Commentary on 'A practice development project to develop the nurse practitioner role in a hospital'

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Walsgrove and Fulbrook are to be commended for presenting a useful and lucid account of their action research project. They ably recount their experiences and identify a range of beneficial practical outcomes from their study. Several of my colleagues and I have recently championed the cause and place of action research in nursing practice – as well as offered our own examples of action research studies undertaken (i.e. Whitehead et al. 2003, Whitehead 2004, Whitehead 2005, Whitehead et al. 2004a,b). I can vouch for the fact that effective action research does not come about by chance, nor without committing extensive resources and time. I can also confirm, however, that the rewards and outcomes tend to be extensive – as is the case in Walsgrove and Fulbrook’s (2005) study. There are only a few minor points that I would challenge. Firstly, the authors very much commit to the UK context of the developing nurse practitioner role. This is a slight oversight, in respect of the fact that similar nurse practitioner roles are developing in other countries. In New Zealand, for instance, the nurse practitioner role is establishing itself as a mainstay for the Ministry of Health’s primary health care strategy. Secondly, I would like to pick up on a point that is made in text: Walsgrove and Fulbrook state that: Against the background of recent health policy, nurses have been in a strong position to develop their roles. (p. 445) I would refute this last comment suggesting, instead, that nurses have not been in a good position to develop their changing roles, but as a result of the emerging health policy agendas of other health disciplines, have had changes conferred or ‘passed down’ onto them. I believe that this is precisely the reason that nurse practitioners face the chal- lenges that they do in deciding on what to do and acting upon their imposed role. This is precisely my point when I have argued that nurses need to develop themselves as health policy activists and careerists in order to determine their own collective agendas and roles (Whitehead 2003). I believe that action research should be a mainstay of nursing research activity. It is still in its infancy in our profession, but I would like to see its use dramatically escalate over the coming decade. Extensive use of action research is likely to facilitate the move away from introspective ‘navel-gazing’ nursing research that offers little by way of tangible practice-orientated change and outcomes, towards long-term, participatory, cyclical research that provides evidence of organisation-wide change and reform. I like the use of schematics, in Walsgrove and Fulbrook’s (2005) article, that make it easier to demonstrate the change processes that accompanied their research project. I would recommend similar guides, alongside the action research model that I have also developed (Whitehead et al. 2003), as templates for ‘budding’ action researchers and for implementing radical organisational change. Once again, Walsgrove and Fulbrook (2005) are to be commended for taking on their extensive and consuming project and sharing its positive and ongoing outcomes with us. References Whitehead D (2003) The health-promoting nurse as a policy expert and entrepreneur. Nurse Education Today 23, 585–592. Whitehead D (2004) Health Promoting Universities (HPU): the role and function of nursing. Nurse Education Today 24, 466–472. Whitehead D (2005) Health Promoting Hospitals: the role and function of nursing. Journal of Clinical Nursing 14, 20–27. Whitehead D, Taket A & Smith P (2003) Action research in health promotion. Health Education Journal 62, 5–22. Whitehead D, Keast J, Montgomery V & Hayman S (2004a) A preventative health education programme for osteoporosis. Journal of Advanced Nursing 47, 15–24. Whitehead D, Keast J, Montgomery V & Hayman S (2004b) Participatory action research in a hospital-based Osteoporosis Service. Health Education Journal 63, 347–361.

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