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Qualitative
Health Research
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A Cooperative Inquiry Into Action Learning and Praxis Development in a Community Nursing Module
Emrys R. Jenkins, Gaynor M. Mabbett, Andrea G. Surridge, Joanna Warring and Elizabeth D. Gwynn
Qual Health Res 2009 19: 1303
DOI: 10.1177/1049732309344110
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Teaching Matters
A Cooperative Inquiry Into Action Learning

and Praxis Development in a Community
Nursing Module
Qualitative Health Research

Volume 19 Number 9
September 2009 1303-1320
2009 The Author(s)
10.1177/1049732309344110
http://qhr.sagepub.com
Emrys R. Jenkins
Gaynor M. Mabbett
Andrea G. Surridge
Joanna Warring
Swansea University, Swansea, Wales, United Kingdom
Elizabeth D. Gwynn
Princess Street Surgery, Gorseinon, Swansea, Wales, United Kingdom
As nurse lecturers we investigated practice development and action learning approaches aimed at enabling postregistration bachelors- and masters-level nursing students (Community Health Studies, Nursing in the Home) to
advance practice in the context of policy and professional developments. A patchwork text was used to assess summatively what students achieved (practice change/development) and how this was informed critically, via an
extended epistemology. First-person inquiry supplemented by cooperative inquiry postcourse completion (including reflective discussions with 16 students and 16 practice mentors) were used to assist coresearcher constructions
of meaning. A relational, tripartite approach to learning and assessment (students, teachers, and practice mentors
collective contributions) depends on continuing reflective attention. Action learning enhances interrelation of experience with dialectic thinking. The patchwork text functions to promote creative writing, evaluative thinking, and
praxis development. Role modeling by all, being genuine and not just talking genuine, is challenging yet crucial if
people are to function as mutual resources for learning.
Keywords: action research; nursing, community; nursing, education; research, collaborative; teaching/learning
strategies
s a team of university-based, community health

care lecturers, we explored student/teacher evaluation that consistently highlighted the gap between
what is learned and assessed in university and the
complex demands of practice, echoing nursing and
education discourses (Ashworth, Gerrish, & McManus,
2001; Endacott et al., 2004; Gallagher, 2003; Gerrish,
Ashworth, & McManus, 2000; Mulhall, 2001; Rolfe,
2002, 2006). In 2006 a new module, Developing
Specialist Nursing in the Home, an action learning
ethos, was adopted (Johns & Freshwater, 2005; McGill
& Brockbank, 2004; Unsworth, 2000), designed to
enable students to develop practice in keeping with
Authors Note: This research was made possible by the active
contributions and cooperation of student and clinician colleagues
too numerous to name. We are grateful to them and also to the
reviewers for their constructive input and attention to detail.
local needs and the wider sociopolitical background.

Module planning included critical appreciation of
assessment methods, not least because we sought
to appraise learning in terms of what students
achieved (practice change/development) and how this
was informed critically. We chose to use a patchwork
text (Winter, Buck, & Sobiechowska, 1999; Winter,
Hungerford, & Paget, 2004) that students built up gradually, consisting of separate components (patches) in
the form of accounts or stories about practice actions
and literature/research that were shared reflexively
via action learning (AL) sets.
Together we facilitated action learning sets (each
with 4 to 5 district nurse students) and collectively
debriefed after each set. We were committed to evaluating and researching our own education practice,
and crucially, to do so collaboratively, in ways that
Cheek (2008) referred to as exploring what kinds of
1303
1304 Qualitative Health Research
assumptions influence the way we think and speak

about collaborative research (p. 1602).
As the AL sets proceeded we adopted first-person,
self-reflexive inquiry (Marshall, 2001; Torbert, 2001),
primarily to supplement debriefing and ultimately to
assist our postcourse decision making, with respect to
choice of research methods. These included fourthgeneration evaluation (Guba & Lincoln, 1989; Koch,
2000; McCormack, Manley, & Garbett, 2004) and
appreciative inquiry (Cooperrider & Whitney, 1999;
Whitney & Trosten-Bloom, 2003). Although both
seemed relevant, we elected to undertake a cooperative inquiry (Heron, 1996; Heron & Reason, 2001).
This was mainly because first, we were uncertain
where our efforts might lead and did not want to
exclude the possibility of new knowledge generation
(although valuing evaluation, we did not wish to preclude a more explicit research orientation). Second,
we identified overt connections and congruence
between our education ethos (valuing and revaluing
diverse forms of knowing, including practical knowing via reflective appraisal) and the characteristics of
action research that Reason (2006) described as
addressing worthwhile practical purposes and
drawing on an extended epistemology that integrates
theory and practice (pp. 188-189). Third, we chose
not to adopt appreciative inquiry because of our complete lack of experience in its use and a compelling
concern that we attend to quality in our research
efforts. An appraisal (albeit brief) of relevant literature and likely preparation requirements indicated
that our research progress would be subject to considerable delay as we learned about the method.
Finally, we collectively acknowledged an ongoing
reticence that we articulated as an unwillingness to
prescribe or even envisage likely outcomes, and a willingness to try to practice what we were preaching, to
be genuinely reflective individually (on personal levels) and together at a collaborative level. Personal/
individual reflection is termed first-person inquiry
by Torbert (2001, p. 251) and self-reflective practice
by Marshall (2001, p. 433). At the outset, we agreed
we would each engage in self-reflection, noticing,
recording, and appraising our experiences of involvement with the module, the students, and colleagues as
a preliminary cycle designed to inform our emergent
decision making for postcourse research. We construed
this personal engagement as self-reflective (good) education practice and did not seek ethics approval
(though committee approval was sought for the postcourse cooperative inquiry, as noted below).
As the module proceeded we each continued to

appraise our first-person experiences, including discussions and conversations with others. Increasingly,
we began to recognize limitations of first-person
activity, noticing that even the best self-reflective
strategies are inadequate unless they translate into
presence with another (Thorpe & Barsky, 2001,
p. 767). Responding constructively requires dialogue
with others, a shift to second-person inquiry (Reason
& Bradbury, 2001, p. 449; Torbert, 2001, p. 253), representing personal decisions about what to share and
what to hide. These decisions and challenges were
made overt by the cooperative inquiry process and yet
afforded us a concurrent sense of safety. Initially we
sought to include student mentors, known as community practice teachers (CPTs), and former students
as coinquirers. Unfortunately, unpredictability faced
by students postcourse, and the logistics of collective
face-to-face dialogue with CPTs via coinquiry meetings, combined to dissuade us from including them as
coinquirers. Clinical emergencies and demands precluded regular attendance. Coresearchers were therefore exclusively nurse lecturers, though we did
engage with CPTs and former students in reflective
discussions to inform the inquiry.
Evolving Questions
During the summer of 2006 we engaged in discussions about the practical aspects of delivering the
revised module and our shared view of how we would
each facilitate the action learning (AL) sets. We asked:
1. How might we judge the worth of the changes?
2. What weaknesses and strengths might be identified,
and how?
3. How might our own prejudices impact on our
appraisals?
At this early stage we elected to adopt a first-person

inquiry approach (Marshall, 2001; Torbert, 2001) as
the module progressed, maintaining reflective records
that complimented regular post-AL set debriefing
sessions. Later, when we engaged in cooperative inquiry,
we constructed the following questions:
1. What did we learn from the AL sets about teaching/
learning, supervision, and assessment?
2. How were our teaching/learning approaches valued
by district nursing students?
3. How did the module impact on district nursing
practice?
Jenkins et al. / Action Learning and Praxis Development 1305
4. What academic merit applies to our teaching/learning

and research experiences?
Methods
life and develop new and creative ways of looking at

things; and (2) learn how to act to change things
you may want to change and find out how to do
things better. (Heron & Reason, 2001 p.179)
We sought to act as self-directed coresearchers, embracing the extended epistemology that Heron (1996, pp.
52-61) described. This is outlined as:
First-Person Inquiry and

