Aim: The purpose of this paper is to present a model developed from the evaluation outcomes of a practice development programme in a special care nursery.

Background: A family-centred philosophy of care, where parents are viewed as integral partners in their care of their child, is central to paediatric nursing practice. Whilst nurses understand and subscribe to the notion of family-centred care they seem unable to achieve the principles in practice. It was thought that the implementation of a practice development programme with a focus on family-centred care might enable staff in the special care nursery to overcome barriers to this way of working.

Methods: A realistic evaluation was undertaken. The strength of the approach lies in the mechanism-context-outcome connections, which has the potential to offer researchers a more complete picture of what is happening with practice development and why it is happening. Consideration therefore is not just focussed on the outcomes achieved it also includes what conditions were present in the context that influenced the success or failure of an intervention and ultimately what factors assisted in achieving the outcomes.

Results: The importance of four key aspects that influenced the success of the practice development programme emerged from this work; teamwork; learning in practice; inevitability of change and the care environment. These findings were incorporated into a model (TLC model) with each element seen as fundamental in changing the overall culture of the special care nursery to one where family-centred care was part of everyday practice. The importance of culture mapping, facilitation development and leadership support within the context were also highlighted as central to the overall success.

Conclusions: It is suggested that this innovative model may help guide practitioners in all practice settings in achieving their espoused philosophy of care within the reality of everyday practice.

Implications for practice:

• Consideration should be given to using models such as TLC to provide a framework for practice development work within teams
• A first step in beginning any practice development work should include a review of how the team is working together
• Mapping workplace culture should incorporate a variety of methods and should consider ways in which staff will be engaged in the process
• Facilitation development (internal) is fundamental to the ongoing success of practice development programmes of work
• Leadership support is vital to the overall success of practice development

This article by Val Wilson is licensed under a Creative Commons Attribution Non-Commercial 3.0 License.