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Table 4 Outcomes from the project gained through facilitated feedback and non-participant observation of nursing practice.

From: Developing the practice context to enable more effective pain management with older people: an action research approach



Action cycle

Non-participant observation of nursing practice revealed that nurses discussed pain with older patients when they were working with them.

Nursing staff use all available opportunities to speak to older people about their pain.

Communication Action cycle one

Nurse: 'We discuss how we can improve practice and how we may better help older patients to understand their care.'

Reflection revealed that many older people had impaired hearing. Action - nursing staff encouraged all members of the MDT to stand closer to older patients when they were speaking to them.


Post research semi-structured interviews revealed that older people perceived that; 1. nursing staff assessed and treated their pain regularly, 2. they were partners in their care.


Improved reflection skills

The nursing team introduced; - Reflection and feedback at the end of a shift for junior nurses who take charge.

Communication Action cycle one

Ward managers developed an understanding of the significance of role modelling behaviour.

- Attend the morning medical ward round to role model how it should be conducted and encouraging junior nurses to ask questions.

Communication Action cycle one


- Take a patient caseload when the junior nurse is in charge of the unit to role model how to communicate with nurse in charge.

Interruptions Action cycle two

Senior ward nurses adopted a more facilitative approach to communicating with junior staff.

- Ask junior nurses guiding questions, rather than providing answers.

Communication Action cycle one

Ward nursing staff began to undertake new initiatives and evaluate these

- Incorporated changes into off duty gained through facilitated sessions.


- Setting target dates for implementing and evaluating changes, e.g., discuss pain with older people when they are working with them.

Communication Action cycle one


Pain assessment practices


Completing a pain algorithm

Action cycle three