Communities of practice (CoPS) provide a potentially useful practice based framework for constructing work based collaborative learning and promoting engagement with local and professional groups and communities. In nursing, we have, increasingly, to manage and deploy new and existing knowledge, although CoPs are currently not widely used to do this. This paper debates the framework created by Wenger and reviews the role of the CoP as an innovative way for educators and practitioners to collaborate to develop and manage new knowledge and emerging practice.
The main aim of this study was to examine, from the consumer's perspective, the components of best nursing practice in the care of acutely ill hospitalized elderly people who coincidentally suffered from dementia. Due to the complexity of the problem under investigation a triangulated design was formulated. This design comprised survey methodology, audit and critical incident technique. Data derived from each of these approaches were analysed first in isolation and subsequently combined at a conceptual level. The sample comprised 213 people aged 65 years and older, who were consecutive admissions from two acute medical and two acute care of elderly people wards. Sixty-six per cent of these individuals were found to suffer from cognitive impairment, 40% experiencing severe problems. The documentary survey revealed that patients with normal or severely abnormal cognitive functioning were more likely to have this noted than those with mild-moderate levels of impairment. No evidence of formal assessment was located and only 15% of these patients had items included in their nursing care plans associated with their chronic confusion. A sub-sample of 41 chronically confused people and their main hospital visitor were invited to participate in critical incident interviews. These conversations led to the identification of four major themes which reflected the most valued aspects of the nursing care which had been received or observed. The relationship between documentary care scores and the proportion of positive descriptions of care within each of the four themes was explored. The findings indicate that acute nursing care is deemed only to be at its best when it is delivered in tandem with dementia care. Discrete areas for practice development are identified and standards to guide nursing care are proposed. In addition to the practice development issues raised by the work, the methodological lessons further advance the practice of multi-method research.
This article reports case study research which addresses the gap in knowledge about dementia in the workplace. Receiving a diagnosis of dementia whilst still in employment may have negative consequences for a person's identity, further compounded by loss of employment. This study is the first to explore the employment-related experiences of people with dementia and their employers to determine the potential for continued employment post-diagnosis. Sixteen case studies centred on a person with dementia who was still in employment or had left in the previous months. Each involved interviews with the person with dementia, a family member and a workplace representative. This triangulation of the data promoted rigour, allowing the experiences to be viewed through a variety of lenses to build a clear picture of each situation. Thematic analysis was carried out and three themes were developed: (a) dementia as experienced in the workplace; (b) work keeps me well; and (c) wider impact of dementia in the workplace. These findings have the potential to initiate changes to policy and practice related to supporting employees with dementia. The implications of this research are multifaceted and need to be considered in terms of the individuals' wellbeing, organisational support, as well as the wider theoretical, economic and societal consequences of supporting an employee with dementia.
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