This is the last in a series of three articles Series editors: Catherine Pope and Nicholas Mays The barriers to the uptake of the findings of traditional quantitative biomedical research in clinical practice are increasingly being recognised. 1 2 Action research is particularly suited to identifying problems in clinical practice and helping develop potential solutions in order to improve practice.3 For this reason, action research is increasingly being used in health related settings. Although not synonymous with qualitative research, action research typically draws on qualitative methods such as interviews and observation. #### Summary points Action research is increasingly being used in healthcare settings It is a style of research rather than a specific method Three elements are important: the participatory character of action research; its democratic impulse; and its simultaneous contribution to social science and social change ![][1] (Credit: LIANE PAYNE) Action research is not easily defined. It is a style of research rather than a specific method. First used in 1946 by Kurt Lewin, a social scientist concerned with intergroup relations and minority problems in the United States, the term is now identified with research in which the researchers work explicitly with and for people rather than undertake research on them.4 Its strength lies in its focus on generating solutions to practical problems and its ability to empower practitioners—getting them to engage with research and subsequent “development” or implementation activities. Practitioners can choose to research their own practice, or an outside researcher can be engaged to help them identify problems, seek and implement practical solutions, and systematically monitor and reflect on the process and outcomes of change. Most definitions of action research incorporate three important elements: its participatory character; its democratic impulse; and its simultaneous contribution to social science and social change.5 Participation is fundamental to action research: it is … [1]: /embed/graphic-1.gif

Aims: To synthesize evidence and knowledge from published research about nurses' experiences of nurse‐patient relationships with adult patients in general, acute inpatient hospital settings.Background: While primary research on nurses' experiences has been reported, it has not been previously synthesized.Design: Meta‐ethnography.Data sources: Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO.Review methods: Qualitative studies describing nurses' experiences of the nurse‐patient relationship in acute hospital settings were reviewed and synthesized using the meta‐ethnographic method.Results: Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients.Conclusion: The findings of this meta‐ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.