Table 10 Number of studies exhibiting each of the five types of extra benefits, with examples

Leadership (21)

For some, the process led to a greater confidence (“We do not sit back so much anymore. We speak up”) and more assertiveness (“People were starting to play with in a little bit -- try it out and feel that they had the backing”). This led to:

Greater clarity in what everyone needs, “I need time to think about that.” “I need to have it written down to understand it,” “I need to see a picture” … “I need attention.” Which helps me very much; then it is easier for me to say, “This is what I need. This is what’s helpful.”

One person noted that the group on occasion may not have listened enough to one member who would have preferred a different approach, and it might have helped to inquire about “commitment” or take a “look at alternatives.” [51]

General workforce development (41)

a Co-researchers felt able to share their ideas, the gaps in their knowledge, and recognized the importance of time for thinking and reflecting on nursing research and practice [52]

b By allowing the client group to fully participate in the change process, new skills have been developed. These skills include team problem identification, decision making, cooperation, and in some cases leadership. With the collaborative climate being reinforced, members of the client group appear willing to take more risks in making suggestions, confronting issues, and encouraging and supporting others [53].

c Each of the co-researchers demonstrated ongoing positive and painful enlightenment through their own personal development and participation in the action learning sets [54].

d The members of the core group noticed a shift in their own way of thinking about patients, and in the actions of the expert patients. [55]

e … by having the opportunity to share experiences from practice, the FARG members became more familiar with the contributions their colleagues, from other occupational groups, made to resident care. For example, an enrolled nurse member reported that as a consequence of her participation in the group she had “a bit more of an understanding about what each [staff] area gets up to [and] what challenges they have.” Similarly, another enrolled nurse member reflected on her new understanding of the different contributions that other staff members make to the care of residents when she noted, “It’s certainly opened my eyes a lot.” [52]

Group benefits (27)

The single most important indicator of full achievement of outcomes was that the work group members developed mutually supportive and trusting relationships between themselves and with the facilitator. [56]

Data from the participants indicated an overall positive response towards action research methodology. Positive aspects of participation in the CBAR as identified by the nurses were: A feeling of teamwork; Recognition of the value of participant’s knowledge and experiences [57].

Towards the end of the study the health professionals from both practices reported being much clearer about the nature of prediabetes and the associated risks, and placed more importance on acting systematically as a team to address the problem. [58]

Having more meetings in itself was not enough. The nature of the communication and type of interaction was also important. People engaged with each other in a manner that was respectful, appreciative, built trust and included social bonding. Doctors and nurses often embarked on real relationships for the first time [59]

Broad systemic developments or changes (29)

The DSU nurses were able to focus activities directly related to the needs of the patients undergoing complex day surgery. Most significantly, the team members took responsibility for decisions made regarding changes and the outcomes. As a result of the opportunity to communicate openly with others, in addition to the team’s ability to think and discuss their work critically, their practice became more effective, safer for patients and patient centered. These changes were apparent to others, and provided a model of enablement that is now used elsewhere in the organization [60].

The broad impact of the program has been confirmed by trainees from other Middle Eastern countries, who stated that they would now have the knowledge and skills to help children in pain when they returned to their home hospitals [61].

The next step for these NCs is to further develop the research aspects of their roles. For some, this may mean handing over of part of clinical and consultancy work to create “space” for effective research. For others, it means doing other aspects of the role differently to make research happen. Their influence continues to extend beyond the organization to influence national and international healthcare agendas [62].

There was also evidence at both teams that the changes that had occurred were part of a process that would not now easily be reversed. On the contrary, they were part of an ongoing process that now had increased momentum within the teams and their wider organizations [63].

University partners’ capacity (6)

With regard to my own empowerment I found the experience of collaboration, reflection and discussion with other participants enhanced my self-awareness, increased my appreciation for and understanding of other participants and brought me marginally closer to being able to achieve the “interpersonal elegance” for which I was striving [64].

Finally, in terms of my own work, I have just been invited to engage in a two–year practice development partnership with a new mental health occupational therapy Trust. The plan we have negotiated is to implement a similar process as used within this study across a much larger service. This will provide an opportunity to further test and refine the approaches and conceptual frameworks developed during this inquiry [65].