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ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUALITATIVE

Building research capacity and productivity among advanced practice

nurses: an evaluation of the Community of Practice model

Janice G. Gullick & Sandra H. West

Accepted for publication 29 September 2015

Correspondence to J.G. Gullick:

e-mail: [email protected]

Janice G. Gullick MA PhD RN

Senior Lecturer/Coordinator/Master of

Emergency & Intensive Care Nursing/

Director/Postgraduate Studies

Sydney Nursing School, University of

Sydney, New South Wales, Australia

Janice Gullick@GullickJanice

Sandra H. West BSc PhD RN/RM

Associate Professor of Clinical Nursing/

Coordinator/Higher Degree Research

Students

Sydney Nursing School, University of

Sydney, New South Wales, Australia

GULL ICK J .G . & WEST S .H . ( 2 0 1 6 ) Building research capacity and productivity

among advanced practice nurses: an evaluation of the Community of Practice

model. Journal of Advanced Nursing 72(3), 605–619. doi: 10.1111/jan.12850

Abstract Aim. The aim of this study was to evaluate Wenger’s Community of Practice as a

framework for building research capacity and productivity.

Background. While research productivity is an expected domain in influential

models of advanced nursing practice, internationally it remains largely unmet.

Establishment of nursing research capacity precedes productivity and

consequently, there is a strong imperative to identify successful capacity-building

models for nursing-focussed research in busy clinical environments.

Design. Prospective, longitudinal, qualitative descriptive design was used in this

study.

Methods. Bruyn’s participant observation framed evaluation of a Community of

Practice comprising 25 advanced practice nurses. Data from focus groups,

education evaluations, blog/email transcripts and field observations, collected

between 2007 and 2014, were analysed using a qualitative descriptive method.

Findings. The Community of Practice model invited differing levels of

participation, allowed for evolution of the research community and created a

rhythm of research-related interactions and enduring research relationships.

Participants described the value of research for their patients and families and the

significance of the developing research culture in providing richness to their

practice and visibility of their work to multidisciplinary colleagues. Extensive

examples of research dissemination and enrolment in doctoral programmes

further confirmed this value.

Conclusion. A Community of Practice framework is a powerful model enabling

research capacity and productivity evidenced by publication. In developing a solid

foundation for a nursing research culture, it should be recognized that research

skills, confidence and growth develop over an extended period of time and

success depends on skilled coordination and leadership.

Keywords: advanced practice nurses, community of practice, qualitative research,

research capacity

Introduction

Advanced practice nurses (APNs) must provide clear evi-

dence of research productivity to address the research

domain in influential models of advanced nursing practice

(Ackerman et al. 1996), government policy (NSW Health

2011) and role descriptions (Cashin et al. 2014). There are

co-existing gaps in research preparation and infrastructure

to support APN research (Watson et al. 2005) and the

prominence of research expectations in organizational and

policy documents does not necessarily translate into

research activity (O’Baugh et al. 2007). It is, therefore,

important to consider frameworks for research capacity

building. Nursing research capacity is a necessary precursor

to productivity requiring specific skills, a culture of collabo-

ration and sustainable pathways for conducting research in

busy clinical environments.

While O’Byrne and Smith (2010) claim the expected level

of nursing research competency remains unclear, APN role

descriptions including Clinical Nurse Specialists (CNS) in

the UK and US (Baldwin et al. 2013) and Clinical Nurse

Consultants and Nurse Practitioners in Australia (Table 1)

clearly articulate important research expectations (Chiarella

et al. 2007, NSW Health 2011, Mick & Ackerman 2013).

This study will use the broad term of Advanced Practice

Nurse (APN) when discussing such roles.

Background

O’Byrne and Smith’s (2010) review of 16 papers describes

three nursing research capacity-building models: the Evi-

dence-Based Practice Model focussing on skills in appraisal

and synthesis to facilitate research translation (Melnyk

2007); the Facilitative Model focussing on research leader-

ship (Ryan & Aloe 2005, Stetler & Caramanica 2007) and

the Experiential Learning Model that develops individual

capacity through direct, ‘hands-on’ learning (Fitzgerald

et al. 2003, Priest et al. 2007). Evaluations of these models

note a lack of defined outcomes and methodological rigour

(O’Byrne & Smith 2010, B€ack-Pettersson et al. 2013,

Wilkes et al. 2013).

There is also evidence that health service managers con-

sistently value the domains of clinical service and consul-

tancy over research when considering APN workloads

(Wilkes et al. 2013). The expectation for research produc-

tivity for Australian APNs and the obvious difficulty they

had complying, despite their desire to achieve high-level

research outcomes (Bloomer & Cross 2011, Wilkes et al.

2013), led to the establishment of a Research Community

of Practice (CoP) (Wenger et al. 2002). This is a variation

in the experiential learning model providing both situated

learning and research mentorship to build research capacity.

The Community of Practice (CoP)

Wenger (1998) conceptualises a CoP as a vehicle for collec-

tive learning in a field of shared human endeavour,

Why is this research needed?

� Internationally, influential models of advanced nursing practice note research as an integral practice domain.

However, the prominence of this expectation in job

descriptions and policy documents does not necessarily

translate into research productivity.

� Previously published evaluations of research capacity building note a lack of defined outcomes and methodologi-

cal rigour.

