Nurse Education in Practice 10 (2010) 52–56

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Nurse Education in Practice

journal homepage: www.elsevier .com/nepr

Expanding clinical research capacity through a community of practice (CoPER)

Alison Short a,b,*, Wanda Jackson c, Peter Nugus d

a School of Nursing and Midwifery, University of Western Sydney, Australiab School of Public Health and Community Medicine, University of New South Wales, Australiac Research Strategy Office, University of New South Wales, Australiad Centre for Clinical Governance Research in Health, University of New South Wales, Australia

a r t i c l e i n f o

Article history:Accepted 20 March 2009

Keywords:Research capacityClinical nursing researchGroup processesProfessional roleCommunities of practice

1471-5953/$ - see front matter � 2009 Elsevier Ltd. Adoi:10.1016/j.nepr.2009.03.016

* Corresponding author. Address: School of NursinHealth and Science, University of Western Sydney, LoDC, NSW 1797, Australia. Tel.: +61 2 9685 9036; fax:

E-mail addresses: a.short@uws.edu.au, a.short@uns

s u m m a r y

Purpose: The proposed CoPER project (Community of Practice for Engaging in Research) responds to aneed for increased research capacity in a clinical setting. We put forward an argument and a designfor a prospective action research project to extend research capacity via an integrated academic and prac-titioner community of practice in an Emergency Department (ED).Procedures: This paper explores the research needs of clinicians, articulates the concept of community ofpractice in light of these needs, and outlines the rationale for considering communities of practice as apotential contributor to building research capacity in a clinical setting.Findings: A potential methodology is suggested to test the linkage between research needs, the concept ofa community of practice model in a clinical setting, and the contribution of such a model to buildingresearch capacity in a clinical setting via the CoPER framework.Conclusions: Combined data from this proposed mixed method action research (survey, focus groups,interviews, observation) are expected to enable the production of a set of facilitators and enablers witha view to building a community of research practice which make the case study transferable to other clin-ical and non-clinical work settings.

� 2009 Elsevier Ltd. All rights reserved.

Introduction

Consumers and policy-makers increasingly demand improve-ment in health care services, and expect that developments aregrounded in defensible research (Kellner et al., 2004). Evidence-based practice links practitioners to the research base. However,gaps exist in the evidence available, particularly in new and diversedisciplines such as emergency medicine (Wright et al., 2005).Clinicians in these settings can best identify the most pressingneeds but are not always equipped to pursue the formal researchprocesses required to explore their innovative solutions or tovalidate and extend the application of best practice. More researchwill continue to be demanded and this paper responds to the needfor clinical practitioners to take a role as generators – not justconsumers – of health practice research.

Many practitioners have undertaken undergraduate researchtraining in an academic context, but may not have had the oppor-tunity to engage in research activities within their clinical practice.Time lapse, lack of practice and lack of confidence might mean theyare unlikely to spontaneously embark upon research which may

ll rights reserved.

g and Midwifery, College ofcked Bag 1797, Penrith South+61 2 9685 9023.w.edu.au (A. Short).

otherwise support novel approaches or validate current processesin forms that would be valuable to practitioners in other settings.To create the evidence-base of future teaching and healthcarepractice, and based on an understanding of current research needs,it is necessary to reinvigorate their interest in research and supportthe application of research techniques. This can be expected toextend their research capacity and in turn support innovationand improvement in healthcare.

The proposed CoPER (Community of Practice for Engaging inResearch) framework is innovative in looking at how we canharness the considerable untapped knowledge in the hospitalsetting based on practice experience. Such an innovation can builda thriving, sustainable interdisciplinary community of practicewith a research focus. This paper develops a methodology withnew conceptual understandings linking practice, research andhigher learning in the clinical setting. Its aim is to explore the valueof a communities of practice model to the problem of extendingresearch capacity within the clinical setting of an EmergencyDepartment (ED). We propose that an iterative and practitioner-relevant ‘‘action research” methodology can best help to assessits impact on clinician research capacity.

The importance of making connections between academic andcommunity partners has been recognised. Such partnershipsengage scholars in applying knowledge to significant and mean-ingful emergent community problems via a participatory process

A. Short et al. / Nurse Education in Practice 10 (2010) 52–56 53

(Boyer, 1997, 1996; Calleson et al., 2005; Burrage et al., 2005).The CoPER framework imbues the healthcare setting with princi-ples and understandings of research in graduate education inorder to facilitate real world knowledge and knowledge genera-tion. This paper establishes the need for clinical research, focusingon the ED as a case study; outlines the proposed community ofpractice approach; argues for the appropriateness of an actionresearch methodology to engender a community of practice;and considers the ripeness of a particular case setting forapplication of this model.

