Routines mediate educational solutions in clinical practice: A discussion paper on design-based research

Aim: This study aimed to explore the appropriateness of using a design-based research approach in inducing change by exploring the research question: How can implementing new learning tools in hospital practice lead to sustainable change? Background: Although design-based research is conducted with the idea of bridging the theory/practice gap, we perceived a gap between design, enactment and sustainable change. We assume that context—particularly routines—plays a decisive role in this gap. Design: Qualitative design-based educational research Methods: Discussion of the design-based research approach based on a case study. The results of the case study are interpreted with a theoretical explanatory model. Results: We explored theories about practice, routines and routine dynamics. The identified elements of routine dynamics could be related to our context, findings and experiences. From the case data, an eye-opening insight emerged. Context, especially the prevailing routines and new routines to be developed in this context, are significant constituents in all phases of design-based research. Furthermore, elements of routine dynamics can explain the variance in enactment and the difficulties involved in establishing a new educational routine in nursing clinical practice. Conclusion: The inclusion of routine dynamics in the DBR research protocol is a necessary addition to ensure the successful design and implementation of a new educational tool in clinical practice.