Cooperative Inquiry
First-person inquiry describes self-reflective practice (Marshall, 2001; Torbert, 2001) as serious, selfquestioning, personal discipline. As we planned the
revised module and later, as the module proceeded, we
each adopted first-person approaches (self-reflective
practice) keeping records as diaries, notes, or journals,
and found useful advice on structure and format
(Hughes, 2000; Marland & McSherry, 1997) that complimented reflective writing tips on being creative,
using metaphor, poems, and the unsent letter (Rolfe,
Freshwater, & Jasper, 2001, p. 61). We shared our
reflections during post-action learning (AL) set debriefing. At this early stage we were not engaged in cooperative inquiry. We strove to be critically reflective but
we did not employ the language or procedures (such as
validity checks) that characterize cooperative inquiry.
Rather, we aimed to act as informed, reflective educators who were engaged in an emergent process of
learning about which research methods would be most
suitable. Also, we had not sought ethics approval for
this more personal, preliminary activity. Using inner
and outer arcs of attention (Marshall, 2001, p. 433)
was helpful in checking our first-person inquiry quality, so that we tried to reflect not just on isolated incidents but on a range of experiences and responses,
picking out words or details that prompted reaction or
energized us. Sometimes, some of us felt we were
learning a new language, one of understanding that
also confuses. At times, we had to remind ourselves of
the potential seduction of conversation to reaffirm but
not to challenge. Progressively, debriefing and ongoing conversations led us to see merit in beginning a
cooperative inquiry as an explicitly research-oriented
development.
We adopted constructions of cooperative inquiry
(Heron, 1996; Heron & Reason, 2001) that Jenkins
(2007) presented, meeting regularly as a group to
research our experiences. Cooperative inquiry has been
explained as
a way of working with other people who have
similar concerns and interests to yourself, in order
to: (1) understand your world, make sense of your
1. Experiential knowing, including tacit, intuitive, felt

knowing
2. Presentational knowing, sharing experiences using
words, pictures, poems, and stories to clarify meaning and appreciation
3. Propositional knowing or knowing about ideas,
concepts, and theories
4. Practical knowing, including skills and abilities,
knowing how to do
We explored and constructed ground rules, quickly

realizing unforeseen implications. Dialogue about ground
rules and ways of coresearching functioned to help us
check on our individual and collective assumptions:
The last thing is about risk, we wont get very far
unless we are sufficiently able to step off some cliffs
and take a few risks and hope the parachute opens.
Thats when it will get really interesting, when we
can step into chaos instead of staying on safe ground
and of course that needs support and for us to be
respectful. (coinquiry meeting notes; teacher)
Its opening up yourself really isnt it, thinking God,
people will know Im a right idiot now. (coinquiry
meeting notes; teacher)
Ground rules were considered in terms of relevance, applicability, and implications for coinquiring
with each overlapping and interrelating with the others and with each regarded as having equal merit. We
adopted the following ground rules:
1. Support and challenge: prerequisites for sustaining a
milieu characterized by constructive challenge and
essential for differentiating reflection and inquiry
from collusion (conscious and unconscious)
2. Humor and fun: resulting in divergent thinking,
helping us see connections that opened up patterns
of thought to new possibilities (Greenwood &
Levin, 1998 p.107)
3. Integrity, authenticity, openness, and being truthful:
all harder to practice than write down, and not universally possible all of the time, but, for example,
instrumental in the useful combination of challenge
with support
4. Creating and sustaining trust and commitment:

which became more a function of our actions than
our words so that others learned we were worthy of
their confidence
5. Mutual respect and understanding: where this was
doubted we expected clarification as an aspect of our
mutual responsibilities
5. Risk and freedom to speak without recrimination: so
that coinquiry represented a space where each of us
was free to voice what might seem silly, irrelevant, or
as evidence of relative ignorance (appraising these
contributions should be purposefully driven by reflective attention that first accepts and then explores,
critically and supportively)
6. Balance between structure and exploration: acknowledging what counted as too loose or too rigid, using
challenge and support to check legitimacy of our
explorations (so that, for example, we did not spend
excessive time on hobby-horse issues characterized
by personal bias or prejudice )
7. Responsibility: with each of us striving to be personally responsible for our contributions, speaking in the
first person and contextualizing our dialogue (for
example, rather than speaking about far away places
and people that bear little relevance to our situations)
This ground-rule dialogue was a precursor for considering validity procedures (Heron & Reason, 2001,
p. 184), differentiating critical appraisal and subjectivity
from mere recollection or description. Cycles of continuing reflection enabled us to evaluate what worked,
to what extent, and why. Yet we appreciated bias, misconception, and prejudice as examples of dangers we
needed to help each other explore. Our validity
procedures also served to make explicit our awareness of the dangers of groupthink (MacDougall &
Baum, 1997, p. 532), power imbalances, and dominance masquerading as collective agreement. We
adopted the following validity procedures:
1. Research cycling: balancing action and reflection, if
we only concerned ourselves with theory/propositions then we would perpetuate an ivory tower
mentality; action was the ultimate test of theory
2. Developing critical attention: for example, playing
devils advocate, challenging what we had claimed
previously, perhaps as a result of reading or ongoing
reflection, evidence of being critical rather than
merely accepting
3. Authentic collaboration: particularly interesting
given our ground rules
4. Dealing with distress: sometimes some of the things we
uncovered were things that we had not wanted uncovered; we would need to be alert to being supportive
enough to allow us to explore the distress without

closing down the issues or denying them
5. Managing chaos and order: some people are more chaotic and some are more ordered, the world is both and we
had to try to accommodate both chaos and order despite
our own tendencies to one or the other; we needed to not
be so chaotic that we were not productive and not be so
ordered that what we produced was boring or sterile
Our considerations of validity led directly to

exploration of how we might gauge the quality of the
research, its worth, relevance, and usefulness. A key
aspect of this quality appraisal lay in our presentations of the choices we made (Reason, 2006), their
rationale, and selection from alternate options. This
figured in the ways we appraised student assessment
(patchwork texts), where we looked for clear explication of choices made and rejected, and why. Similarly
here, we have striven to indicate our choices and their
rationale to readers. We planned the research to be on
ourselves, yet we were aware of how others, not least
students and colleagues, were likely to influence our
processes. In December 2006, our proposal was considered by the schools ethics committee. We incorporated several amendments and approval was granted
in February 2007.
Research Cycles and Processes

