Planning for Unit-Based Change—A Qualitative Research Approach

Purpose:
This presentation describes a phenomenological study designed to assess unit-based culture and perceptions associated with nursing orientation at a rural hospital. The study is Phase I of a larger project to re-envision orientation with a goal of improving the practice environment for nurses.

Background/Significance:
Hospitals across the nation use a variety of strategies to assist in role transition of newly licensed registered nurses. Recognition of the ineffectiveness of a long-standing orientation process resulted in a need to critically examine current approaches. An established research technique was chosen for baseline assessment since it would provide an accurate starting point for large-scale program revision. Integration of findings into the revision will help achieve sustained unit-driven change.

Methods:
An interview-based study is being performed using Interpretive Phenomenological Analysis (IPA). The authors consulted with local university faculty for guidance and validation of the study through institutional review board approval. Two study groups were identified—nurses hired during the past year and nurses who functioned as preceptors during the same year. After informed consent is obtained, volunteers participate in anonymized structured interviews which are transcribed for analysis. Using a collection instrument, transcripts are independently reviewed and categorized into themes. Complete summarization will occur after the last interview is analyzed.

Results:
Early themes have emerged. Newly hired nurses are identifying four issues: 1-Inadequate communication about program purpose, expected outcomes, and evaluation of progression. 2-Majority of orientation activity occurs exclusively at the bedside with limited opportunity for "off-line" reflection and feedback. 3-Preceptor inconsistency including use of multiple preceptors with significant variability in orientation strategies. 4-Inadequate end-point transition to independent patient care. Three preceptors themes are evolving: 1-Lack of structure/unclear expectations. 2-Lack of formal training and ongoing support for preceptors. 3-Frequent unplanned, improvised orientation assignments.

Conclusions and Implications for Practice:
The authors use of a unit-based assessment and analysis to produce locally valid information provides an evidence-based starting point for sustainable practice improvement. Use of this strategy may assist others as they plan and implement best practice solutions for improved patient care.