title: Developing the practice context to enable more effective pain management with older people: an action research approach.
abstract: BACKGROUND
  This paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice. While the intention of the project was to identify and change factors in the practice context that inhibit effective person-centred pain management practices with older people (65 years or older), reflective critical engagement with the findings identified that enhancing pain management practices with older people was dependent on cultural change in the unit as a whole.
  
  
  METHODS
  An EAR approach was utilised. The project was undertaken in a surgical unit that conducted complex abdominal surgery. Eighty-five percent (n = 48) of nursing staff participated in the two-year project (05/NIR02/107). Data were obtained through the use of facilitated critical reflection with nursing staff.
  
  
  RESULTS
  Three key themes (psychological safety, leadership, oppression) and four subthemes (power, horizontal violence, distorted perceptions, autonomy) were found to influence the way in which effective nursing practice was realised. Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice.
  
  
  CONCLUSIONS
  Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature. Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments.
authors.affiliation: Institute of Nursing Research/School of Nursing, University of Ulster, Shore Road, Newtownabbey, Co. Antrim, Northern Ireland. bg.mccormack@ulster.ac.uk
authors.forename: Donna
authors.initials: D
authors.lastname: Brown
authors.forename: Brendan G
authors.initials: BG
authors.lastname: McCormack
mesh_terms: D000368:Aged; D017144:Focus Groups; D006302:Health Services Research / Q000379:methods; D006801:Humans; D015404:Nursing Methodology Research / Q000379:methods; D009736:Nursing Process; D009741:Nursing Staff, Hospital; D059408:Pain Management / Q000379:methods*; D061214:Patient Safety; D016730:Program Development