122

knowledge and understanding of thevirus: how it can be contracted andtreated. Now, after being involved in theteaching process I think it is a very goodway of allowing first contact with apatient in an environment that is safe forall concerned. One in which I, as apatient, feel able to talk openly with agroup of people who are willing to learnand (hopefully) glean information theymight not otherwise have known. Theone subject that pops up consistently isthat of treatments and the side-effects.These, of course, vary from person toperson and I can only talk about my ownexperience. But, being able to ask thequestions to someone taking the treat-ments, I think, helps the class tounderstand it in a way that a session witha pharmacist would not.

Having been involved in this processfor a little over a year now, I hope theHealth Board will continue this worth-while exercise. After speaking to quite anumber of groups I have not yet had anynegative reactions, in fact, quite thereverse in that all the groups seem to

have enjoyed having the opportunity tomeet, hear and speak to an HIV-positiveperson. Certainly, from my point of viewteaching has empowered me to be moreopen and frank about my condition andhas given me confidence to cope betterwith the virus, the treatments and allthey entail.

I also attend a patient group. Themembers of this group come from variousbackgrounds and we meet on a regularbasis to discuss the sessions. This hasgiven me an insight into how the diseaseaffects different people and their meansand ways of coping with the problemsthat arise from time to time. I would saythe benefits far outweigh the pitfalls and Ihave found teaching to be an upliftingand confidence-boosting experience.

Robert Palmer

Address correspondence to: Robert Palmer,Apt3/1 18 Rutland Court, Saddlers Gate,Kinning Park, Glasgow G51 1JW (E-mail:midas1@btinternet. com).

Having been a practice developmentnurse for three years I am beginning tounderstand some of the complexities andmisunderstandings about the role. Myown philosophy is developing throughreflecting on my role as practice devel-opment nurse for older adult mental

health services in Sheffield and it is mytop ten observations and tips that I wishto share here.

1 Practice development ismessy!I had come to this conclusion some timebefore it was confirmed by McCormack etal. (1999). Oh, what a relief to find that itis not abnormal to sometimes feel asthough I was wading through mud,

Ideas and opinions

Practice development:top ten tips

PDHC 1.2_crc 27/11/02 12:00 PM Page 122

getting nowhere fast. In a way, how can itbe anything but messy with the complex-ities of working in a huge organizationwithin teams of people with their ownbeliefs and cultures of care. The speed ofchange can feel overwhelming to manyand a challenge to develop practice mustfeel a challenge too far for some.Somehow, accepting that it is a messybusiness can provide some order to thechaos, and the unrealistic expectations ofoneself and others can be challenged.

2 Know your allies andyour enemiesKnowing your allies is vital. Havingothers with a shared vision can help tosustain the development when you arenot there. Enthusiasm is catching andhaving a colleague to bounce ideas offcan keep you both going when things gettough. Knowing your enemies isimportant, to try and understand whythey are your enemies. Fear of change,fear of being shown up and the need forsupport and education are often factors.Sometimes, the enemy is damaged fromprevious do-gooders wading in throughthe mud, promising the earth and thendisappearing without trace.

3 Find support mechanisms andsupervisionstructurePreviously, I had relied on a clinicalsupervisor. Now, my role falls for supportfrom a more diverse set of mentors, bothformal and informal. You may wish toshare the successful or the difficult teammeeting you have just had with a fellow

colleague you can trust. There may alsobe the need for a more formal setting toplan future strategies or to tacklerecurring behaviour in yourself or others.I also find myself needing different earsfor different situations. The organiza-tional psychologist can help to makesense of the reflective practice groupdynamics being encountered; theresearch nurse might help to design amethod for evaluating a piece of work; afellow practice development nurse mightoffer some peer support and reflectionupon the role.