� Wenger’s Community of Practice model presented a promising theoretical and practical framework for research

capacity building that could assist senior nurse clinicians

to meet their advanced practice domains.

What are the key findings?

� Wenger’s Community of Practice model invited varying levels of participation, allowed for evolution of the

research community and created a rhythm of research-

related interactions and enduring research relationships.

� Community of Practice members perceived value in their research findings for their patients and families. They

noted the significance of the developing research culture in

providing richness to their practice and visibility of their

work to multidisciplinary colleagues.

� Value was further demonstrated through extensive exam- ples of research productivity and dissemination and

through enrolment in higher degree research.

How should findings be used to influence practice, research and education?

� Wenger’s Community of Practice should be considered as a model to enable research capacity, productivity and pub-

lication for advanced practice nurses.

� It should be recognized that in developing a solid founda- tion for a nursing research culture, research skills, confi-

dence and growth develop over an extended period of

time.

� Skilled onsite coordination and leadership appear to be vital components for a successful and productive nursing

research Community of Practice.

J.G. Gullick and S.H. West

enhanced by mutual concerns, passions and regular group

interactions. Three crucial criteria define a CoP and our

application as a model for research capacity building: the

Domain – a shared commitment to the domain of interest;

the Community – members engage in group activities to

learn from and support each other and Practice – CoP

members are practitioners. CoP members develop a bank of

resources embodying elements of shared practice that may

include stories, tools and approaches to problem-solving

(Wenger et al. 2002, p. 27-40).

The experiential learning model is extended by Wenger’s

positioning of people as social beings and his concept of sit-

uatedness extends understandings beyond ‘learning-by-

doing’. Knowledge develops through active participation in

a valued enterprise with learners fully participating in their

world and generating meaning (Tennant 1997, p. 73, Wen-

ger 1998, p. 4).

CoPs may exist in many forms: face-to-face or online;

some formally recognized and funded, with others informal.

The concept is applied in business, government, education

and professions and enables connections across formal

organizational structures.

CoPs require cultivation; fostering participation rather

than organizing and directing. Wenger describes seven prin-

ciples that foster the CoP’s energy and internal direction

(Wenger et al. 2002, p. 13). These theoretical principles

which frame our evaluation are: designing for evolution;

opening dialogue between insider and outsider perspectives;

inviting differing levels of participation; developing public

and private community spaces; focussing on value; combin-

ing familiarity with excitement and creating a rhythm for

the community. While the CoP model has been used in

nursing practice development (Tolsen et al. 2006) and to

develop health research capacity (Short et al. 2010), no rig-

orous evaluation has been published.

The study

Aim

The aim of this study was to evaluate Wenger’s (2002) CoP

model for building research capacity and productivity of

APNs.

Design

Bruyn’s (1966) participant observation, in a longitudinal,

qualitative descriptive design, was used to evaluate the CoP

as a model for research capacity building. While there is lit-

tle precedent for Bruyn’s method in health service evalua-

tions, with its origins in social anthropology, it has a rich

history conceiving systematic, qualitative descriptions and

explanations of the symbolic modes of life amongst distinct

social groups. The participant observer describes the natural

meanings and expressions of participants in his/her own

way and interprets these expressions in the light of theory

(Bruyn 1966, p. 185). The method includes both interview-

ing and observation and requires the observer to share in

the life, activities and culture of the social group. Personal

involvement, including sympathetic identification, is recog-

nized as part of the research; however, researchers refrain

from moralizing or judging (Bruyn 1966, p. 66). This study

therefore provides a description of the documented traces

of behaviours, beliefs and events and presents our

Table 1 Domains of practice of APNs in Australia.

Nurse Practitioners in Australia

Australian Nursing & Midwifery Board (ANMB 2014)

Clinical Nurse Consultants in Australia

(NSW Health 2011)

Nurse Practitioner (NP) roles are guided by National Standards that

describe a senior nurse clinician who:

1) assesses using diagnostic capability

2) plans care and engages others

3) prescribes and implements therapeutic interventions

4) evaluates outcomes and improves practice

NPs are also expected to “implement research-based innovations

for improving care”.

Most NPs in Australia qualify with a Master of Nurse

Practitioner.

In New South Wales, Australia, a Clinical Nurse Consultant has a

position description covering five domains:

1) Clinical Service and Consultancy; providing expert clinical

advice to health professionals, patients and carers;

2) Clinical Leadership; facilitating development of expert

clinical practice;

3) Research; initiation, implementation and dissemination of

research findings;

4) Education; developing and delivering specialty education

programmes;

5) Clinical Services Planning and Management; participating in

strategic and operational positioning of their clinical service

NSW CNCs ideally have postgraduate qualifications with a

Masters being the desired preparation (ANMB, 2013).

JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUALITATIVE A Community of Practice to build research capacity

understandings in a manner that best fits and remains close

to the data (Sandelowski 2000, 2010).

Participants

The onsite CoP coordinator (and researcher), a doctorally

prepared Clinical Nurse Consultant (CNC) (JG), invited

participation from 40 APNs from a single teaching hospital

in Sydney, Australia. Twenty-five APNs with median of 20-

years’ experience expressed interest and provided written

consent (Table 2).

Most participants self-selected into research clusters (3-5

APNs) created around clinical groupings. Each cluster was

mentored through a qualitative research project. Three par-

ticipants (one cluster) withdrew due to workload and two

left the institution (6-months after training and before their

research commencement), having agreed to retention of the

early data they contributed. Four new participants joined;

two as new employees and two returning from extended

leave.