The module ran from October 2006 to March, 2007.
Five AL sets (with teacher debriefings) took place at 4
to 6 weekly intervals. Appendix 1 presents a synopsis
of one teachers notes of a first AL set, as an illustrative
example. Students concurrently underwent other classroom teaching both in respect of the Specialist Nursing
in the Home module, other modules, and practice placement experiences. In June 2007, we began cooperative
inquiry sessions, using a digital recorder to capture
dialogue. Comprehensive notes were constructed
from recordings (not transcriptions) for subsequent
appraisal, accuracy, and meaning. Coinquiry continued through summer into October as we reviewed
experiences, feedback from students and clinical
mentors, and constructed revised approaches to the
next module/student group.
Cycle 1: First-Person Inquiry

and Formative Evaluation
Immediately prior to the first AL set, we discussed rotating facilitators/groups so teachers would
spend time in all five groups. Debriefing after the
first AL set made explicit students and teachers

wishes to retain facilitators and not alternate them.
Consistency of approach, familiarity, and feelings of
safety were stated as being jeopardized by rotating:
Remember we talked about feeling safe. I think you
need that continuity of the basic group. You all teach
in a different way you all have slightly different ideas
and I think that [alternating facilitators] would have
confused us. (reflective discussion notes; student)
This development was somewhat unexpected, and

served to prompt us to appraise our AL set experiences
as connections between positive and negative dimensions during subsequent AL set debriefing sessions.
Generally, positive experiences were confirmed in all
groups. Dialogue and metaphor were critically received
and utilized. Some students and teachers described
their predominant postsession feeling as elation. As an
example of a negative experience that we reconfigured positively, one teacher expressed frustration
when a student proposed an unsuitable project (grandiose in scale and content), though the student quite
suddenly shifted to a different, much smaller (and
more achievable) project midway through presenting.
This represents an effect of the AL set process and
dialogue at work. Each teacher explained her or his
attempts to keep to the planned format. When community practice teachers (CPTs) attended AL sets,
their contributions added a different perspective that
enhanced the quality of the learning experience for all.
This was the case even though what clinicians said
mirrored what lecturers said. Yet, it seemed to have a
different, more credible impact because of who they
were (clinicians). Williams and Taylor (2008)
addressed clinical credibility of university (nursing)
teachers, and citied as a barrier the explicit, organizational valuing system within the HEI [higher education institution], which places emphasis on research
and publishing to the detriment of clinical practice
(p. 906). In their work on preregistration nursing studentmentor relationships, Webb and Shakespeare
(2008) found that students needed to portray themselves as appropriately enthusiastic, confident, assertive and competent . . . not seen as overconfident or too
assertive (p. 569). These types of factors applied in the
AL sets and warrant additional study, not least because
of the differing context of postregistration education.
Concerns about module assessment endured for
students and teachers, who each had difficulty in
expressing what a good assignment (patchwork text)
might look like. Guidelines (provided via student

handbook; see Figure 1) were characterized as
wordy and technical.
In response, an open discussion between all students and teachers was used to review indicators of
assessment quality, including encouraging students to
make choices and their rationale explicit (Reason,
2006) and relevant to context, evidence, and experience. Afterwards, teacher debriefing revealed both
students and teachers feeling uncertain, clear, doubtful, and hopeful. Some students provided useful
examples of record keeping and ideas for the assignment. The key quality issues that were presented (see
Figure 2) seemed to be understood by most, and students expressed a commitment to presenting written
work for supervisory feedback at early stages.
In summary, our first-person experiences of action
learning and impressions of students perceptions
were encouraging. We wondered whether its adoption
in other modules/courses might be advocated, though
that type of consideration illustrated the value in our
pursuing a second cycle, postcourse, using cooperative inquiry.
Cycle 2: Ongoing First-Person

Inquiry and Cooperative Inquiry
We quickly recognized value in engaging with
former students and CPTs to explore module experiences. We chose not to simply interview these people
because of connotations of treating them as data fodder. In preference to a smash and grab approach
(Clarke, 2006, p. 175; Lathlean, 1996, p. 36), we
sought critical dialogue with them, part of our firstperson inquiries, helping us appreciate contributions
reflexively. During August and September 2007,
coresearchers met individually with 16 students
and 16 CPTs and recorded reflective discussions
about our research interests and questions. These
were appraised via second-person coinquiry, and by
December 2007, we had cocreated the illustration of
our research in Figure 3, characterized as applying
(in connected ways) to (a) people, (b) processes, and
(c) products.
Each element (people, processes, products) is
interdependent, understood best in relationship with
the others, a dynamic and relational (nonlinear, nonstage) view of our work. In summary, our first- and
second-person inquiry connected students, CPTs, and
teachers with others through a critical appreciation of
processes that fostered meaningful learning and
praxis development (knowledge and application each
Figure 1
Abridged Quality Indicators Taken From Assignment Guidelines for Students
[The patchwork text is] built up gradually, consisting of separate components (patches) in the form of accounts of, or stories from,
practice and literature/research that are shared reflexively in small group discussions. These reflections enable retrospective interpretation
of the earlier pieces and lead to the text illustrating starting points/experiences, reflections, ongoing learning, practice experiences and
eventually, an overall coherent synthesis. The Patchwork Text asks students to combine different ways of writing (e.g. a story, a personal
memory, a book review, a commentary on a lecture, notes from a placement experience, etc.) and to move between description,
imaginative creation and analytical commentary. Students are encouraged to integrate the diversity of parts of the course/module in
order to make learning a process of constructing meaning (as opposed to merely mastering information). Specifically, assessors will
judge work in respect of:

Careful, detailed observation and description of events and situations

Empathizing with the standpoints of others
Noticing the various emotional dimensions of events and situations
Independent, critical and evaluative thinking
Addressing the complexities of issues, events, and situations and articulation of the value and limitations of assessment and
prioritizing
Making connections between different events and situations to inform planning (acknowledging differences/similarities between
specific details and general principles derived from various knowledge types relevant to specialist practice)
Effective communication of complex concepts and decision-making processes to professionals and nonprofessionals
Demonstrating learning in response to professional experience and the reflective process, including writing about it
Personal insight and developing self-awareness that illustrates constructive coping, challenge, and change
Demonstrating that the learner outcomes incorporated within the role attribute of team working have been explored clearly
Coherent structure and presentation, including format, typography, and referencing
Additional indicators applying to MSc students

Originality and creativity in utilizing the knowledge base and methods of inquiry in practice
The ability to act autonomously and involve others appropriately (particularly in relation to more systemic/cultural issues and
implications)
Figure 2
The Patchwork Text Assignment:
Key Quality Issues
1. Well presented, expressed, and
referenced
2. Practice relevance and
ALL SET AGAINST A
theory/knowledge/research
BACKGROUND OF:
integrated
3. Personal and collaborative
Patient centeredness
knowing and learning AND
broader systemic influences and
An area of practice
implications
chosen for
4. Weaknesses and strengths
development/leadership
acknowledged, progress and
regress identified
Policy
5. Role attributes/prescribed
outcomesrelevance and
Future implications
evidence (teamwork and
leadership)
6. Choices and their rationale made
explicit
informing the other). Our constructions of people,

processes, and products are illustrated in the following
section.
Constructions
Our first construction was that of the people
involved in the education and research processes,
including not only those directly involved, but also
peers and team colleagues who played a significant yet
almost hidden role in learning/researching. Second, the
processes and relationships that people engaged in were
characterized by core values, attributes, links, and
behaviors that interfaced with action learning approaches
(including challenges) and the relational nature of district (home) nursing (families, neighbors, communities).
Finally, the products of our learning and researching
fall into three broad areas: learning, practice/practitioner
development, and academic achievement.
People
Mostnot allpeople asserted personal, collective, and more systemic benefits from the action
learning (AL) sets and resulting practice changes.
Sense making through reflection and dialogue was
enhanced as we developed increasing recognition of
Figure 3
A Connected View of the Research Process
People
Processes
Products
Relationships & the Relational

