"Seeing" the Difference: The Importance of Visibility and Action as a Mark of "Authenticity" in Co-production Comment on "Collaboration and Co-production of Knowledge in Healthcare: Opportunities and Challenges".

The Rycroft-Malone paper states that co-production relies on 'authentic' collaboration as a context for action. Our commentary supports and extends this assertion. We suggest that 'authentic' co-production involves processes where participants can 'see' the difference that they have made within the project and beyond. We provide examples including: the use of design in health projects which seek to address power issues and make contributions visible through iteration and prototyping; and the development of 'actionable outputs' from research that are the physical embodiment of co-production. Finally, we highlight the elements of the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) architecture that enables the inclusion of such collaborative techniques that demonstrate visible co-production. We reinforce the notion that maintaining collaboration requires time, flexible resources, blurring of knowledge producer-user boundaries, and leaders who promote epistemological tolerance and methodological exploration.

Nurses' use of the Internet in clinical ward settings.

BACKGROUND: The potential of the Internet as a fast and efficient way of accessing evidence to support nursing practice has been well recognized. In addition, nurses have highlighted the need for training in the use of information technology, information retrieval and critical appraisal as essential to their professional development. AIM: The aim of this paper is to present selected results of a longitudinal project that evaluated the impact of networked computers, with open access to the Internet, on four acute wards in a large UK teaching hospital. METHOD: Evaluation methods in the project included monitoring data from an Internet surveillance software package, a questionnaire survey with the nurses (n = 97) and in-depth interviews with a sample of nurses (n = 12). FINDINGS: A complex picture was revealed of the nature of Internet use and the factors that nurses perceived as influencing this. The majority used the networked computers and some frequent users emerged. Nurses were able to use the technology during quiet periods throughout the day and night. Patterns of use were mixed, with nurses accessing the Internet for a combination of work and non-work-related activities. They integrated use of Internet technology into their working days in ways that appropriately fitted patterns of clinical activity. Factors relating to the organization, workplace culture and training were identified influencing Internet use. CONCLUSIONS: Open access to the Internet in the workplace emerged as a useful but unrefined tool for encouraging the retrieval of information for practice. Future development of this technology in the workplace must include support and training for professional staff in order to enhance the skills required. Recommendations are made about what and how training may be useful in promoting nurses' use of Internet technology in clinical settings.