Participant preparation

The onsite CoP coordinator provided research mentorship

and with a university-based academic (SW), coordinated

14-hours of face-to-face workshops (2-3 hour sessions),

along with a CoP resource website and blog site for com-

munication and peer support. Situated ‘learning-by-doing’

for each cluster then followed.

Data collection

Sources of CoP evaluation data included 170 group emails

and blog communications, 58 education session evaluations

and field observations of APN engagement in the CoP from

2007–2014. Six focus group interviews with APNs at three

time points were conducted by two independent academics

not otherwise involved in the study. Interviews were audio-

recorded and professionally transcribed.

With publication an important endpoint, observation

continued until the final cluster using phenomenology

achieved publication. Outcomes included evidence of

research dissemination: publication in peer-reviewed jour-

nals; reports to professional organizations or government;

conference presentations; workplace seminars and research-

focussed teaching delivered by participants. The prolonged

exposure in the research setting was managed with a con-

tinued focus on active collaboration by the coordinator, as

participant observer and an open attitude that focused on

freedom of expression, encouragement and acknowledge-

ment of each small step achieved by participants in complex

clinical roles.

Ethical considerations

Hospital and university ethics committees approved the

study. APNs were not directly approached for recruit-

ment but answered an email expression of interest. To

further reduce the opportunity of coercion, APNs could

participate in research training and mentorship without

themselves being participants of this evaluation. Partici-

pants were allocated pseudonyms. Because participants

know each other, participant characteristics and their

links to quotes are kept to a minimum to maintain con-

fidentiality.

Data analysis

Data were firstly read, reflected on and thematically orga-

nized by both researchers. Whilst Qualitative Description

most commonly uses content analysis, other approaches to

data analysis are accepted providing the methodological

processes are clearly articulated (Caelli et al. 2003). We

reference Caelli et al.’s understanding of Qualitative

Description which describes the use of an analytic lens to

determine meanings as ‘embedded in the theoretical con-

text of the research’. This fits well with Bruyn’s descrip-

tion of analysis for participant observation, requiring data

to first be deconstructed intellectually, separating events

(research-related interactions), beliefs (about personal

research capacity in own APN practice) and patterns of

conduct (demonstrating engagement with, or disconnec-

tion, from research behaviours) so that new relationships

become apparent. These are then reconstructed in a man-

ner that relates them to a theoretical viewpoint (Bruyn

1966 p.34).

Wenger’s Seven Principles for cultivating a Community

of Practice were therefore used as the analytic lens to

describe the central representations around which the cul-

ture of the CoP was organized. Recurring categories and

patterns that were fully developed and seen to cut across

Table 2 Characteristics of participants.

Role descriptor

and gender N (%) Highest qualifications N (%)

CNCs 23 (92%) Bachelor degree 3 (12%)

NPs 2 (8%) Graduate Certificate 2 (8%)

Females 23 (92%) Graduate Diploma 7 (28%)

Males 2 (8%) Masters degree 12 (48%)

PhD 1 (4%)

J.G. Gullick and S.H. West

the data set were identified (Caelli et al. 2003) and the

extent to which the explanations seemed trustworthy and

appropriate to the theoretical framing of the CoP were con-

sidered.

Rigour

Bruyn’s construct of ‘six indices of subjective adequacy’

guided the rigour of this work (1966 p. 180–5). Our design

demonstrates adequate Time, observation occurred over

7 years (longer observation increasing accurate interpreta-

tion of social meanings); Place, a geographical closeness

allowing observation in the context of participants’ every-

day lives; Social Circumstance, measured by the large num-

ber and variety of observer-witnessed social circumstances;

Language, the researcher as an insider was conversant with

professional vernacular and social nuance; Intimacy of

Encounter, the researcher participated in professional

encounters, meaningful gatherings and rituals in APN cul-

ture and Social Consensus, by recording how participants

confirm meanings, directly in conversations among them-

selves in their natural setting and indirectly by observing

professional rituals and gatherings. An audit trail, interview

guides and independent initial coding by researchers further

enhanced rigour.

Theoretical positioning (Caelli et al. 2003) is an impor-

tant element of rigour. The researchers identified several

self-held attitudes towards the phenomenon prior to study

commencement. JG, a colleague of participants, performed

a similar APN role. She had initiated research projects as

both junior and senior clinician and later as a clinical aca-

demic. She believed APNs’ research capacity was a matter

of confidence, process knowledge and commitment. The

participant observer needs to incorporate aspects of engage-

ment and detachment (Bruyn 1966 p.14; Patton 2015): this

required constant reflection given JG’s position as a pre-

existing member of that community.

SW, a university academic, believed clinical nurses priori-

tized content knowledge (their comfort zone) over other

types of knowledge. The APNs’ immersion, comfort and

identity in the ‘busyness’ of the clinical area was believed

by both researchers to be a major barrier to the production

of research-based nursing knowledge. SW’s position as an

outsider allowed investigator triangulation, helping to mini-

mize interpretation bias.

Findings

Wenger’s (2002) Seven Principles to foster a CoP’s own

energy, character and internal direction provide the

theoretical framework for discussion of our results

(Table 3). Key design aspects allowing evolution of the

community emerged through group learning in negotiated

research clusters. This was enhanced by flexibility of edu-

cation delivery and cluster activities, staged research pro-

cesses and onsite research coordination. Flexibility was

the most important determinant in participant engagement

with face-to-face education with every session held at

least twice and available online.