4 Be prepared for thelong haulBefore starting this job I had hugelyunderestimated the amount of time thatneeds investing in even a small practicedevelopment to ensure that it succeeds.Much of the work involved is unseen anddifficult to describe. The preparation andgroundwork (which may involve discus-sions within clinical teams and exploringwhat other similar developments exist) istime-consuming. Ensuring a developmentis in the right hands and offering supportto those hands to ensure the developmentis sustained takes time. Understandingbarriers and finding ways of overcomingthem needs time for reflection andplanning. It takes self-confidence and anability to explain the nature of practicedevelopment to resist the quick-fixsolutions that are sometimes expected.

5 Be proud of smallachievementsDeveloping practice can be a slow processand it is easy to feel overwhelmed by the

Ideas and opinions 123

PDHC 1.2_crc 27/11/02 12:00 PM Page 123

124

task in hand. It is important to breakdown the task into small steps and tocelebrate what sometimes feel like onlyvery small changes. Over time the smallchanges will add up to substantial devel-opment in practice.

6 Be facilitativeIt can be difficult to find the rightbalance between facilitating a devel-opment and actually implementing ityourself. I have found each situationrequires a different approach. Onoccasions I have become too involved ina project and so staff perceived it as beingowned by me. On another occasion, itwas more helpful for me to start a projectso that staff could see the benefits andwant to continue to take it forward. Ifthere seem to be barriers to a devel-opment moving forward it is well worthstanding back and reflecting on your ownrole within this.

7 Do the groundworkand know the literatureIt is always worth exploring if similarprojects to your own already exist, as it ispointless trying to reinvent the wheel. Asthe project develops there comes a timewhen it is important to examine the liter-ature more thoroughly as this helps tostrengthen the rationale for the devel-opment and can help to attract fundingto support a project. It is important tocommunicate to others the reasons forreviewing the literature, as it is essentialthat the development remains groundedin practice and is not seen as being an

academic exercise, as this can alienatepeople.

8 Be able to place theinitiative in thecontext of widerdevelopmentsThis may not be relevant in the earlystages of a project, but if the project is tohave credibility across practice areas ithelps to understand the initiative in thecontext of government policy and organi-zational strategic goals. Once again, thisis essential if trying to attract funding.

9 Search out opportunities toadvertise andcelebrate the workThese events, no matter how small, canhelp to boost the morale of those workingon the project and can help to gainsupport from other arenas. There is also aresponsibility when developing a practiceto share it with others and open theinitiative up for debate.

10 Above all, don’t give up

Sometimes, trying to develop practicecan feel like extremely hard andthankless work. There are times whencomments such as ‘We’ve tried this before’or ‘It’ll never succeed’ or ‘We just don’t havethe time’ can grind you down. There aretimes when moving a developmentforward might be unwise because of staffsickness or high clinical activity.However, respite does usually come along

Ideas and opinions

PDHC 1.2_crc 27/11/02 12:00 PM Page 124

and you can pick up the project whereyou had to stop, even if that is days,weeks or months later. The health serviceseems to have a reputation for startinggood initiatives and not sustaining orcompleting them, so do not perpetuatethis culture. There are more times whenthis seems like the perfect job, helpingothers to realize their ideas and reachtheir full potential for themselves andtheir workplace.

ReferenceMcCormack B, Manley K, Kitson A, Tichen A,

Harvey G. Towards practice development—avision in reality or a reality without vision?

Journal of Nursing Management 1999; 7:255–264.

Jane McKeown—Practice DevelopmentNurse, Services for Older People withMental Health Problems, Community

Health Sheffield.

Address correspondence to: JaneMcKeown RMN BA(HONS) PGDIP.ED., Practice Development Nurse,Community Health Sheffield, Service forOlder People, Phoenix House, FulwoodHouse, Olde Fulwood Road, SheffieldS10 3TH (e-mail: jane.mckeown@chs.nhs.uk).

Ideas and opinions 125

PDHC 1.2_crc 27/11/02 12:00 PM Page 125