The need to increase research capacity in a clinical setting

There have been calls to increase the amount of clinical researchundertaken (Wills, 1998). However, it is not feasible to increase theamount of research completed in a clinical setting without firstincreasing the research capacity amongst clinicians. Wills notesthat there is a need for shared knowledge between clinicians andresearchers for best research to improve healthcare. Kernick(2005) also suggests the need for closer links between the aca-demic/research community and the practitioner/clinician commu-nity, noting that ‘‘the call is for a fundamental reappraisal to enableit [research] to become more embedded in the realities of healthcare delivery” (p. 5). There is a need for academics to enable, facil-itate and support practitioners in setting and meeting their own re-search agendas, as argued by Rolfe (2007) in the context of nursingscholarship. Ham (2003) notes that ‘‘the future of the health caresystem depends on the link between top-down and bottom-up ap-proaches to improvement” (p. 4). Helping clinicians become clini-cian–researchers contributes to building research capacity andenhances the evidence base (Albers and Sedler, 2004; Cusick andMcCluskey, 2000; Rolfe, 1998; Weisz et al., 2004). Research capac-ity in this context refers to such skills as: the ability to identifyopportunities in practitioner based research (in terms of problema-tising healthcare issues and seeing value in validating local prac-tice); to identify and critically interpret literature relevant tolocal issues; and to participate in the formulation and testing ofhypotheses via relevant methodologies (Bateman and Kinmonth,2001; Garrett, 2007). Although not every clinician must becomea researcher, individual practitioners must collectively be able tocontribute to the research effort in many ways. The further benefitsof research capacity building may be to affect staff experience ofthe hospital system, in turn impacting on issues such as empower-ment, recruitment and retention (Carnwell et al., 2004; Short et al.,2007, 2009). A successful model of research skills development hasbeen applied to primary health care (Zwar et al., 2006) focusing onbottom-up skills development for practitioners. However, theapplication of any systematic/coordinated strategy to researchcapacity development in the ED setting is a new initiative.

Research and researcher needs in the emergency department

As one of the newest areas of specialization (Palmer, 2002; Zink,2006), emergency medicine is rapidly expanding in size and scope(ACEM, 2006). In order to further support evidence based practice,more research is needed within the interdisciplinary context of theED (Wright et al., 2005; NICS, 2004). The paucity of research froman ED perspective impacts significantly on safety and quality of pa-tient care, and it is important to engage clinicians in research dueto their unique, pragmatic and practice-knowledge viewpoints(Kirpal, 2004; Benner et al., 1999). Despite there being no shortageof ideas, current ED research is typically incoherent, poorlygrouped, uncoordinated, and attempts to organize research at abroad organisational level have reported limited success (Wrightet al., 2005). Anecdotally, many staff in the ED setting demonstrate

an interest in research but there is no clear structure for buildingskills and knowledge, indicating that there is a need for more re-search support for ED staff (Short et al., 2007, 2009). The idea ofcollectively harnessing practice knowledge to improve researchdevelopment in the emergency department context has receivedlittle research attention. Only one collaborative ED research projecthas been reported (Panik et al., 2006), which developed researchideas within a quality of care focus and subsequently improvedresearch skills for the staff involved.

Only one study has examined overarching ED research needs,opportunities, barriers and ideas for future change, thereby estab-lishing a model for enhancing individual research capacity in theED (Short et al., 2007, 2009). Qualitative data from this mixedmethod study record participants’ suggestions. These include theneed for increased peer mentoring and small groups or researchteams. They also reveal anecdotal and formal discussion amongstclinicians showing that many of the clinical staff have been ex-posed to research through limited research experience and associ-ation with researchers and research activities, and that they havesome skills or recognise the skills needed. Yet, clinicians apparentlystill do not feel capable of applying this knowledge to developing aresearch idea. Short et al. note specific difficulties in training andprofessional development within the ED context as difficulties ex-ist in time scheduling, fluctuating workload demands and access toelectronic communication, and suggest that these need to be ad-dressed as part of research capacity building (Short et al., 2007,2009).

Communities of practice as the model for change

A ‘‘communities of practice” model in the ED setting may offerthe opportunity to enhance research skills and knowledge buildingwhich underpin the growth of a research culture. This approachhas the potential to re-focus the research effort from the individualand provide the necessary ‘‘support” for research and the develop-ment of clinician–researchers.

A community of practice denotes the set of implied practicesthat are shared by a particular group of people (Wenger, 1999). Itcan also be conceived as a particular culture within an organisationthat is the set of observable – though often tacitly held – practices,norms, values, rules and metaphors (Alvesson, 2002; Martin,2002). Communities of practice typically can ‘‘drive strategy, gen-erate new lines of business, solve problems, promote the spreadof best practices, develop people’s professional skills, and helpcompanies recruit and retain talent” (Wenger and Snyder, 2000).They are seen as part of a social theory of learning Wenger,1999) and culture change.