Training time for the APN’s was negotiated with nursing

administration as ‘in-kind’ support as part of an Industry/

Faculty funding agreement. Although APN time was not

backfilled, attendance levels were high. Session evaluation

data indicate that attendees had difficulty in arranging

release from their clinical duties on the day for 43%

(n = 24) of evaluated occasions of attendance. Despite this

difficulty in ‘getting away’, the educational activities made

participants feel valued. This was attributed to the nursing

focus of the research and the structuring of learning around

their needs: ‘. . .and to be invited to participate in it!’ (Mor-

gan, FG-5).

The onsite-positioning of the coordinator and her APN

role meant that she was well-known and deemed accessible:

She was very supportive, always accessible and really drove both

projects. You could always ask questions. . . and that’s what you

need in a busy hospital. . . it’s hard to get the headspace and it still

has to come from within. . . but you need someone driving it and

giving that enthusiasm. (Helen, FG-6)

Research clusters created their own group learning strate-

gies, sharing ideas and learning from each other:

We used strategies like, sit in and listen to an interview and pull it

to pieces and say ‘How would we improve on this next time?

(Tina, FG-2)

The research was offered at two stages using the same

data set (Table 4). The nurses firstly sorted and reported

their data using a qualitative, quality improvement method

(Picker Dimensions of Care) (ACI (NSW Agency for Clini-

cal Innovation) 2014) allowing acquisition of foundational

research skills and incorporation of findings into the quality

improvement cycle. Members and/or clusters could com-

plete/exit at this stage. For the three clusters who wished to

go further, the second stage involved more in-depth analysis

using Heideggerian phenomenology.

The Picker Dimensions suited APNs who either felt too

time poor for deeper research engagement, or who were

uncomfortable with the dense nature of phenomenology.

Vanessa was somewhat overwhelmed by hermeneutic

analysis:

JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUALITATIVE A Community of Practice to build research capacity

Table 3 Data elements relating to Wenger’s theoretical principles.

Principles Identified data elements Evaluative comments

Designing for evolution

(Wenger 2002, p51) • Flexible education delivery • Two-stage research process • Group learning in negotiated

research clusters built on

co-existing personal/professional networks

• Onsite research coordination • Research clusters created their own group

learning strategies

• Nursing focus of the research • Structuring of learning around

the APNs needs

• Research capacity building & productivity is a long-term process

• Each cluster had different ways of working

• Design should not impose structure, but assist the community to

develop. Some participants were

convinced by their peers to join

rather than initially expressing

interest & these members were less

productive.

Opening dialogue between

inside and outside

perspectives

(Wenger 2002, p54).

• Onsite, insider coordination strengthened coordinator

understanding of the community’s needs

• Implementing recommendations meant drawing in &

negotiating with other members of the

multidisciplinary team

• Research dissemination lists sent to nurse & hospital administrators

• Medical heads of department became aware of nursing research findings

• Research dissemination through professional organizations, department

of health performance &

redesign, research-informed

clinical teaching &

publication in peer-reviewed journals

• While the university academic, as a co-designer & researcher provided

an outsider perspective, the

embedded nature of the CoP

coordinator may have limited

potential for innovation.

Inviting different levels

of participation

(Wenger 2002, p57-8)

• Opt-out possible for second stage of phenomenology

• For highly productive members, research meant homework

• In every cluster a natural leader would emerge & at

least one member had a significantly reduced

level of participation

• Need for negotiation around levels of contribution

• Less active participants still felt they were

members of CoP

• Members were unprepared for unequal level of contribution

• Clinical busyness created unequal contribution

• Some push ahead but others could feel left behind/excluded

• The full time clinical role of coordinator meant less

active members were likely to receive

less attention

Develop public and private

community spaces

(Wenger 2002, p 58)

• Website useful as a repository for resources • CoP visible on the

agenda for CNC meetings

• Limited public community focused events

• Multiple public research sharing events

• The enduring web of research relationships strengthened the APN community

• Blog not useful due to lack of time • The privacy of email preferred as a

communication medium

J.G. Gullick and S.H. West

I really enjoyed the Picker review. . . it was straightforward; you

knew what you were looking for. It wasn’t the layers that you have

to go through for the other. . . (Vanessa, FG-4)

Cathy, however, felt the Picker Dimensions were over-

simplistic and enjoyed the abstraction of phenomenology:

The Picker was almost superficial. . . like the questionnaire you have

in a hotel. . . it ticks all the boxes for some people but. . . it didn’t

push any buttons for me. (Cathy, FG-5)

Helen also enjoyed the intellectual rigour of phenomenol-

ogy. It delivered richness to her role and an understanding

of patients and families that stood out against the task-

orientated ‘housekeeping’ aspects of her job. As a member

of one of three clusters that eventually achieved publication

of highly philosophical papers, Helen reflected on her early

engagement with philosophically informed research:

The intellectual richness, it was a different way of communicating

with others. . . I remember trying to say ‘Heideggerian Hermeneutic

Phenomenology’ {laughing}. . . I had to present it at this conference

and it took me a week. . . I had it up on the fridge. (Helen, FG-6)