Nature of District Nursing
VALUES
multiple
conceptions
of knowing
Students
& their
peers
CPTs
& their
peers
CONNECTIONS
between
individual & systemic
private & shared
Teachers
& their
peers
Learning
recording
reflecting
evaluating
doing
ATTRIBUTES
honesty
respect
trust
authenticity
ACTIONS
dialogue, support
challenge, risk
rolemodelling
Action Learning Sets

and Diary Keeping
Practice/
Practitioner
Development
confidence
creativity
Academic
Achievement
Patchwork
Text as
evidence of
choices &
competence
Challenges
Note: CPT = community practice teacher.
the contributions of others, particularly those in different (not peer) groupings. A positive emphasis predominated, though almost always with a concomitant
recognition of other sides of the coin. The tripartite
system of student, teacher, and CPT (and relevant
peers) was valued as a supportive base from which
individuals could challenge with increasing confidence. CPT and teacher enthusiasm were key motivators for students, with implications for role modeling:
She [CPT] was really enthusiastic when she came
back from her experience of being in an action learning set. But she is the type of mindset, she is very
much into looking for new things and developing.
(reflective discussion notes; student)
Role modeling emerged as a significant influence

on learning and development. People were mutual
resources for learning through critical processes and
supportive challenge. Role modeling qualities often
seemed almost invisiblehow people were with others. Although we do not claim to illustrate role modeling particularly well in this article, we identify it as
a quality we do not wish to disappear (Fletcher,
1999, p. 3) or be ignored:
Role modeling is related to authenticity, being genuine
not just talking genuine. None of us are perfect and this
might be easier said than done but role modeling is done
well when we can be seen to try to live our ideals and
our inadequacies. (coinquiry meeting notes; teacher)
Conversely, some lack of supportive challenge

and poor communication was identified. We all
expressed difficulty in being absolutely honest all
the time. Students described conflicting advice from
teachers, perhaps because teachers were also new to
the process. This explanation was initially seen
negatively by students, yet later was also perceived
as evidence of teachers honesty and authenticity.
Including more AL sets was recommended by students who appreciated their utility in making sense
of complex, messy issues. You get out what you
put in was one (typical) student comment highlighting personal responsibility. The same student
explained how she and her community practice
teacher (CPT) helped each other through it.
Beneath these responses lay deeper concerns about
unrealistic wishes for simple, clear directions and
information that are seductive yet all too simplistic
in the face of uncertainty and unpredictable circumstances. An example of student reflexivity (and a
challenge for one teacher) occurred during a postcourse discussion:
When they come into university students expect
certain academic assessments irrespective of their
personal [creative] talents. All of their schooling
has dictated and channeled them into doing an academic essay with an introduction, middle and end,
which is measurable. And now you are asking them
all of a sudden to do a patchwork text. (reflective
discussion notes; student)
When the teacher asked whether students should be

given a choice of assessment format (either the
patchwork text or an article for publication), a student replied,
Well, you could, thats a good idea but the only thing
about letting them choose, they dont explore other
avenues then, do they? I found the patchwork text
hard but Im still glad I did it and I still learnt a lot
from it and Im glad I did it now. And yet I would
have chosen the other option and I would have lost
out then, wouldnt I? (reflective discussion notes;
student)
For the teacher, this was an example of how he had

fallen prey to a superficial understanding and valuing
of choice that demonstrated linearity of thinking even
though lateral thinking was espoused. It also highlighted the importance of dialogue and a limitation of
introspection.
Students emphasized their need to maintain reflective diaries and construct patches as the module
proceeded. These writing tasks developed their
selectivity about what to include or exclude. Students,
teachers, and CPTs often citied confusion, muddle,
frustration, and apprehension, exacerbated by a perceived lack of clarity. These were overlaid (equally
variably) by enthusiasm, curiosity, and excitement.
New ways of thinking and writing were being advocated. We were challenged by fear of failure, uncertainty, and safety, compounded by the absence of
discrete answers:
Nancy Klein would say, If you knew that they
would take notice, what would you do? We stop
ourselves from doing things by making negative
assumptions. (coinquiry meeting notes; teacher)
Relationships underpinned the lived experience of

the module. The team included teachers, CPTs, and
clinician colleagues, all working with students. CPTs
attended AL sets and teachers assisted reflective
appraisal in practice environments. CPT contributions
to AL sets were highly valued, serving to compliment
theory and practice voices, even given logistical limits
on time and travel:
I think its because theres somebody here who is
actually doing the job, for real, but because they are
a CPT they have also got some idea about the academic understanding about, you know what a degrees
about and what youre trying to do. So they can
bridge the gap. (reflective discussion notes; CPT)
Honesty in relationships was valued, though recognized as sometimes being more aspirational than
realized. To be human was to err:
I never made anything up during reflective sessions
but there were some things that I kept to myself. I
might not verbalize things but I did include them in
writing in my patch text. As we said before, you
want to fit in, and you want to be accepted, and you
are in an environment where they have had probably
another five students before you all coming in wanting to implement a change. Youre sort of scratching
at everything thinking, Well, what can I do? To get
people to accept it then, although they were brilliant,
it was just the odd one or two remarks. To discuss
that with other members of the team was difficult.
There was universal agreement that

1. Being open to new ideas, challenge, and striving to
be self-evaluative enhance reflection and learning
2. Sometimes we can all be the opposite of (1), above
3. Variety of background, experience, age range, and
gender make for more constructive AL set working,
although sometimes lots of relevant prior experience can lead to stumbling blocks in the form of
resistance or defensiveness in acknowledging the
groups sensible suggestions
People and the assessment. Early confusion and

apprehension associated with patchwork text evolved
through experience and reflection to more positive
appreciation:
The light came on when everybody kept on giving
different approaches, and I had not even ventured to
do a patch by then, but some of them had, everybody
was saying the way that they had done it and you
[teacher] just kept on saying, Yes that sounds good,
to everything. Yes you can do that, that sounds
really good, really interesting. In the end my mind
was well if its that much my work and [teacher] is
saying yes to everything I cant fail, because there is
no right and wrong. So that was the first time that I
think I felt kind of reassured by the whole process.
Although this view is illustrative, it leads more obviously to questions of what constitutes quality in
assessment, what would a good patchwork text look
like, contain? Abridged answers involved students
presenting evidence of their praxis: accounts of critically informed action used as part of a learning
dynamic through sharing. Guidelines were based on

work by Winter and colleagues on patchwork texts
(Winter, 2003; Winter et al., 1999; Winter et al.,
2004), Hays (2005), on writing for self-discovery,
Heath (1998) on diary keeping, and Jasper and Fulton
(2005) on practice-based portfolio marking criteria.
These were presented in the course handbook and
supplemented by ongoing reflective attention and
open discussion (see Figures 1 and 2).
Guidelines assisted shared understanding of shape
and form of the assignment. We recognized that individuals could present work in different ways yet still
be judged to have produced high-quality work.
Assignments were marked independently by teachers.
Coinquiry and student/CPT feedback prompted us
to include clinicians more effectively. Since 2007
CPTs have formally verified that students written
accounts constituted valid representations of placement activity and learning:
Its not just about CPTs verifying that something has
been done. Its also about understanding and that
what has been written is of value, meaningful, worthy. (coinquiry meeting notes; teacher)
Dialogue and challenge were the main means by

