|Year : 2019 | Volume
| Issue : 4 | Page : 116-122
Exploring communities of practice among medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia
Sharifa Alsayed, Jennifer de Beer, Tahani Ali Uyoni
College of Nursing, University of King Saud bin Abdul Aziz University, Jeddah, Kingdom of Saudi Arabia
|Date of Submission||27-Aug-2019|
|Date of Decision||10-Oct-2019|
|Date of Acceptance||13-Oct-2019|
|Date of Web Publication||18-Dec-2019|
College of Nursing, University of King Saud bin Abdul Aziz University, Um Salem Street, Jeddah
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Communities of practices (CoPs) are a process in which workers interact and acquire knowledge from each other at the workplace. This informal knowledge in the workplace can assist professionals to become active knowledge builders with sufficient autonomy regarding specific knowledge or skills required. In addition, this approach that supports informal learning facilitates learning among nurses in the workplace. A cross-sectional descriptive design study was conducted to discover facilitators and barriers that affect the implementation of a CoPs approach. The results show that CoPs seemingly provides a forum for sharing on the job, allowing for successful transition and retention. This and other findings can help in improving and facilitating this approach widely among nurses at the workplace. Purpose: This study explored CoP among medical and surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia. It also presents the facilitators and barriers in implementing the CoPs approach. Study Design: A cross-sectional descriptive design was used. Sixty-seven medical-surgical nurses were conveniently sampled at a military hospital in Jeddah, Saudi Arabia. Data were collected using a structured, validated questionnaire. Methodology: Descriptive and inferential statistics were used for data analysis and were presented in frequencies, percentages, and P values. Results: A total of 62 nurses, mostly females, participated in this study. The mean age of respondents was 30.95 years, and N = 52 (83.9%) had a bachelor's degree in nursing, with N = 26 (41.9%) having between 5 and 10 years of experience in nursing. Most respondents (82.3%) had a clear understanding of what a CoP is. Most respondents N = 40 (64.5%) agreed that they wished to share their knowledge within the community. The top facilitators of a CoP as expressed by respondents were: to deliver solutions for daily problems N = 49 (79%) followed by N = 41 (66.1%) of respondents agreeing that CoP transfer best practices and results in the development of new knowledge N = 30 (48.4%). The most common barrier to a CoP identified within this study was lack of time as expressed by most participants N = 46 (74.2%), followed by a lack of confidence, N = 36 (58.1%) and a fear of not sharing correct information N = 31 (50%). Conclusion: This study described the facilitators and barriers of CoPs. Furthermore, the study highlighted the critique of CoP from the literature. Despite this critique, CoPs are found to provide a forum for sharing on the job, allowing for successful transition and retention.
Keywords: Communities of practice, learning on the job, shared learning, transfer of knowledge
|How to cite this article:|
Alsayed S, de Beer J, Uyoni TA. Exploring communities of practice among medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia. Saudi Crit Care J 2019;3:116-22
|How to cite this URL:|
Alsayed S, de Beer J, Uyoni TA. Exploring communities of practice among medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia. Saudi Crit Care J [serial online] 2019 [cited 2022 Aug 20];3:116-22. Available from: https://www.sccj-sa.org/text.asp?2019/3/4/116/273452
| Introduction|| |
The concept of communities of practices (CoPs) was developed more than 27 years ago, with a specific focus on apprenticeship by Lave and Wenger through their exploration of situated learning theory, and the ensuing work of Wenger (2000). Lave and Wenger have defined learning as “a situated activity (that) has its central defining characteristic, a process called legitimate peripheral participation” which explored how “a person's intentions to learn are engaged, and the meaning of learning is configured through the process of becoming a full participant in a sociocultural practice.” Later Wenger et al. defined CoPs as “groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise in the area by interacting on an ongoing basis.”
CoPs allow for members to share, learn, or create explicit knowledge in a joint effort for the same field of interest. CoPs have three fundamental elements: knowledge, community, and practice. Knowledge is created on common ground and common knowledge with the community; community creates the social fabric of learning., Further to this, Couros expresses that a CoPs are defined along three dimensions namely mutual engagement (CoPs involve people engaged in certain common interests), joint enterprise (mutual accountability), and shared repertoire (ways of doing things that the community has developed or followed in the course of its existence).