Nurses’ experience of ‘clinical busyness’, commonly cited

as a barrier to research capacity and participation (Priest

et al. 2007, Richardson et al. 2007) was the greatest chal-

lenge for participants and putting time aside in the diary

was not always sufficient:

It’s about being structured. . . allocating time. . . then striving

for that. . . You treat it like a luxury to do research. . . and

still the clinical aspect of your role overrides that. (Narelle,

FG-2)

Because of the constraints of clinical business, it became

apparent to participants that research work meant ‘home-

work’. This was perceived as either an intrusion, or as a

way of managing work they valued, but could not fit into

an 8-hour day:

It started to impose on our home life. . . we shifted from doing it in

the hospital to, ‘I don’t have time for this’, so then you take it

home. . . You didn’t have that designated time. (Freya, FG-5)

Others chose to take research home because of mutual

convenience to their participants and themselves:

Table 3 (Continued).

Principles Identified data elements Evaluative comments

Focus on value

(Wenger 2002, p59) • Research constantly framed as a

key indicator of CNC/

NP professional performance.

• Educational activities made participants feel valued • Acknowledgement of quick wins • Research dissemination lists to all

CoP members

• Made nursing inquiry observable, changed practice & improved patient & family experience

• Awareness of a developing research culture & ability for growing independence

• Awareness of personal & professional growth.

• A difference in value perceived between involvement in medically

oriented studies vs. nursing-focused

research which was seen as more

meaningful within the group

Combine familiarity with

excitement (Wenger 2002, p62) • Research analysis weekend • Half-day research presentations • Team teaching delivered by APNs to UG &

PG nursing students

• Creation of a short film by one cluster that won a short film award

• Oral & poster presentations at conferences

• Larger events did not need to be frequent to be effective

• Smaller events were often member/cluster driven

• Clusters that engaged with these opportunities were the

most successful

Create a rhythm for the

community (Wenger 2002, p62-3) • Corridor chats were a motivating

force within & between clusters

• Most rhythmic activity happened at cluster level • The coordinator created much of

the rhythm behind the scenes

• Groups that had less internal energy & motivation were

less responsive to coordinator

communication, meeting action

points, etc. were, unintentionally,

less likely to receive

coordinator time

JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUALITATIVE A Community of Practice to build research capacity

I did the [phone] interviews from home. . . It was easier when the

kids had gone to school and I had a quiet environment. . . I’m in an

office with three other people. (Linda, FG-6)

Unequal levels of contribution were discussed at

length by participants. There were times when cluster

instability, because of leave or secondment, undermined

continuity of cluster work. In this study the strongest,

most productive clusters had at least two motivated core

members. Usually a natural leader would emerge and

take responsibility for pushing progress and every cluster

had at least one member who had significantly less

involvement:

You’ve always got people who form different roles within a

group. . . people that have more motivation. . . are better at inter-

view skills. . . or better at analysis. They’ll pull right back on things

that they’re not interested in or believe they’re not good at. (Mor-

gan, FG-5)

At times, a lack of collaborative progress meant one or

more people would push ahead to achieve a project out-

come. Melinda explains:

In my cluster it was a bit disappointing that some. . . wouldn’t

engage. That created a bit of friction. . . Even though we tried really

hard, I still felt guilty ‘cause we took it and ran, but I also felt. . . a

bit let down by the others. (Melinda, FG-5)

From another cluster, Linda described feeling left behind

in relation to a quality initiative that emerged from their

cluster work:

Table 4 Structure of APN research process.

Elements Processes

A two-stage analysis of a single qualitative patient

and family data set collected by the APNs.

1) Picker Dimensions of Care

Stage 1 – Picker Dimensions of Care

Process: A quality improvement method to determine areas for patient and family

centred service improvement (Picker Institute, 1998, ACI (NSW Agency for

Clinical Innovation) 2014). Qualitative interview data are themed and prioritized

under the dimensions of: (1) Access to care; (2) Respect for patients’ values,

preferences and expressed needs; (3) Coordination and integration of care; (4)

Information and education; (5) Transition and continuity; (6) Physical comfort

and clean and comfortable environment; (7) Emotional support and alleviation

of fear and anxiety; and (8) Involvement of family and friends.

Picker findings were used by each cluster to develop a report with recommendations

to the local Area Health Service and to the State Health Department’s Performance

Improvement Unit. Results were further disseminated through conference and seminar

presentations. Clusters/members could finalize their engagement with data at this

stage, if they wished.

Purpose: Allows acquisition of foundational research skills (ethics process, recruiting

and consent, qualitative interview skills, basic thematic interpretation) and the

incorporation of findings into the quality improvement cycle. Has a focus on service

development as an important domain of APN practice. Provides a method for patient

and family engagement embedded in the quality processes of NSW Health. Provides

experience in quality reporting with a focus on developing and implementing quality

recommendations.

2) Heideggerian Phenomenology Stage 2 – Heideggerian Phenomenology

Process: Hermeneutic analysis of patient and family interview data using an existential

philosophical framework (Heidegger 1962). This circular interpretation process

of “reading, writing, talking, mulling, re-reading, re-writing” (Smythe

et al. 2008, p,. 1393) uses back-and-forth comparisons between the parts

(individual quotes and stories) analysed against the whole (greater backdrop of the

participant within their described family and broader culture and society).

Dissemination of phenomenological findings occurred through conference and

seminar presentations, postgraduate teaching by clinicians and peer-reviewed

publication in high quality nursing journals.

