The development of nursing practice has become a central feature of modern
healthcare. The advent of clinical governance has resulted in the development of an
organisational climate where practitioners are encouraged to develop direct care and
health services. Despite the desire of many professional groups to develop practice
within the NHS, there has been a shortage of research which has specifically examined
the processes of practice development in such a way as to identify the factors which
facilitate or hinder developments.
This study examines the nature of practice development and how this process is
influenced by organisational, structural, individual and contextual factors. Using
techniques developed by Walker and Avant (1995), the critical attributes of practice
development were identified and it was contended and accepted that practice
development was a specialist form of innovation. The study identified positive and
negative factors which were shown to influence practice development using two
principal methodologies. Firstly, a UK-wide Delphi survey was carried out with 139
Directors of Nursing in order to identify their perceptions of key influences on practice
development. A total of 24 positive and 23 negative categorisations was identified
from the surveys; these were grouped using principal component analysis into 8
components. Following on from this a series of case studies was carried out to examine
which factors influenced the development of practice, and how this influence
manifested itself. Findings from the case studies highlighted that there was some
congruence between the perceptions of Directors of Nursing and the factors which
were found to influence development. Several factors were identified as having a
positive influence including championship, participation, ownership and flat
management structures; whereas factors such as leader dependence, pressures and inter-professional tensions had a negative influence in some developments. In addition
the study identified that the influence of other factors such as personal interest, merger
and organisational transition are often underestimated.Funding from Northumbria Healthcare NHS Trust