The most important feature of CoPs is that they emerge more or less spontaneously from informal networking among groups of individuals who share similar interests or passions. In other words, CoPs are an approach that supports informal learning in the workplace, which can assist professionals to become active knowledge builders with sufficient autonomy regarding specific knowledge or skills required. Recently, however, CoPs have been mostly initiated by senior management, instead of emerging spontaneously from workers.
While the concept of CoPs has become widespread, it is significant to note that it has its roots in theories based on the idea of learning as social participation such as the social learning theory which is linked to Bandura's and Vygotsky's theory associated with social interaction in learning. Both Bandura and Vygotsky posit that social interaction plays a fundamental role in the development of cognition. Besides, Wenger and Couros discussed that learning within the social learning theory is displaced. “Learning becomes fundamentally, a social phenomenon and is placed in the context of our lived experience and participation in the world.”
CoPs are featured considerably in the literature since its inception, commonly in the discipline of education, business economics, psychology, computer sciences, and health-care sciences. However, the first substantial discussion of CoPs in nursing was in 2000 in discussions of situated learning in clinical education.,
According to Gitell et al., there is a need to provide cost-effective and high-quality patient care due to the increase in health-care costs as a result of increased chronic illnesses and the aging population. Furthermore, health-care systems are challenged to provide integrated, relevant, and accessible services. Hence, to meet these challenges health-care systems and nurses must find effective ways to “increase interprofessional and inter-regional collaboration so that expertise can be enhanced, disseminated, and more effectively translated into practice.”
Sim and Radloff also highlighted that to promote accountability and improve on professional skills and expertise, nurses need to continually update their knowledge within their specialized areas of training and work. Although ongoing formal training for nurses is widely available, time and lack of financial resources are all too often barriers to nurses making use of such opportunities to upskill themselves through this route. Thus, the workplace, where nurses spend most of their time engaging in clinical practice and care, should become the field of ongoing learning.
Despite the benefits of CoPs, there are some limitations to it. According to Kerno, members of a CoP have to have sufficient time to engage in prolonged sustained discourse for the CoP to be effective. Without sufficient time for engagement, the CoP may become obsolete. Further to this, organizational hierarchies can compromise a CoP regarding issues of power and control. For a CoP to be effective and useful, members that are functionally similar must come together to share ideas and knowledge and solve common issues. In addition, Kerno stated that “organizations operating in Western societies are likely to be less successful than their Eastern counterparts in capitalizing on the CoP approach because of historic, inherent, and continuing sociocultural differences that create relative disadvantages.”
Aim of the study
The study aimed to explore CoPs among medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia. The main objectives for this study were as follows: (1) to describe the understanding of CoPs by medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia, (2) to describe factors that facilitate CoPs among medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia, and (3) and to describe factors that hinder CoPs among medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia.
| Methodology|| |
The data for this study were collected through a descriptive cross-sectional quantitative approach.
The setting for the study was medical-surgical units at King Khalid Hospital, Jeddah. King Khalid Hospital is a 531-bed military hospital located in the Western Region of Saudi Arabia, which consists of a variety of surgical and medical units.
Population, sampling, and sample size
The study included expatriate and Saudi medical-surgical nurses. At the time of the study, there were a total of 267 nurses. The researchers followed a convenience sampling technique and aimed to sample all the nurses, as the population size was small; however, despite numerous data collection attempts, over a period of six months, only a sample of 62 nurses was realized [Table 1].
Data were collected through a semi-structured questionnaire named “The Impact of Community of Practice on Knowledge Sharing,” and it consisted of two sections; section A, focused on the demographic details of nurses and consisted of 5 items, and section B focused on the 17 factors that facilitate and hinder CoPs. The 17 items were divided into two subscales with seven items for each subscale. The questionnaire was developed by Zhang and aimed to explore the impact of CoPs in knowledge sharing. This is an online survey that does not have any copyright. Responses were measured on a 7-point Likert-type scale that ranges from 1 to 5; (1 = strongly disagree and 5 = strongly agree). The score ranged between 0 and 90; the cutoff point was 45.