Key characteristics of communities of practice include that theyselect and organize themselves and set their own agenda and lead-erships. However, central to the current proposal, they thrive bestwhen fostered in bringing people together, in infrastructure sup-port (Wenger, 1999). A community of practice is built up throughinteraction, such as role modelling, that occurs as persisting prac-tice structures (Schatzki, 2006) and is reinforced by formal organ-isational boundaries (DiMaggio and Powell, 1983). Althoughmembers of a community of practice ‘do’ shared practices inobservable ways, the tacit character of many such practices makesit difficult for community members to recognise – much less talkabout – those practices (Spender, 1994). Such talk about practiceis central to the reflective practice of a community that valuesresearch.

A shared culture that is based in practice and allows flexiblelearning is ideally suited to a learning community of practice (Laveand Wenger, 1991). Within this context, the shared culture of EDwork teams, in which members seek to learn to operate in different

54 A. Short et al. / Nurse Education in Practice 10 (2010) 52–56

ways, makes them ripe to evolve into a ‘‘research learning” com-munity of practice. However, there is some disagreement aboutthe relationship of teams and communities of practice (Gordonet al., 2000). O’Donnell et al. note that teams are driven by account-ability, workplans, tasks with clear boundaries, team leader ormanager, shared goals and deliverables, and cognitive process,whereas communities of practice are driven by values, shared inter-est, interdependent knowledge, organic development, core group/coordinator, identity and reflective process (O’Donnell et al.,2003). In the hospital context, clinical work is so heavily embeddedin the organisational endeavour of the emergency department thatstaff have a tendency to identify more strongly with the ED thanwith their own discipline in the broader hospital context (Nugus,2007). Thus, the ED can be considered a ‘‘joint enterprise” (Wenger,1999) and viewed as a discrete organisation from which its owncommunities of practice emerge.

Collaborations named ‘‘communities of practice” currentlyexisting in the healthcare field typically focus on specific issuesand problems using a ‘‘network” approach (NICS, 2004; HARP,2008; NMHSRP, 2008). These task-focused health care communi-ties of practice appear to be successful, most likely due to the col-laborative nature of professional practice. However, the healthcareliterature has paid scant attention to the capacity of a communityof practice approach to impact on intangible learnings and culturechange. Only one ED study using a community of practice modelhas been located, which looked at emergency medicine educationand professional development (Wilson, 1999). This study found acomplex and highly interactive knowledge development processas practitioners developed over time to become part of the EDcommunity of practice. It noted, at the same time, a sense of alien-ation between ‘‘academic” and practical workplace knowledgewhich required further attention (Wilson, 1999).

The capacity of action research to generate a research culture

Conventional approaches to medical research, ‘testing’ of vari-ables on one population while maintaining an untouched ‘control’population, are inappropriate to the highly-contextualized so-cially-oriented intervention needed to foster research capacity.The value of the research community ‘‘needs to be measured innon-traditional ways” (Wenger, 1999). We contend that action re-search is the most viable approach to sensitively researching theimpact and relevance of communities of practice to the issue ofextending research capacity of clinical practitioners since it alsoaddresses issues of leadership, mentorship and group culture.

Action research is a collaboration between researchers and par-ticipants, involving their mutual participation in the research-prac-tice interface, in order to enhance one or more aspects of the worldof the participants (Walsh and Fegan, 2007). Action research in-volves the researchers directly in the research process. It engagesparticipants in setting the research agenda through consultationand reflection on regular and iterative cycles of feedback aboutthe progress of the research (Badger, 2000).

Action research is an appropriate methodology to foster a cul-ture (community) of research because it gives clinicians researchtools to reflect on and learn from their practice. Such activeinvolvement of the clinicians in the research process makes themaccountable for the practical outcomes of the research. This en-sures the project’s practical relevance or ‘‘ecological validity”,meaning that the research resonates with the everyday, common-sense world and practices (Spooner and Pachana, 2006) of partici-pants. Indeed, the action research methodology to generate aresearch community of practice in a clinical setting is methodolog-ically innovative because the ‘‘practice” is the research. This pro-cess builds capacity. It generates not only practice-relevant

research outcomes, but generates a process to produce practice-rel-evant research outcomes.

A CoPER case study

The proposed CoPER framework is recommended for imple-mentation in the ED of an urban tertiary teaching hospital, servingas an action research case study for further interventions in dis-persed networks. Over 200 interdisciplinary clinical staff employedin this ED currently attend to approximately 60,000 patient pre-sentations per year. A number of cross-disciplinary working teamscurrently exist, responding to clinical issues related to paediatricsand major disaster response, in addition to conventional servicesof triage, resuscitation, assessment, initial treatment and dischargeor transfer. Currently, the research culture of this ED revolvesaround several individual staff with designated research skillsand knowledge. Previous research suggests that many research-interested staff feel excluded or unsupported (Short et al., 2009).Indications are that a project using groups will fit well within thecurrent ED culture (Short et al., 2009).