which differences and interpretations were acknowledged, valued, and explained so that supervisory advice,
judgments, and marking could be validated fairly.
The patchwork texts were extremely interesting to
mark. Appendix 2 provides an illustrative extract
from one submitted assignment. Many students
regarded it as the easiest assignment because it was
based on lived experience, lived reflections, and relevance of theory to practice and practice to theory.
CPTs perceived the assignment as valid in that students wrote about how learning (including theory)
influenced practice, though validating the assessment
required CPT input (confirmation of authenticity of
accounts) in addition to teacher appraisal.
Processes
Relationships. Relationships are predominant
influences on social learning, described as inevitable
and life-sustaining by Wenger (1998, p. 3).
Introspection was revealed as well intentioned but
limited; being evaluative was enhanced through relationships characterized by toleration, mutual respect,
and trust. Dialogue revealed that introspection could
often mislead, and sometimes equate to single-loop
learning (Greenwood, 1998). Challenge invariably
enhanced double-loop learning (Greenwood, 1998)

and appreciation of systemic influences. By attending to supporting and not directing students, CPTs
could use their close relationships most effectively in
assisting student self-development. These influences mirrored the relational nature of district nursing. District nurses are faced by individual patients,
in or without families, within particular cultural boundaries. Unpredictability, difference, diversity, uniqueness, and complexity present alongside the routine,
similarity, homogeneity, and the commonplace:
To me district nursing is not just one thing its a lot
of things . . . visiting a patient to change a catheter,
and of course everything becomes complex, perhaps
the patient hasnt been eating or drinking, there may
be some other illness or infection present or factors
impinge on the environment or on the person themselves or on their family. So district nurses need a lot
of skills and a lot of background knowledge and to
reflect to learn from experience. For me, I think with
the patchwork quilt, its about bringing all of these
things in together, a little bit of this and a little bit of
that making up a bigger piece. People are all different and if you look at something like terminal care,
that is a very complicated area of district nursing and
theres a lot of stuff to bring into that, not just the
patient but families and carers and everything else.
So theres a lot of background knowledge needed,
but people grieving, death and dying needs sensitivity and how to recognize all of that . . . district nurses
wash their hands in other peoples sinks. (reflective
discussion notes; CPT)
The challenge for educators was to sustain learning relationships that influenced practice positively,
and that this could be justified via critical review
rather than assumption, collusion, or acquiescence to
authority. We were attempting to adopt approaches
that countered the separation of theory from practice
and mechanisms that push students to tell us what
we want to hear (to imitate our values). Instead, we
sought to work in ways that expected creativity and
challenge from learners as we explored with them the
options in engaging with nursing practice phenomena, aiming to solve real-life problems in context
(Greenwood & Levin, 2005, p. 54):
Its just things like, if you spent the day here or anywhere, you could see how our working environment
is terrible, an office built for two people is home for
up to seven people. Youd see how many patients we
have to see and the conditions some people live in.
How noncompliant some people are. The amount of

phone messages that are waiting when we get back.
(reflective discussion notes; CPT)
Action learning sets and impact. These were challenging yet also (for most) inspirational, a good deal
of fun and a good idea, better than solitary thinking. A broad mix of members backgrounds, gender,
ages, and geographical locations were all seen as
advantageous. Difference and diversity became
strengths. Feeling safe was repeatedly cited as a
crucial feature of support, and in some instances students expressed that the AL sets functioned to enable
them to safely explore issues that were unspoken
elsewhere. For example, students were unsure and
somewhat confused, yet felt unable to seek clarification. AL sets provided safe opportunities for students
to voice concerns. Some who described themselves as
more introverted personalities explained how AL sets
were places where they could listen, learn, and contribute, at their own pace and level, leading to opportunities for dialectic thinkingthinking outside the
box:
Like when [teacher] said . . . I said, Well mines
gone really smoothly, I havent had any friction from
the team, its gone really well, and then she kind of
turned it on its head and said, What would you have
done if it hadnt gone so well? Write a patch about
that. (reflective discussion notes; student)
Community practice teacher (CPT) input was not

designed to enable a comprehensive appreciation of
each students journey, but about complimenting the
theory voice with a practice voice. CPTs acted effectively, as consultants. When CPTs were present, student contributions were more objective and thoughtfully
considered, for example, phrased in more tentative
expressions. When CPTs were not present, more
judgmental language was occasionally used when
referring to CPTs. This happened rarely, but signified
the need to better challenge judgmental expressions.
Negative feedback on CPT attendance was minimal,
centering around perceptions that sometimes the discussion became sidetracked into areas that were of
questionable relevance to the AL sets purposes.
Without exception, students and teachers regarded
diary keeping as invaluable, though volume and selectivity of input were both issues. Writing diaries and
assignments was a way of reflecting, a learning
opportunity. Students generally found the patchwork
text difficult to write initially, and though diaries
were invaluable, the attention students were able to

pay to the patchwork text varied in keeping with the
assessment demands of other modules being navigated as the course proceeded:
I have got to say that I was never into reflection. I
have reflected with colleagues but not in a particularly structured way, but after doing the patchwork
text I feel much more confident and knowledgeable
about reflecting. I enjoyed, in fact I preferred writing
in that style, once I knew what I was doing. (reflective discussion notes; student)
Students increasingly recognized that diaries needed

to include evaluative thinking, not mere description.
Although accuracy was key (else all that followed
was based on misperception), it was insufficient.
Evaluative attention was afforded by using margins
and graphics to question (So what? What if? How?
Why?).
Challenges. Geography and time constraints limited CPT attendance at AL sets and teacher attendance
in clinical areas. We all struggled to understand how
the patchwork text could be used to illustrate meaningful practice development in the time available:
Of all of the modules that we studied that was the
most challenging, and I think it was for this reason,
reflection and creative writing [not suited to her
style], thinking outside the box, particularly when in
most of the other modules you are encouraged to
think inside the box. You are asked to do all of these
different things in a very short period of time.
Teachers were simultaneously excited and concerned;

some expressed worry about their facilitation skill and
supervision advice. CPTs were similarly challenged
by lack of familiarity and providing advice to students. These challenges were as affective as they
were intellectual, and required emotional intelligence (Goleman, 1996; Jordan & Troth, 2002;
McQueen, 2004) as much as cognition and problemsolving skills.
An overemphasis on cognition presented a challenge, insofar as teachers (especially, though not
absolutely) noticed a tendency to reify reflection as a
purely cognitive exercise. This served to sustain
interesting conceptual analysis and discussion that
functioned to maintain distance from practical knowing and relevant implications, effectively valuing
(disproportionately) theory more than practice. We

were challenged to reflect more objectively, holistically (Bleakley, 1999), to appreciate diverse ways of
knowing (including practical knowing) in keeping
with Herons (1996) extended epistemology.
for shared social reflection and influence. Postcourse

action learning is being used, for example to develop
leadership and team work and patchwork texts are
continuing to be used by clinicians to illustrate practice and learning. (coinquiry meeting notes; teacher)
Potential dangers included spoon feeding, when

others provided too much support; too little challenge; and when learning was construed as a purely
intellectual exercise without connecting knowledge
with practice through reflection. CPT role ambiguity,
when students regarded them as teacher, assessor,
manager, and friend, was countered by tripartite dialogue. A vehicle for this was recommended, involving CPTs validating written work at early, middle,
and later stages of the module:
Practice/practitioner development. A practice development ethos characterized module design and