Data collection started after approval from the Research Unit at the College of Nursing-Jeddah. Thereafter, permission was sought from the Institutional Review Board (IRB number SP16/019/J) at King Khalid Hospital. Once the permission was obtained from the necessary authorities, the researcher made appointments with the unit managers of the respective wards to discuss the aim of the research and to set up a convenient time for data collection.
Validity and reliability
The study instruments were tested for internal reliability using Cronbach's alpha correlation coefficient. Internal consistency reliability was done for the questionnaire. The subscales were assessed using Cronbach's alpha coefficients. The Cronbach's alpha values ranged from 0.83 to 0.87, indicating good internal consistency across the subscales. Furthermore, a pilot study was conducted on 5% of nurses who were excluded from the final data collection to ensure the clarity and applicability of tools, and to identify obstacles that may be encountered during data collection. In addition, the time required to complete the study questionnaire was estimated. Further content validity was ensured by ensuring that the questions on the questionnaire were directly linked to the objectives of the study.
The Statistical Package for the Social Sciences computer software (SPSS for Mac, Version 21.0) was used to analyze the data. Different types of analysis were used for this study. First, to describe the sample from which data will be collected, descriptive information on age, gender, level of nursing education, area of experience, and the number of years of experience have been described, as well as the means, range, and standard deviations. Second, to determine any differences in the scale item scores, Chi-square, t-tests, and analysis of variance was used to investigate any significant differences among the scores. Pearson's correlation coefficient analysis (r) was used to test the nature of the relationship between study variables.
| Results|| |
Demographic details of respondents
A total of 62 nurses participated in this study. Most respondents were female. Most respondents (56.5%) were between the ages of 25–35 years with the mean age being 30.95 years. Most respondents (83.9%) had a bachelor's degree in nursing, with N = 26 (41.9%) having between 5 and 10 years of experience in nursing.
Understandingthe meaning of communities of practices
Most respondents (82.3%) had a clear understanding of CoPs. It was noted that older nurses, >35 years of age (31.3%) were not sure what a CoP was. Furthermore, N = 57 (91.9%) thought that they were members of CoPs. Interestingly, even though a significant percentage of the older nurses were not sure of the understanding of a CoP, but the majority of them (87.5%) thought they belonged to a CoP.
Knowledge sharing within communities of practice
As shown in [Table 2], the majority of respondents agreed with statements relating to the sharing of knowledge within a CoP. Most respondents (64.5%) agreed that they wished to share their knowledge within the community, and knowledge was shared because they trusted members with whom it was shared. However, it was noted that some respondents (32.3%) disagreed that they preferred to share knowledge with people who had a high reputation in the field of nursing.
Facilitators of communities of practices
The top three aims of a CoP as expressed by respondents were: to deliver solutions for daily problems as N = 49 (79%) of respondents expressed this as a main aim, followed by N = 41 (66.1%) of respondents agreeing that the aim of a CoP is to transfer the best practices and development of new knowledge (48.4%). However, there was a significant difference noted in terms of gender concerning this aim. Only N = 7 (29.2%) of male nurses agreed with this aim as opposed to N = 23 (60.5%). The third most important aim of a CoP, as expressed by male nurses (45.8%), was that CoPs coordinate ward activities and projects. Further to this, the aim of the development of new knowledge showed a significant difference in terms of years of experience with the majority of respondents with >5 years of experience (68%) and >10 years of age (45.5%) agreed that CoPs develop new knowledge, while only 30.8% of respondents with 5–10 years of experience agreed with P = 0.028).