Purpose: To develop a “thick” narrative description (Ryan & Aloe 2005) of the

lived experience of illness and hospitalization for generating new nursing knowledge.

To expose APN’s to a rigorous qualitative research method with a strong conceptual

and philosophical grounding as a basis for analysis and writing for publication.

J.G. Gullick and S.H. West

We weren’t included, yet our name was on it. . . we felt really bad

that we didn’t contribute, but we wanted to contribute. (Linda,

FG-6)

A focus group discussion reflected on the important

aspects of cluster formation and the CoP structure as a

whole:

When people aren’t pulling their weight you need to try and fig-

ure out why. Is it simply lack of confidence? So they need sup-

port and motivation to continue (Morgan, FG-5). . . And I guess

we put our own expectations onto others, ‘You should be feeling

the same as me’. . . And you can’t enforce that (Freya, FG-5). . .

People have different ways that they work and behave. . . Even

something like Meyers-Briggs [personality typing] might be useful

in identifying how we can bring the best to a given situation.

(Cathy, FG-5)

The level to which inactive participants still considered

themselves CoP members was surprising and pleasing and

demonstrates that learning and a sense of inclusion can

occur at many levels. (Wenger 2002, p. 57) describes the

need to ‘build benches’ for those on the sidelines to keep

members feeling connected. Judy attended research training

but did not actively participate in her cluster. She described

her vicarious engagement four-years after CoP commence-

ment:

From the outset I felt really motivated and excited that there was a

group movement happening. I haven’t given up on it yet. I still con-

sider myself a part of it. (Judy, FG-5)

At CoP level, participants created and valued space for

face-to-face interactions about research through corridor

chats and on a more public level, gave regular CoP reports

at APN meetings. The CoP gathered once for a half-day of

research presentations, further education and discussion.

Interview data revealed that despite heavy clinical work-

loads, participants would value more opportunities for

whole-of-CoP engagement.

A blog site had been created as public space for busy

CoP members to support the rhythm of community interac-

tions. However, the majority did not find the blog useful.

The most common reason provided was lack of time and

traditional communication formats suited participants bet-

ter. With the CoP established ‘pre-Facebook’ (2007), this

culture of social media was not well-established:

The blog is more social chit-chat. . . (Meg, FG-2)

I’d rather email [coordinator] ‘cause I think I’m stupid some-

times. . . It’s a privacy issue. . . maybe I don’t want to share this

query? (Narelle, FG-2)

Adding to the rhythm of the CoP was the process of

combining ‘familiarity with excitement’ (Wenger 2002,

p.62). We occasionally punctuated the day-to-day cluster

activity with special events. This was framed in a way

that was relaxed and enhanced the bonds between CoP

members:

Okay guys. . . Here is a proposition. We have a house. . . nice spot

on the water, 10 beds, wine glasses in the cupboard for postanaly-

sis bonding. What do you think about an intensive research analy-

sis weekend?. . . This would rely on most of your interviews &

NVIVO training being complete. . . (Email from coordinator to

clusters 16/6/08)

Clusters investing time for these opportunities had the

greatest research productivity and dissemination.

The ‘focus on value’ was created by making personal and

professional growth visible. Our participants initially

described a lack of insight into research processes, a lack of

confidence and skills and an inability to translate research

from their university courses to practice. This disturbed

them because research was constantly framed as a key indi-

cator of their professional performance.

. . .there’s all this talk about ‘This this is in your description, you

need this to make practice better. . .’ but then there’s a lack of path-

ways to support you. (Judy, FG-5)

‘A focus on value’ was firstly made visible by acknowl-

edging quick wins and communicating research dissemina-

tion lists to all CoP members:

I think it was good for [coordinator] to remind us how far we’d

gone. . . to give us. . . ‘quick wins’ when we presented. . . posters. . .

conferences. . . We ran some [gastrointestinal] study days. . . the

feedback we got from that was really great. . . It gave us more

energy to say ‘This stuff is valuable’. (Vanessa, FG-4)

‘Value’ was communicated through findings that made

nursing inquiry observable, changed practice and improved

the experience of patients and families as illustrated by the

following field note:

Tina raised car parking with Master Planning. From June, there

will be Courtesy Transport for visitors and patients, with pick up

from main car park and drop off near main entrance. Tina also

met with Head of Department re draft Picker report. He was very

excited. . . rang the Director of Nursing and said ‘I love this sort of

research!’ (2/5/09 Coordinator field notes)

While some APNs had been involved in data collection

for medical-led studies, they valued this nursing-focussed

research. The qualitative methodology gave them access to

understandings about their patients that surprised them,

JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUALITATIVE A Community of Practice to build research capacity

despite their long clinical experience. In some instances,

revelations related to service delivery:

It makes us understand that just one tiny little thing. . . can be the

focus of their entire experience of hospital. (Morgan, FG-1)

On a deeper level, there were profound, shared aspects of

patient and family experience not previously apparent and

this new knowledge changed their whole approach to

patient care:

One patient talked about his pain score, not physical but emo-

tional. . . ‘My nightmare score is 8 but my pain score is 2’. So try-

ing to understand the impact of that life-changing event. . . I

thought this guy looked okay. . . and when you start talking they

have so many issues and a lot are psychological, hidden because

you just look at the physical side. (Helen, FG-3)

A successful research-focussed CoP is a long-term project

(Figure 1). Participants reflected on the length of this pro-

ject, noting it was the duration of intensive engagement that

allowed eventual publications in peer-reviewed journals and

the feedback of that work into professional growth and

clinical practice change. ‘Value’ was palpable as the CoP

developed research confidence and established a culture of

inquiry:

It’s incredibly rewarding to have something published internation-

ally. That’s what makes you feel this project has been a success.