Academic input to the proposed research community of practiceis available through the Emergency Medicine Research Unit(EMRU), established as a collaboration between the area healthservice and an affiliated university following a documented needto foster research in emergency medicine (SWSHN, 2004). Theinvolvement of EMRU, endorsed by hospital management, locatedon site and familiar to practitioners, is expected to help to mitigatethe difficulties in time scheduling and fluctuating workload de-mands that might otherwise act as barriers to professionaldevelopment.

This innovative community of practice will bring together prac-titioners and academic researchers to collectively explore locallyrelevant topics. Through a process of communication, modelingand exchange around research issues, it should extend interdisci-plinary research capacity within a busy healthcare setting. Existingwork teams, as noted above, share a common culture whichencompasses manner of operating, awareness of needs, and a de-sire for change, which make them ripe for a learning-oriented com-munity of practice. The community of practice model answersexpressed practitioner desire for support, mentoring, models anda team-based approach (Short et al., 2009). The collective natureof the experience has the potential to alleviate individual concernsabout research capability (Short et al., 2009). The involvement ofclinician–researchers currently working in the ED together withacademic input ensures that the practitioners have genuine oppor-tunities to extend their research capacity through interchange andparticipation in structured research processes.

The proposed action research process-product centres on facil-itating, and collaboratively charting the progress of, research men-toring relationships between senior and junior clinicians, andexpanding the hospital’s formal relationship with the partner uni-versity. The community of research practice can be operationalizedthrough a mixed method action research which includes a survey,focus groups, interviews and observation. Materials that are gener-ated by participants and researcher records will be used to chartparticipant progress. After initial engagement with clinicians, preand post surveys will record participant perception of individualchange in capabilities and attitude. Emergent research topics canbe generated within broad theme areas of: interdisciplinary careand communication; improving patient care; and reflective prac-tice systems and service delivery. Small, internally governed andsupported research groups can work towards meaningful, tangibleoutcomes of literature reviews and research proposals developedby participants. The stages of this action research project include:data gathering; negotiation of themes; goals and groups; reflec-

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tion; evaluation; and feedback with participants. Combined dataenables participants to produce a set of facilitators and enablersof building a community of research practice which make the casestudy transferable to other clinical and non-clinical work settings.

Conclusion

This paper presented the systematic development of a rationalefor engendering a community of practice to address the educa-tional objective of extending research capacity in the context ofthe ED. It argues for an action research approach which engagespractitioners in a situated and personally meaningful research pro-cess within a group setting based on existing teams. Such an ap-proach ensures that the value-generating practices are clinician-led. We believe that this holds more promise for sustainability than‘‘top-down” research initatives, such as those that might otherwisebe initiated (rather than facilitated) by academic researchers orhospital or departmental managers. Furthermore, action researchpositions a partner university through its clinician academics andfacilitating researchers in dynamic scholarship in this setting.Building a research culture goes beyond the facilitation of individ-ual research projects or training in specific research skills. A CoPERproject shows how a culture might be built within a responsiveclinical unit in which clinicians observably value, talk about andpromote research. In particular, clinician–participants needencouragement to identify and explore further opportunities forresearch, to locate this research within current academic knowl-edge, and to participate in the developmental planning needed toanswer specific research questions.

A CoPER project systematically links academic and clinicalknowledge by supporting a research community of practice withinthe ED, which in turn has the potential to change culture in thehospital setting. It exceeds the outcomes of an issues-focused pro-ject team because it emphasises the development of research capa-bilities, building and exchanging knowledge. This project alsounderscores the importance of designing cross-disciplinary re-search projects for greater relevance and applicability, and multi-ple perspectives, thereby leading to better translational researchwhich is relevant to everyday work in the healthcare setting. Suchresearch enhances skills and knowledge linked to research basedon practice reflection. It delivers both tangible and intangible out-comes such as empowering staff. It allows staff to take pride in thedeveloping uniqueness of their contribution to the culture andworklife of the ED. Such empowerment can be expected to enhancestaff recruitment and retention. Using a CoPER to build a thriving,sustainable interdisciplinary research community of practice, thistranslational research is expected to improve the practical rele-vance of medical research. It is expected to foster interest in andpursuit of, further higher education, as well as impacting on work-place issues and ultimately enhancing the quality and safety of pa-tient care.

Conflict of interest statement

There are no financial or personal conflicts of interest involvedin this paper.

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