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Puzzling practice: a strategy for working with clinical practice issues.

Kenneth Walsh¹, Cheryle Moss, Jane Lawless

¹Nursing Research and Development Unit, Waikato District Health Board, Hamilton, New Zealand. walshk@waikatodhb.govt.nz

International Journal of Nursing Practice

|March 5, 2008

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This paper introduces "puzzling practice," an innovative approach to address clinical issues in daily healthcare. It outlines seven key elements to help clinicians and teams effectively explore and solve practice challenges.

Area of Science:

Healthcare Practice Development
Clinical Problem-Solving
Action Theory

Background:

Clinical practice presents complex issues that require innovative exploration methods.
Existing approaches may not adequately address the nuanced challenges faced by clinicians.
Practice development is crucial for enhancing healthcare quality and effectiveness.

Purpose of the Study:

To present the evolution and application of "puzzling practice" as a method for exploring and reframing clinical issues.
To delineate the elements and techniques of puzzling practice developed over two years.
To illustrate a specific framework of puzzling practice useful for clinicians and teams.

Main Methods:

Action theory-based processes were employed over a two-year period by four authors.

Related Experiment Videos

Development and application of several frameworks for "puzzling practice" in practice development and research.

Utilizing a semi-fictitious example to illustrate the seven elements of a particular puzzling practice approach.

Main Results:

The paper details seven elements of a specific "puzzling practice" framework: naming the issue, puzzling the issue, testing the puzzle, exploring the heart of practice, formulating the puzzle question, visualizing the future, and generating new strategies.
Each element is explored through a narrative example and its underlying theoretical foundations.

Conclusions:

"Puzzling practice" offers a structured yet flexible method for clinicians and teams to engage with and resolve complex practice issues.
The seven-element framework provides a practical tool for enhancing problem-solving and strategy development in healthcare settings.
This approach supports continuous practice improvement and innovation within everyday clinical work.