Getting to that endpoint, but then realizing, publication is not the

endpoint. . . I would never have envisaged four-years later we

would still be going but it has led me to do another phenomenolog-

ical research project. . . Obviously that has developed some sort of

research culture. . . It’s given me the confidence to do it myself.

(Morgan, FG-5)

CoP members not only expressed professional growth but

also personal growth in a nurturing community:

I was new in the role so it opened-up avenues. . . to network. . . get

to know what was happening outside. . . to take the doors off if

you like. . . So we’ve achieved that. . . To see people’s faces instead

of their emails. . . and I’m very thankful at this stage of my

career. . . I’ve never really felt mentored in nursing. . . it’s really

helped me to be a better person and at the same time learn about

research. (Gretel, FG-4)

Discussion

The aim of this study was to evaluate a research CoP for

building nursing research capacity and productivity.

Increased capacity was demonstrated through the

descriptions of increased confidence and further indepen-

dent research activity. Increased productivity was evident

from the clear research outputs generated (Table 5).

Research findings were disseminated through peer-reviewed

journals (Khatri et al. 2012, Gullick et al. 2014, Monaro

et al. 2014) and multiple conference presentations and

were incorporated into research-informed university teach-

ing delivered by APNs at both undergraduate and post-

graduate level.

When considering how to ‘design for evolution’ (Wenger

et al. 2002, p. 59), we believed that introductory research-

focussed education was important; a view supported by our

participants and others (Fink et al. 2005, Parkin & Bullock

2005, Newhouse et al. 2007). The quality of CoP coordina-

tion was another important aspect of designing for evolu-

tion and skilled, onsite research mentorship was pivotal to

our outcomes. Strong leadership has been emphasized inter-

nationally in reports of experiential learning (Fitzgerald

et al. 2003, Priest et al. 2007) and in research capacity

building generally (Perry et al. 2008, Strout et al. 2009,

Caan et al. 2005). Our participants attributed the CoP’s

success to the coordinator’s availability, flexibility, skill-set

and willingness to drive the project.

For Wenger (2002), designing for evolution is founded

on the premise that CoPs develop on pre-existing personal

networks. This was achieved by drawing research clusters

from existing clinical alignments. The subsequent dynamics

in each cluster then either enhanced or impeded research

productivity. Successful clusters created structure around

progress and meetings and the ‘pushing’ gradually shifted

from initiatives of the CoP coordinator to an expression of

intrinsic cluster motivation. In the assignment, or self-selec-

tion of participants to clusters, previous working/personal

relationships did not necessarily guarantee productive

research relationships. More careful thinking about person-

ality traits and clinical synergies between cluster members

from the beginning may have enhanced planning and

formed a basis for cluster management throughout the pro-

ject’s life. For example one cluster of very senior APNs with

differing specializations within a broader clinical service

collected data, but did not proceed to analysis. For us this

highlighted that clinical experience and professional drive

do not necessarily translate to group research productivity.

Interestingly, some in this cluster were encouraged by their

peers to join the CoP rather than self-nominating; a phe-

nomenon noted to result in less engagement for several par-

ticipants across the CoP.

Designing for the evolution of increasing skill and depth

of research was facilitated by the use of two distinct analyt-

ical methods of varying complexity that appealed to

J.G. Gullick and S.H. West

different personalities and levels of academic interest. Gul-

lick and West (2012) provide further detail on the specific

framework and joint application of these analytical

approaches. The Picker Dimensions of Care are very

practical in their application to quality and service develop-

ment and so addressed other important domains of APN

practice. Although this method is more aligned to quality

improvement than rigorous research, by beginning with a

simple, more immediately applicable approach, quick wins

were achieved and participants remained intellectually

2007

2008

2009

2010

2011

HEC approval

APN recruitment

CoP formed

Research training sessions

Patient & family data collection commenced

Patient & family data collection

completed

Picker analysis continues

Picker analysis completed

Clusters formed

Picker analysis

APN focus group

Research training: hermeneutic

analysis

Phenomenological analysis

commenced

Phenomenological analysis completed

APN focus group

Writing for publication

CoP now incorporated into hospital research culture for APNs

2012/13

7 Clusters formed: Burns

Emerfency Geriatrics Endocrine

Haematology Haemodialysis

GIT cancer Musculoskeletal

1 cluster (3 APNs) withdrew before

patient/familydata collection

1 cluster did not complete analysis

PA R

T IC

IPA N

T O

B S

E R

V AT

IO N

S hort film

5 reports to professional organisations

R esearch design

paper published 3 phenom

enological papers published

10 conference papers

2 P hD

enrolm ents

Figure 1 Community of practice evaluation timeline.

JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUALITATIVE A Community of Practice to build research capacity

engaged in the CoP. Importantly, our research design

included an ‘opt-out’ option so nurses could exit their

investigations after disseminating findings from their Picker

analysis and making recommendations for practice change

through a report to the Department of Health.

