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Puzzling practice: A strategy for working with clinical practice issues

Authors

  • Kenneth Walsh RPN RN BNurs PhD,

    Corresponding author
    1. Director, Nursing Research and Development Unit, Waikato District Health Board, Hamilton, and Clinical Professor of Nursing, Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
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  • Cheryle Moss BAppSc MSc GradDipEdAdmin IAE RN CCUCert PhD(SCU) FRCNA,

    1. Research Co-ordinator, Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
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  • Jane Lawless RN GradDipNsg,

    1. Practice Development Facilitator, Nursing Research and Development Unit, Waikato District Health Board, Hamilton, New Zealand
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  • Rhonda McKelvie RN BSc(Hons) MN,

    1. Practice Development Facilitator, Nursing Research and Development Unit, Waikato District Health Board, Hamilton, New Zealand
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  • Lindsay Duncan RN ADN BN Accredited Diabetes Nurse Specialist

    1. Practice Development Facilitator, Nursing Research and Development Unit, Waikato District Health Board, Hamilton, New Zealand
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Kenneth Walsh, Nursing Research and Development Unit, Waikato District Health Board, Private Bag 3200, Hamilton, New Zealand. Email: walshk@waikatodhb.govt.nz

Abstract

In this paper we aim to share the evolution of innovative ways to explore, ‘unpack’ and reframe clinical issues that exist in everyday practice. The elements of these processes, which we call ‘puzzling practice’, and the techniques associated with them, were delineated over a two year period by the four authors using action theory based processes. The authors have evolved several different frameworks for ‘puzzling practice’ which we draw on and use in our practice development work and in our research practice. This paper pays attention to a particular form of puzzling practice that we have found to be useful in assisting individual clinicians and teams to explore and find workable solutions to practice issues.

The paper uses a semi-fictitious example of ‘Puzzling Practice’ gleaned from our experience as practice development facilitators. In this example ‘puzzling practice’ uses seven different elements; naming the issue; puzzling the issue; testing the puzzle exploring the heart of out practice; formulating the puzzle question; visualizing the future; and generating new strategies for action. Each of the elements is illustrated by the story and the key foundations and ideas behind each element is explored.

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