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THEO (Therapeutic Optimisation) study
The THEO study is a complex intervention and research study that is using both an increase in registered nurse staffing and a programme of practice development activities to support the embedding of continuous improvement to increase the quality and safety of care delivered to patients on older people’s wards. The THEO intervention will be delivered via a participatory action research (PAR) approach, which is further embedded into a quasi-experimental (before and after implementation) research study conducted across two NHS (National Health Service) Trusts within the Norfolk & Waveney Integrated Care System.
The THEO study is a collaboration with the NICHE team, UEA ,University of Staffordshire, London South Bank University, the Norfolk Community Health and Care NHS Trust and the James Paget University Hospitals NHS Foundation Trust.
Table 1: Summary of the study
Phase | Who is leading | Intervention |
|---|---|---|
1.Pre-study
| All stakeholders | Development, recruitment and induction of two registered nurses for each unit. |
2.1 Implementation (Part 1) | NICHE team, UEA | Integration of the new registered nurses into the existing clinical teams and planning and planning for PAR with the co-researchers. |
2.2 Implementation (Part 2)
| NICHE team, UEA
| PAR will involve active participation from staff members, patients, family members and carers to participate in gathering and analysing evidence about current delivery of care. This will then be used to identify and implement innovations through shared decision making. |
3. Ongoing integrated (Process and outcome) evaluation
| University of Staffordshire | Wrapped around the implementation of the PAR are three other research elements, involving quantitative, qualitative and process evaluation research. |
NICHE workstream 2: The Therapeutic Optimisation (THEO )project
March 2025
What and why THEO?
The THErapeutic Optimisation (THEO) project developed by the NICHE Anchor Institute at the University of East Anglia, is a novel and complex intervention research study aimed at optimising the nurses and patients’ experience of care. The THEO study is a collaboration with the NICHE team, UEA , University of Staffordshire, London South Bank University, the Norfolk Community Health and Care NHS Trust (NCHC) and the James Paget University Hospitals NHS Foundation Trust (JPUH). The NICHE team are leading on the THEO intervention which is described below and the University of Staffordshire team are leading on the overall research protocol development and the national ethics application. They will also be undertaking both quantitative, qualitative and process evaluation following on from the intervention.
THEO Intervention
The THEO intervention is providing an uplift of two registered nurses working as embedded researchers, combined with a process of participatory action research (PAR). This is partly influenced by evidence that showed that higher nurse staffing levels were associated with better patient outcomes, shorter length of stay and less frequent nurse burnout or job dissatisfaction. The participatory action research (PAR) intervention uses Practice Development (PD) methods as a facilitated intervention to achieve a participatory approach to inquiry. Participatory approaches to research moves away from the traditional stance of “studying a subject and making a judgement about that subject” and involves a collaborative, participatory and inclusive approach where all involved are partners in both the research and resulting actions and outcomes.
The THEO intervention co-researcher team
The participatory action research (PAR) intervention involves recruiting core volunteer co-researchers from the existing ward nursing team as bringing expertise in this innovation and collaborating with patients to understand their experiences of care. The co-research team will comprise of the THEO PD Facilitator, the new embedded researchers and the volunteer co- researchers, who will have time and space to work in collaboration, to “look” (i.e., gather evidence about a situation or context), “think” (i.e., reflect together to critically analyse the evidence), then “act” (i.e., develop a shared action plan, from which to take informed action). This process will generate both knowledge and agreed action from which to improve the experience and care for both the ward staff and the people who receive care on the ward.
What is happening now?
The new clinical embedded researchers commenced in post in February and March on ward 12 (JPUH) and the North Walsham Community Unit (NCHC). Approval from the Research Ethics Committee was granted in February and the participatory action research activities , will commence in April and May 2025.
Further reading
Odell, J (2024) Perspectives paper: Seeking a novel approach to practice driven transformation through research. Journal of Research in Nursing Vol 29 Issue 8 https://doi.org/10.1177/17449871241301766.
Odell, J. (2024) Bridging role, theory and practice. May 2024.(NICHE website) NICHE BLOG - MAY 2024
For more information please contact: Jo Odell, Senior Research Fellow /THEO PD Facilitator,: Email: J.Odell@uea.ac.uk
Read the blog here: NICHE BLOG - MAY 2024 - Groups and Centres (uea.ac.uk)