Changing nursing practice through reflection on the Roper, Logan and Tierney model: the enhancement approach to action research.

To the clinical practitioner both nursing models and nursing research may currently be highly valued by practitioners or managers. Yet, by facilitating group reflection on the nursing model identified in the ward philosophy and adopting the enhancement approach to action research, surgical nurses were empowered to effect change and, consequently, to enhance the quality of patient care in their ward. The study was undertaken in two phases over a 15-month period and utilized a multi-method approach. In phase 1 triangulation of the data enabled the practitioners/co-researchers to identify and reflect on patients' psychological needs within the independence/dependence continuum of the Roper et al. (1990) model. Phase 2 involved a collaborative approach to the planning, implementation and evaluation of innovations which resulted from reflection on practice. Nurse-doctor relationships including anaesthetist noncompliance were, though, a controversial issue. Collaborative practice was undermined by the co-researchers' ambivalence concerning feedback from the medical staff. Overall, however, the individual contribution of each co-researcher was recognized and valued. They had both choice and control which enabled them to develop personally and professionally. Group reflection was seen as essential feedback strategy during the change process.