included explicit assessment of mandatory competencies including team working and leadership (Nursing
and Midwifery Council, 2001). Students did not function as fully informed practice developers; their status,
comparatively short periods in a given area or team,
and relative lack of power meant their contributions
to practice development or facilitation did not match
definitions and descriptions in nursing discourse
(Garbett & McCormack, 2002; Manley & McCormack,
2003; McCormack et al., 2004; McCormack & Garbett,
2003). This was especially applicable to sustaining a
dynamic cultural influence. Yet, students were required
to develop as practitioners, using critically informed
action to improve practice at a micro/team level that
demonstrated improved patient care. This constituted
an aspect of practice development that Bryar and
Griffiths (2003, & 15) illustrated as professional
development, which is not only about implementing
research findings but also about changing practice
through reflection, critical thinking, and evaluation.
Unsworth (2000) cautioned against using the terms
practice and professional development interchangeably, because the former must be patient oriented
while the latter need not be. So, although it would be
misleading to characterize students as becoming adept
practice developers, the module did develop them as
practitioners, and this was evidenced through their
positive influences on patient care and teamwork.
Students were able to demonstrate discernable growth
of confidence, creativity, and emotional competence,
including regress and progress, echoing the skills,
knowledge, personal development, and growth that
Wilson, Keachie, and Engelsmann (2003) attributed to
involvement in an action learning set. Additionally,
students developed abilities to be more selective as a
way of avoiding being overwhelmed by information,
becoming more self-evaluative and acting as positive
role models. In summary, students were able to represent the complexities of their practice, learning, and
achievements.
The experience is viewed as a whole team issue, not

merely one CPT plus one student, with implications
Academic achievement. Assessment had formerly

been characterized as disproportionately weighted
Products
We have chosen to illustrate our continuing
learning in three main areas: action learning, practice/
practitioner development, and academic achievement,
though each is inextricably related to the others.
Action learning. Emphasis on the process approach
was enhanced by module structure that was long and
thin (longer rather than shorter timeframes), enabling
time for action, effect, and reflection to be meaningfully applied. AL sets worked best when members
represented different ages, backgrounds, and gender,
and when CPTs could attend. Facilitation was secondary to all working toward sustaining a safe and evaluative milieu. Linking learning to action as autonomous
decision making was the life blood of the AL sets:
That came out in their writing, to me it just seemed
to make so much sense, you read it and it was far
more about themselves it was far more in-depth, it
was far more effective then, they analyzed what they
had done far more effectively than in a reflective
[one-off reflective essays/critical incidents] piece of
work. (coinquiry meeting notes; teacher)
It made far more sense of reflection for me. I struggled with the one-off instance of reflection, whereas
that [patchwork text] made perfect sense. (coinquiry
meeting notes; teacher)
I can see that now, I can understand your point
because of it. (coinquiry meeting notes; teacher)
toward theory/knowledge possession and presentation by students. Yet excellent essays do not necessarily a good district nurse make, and of course, good
practice is good only insofar as those responsible for
it can justify execution, rationale, purpose, and value.
The patchwork text (Winter, 2003; Winter et al.,
2004) was designed to present evidence of interrelationships between theory and practice, principle and
context, weaknesses and strengths. Coinquiry established its process-driven nature, with learning becoming developmental, linking reading with talking
(reflecting) and doing (practicing). For most students,
teachers, and CPTs the assessment process was instrumental in increasing confidence, and reflected a more
truthful/honest (valid) assessment of achievement in
praxis terms:
You know when I came into this course thinking
black and white, and now I try to think of all these
different avenues and different perspectives. I think
thats benefited me not just professionally as a nurse
but in all aspects of my life. (reflective discussion
notes; student)
A minority of participants provided counter examples, where the words on paper failed to reflect adequately the perceptions of practice experiences.
Crucially, this amounted to more than mere difference of emphasis or interpretation. One patchwork
text, considered to be presented well, was awarded a
good mark, yet our postcourse coinquiry revealed
serious questions about its quality as perceived by the
relevant CPT. This had been compounded by the CPT
not being able to see drafts of the work periodically,
or only with difficulty, so making student and teacher
feedback problematic. Our shared emphasis, from the
module outset and throughout, had been collaboration between students, CPTs, and teachers, yet the
practice reality in one instance revealed communication
breakdown that seemed to have been unnoticed, ignored,
or disappeared (Fletcher, 1999, p. 13). Coinquiry
served to reemphasize the need for ever-present
attention to process, including communication if
assessment was to be comprehensive. Responsibility
for assessment had to be similarly shared between
student, teacher, and CPT so that connections were
validated and valued holistically:
We have involvement in 50% of the course but it
always seems that its the college bit of the course
that gets most attention, more than 50%. But weve
got an equal responsibility to ensure that this person
is fit for practice. It is a huge responsibility . . . it

would be very hard if you had a student who you
thought was not competent or could not relate to
people. You dont want to be failing people, but
youd have to. It seems like the two sides as separate
with more emphasis placed on the college side. With
sessions like that, the action learning sets, they come
together more, and you feel like as a CPT what you
say has got some relevance, worth credibility. (reflective discussion notes; CPT)
In one instance, one coresearcher, whose role was

that of a part-time lecturer/practitioner and part-time
team leader in clinical practice, voiced concerns
about the student with whom she was working in a
CPT capacity (i.e., acting as student mentor in clinical practice). The student had claimed that some of
her efforts to promote informed change had met with
resistance from the clinical team, and this was disputed by the team leader/CPT/coresearcher. The student was thought to have been misguided and
insufficiently reflective in making her observations
and claims. During the course, as the AL sets proceeded, this CPT/coresearcher and student continued
to voice different perceptions of their shared experiences, yet without resorting to negative or stigmatizing behaviors. Each noticed the dissonance involved
and did not deny it; rather, both sought to reflect and
continue to listen to the other without caving in to
positions (and propositions) that were neither understood nor felt. When the CPT/coresearcher was
appraising the students patchwork text assignment
for feedback purposes, she realized that the students
views were both informed and rational, and described
this experience as insightful during a coinquiry
meeting. We claim this as an exemplar illustrating
toleration and management of dissonance (markedly
alternate perceptions) through ongoing reflection that
includes dialectic appreciations (through critical dialogue and appraisal of text) leading to more thoroughly informed decision and choice making (rather
than falling prey to simple, immediate, seductive, yet
invalid conclusions).
The research process made overt positive and
negative issues, including supervision. Generally,
patchwork texts served to link learning with practice
and development, and writing led many students to
change their perceptions. Writing as reflection has
been enhanced and some continue to use it postcourse, voicing appreciations with respect to ongoing
role development and particularly in applying theory to
practice. Constructing a patchwork text (as assessment)
is relatively unexpected in higher education. Students

explained that the style was difficult to grasp and too
few words were allowed. It required a degree of creative writing and imagination that some students
found unnerving. Almost all students described teachers advice as Double Dutch (something that is not
understood, is meaningless or incomprehensible) to
begin with. Most believed more direction would have
helped, for example provision of an illustrative, highqualityalbeit fictitious (model)assignment.
Although all students expressed that diaries were
invaluable, recording was variable as the demands of
other module assignments took precedence. Some
students insisted that their diary entries made up the
bulk (50% at least) of the assignment, with the
remainder comprising links between the entries,
illustrating critical appreciation and application of
evidence:
It was very much hands-on, when you read them or
heard about them you could almost imagine what it
was actually like. I think that if you can see the theory applied to practice its easier then to understand
it. (reflective discussion notes; student)
Coinquiry confirmed the patchwork text as a valid