A further finding is that older nurses (>35 years; 50%) expressed that a CoPs aim was to identify experts as opposed to the younger nurses (<25 years, 9.1%; 25–35 years, 11.4%) with P = 0.006. In addition, another significant finding in relation to the aim of independence of organizational and geographic boundaries, highlighted that nurses <25 years of age (27.3%) responded more favorable than nurses between 25 and 25 years of age (11.4%) and >35 years of age (18.8%) with P = 0.034. Besides, [Table 3] highlights the benefits of CoPs for members. The most significant benefit for members was that members received access to valuable information, as expressed by N = 36 (58%) of respondents. In addition, N = 34 (54.8%) added that the benefits of CoPs are that it makes members more efficient while N = 32 (51.6%), expressed that members are more productive within a CoP. However, a significant difference noted in terms of gender was that 50% of male nurses felt that members learn permanently within a CoP as opposed to only 23.7% of females.
Another significant finding highlighted the importance of CoPs for the organization as a whole. The most important result of a CoP for the organization was quality improvement, as indicated by 64.5% of the respondents. However, more male nurses (41.7%) than female nurses (13.2%) P = 0.004, felt that market development was more beneficial for the organization as a result of a CoP. Further to this, the most important motivator to share knowledge in a CoP was the idea of receiving information, which was expressed by 66.1% of the respondents, and the least important motivator was anticipated reciprocity, which was expressed by only 21% of the respondents. It was noted that majority of the older (>35 years) participants (93.8%) reported that the idea of receiving information as a motivator to share knowledge within a CoP as opposed to the younger respondents (25–25 years (60%); <25 years (45.5%) P = 0.017.
Barriers of communities of practices
The most common barrier to the CoP approach identified in this study was lack of time as expressed by most respondents N = 46 (74.2%), followed by a lack of confidence, N = 36 (58.1%) and a fear of not sharing correct information N = 31 (50%). One significant finding in terms of barriers to CoPs was that more male nurses N = 11 (45.8%) felt that one of the main barriers for involvement in a CoP was learning tensions within the community, P = 0.004. In addition, most bachelor degree nurses N = 42 (80,8%) and diploma nurses N = 4 (50%) expressed that a barrier to involvement in a CoP is lack of time while even though a small proportion, none of the masters prepared nurses agreed with this statement, P = 0.008 [Table 4].
| Discussion|| |
The findings of this study highlighted that most nurses thought that they were members of a CoP. This is keeping with the fact that most nurses should share a lifelong commitment to learning. These sentiments are also shared by the Canadian Nurses Association who posits that registered nurses have a regulatory and ethical obligation to keep abreast of the challenges of an ever-evolving health-care context. Hence, registered nurses should be constantly engaged in the process of learning throughout their professional lives. According to Risling, the nursing profession is a “knowledge-intensive, fast-paced, ever-evolving entity that demands nothing less than life-long learning from its members.” Nurses learn most through a variety of social interactions and collaborations, such as a CoP. Wenger's social theory of learning specifically emphasizes the process of learning on the extent of social participation. The theory emphasizes a subconscious process of learning through participation to legitimize and substantiate individual actions.
Most respondents (82.3%) had a clear understanding of what a CoP was. It was noted that older nurses, >35 years of age (31.3%) were not sure what a CoP was. Furthermore, N = 57 (91.9%) thought that they were members of a CoP. Interestingly, even though a significant percentage of the older nurses was not sure of the understanding of a CoP, the majority of them (87.5%) thought they belonged to a CoP. This is understandable as the concept of CoPs is progressively becoming popular since 1991 through the seminal of Lave and Wenger and was first discussed in nursing in 2008 by Andrew et al. In addition, Wenger et al., discussed that belonging to a CoP may take different forms for an individual across different communities which range from full participation to peripheral participation. Hence, being a member of a CoP is not necessarily something that people are aware of.
Based on the findings of this study, most nurses responded positively to the sharing of knowledge within a CoP. About 90.3% of respondents agreed that they wanted to share knowledge within a CoP. According to Wenger, learning is a social phenomenon, which involves a “dynamic two-way relationship between people and social learning systems in which they participate.” This is also reiterated by Dewey, who emphasized that learning can occur only in the context of relationships and engaged networks. Further to this, learning as a social phenomenon can be linked to the concept of thinking together, as conceptualized by Pyrko et al., who reiterate that learning in CoPs is seen as a social formation of a person rather than simply the acquisition of knowledge. Pyrko et al. have based the concept of thinking together on the work of Polanyi's (1962 cited in Pyrko et al. 2017) idea of indwelling related to personal knowledge. People with the same real-life issues can guide each other and share knowledge, “thus, thinking together allows for developing and sustaining an invigorating social practice over time.” However, it is also significant to state that Pyrko et al. also argues that CoPs was formed during a postmodern framework that leads to skepticism about the notion of knowledge sharing. It is suggested that CoPs can be associated with self-declared experts that monopolize knowing their source of power.
