Samenvatting
**Background:**Professional autonomy is essential to nursing leadership development in Evidence-Based Quality
Improvement (EBQI), yet hospital nurses may struggle to enact this autonomy. This study examined how a participatory
learning trajectory influences professional autonomy and nursing leadership development within EBQI
practice.
**Methods**:
A convergent mixed-methods design combined qualitative Participatory Action Research (PAR) with
an appreciative approach and a prospective pre-post comparative study. Two nursing teams participated in the
PAR trajectory and two served as non-PAR comparison teams. Qualitative and quantitative data were collected
and analysed separately and then brought together at the interpretation stage through triangulation, allowing the
findings from both approaches to be compared and integrated to provide a comprehensive understanding of the
effects of the PAR trajectory.
**Results**:
PAR enabled each team to develop a tailored learning trajectory combining reflection, knowledge development,
and enactment of nursing leadership behaviours. Four key outcomes emerged: (1) increased professional
autonomy, (2) more proactive work practices, (3) enhanced psychological safety, and (4) development of a shared
team vision. Compared with non-PAR wards, nurses in participating wards showed significant improvements
in aspects of professional leadership (Challenge the Process, p = 0.014), attitudes and skills related to EBQI
(p = 0.037), and self-efficacy (p = 0.038).
**Conclusions**:
PAR can strengthen professional autonomy and nursing leadership development within EBQI. Wardbased
learning, guided reflection, and collective practice appear to be key mechanisms. Sustaining improvements
requires ongoing support for practice consolidation and innovation. Transferability may be limited by the Dutch
nursing context, where vocationally and bachelor-educated nurses work together in teams with a different skill
mix than in other countries.
**Implications**:
Nursing leadership development should be embedded in everyday clinical practice through structured
action-reflection cycles. PAR can foster trust, engagement, and team development, while organizational
support is essential for meaningful participation and sustainable impact.