‘Inviting differing levels of participation’, as an element

of good CoP architecture (Wenger 2002, p. 55) was articu-

lated to some extent by this opt-out option. While the

expected level of engagement was communicated from the

beginning at CoP level, it was perhaps not sufficiently dis-

cussed at cluster level where there was a preconception that

everyone would ‘pull their weight’. The reality of unequal

contribution was frustrating to many participants.

Clusters could be strengthened by early cluster-level dis-

cussions on ways of working, framing expectations and

responsibilities to establish ‘house rules’. For example it

may have been valuable to pre-empt the opportunity of

cluster members having variable levels of contribution. Such

discussions could inform decisions about how individuals

and clusters would deal with this situation in relation to

work distribution, communication and authorship; impor-

tant aspects of research training.

Our participants noted the reality of research as ‘home-

work’. This may require re-conceptualisation of APN

‘work’ from the current clock-on/clock-off understanding to

a professional/intellectual model where scholarship is a

matter of ‘being’ rather than ‘doing’ and nurses continue to

reflect on APN practice outside of their contracted hours

(Goodman 2012).

Wenger’s construct of ‘a focus on value’ (2002, p. 59)

explained the motivation of successful CoP members and

was strengthened as participants became aware of produc-

tivity and a systematic development of a body of knowl-

edge. The ‘value-add’ was integral, because as our baseline

data and international research suggests, APNs feel under-

valued (Wolf 2013) and are underprepared for the research

domain of their roles, both in educational preparation and

practical infrastructure (O’Byrne & Smith 2010). The invis-

ibility of CNS work in the UK and USA (Leary et al. 2008,

Fulton 2013) and CNC work in Australia (Cashin et al.

2014) is ubiquitous, with their research and practice/sys-

tems development role unnoticed by the healthcare commu-

nity, policy-makers and the public.

A focus on value was communicated more broadly as

CoP members created an open dialogue between insider

and outsider perspectives (Wenger 2002, p. 54) liaising with

their multidisciplinary team, managers, colleagues from

other institutions and with government and professional

bodies. These discussions increased their visibility as clini-

cians and researchers and strengthened their confidence and

ability to communicate their research productivity.

The detailed examples provided have demonstrated the

robustness of Wenger’s theoretical principles for CoP culti-

vation and the model’s potential for developing research

capacity, productivity and collegiality. There was evidence

of important and meaningful nursing research output,

addressing the lack of defined outcomes and methodological

rigour in previous evaluations of research capacity building

(O’Byrne & Smith 2010). During this project, two partici-

pants enrolled in doctoral programmes and a third

expressed plans to. Our local health district is establishing

a nursing professorial chair and this may further bridge the

practice/research gap for APNs. A limitation of the CoP

model for research capacity building is the prolonged time

between clinician’s data collection and publication. This is

a consequence of heavy clinician workloads and the absence

of ‘research time’ in work-pattern planning.

Limitations

The highest educational award for 12% of the APNs was a

Bachelor degree and only 48% were educated to Masters

or PhD level. This may differ from educational preparation

of APNs internationally and there may be lower expecta-

tions for research use and capacity for non-Master’s pre-

pared nurses (AACN (American Association of Colleges of

Nursing) 2006). Transferability of our findings is also con-

tingent on the availability of skilled, onsite research exper-

tise.

Conclusion

A Community of Practice framework is a powerful model

enhancing collegiality and enabling research confidence,

capacity and productivity amongst APNs. This model may

lead to significant output as evidenced by publications in

Table 5 Community of practice research output (2008–2014).

Type of output N

Published peer-reviewed journal articles 4

Draft manuscripts for peer-reviewed journals 3

International conference presentations 8

National conference presentations 2

State Government Health Department reports 5

Short film 1

Research awards 2

Professional publications 3

Professional seminars 7

APN-led lectures (Bachelor of Nursing students) 3

APN-led lectures (Master of Nursing Students) 5

J.G. Gullick and S.H. West

peer-reviewed journals, conference presentations, ongoing

research activity and enrolment in doctoral programmes. In

developing a solid foundation for a nursing research cul-

ture, it should be recognized that a community’s skills, con-

fidence and growth matures over an extended period and

ongoing success is dependent on skilled coordination and

leadership.

Acknowledgements

We acknowledge our profound appreciation to: A/Prof

Donna Waters & Dr Naomi Malouf who conducted focus

groups; to Dr Mary-Helen Ward for her review and com-

ment on this manuscript; to Sharne Hogan, Director of

Nursing, Concord Repatriation General Hospital for in-

kind support and encouragement; to Virginia Turner, for

her assistance with ethics training; and to the Sydney Nurs-

ing School and Totalisator Agency Board, for their funding

of this project. Finally, we would like to acknowledge the

extraordinary tenacity, professionalism and generosity of

spirit of the nurses who participated in this study.

Funding

This project was facilitated by a TAB International Nurses

Day Scholarship and an Industry Faculty Grant from the

Sydney Nursing School, University of Sydney.

Conflict of interest

There are no perceived conflicts of interest.

Author contributions

All authors have agreed on the final version and meet at

least one of the following criteria [recommended by the

ICMJE (http://www.icmje.org/recommendations/)]:

� substantial contributions to conception and design, acquisition of data or analysis and interpretation of

data;

� drafting the article or revising it critically for impor- tant intellectual content.

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