EXEMPLAR: our shared experience of implementing action learning sets in an acute clinical nursing setting: approach taken and lessons learned.

BACKGROUNDAction learning sets (ALSs) are a process where people form a group or 'set' with the purpose of discussing issues of concern relating to practice (McGill & Beaty, 2001). The process proposes that someone present an issue whilst the rest of the members enable or assist the presenter to explore the issue by asking clarifying, thought provoking and open ended questions. During the session the presenter may reflect on previously unexplored potential actions and make preliminary commitments towards experimenting them into action. Learning does not only occur for the presenter but also for other members in the set, as they themselves critically reflect. Kolb's (1984) learning cycle, which has been represented in Figure 1, demonstrates how observing and reflecting on an experience leads to new planned behavior about the way forward for a future situation.There are four different stages of learning from experience which can be entered at any point although all stages must be followed in sequence for effective learning to take place (Kolb, 1984). During the ALS, the presenter is helped through the stages of reflection and conceptualisation and then plans the active experimentation stage while in the set. Kolb's learning cycle suggests that it is not sufficient to have an experience in order to learn; it is necessary to reflect on the experience in order to make generalisations and formulate concepts which can be applied to new situations (McGill & Beaty, 2001). Reflection can increase critical thinking skills by encouraging learners to think through an important experience step by step, learning from the reflection can then effect future actions (Rogers, 2002).In this way, an ALS can promote new learning for all involved. This arises from reflection and experimenting with new alternatives which can lead to change. Hegenhahn (1990) defined learning as a change in behaviour that comes about by experimentation. Change involves stepping into uncharted waters, out of comfort zones and can makes us feel uncomfortable and unsure (Greene & Grant, 2003). Dewing (2008) describes how learning can occur in the workplace, using reflection and dialogue with self and with others.IMPLEMENTING THE ALSPlanning the changeAs nursing leaders of an inpatient medical unit, the authors were aware that alone they were unable to solve all the issues and concerns within the unit in a sustainable fashion. It was felt that a structured process could potentially lead the team towards systematic practice improvement.Following a period of discussion and careful planning, four 4-h workshops were organised for all unit staff. The workshops were co-facilitated by the manager of the unit and the nurse educators. Twenty-four staff members attended the workshops. High attendance was largely achieved by taking advantage of agreed compulsory education time (CET), an allocated four hour clinical education time accrued every 8 weeks for those staff working 12-h shifts. The workshop structure is outlined in Figure 2.THE PREPARATORY WORKSHOPThe sessions began with a discussion among staff about their expectations of the workshop. Then, individual and shared visions for an effective workplace culture were explored. Participants created a collage of an ideal workplace and what was preventing them achieving this goal. This work was done in small groups. Group feedback followed and a shared ideal work culture was formalised. Inhibitors were listed and prioritised. At this point the group was asked if they would like to participate in an experimental ALS and discuss some of the prioritised issues previously discussed. Issues discussed in these experimental ALSs are summarised in Figure 3.Staff responded positively to the ALS concept in all the workshops and demonstrated willingness for the ALS to be a feature of the unit culture.The leaders' reflectionsThe workshop experience was challenging, as neither of the facilitators were experts in the process. …