The most common facilitators to CoPs as cited in this study were to deliver solutions to daily problems; to transfer best practice and development of new knowledge. Lin and Ringdal, highlighted that clinical knowledge could be developed through CoPs. According to Risling, nursing is a demanding profession. Membership in a CoP may result in nurses learning from their experiences, group knowledge, and other experiential expertise increasing their professional knowledge. An interesting empirical study by Yoo et al. found that participation could not be enhanced directly by the management strategy of virtual communities. However, they found a direct link between participation and sense of community, which in order might be influenced by the management approach. This finding explains why many experienced facilitators who have experienced difficulties in encouraging participation in community practice believe that the cooperative relationship among members is a way to increase the sense of community, which in turn might lead to increase in participation.
The most common barrier toward involvement in a CoP was the lack of time. This could be attributed to the fact that most nurses were busy with direct patient care. This is also reiterated by Hew and Hara, who highlighted from the findings within their study, that a lack of time was a barrier that hinders knowledge sharing within a CoP. Nurses shared their knowledge out of their spare time which would fluctuate depending on how busy the nurses were with their work caring for patients. Learning tensions were cited as the least common barrier within this study. Learning tensions can be a result of power differences between members within the CoP.
Fox (2000) argued that power is generated through a range of social expressions, or discourses, that circulate through our everyday social practices, investigations, talk, and writing. He proposed that determining how a particular topic is talked about gives a person power over that topic, in fact, it brings that topic into being, thus creating the very norms by which it becomes known to others. As social structures that leverage knowledge, CoPs can be viewed as places where power, discourse, and norms operate. In addition, Bentley et al. highlighted that technicians repeatedly and subconsciously leveraged their authority over by asking them not to query their expertise but to trust it. However, according to Wenger et al., an expert member within a CoP will have more power than a novice member, but this power is related to the contribution of knowledge to the CoP rather than authority. Members develop more power as they become competent, and they can be seen as a threat to old-timers.
Limitations and recommendations of the study
This study included a very small sample size. In addition, the study was conducted at a single setting using only a quantitative approach. The study also only included nurses working in the medical-surgical units; hence, the findings of this study cannot be generalized to other areas within the study context. In view of this, the recommendations of this research include including a larger sample size of nurses from other disciplines of nursing inclusive of nurses working in highly technical areas where the culture of the area could differ from the culture of the medical-surgical context. Further to this, it is recommended that research around CoPs are extended to other areas of Saudi Arabia, as research around the phenomenon of CoPs is relatively new in this context, and more research within this rich cultural background would allow nurse educators, nurse managers, and nurses to capitalize on the benefits of CoPs.
| Conclusion|| |
A CoP is an approach that fosters knowledge creation and sharing attitudes within organizations. To enable the establishment of a COP, the community needs to be effectively facilitated and supported. The results of this study have both practical and theoretical implications. Practical implications include the following: (i) organizations should support this approach through policies or rewards; (ii) a more purposeful training program for facilitators which could be designed by CoP practitioners and researchers. In addition, this study described the facilitators and the barriers of CoPs among nurses in the research setting. Furthermore, this study highlighted the critique of CoPs from the literature. Despite this critique, CoPs seemingly provides a forum for sharing on the job, allowing for successful transition and retention in the workplace. In the context of Saudi Arabia, the policy of Saudization necessitates that the current expatriate nursing workforce, be replaced by Saudi nurses. At present, the majority of the nursing workforce is expatriate from different cultural backgrounds to that of Saudi patients. Hence, CoPs can assist in the successful placement and retention of nurses.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]