Appreciative Inquiry as an intervention to change nursing practice in in-patient settings: An integrative review.

BACKGROUND High profile accounts of failures in patient care reflect an urgent need for transformational development in healthcare. Appreciative Inquiry is promoted as an approach to exploring and bringing about change in social systems. Appreciative Inquiry has been used extensively in North American business since the late 1980s. The application of Appreciative Inquiry may have merit in the complex world of human health experiences. OBJECTIVES To identify, evaluate and synthesise the evidence about the impact of Appreciative Inquiry on changing clinical nursing practice in in-patient settings. DESIGN An integrative review and narrative synthesis. SETTING In-patient settings including paediatrics, maternity and mental health. PARTICIPANTS Nurses of all grades, patients, carers, relatives, other healthcare professionals including allied healthcare staff, management and students. DATA SOURCES An electronic search of the following electronic databases was performed in January 2015 and updated in July 2015: MEDLINE, EMBASE, Cochrane Library (Cochrane database of systematic reviews), Cumulative Index of Nursing and Allied Health Literature, PsychINFO, PsychARTICLES, Amed, Assia, Scopus and Web of Science. Hand searching of reference lists of included studies was undertaken. Limits were set to include literature published in English only and publications from 1990 to July 2015. REVIEW METHODS Three reviewers independently assessed eligibility for inclusion and extracted data. Full text articles were systematically appraised using a standardised data extraction instrument in conjunction with criteria to assess whether change using Appreciative Inquiry is transformational. RESULTS Eight studies (reported in 11 papers) met the inclusion criteria. Overall, these studies demonstrate poor application of Appreciative Inquiry criteria in a nursing context. This makes judgement of the impact difficult. One study achieved transformation against agreed criteria for Appreciative Inquiry. Other included studies demonstrated that Appreciative Inquiry is being perceived as a gateway to knowledge translation rather than transformative change in practice. CONCLUSIONS Appreciative Inquiry offers potential for nurse practice development and change but not without cognisance of the pivotal components. If Appreciative Inquiry is to be perceived as a legitimate research endeavour, there must be engagement and attention to rigour. Findings suggest caution is required against the choreography of Appreciative Inquiry where participant experiences are moulded to fit a previously drafted master plan. Further research is needed to explore the role of expert facilitation in securing and sustaining successful outcomes of Appreciative Inquiry.