assessment in that it provided evidence for judging
the quality of student learning and application, with
respect to module requirements including Nursing
and Midwifery Council (NMC) competencies of
teamwork and leadership. Teachers learned much
about the necessity for regular, routine debriefing and
communication with respect to ongoing supervision
(and student advice), and marking/grading assignments. Constructive feedback from the external
examiner was particularly illustrative:
Students early misconceptions were replaced by
engagement . . . as they experienced the empowering
aspects of student centered learning and developing
self-awareness . . . tutors should be encouraged at the
creativity, evidence of the bridge between theory and
practice and the in-depth critical evaluation that
characterized the majority of the assignments. (external examiner report)
An obvious weakness was the relatively informal

means of involving CPTs in verifying authenticity
of student patchwork accounts. Grading student
work requires a tripartite appraisal by student (selfassessment), CPT, and teacher. Coinquiry has confirmed
that action learning, assessment via a patchwork text
and continuing questioning, constitute evidence of

praxis by all, albeit imperfect praxis. The AL sets
epitomized the value of critical dialogue (talking is
good) that is informed and supplemented by action
in practice, together forming a reflective, questioning, evaluative approach to learning and doing. These
elements were enhanced through writing about it all.
The patchwork text transformed recording into
dynamic praxis learning. We were all proud of our
achievements:
It definitely opened my mind and it definitely
enabled me to relate theory to practice . . . the other
thing I realized was that whereas in an essay you
start it and stop it within one piece of time so to
speak, the patchwork text basically started at the
beginning of the course and lasted until the end,
which was another aspect that I was not used to.
The reflective diary was vital as it turned out, asking questions was essential, especially when youre
not sure, not being afraid to come across as stupid,
because obviously this essay [patchwork text] asks
something quite different of you and you need to
ask questions to realize what that is . . . it definitely
expanded my mind and made me look outside of
the box and I think it was a worthwhile exercise
although [laughter] you said mine was a bit like a
counseling manual. (reflective discussion notes;
student)
Concluding Discussion
We have illustrated our first- and second-person
research on our own education practice with respect
to using action learning processes and a patchwork
text assessment. Our presentations characterize learning in ways that connect theory with practice through
critical reflection. A tripartite approach (students,
teachers, and practice mentors) is advocated for collective contributions to impact positively on supervision and learning of theory and practice as praxis.
This is more than a combination of practice-based
learning and classroom instruction; it represents a
praxis orientation that connects experiences through
critical reflection using an extended epistemology
that embraces and values equitably the experiential,
presentational, propositional, and practical. We assert
that students, teachers, and mentors need to display
attributes of support, enthusiasm, open mindedness,
and mutual respect to create and sustain learning
milieu that promote feelings of safety and supportive
challenge. This is not to say that individuals can

function admirably in absolute terms; we recognize
some strengths in acknowledgment of weaknesses,
vulnerabilities, and poor practices as reflecting
honesty and congruence in our approaches to learning. These issues relate directly to the importance
of role modeling by all. Individuals actions, their
development, and the social dimension (impact on
and interrelationships with teams and systems)
require being genuine, not just talking genuine.
If we deny our weaknesses and mistakes our learning is diminished.
Action learning is particularly suitable for providing opportunities for interrelating action with dialectic thinking, and works best when students, teachers,
and practice mentors are involved. Dialogue is the
principal means by which dissonance is explored
and this is supplemented through other means of
presenting, such as imagery and metaphor. In combination, these ways of knowing and understanding/
appreciating facilitate comprehensive appraisal of
proposed resolutions and actions (practice).
The patchwork text helps students to appreciate
and construct relationships between different aspects
of the whole course and practice, constituting a valid
assessment of praxis learning including any prespecified competencies. Keeping a reflective diary/record
is crucial for patchwork text development and also
promotes creative writing and evaluative thinking.
Academic and practice supervision require connected
and reflective approaches so that assessment functions as a learning process. Assessing/marking these
types of assignments requires a team approach in
terms of student self-assessment, first and second
marking systems, and mentor validation of accounts
of practice.
This research contributes to the nursing and education discourse as well as the research discourse
with respect to the value and utility of action learning in promoting praxis orientations and action
research (particularly cooperative inquiry) in practitioner development (students, teachers, clinicians,
and researchers).
Epilogue 2008
Since completing Cycle 2 we have developed the
module to include creative writing sessions and time
for action learning (AL) set members to construct a
quilt via team working (see Figure 4). Individuals
Figure 4
Quilt Making via Teamwork
physically provide material patches that represent

their perceptions and needs, reflect on them within
the AL set, and then work together with other AL set
members to physically construct a representative
quilt. This has demonstrated Herons (1996) extended
epistemology, particularly presentational knowing,
most explicitly:
This approach . . . provides an excellent channel to
encourage both the art and science of nursing and to
promote the interrelationship of theory and practice.
Self-awareness is also a strong feature . . . students
demonstrated an awareness of management and leadership theories and the practical and personal application required to successfully introduce innovation
and achieve change. All of the studies provided evidence of development and a growing awareness of
the attributes required for effective leadership and
team-work. (external examiner report)
Finally, patchwork text has also been adopted in a

module in another masters degree program (advanced
clinical practice), with positive feedback from students, and a second external examiner with a markedly different background, commenting:
I was delighted to read these assignments. I thought
they all evidenced a very good grasp of the utility of
the patchwork text concept, embedded within an
action learning framework. It is evident that students
approached the assignment with some trepidation
but have clearly gained a huge amount from undertaking it. Splendid. (external examiner report)
Appendix 1
A Brief Extract From One Students
Patchwork Text Assignment
Patch eleven 31.01.07
The De Bonos Six Thinking Hats session. I feel apprehensive and nervous but also excited and relatively confident that this will be a good learning experience for both
myself and carers. I really hope this works. Here goes!
I provided each carer with a different colour hat which
provided much hilarity (good they are relaxing, I thought).
I then explained the significance of each coloured hat, for
example, red hat to display warmth and feelings, white hat,
think of a computer printout, blank to display neutrality.
This continued until all hats had been distributed. Each
carer could give an opinion according to the colour of their
hat. This could all go pear shaped and end up a fiasco.
Discussion was needed regarding confidentiality in which
I assured them that anything said would stay in the room,
and that basically they get out of this session what they put
in. There ensued a surprisingly frank, honest session where
every carer participated. From this session I gained a lot of
information which I intend to use to construct teaching
sessions and a teaching pack.
PHEW! That worked really well. Must remember that.
Unless they are really good actors/actresses, I think I have won
them over, or at least gained their attention and motivation.
Through this experience, I feel more confident regarding my leadership skills. I recognise that I have learned a
lot regarding management and leadership skills from my
CPT and have tried to apply these skills to the situation. A
good leader is skilled in balancing individual and team
needs with the achievement of team goals (Banks 2002).
Good leadership skills involve establishing clear channels
of communication (Quinn 2000). Whether the team is large
or small, a free flow of information limits misunderstandings and mistakes. Poor organisation leads to problematic
teamwork-group confusion and unmotivated, uncooperative, defensive or argumentative staff (Banks 2002). Good
leaders get to know their team members and learn what
motivates them. What works for one person will not necessarily work for others.
These patches made me think about the effect colleagues
have on change and professional development. Their knowledge or lack of knowledge regarding change can have a
profound effect on the success of the project (Bryar and
Griffiths, 2003). The way in which my change of practice
was decided was with total involvement of all members of
the district nurse team, which meant that parties had a sense
of ownership in the change (Audit Commission, 2001) also
giving them an opportunity to consider the evidence
involved (Rycroft Malone et al, 2004).
My attention was drawn to the problem of the theorypractice gap (Penney and Warelow, 1999) and how this
affects attitudes towards change. This was illustrated by
team members attitude towards change initially. They

