., 2007. Asymmetrical professors:

unbalanced or misunderstood? Nurse Education in Practice 8,73–75.

Wilson, V., McCormack, B., 2006. Critical realism as emancipa-tory action: the case for realistic evaluation in practicedevelopment. Nursing Philosophy 7, 45–57.

David R. ThompsonDepartment of Health Sciences,

University of Leicester,22–28 Princess Road West,

Leicester LE1 6TP, UKTel.: +44 (0) 116 252 3205;fax: +44 (0) 116 252 3269

E-mail address: drt10@le.ac.uk

Roger WatsonUniversity of Sheffield, Sheffield, UK

Tom QuinnCoventry University,

Coventry, UK

Linda Worrall-CarterAustralian Catholic University,

Melbourne, Australia

Bev O’ConnellDeakin University,

Melbourne, Australia

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