were not aware of policies that mean that change is necessary and that they saw change as a problem, and was only
undertaken to keep managers in jobs. On reading research
into praxis and the theory-practice gap (Penney and
Warelow, 1999, Rolfe, 1993), I was interested in the points
it highlighted, and that if nurses conceived nursing as a
form of praxis, aesthetics, reflection and the valuing of
ones own personal knowledge are essential. Focusing on
reflection and using reflexive praxis to first deconstruct
and then reconstruct ones own clinical practice allows
nursing practitioners to use their experience and wisdom in
such a way that their clinical practice informs theory
(Penney and Warelow, 1999).
Appendix 2
Brief and Amended Notes of
One Action Learning Set
ACTION LEARNING SET 08/11/06.
Roberta, Alice, Pauline, John, Freda, Joan (CPT) and
Edward (facilitator).
NB these are exceptionally brief notes the occasion
was one of those when you had to be there. We laughed
in-between serious talking.
INTRODUCTION what is it all about? Learning and
knowledge and evidence and action in practice. Relevance!
Time for introducing and ways of working, time for presenting and time for evaluating and identifying action
points. Practice development. Leadership. Teamwork.
Talking through our projects. Dialogue and supportive
challenge (not cosy conversations). Individuals to construct and maintain their own records.
NB Role of CPT = linking between practice and university helping us to keep our feet on the ground and to
see/hear teacher and student appraisals re projects and
assignments and to add a practice voice.
HOW SHALL WE WORK?
Time 20 minutes per student re where we are with
our projects. Students as presenters and supporters. Edward
facilitates. Dedicated time at conclusion (15 minutes) for
identifying action points and evaluations of session and
broader module issues.
NB action learning sets and.....

The one at a time rule.

Tyranny of niceness
Safety
Responsibility
Values, beliefs and feelings
Feedback
Sensitivity
(continued)
Appendix 2 (continued)
Attention to process (being evaluative)
Action points
PRESENTATIONS - dialogue challenge, support, suggestions, reading, making the implicit explicit, ethics, personal choices, power of feelings, relevance of communication
and influencing others, balance re scale of project small
can be significant, scale is relevant to what is achievable re
assignment in context of other course pressures.
NB Edward to provide reference/reading re communication, tentativeness (vis a vis dogma), feelings and critical
thinking.
ACTION POINTS
Roberta to engage in dialogue with team colleagues and
brainstorm ideas re project. Consider day to day functions
and issues facing colleagues. (Vegetables, markets and
access figured in health promotion possibilities though
not exclusively).
John similar to Roberta John has broached ideas with
colleagues he will check out issues re the GP practice
security/records/rooms (as possible project alternatives).
Pauline will revisit E records issues soon (not immediately, but after a planned teaching session) to explore
historical notions. Will bear in mind suggestions re literature, feelings, passion and influencing others plus later,
engaging with colleagues who become integrated to the
wider team.
Alice will read, attempt a literature review and try to
organise a multi-disciplinary team meeting (also, possibility of sitting in on Fredas practice team meeting). Original
idea of reflective practice sessions amended - to a multidisciplinary formal session with a focus (possibly) on palliative care patients/issues. Evidence probably not
problematic practicalities and logistics (all in one room,
together) probably the most challenging aspect.
Freda going to suggest short stretch dressings (leg
ulcers) and a company representative to teach with an
ethical appraisal (suggested by Joan) and a clinical justification. (Edward baffled by references to vacuum cleaners
but enthused by reference to patient perception, choice and
utility).
EVALUATION of this session + bigger picture (the
module and assignment).
Joan - explained positive perceptions of the session and
particularly, of the patchwork text a refreshing approach
to assessment that seems well placed to capture practice
relevance as opposed to mere academic priority. Attending
also helped her gain insight into the wider picture of student experience she feels better able to help her own
student as a result.
Roberta positive view of the session has helped her
see choices she has re simple and not over-complicated
issues.
John CPT input helpful, patchwork text becoming

clearer and more useful especially re this Action Learning
process/module. Size (5 + 2) good and mix helpful.
Pauline pleased re seeing some direction feels
more confident and supported to take ideas forward.
Like yesterday (ethics session) she is realising the value
in making explicit what has often been implicit talking
helps us realise what is happening and important or not.
SIGNIFICANTLY (Edwards emphasis I made these
notes!) Pauline felt safe more than she anticipated.
(I, Edward, think this is worthy of reflective attention?)
Alice interesting to hear others contributions. Her
own confidence is raised re her project, particularly the
parallels between these AL sets, reflection per se and her
own project ethos of reflection and dialogue.
Freda size of group good, advantageous re serious
talk, enabled contributions by all. Remains scared of
patchwork text.
Edward Joans contribution was without compare
practice relevance writ large and spoke large and (crucially) softly. Suggestions, comments and observations all
contributed constructively to enhance our openness to alternative or unthought of ideas and (again, crucially) to our learning. The session and the students enthused me yet again there
is so much here that is worthwhile, I feel it, I can rationalize
it (I am working to articulate it better). I am encouraged by,
and grateful to, the group I worked with today.
Note: Pseudonyms are used for all individuals.
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Emrys R. Jenkins, BEd (Hons), MA, PhD, is the academic lead at

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Joanna Warring, BSc (Hons), is a lecturer on the community

health studies team at the School of Health Science, Swansea
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Gaynor M. Mabbett, MSc, PGCE, is the community health

studies team leader in the School of Health Science, Swansea
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Elizabeth D. Gwynn, BEd (Hons), is a district nurse based at

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Qualitative

>> Version of Record - Aug 18, 2009

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A Cooperative Inquiry Into Action Learning

Qualitative Health Research

s a team of university-based, community health

local needs and the wider sociopolitical background.

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1304 Qualitative Health Research

assumptions influence the way we think and speak

As the module proceeded we each continued to

At this early stage we elected to adopt a first-person

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Jenkins et al. / Action Learning and Praxis Development 1305

4. What academic merit applies to our teaching/learning

life and develop new and creative ways of looking at

First-Person Inquiry and

1. Experiential knowing, including tacit, intuitive, felt

We explored and constructed ground rules, quickly

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1306 Qualitative Health Research

4. Creating and sustaining trust and commitment:

enough to allow us to explore the distress without

Our considerations of validity led directly to

Research Cycles and Processes

Cycle 1: First-Person Inquiry

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Jenkins et al. / Action Learning and Praxis Development 1307

first AL set made explicit students and teachers

This development was somewhat unexpected, and

might look like. Guidelines (provided via student

Cycle 2: Ongoing First-Person

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1308 Qualitative Health Research

Careful, detailed observation and description of events and situations

Additional indicators applying to MSc students

informing the other). Our constructions of people,

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Jenkins et al. / Action Learning and Praxis Development 1309

Relationships & the Relational

Action Learning Sets

Note: CPT = community practice teacher.

Role modeling emerged as a significant influence

Conversely, some lack of supportive challenge

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1310 Qualitative Health Research

When the teacher asked whether students should be

For the teacher, this was an example of how he had

Relationships underpinned the lived experience of

There was universal agreement that

People and the assessment. Early confusion and

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Jenkins et al. / Action Learning and Praxis Development 1311

dynamic through sharing. Guidelines were based on

Dialogue and challenge were the main means by

enhanced double-loop learning (Greenwood, 1998)

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1312 Qualitative Health Research

How noncompliant some people are. The amount of

Community practice teacher (CPT) input was not

were invaluable, the attention students were able to

Students increasingly recognized that diaries needed