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Aim: To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID‐19 pandemic. Background: The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated. Methods: A realist study, informed by person‐centredness using mixed‐methods. Online survey (n = 328) and semi‐structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories. Results: Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well‐being. Conclusions: Leaders should intentionally adopt practices that promote well‐being. 'Knowing self' as a leader, coaching and mentoring practice development is important for leadership development. Implications for Clinical Practice: Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes. Impact: The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives. Reporting Method: This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

This article presents the methodological approach used to develop a Person-centred Curriculum Framework. A background overview of conceptualisations of curricula and curriculum development frameworks globally is provided, and critical analysis of these offered. The case for a whole-systems approach to curriculum development is made, in the context of understanding why such an approach can enable the building of capacity for person-centred culture development. The methodological approach derived from the McKinsey's 7S methodology is presented, including an overview of the original methodology and its adaptation for the curriculum development work reported on in this IPDJ Special Issue. The use of this methodological approach in shaping each stage of the development of the curriculum framework is presented. Finally, a critique of the 7S methodology in terms of its strengths and weaknesses is discussed, and options for future practice proposed. [ABSTRACT FROM AUTHOR]

Background: Internationally, the development of person-centred healthcare services is of strategic importance. Healthcare education has the potential to contribute to this agenda by preparing the future workforce as person-centred practitioners. However, there is a lack of clarity about how to design, deliver and evaluate curricula to support person-centred learning and practice cultures. Aim: This article sets out to report on the methodological approach used to distil the key components of a Person-centred Curriculum Framework, and to critically evaluate the implications of this approach for curriculum development. Methods: The McKinsey 7S methodology underpinned this project. A multiphase, mixed methods design was used to synthesise evidence on the components of a person-centred curriculum framework. The eight design stages included an e-survey, telephone interviews, and multiple national and international stakeholder engagement events. Responses were translated into English and synthesised using an adapted directed content analysis approach. Through the stakeholder engagement events, evidence was then integrated until consensus was reached on the key curricular components. Results: A total of 24 academics from 10 countries across five disciplines took part in an e-survey, with responses in two languages. In addition, 31 telephone interviews were conducted with learners, educators and policymakers across six countries, in four languages. The survey and interview evidence was synthesised and presented in tabular form for each of the 7S categories, including a curriculum statement mapped to evidence exemplars, together with a set of thematic actions to assist programme teams in operationalising the Person-centred Curriculum Framework. Conclusions: The project, using a multiphase, mixed methods design, underpinned by the 7S methodology, combined with a multiplicity of stakeholder perspectives, provided a rigorous approach to developing a Person-centred Curriculum Framework that is philosophically and methodologically aligned with person-centred principles. [ABSTRACT FROM AUTHOR]

Background: Globally, humanising healthcare is a strategic response to a distinct need for person-centred approaches to practice. This movement has largely focused on the artefacts of healthcare practice, with an emergent focus on the role of healthcare education in instilling and espousing the core principles of person-centredness. It is increasingly recognised that how healthcare professionals are educated is fundamental to creating learning cultures where person-centred philosophies can be lived out and aligned with workforce and healthcare policy strategies. In 2019, six European countries began collaboration on an Erasmus+ project, Person-centredness in Healthcare Curricula, to develop a Person-centred Curriculum Framework. The other articles in this Special Issue focus on the methodologies employed by the project team, and this article describes the framework. Aim: While curricula exist with person-centredness as a focus, aim or component, few embrace person- centredness as an underpinning philosophy and theory, or use a whole-systems approach. This project aimed to develop a universal curricular framework with the agility to work synergistically with existing curricular processes, in pursuit of the development of person-centred healthcare practitioners and cultures. Methods: The project used an iterative multiphase, mixed methods approach, including an e-survey and interviews. Drawing on authentic co-design principles, to create our framework we engaged with stakeholders in clinical practice and academic institutions as well as healthcare students and those working in health policy and strategic workforce planning. Results: We present a framework for the design, delivery and evaluation of curricula, structured using a modified version of McKinsey's 7S methodology, resulting in each component having a statement, outcomes, and thematic actions to support the realisation of a person-centred curriculum. Conclusion: Our Person-centred Curriculum Framework can facilitate congruency between healthcare education and practice in the way person-centredness is defined and lived out through healthful cultures. Given the iterative origins of the framework, we anticipate its evolution over time through further exploration following its implementation and evaluation. [ABSTRACT FROM AUTHOR]

Background: In contemporary health and social care services and systems, there is a critical need for nursing care that is agile in its delivery, integrated across sectors, responsive to complex need, and focused on prevention, self-care and wellbeing. Community nurses are at the centre of these services, working in and across a variety of complex systems that depend on the expertise they bring to individuals, communities and populations. However, ensuring this capability is brought to the forefront of quality frameworks is a challenge as care practices are often reduced to moments of interaction or intervention that are tangible and objectively measured. We know, though, that community nurses bring vital and wide-ranging expertise to the health of populations. The Queen's Nursing Institute Scotland has re-established the Queen's Nurse Development Programme to address these contemporary agendas and ensure the potential of expert community nursing is demonstrated and recognised. Aim: To engage in a participatory evaluation of the experience of the nine-month development journey of the 2019 Queen's Nurse Development Programme participants. Methods: A Collaborative Critical Creative Inquiry (CCCI) methodology was used, operationalised through a five-phase inquiry process, informed by Theory U 'presencing' and its five movements for attending to and co-shaping reality to achieve presencing. Our embedded and embodied data-collection methods drew specifically on participants' creative expressions, reflective diaries and journals, and project notes. Findings: The results of each phase of inquiry informed subsequent phases, culminating in a final phase (synthesis) where key themes representing the findings from all phases were derived. These themes were self-growth, community and practical impacts. Conclusion and implications for practice: The importance of slowing and stillness, linked to the spaces created for creative reflective learning and development has been significant in this programme. Being present to listen to self, and engage in self-care and self-growth is something the programme provides and that is highly valued. We would argue that if health systems are serious about the transformation of services and people, then these kinds of programmes are critical to success. [ABSTRACT FROM AUTHOR]

In recent years, there has been a shift in orientation towards person-centredness as part of a global move towards humanising and centralising the person within healthcare. Person-centredness, underpinned by robust philosophical and theoretical concepts, has an increasingly solid footprint in policy and practice, but research and education lag behind. This article considers the emergence of person-centredness, including person-centred care, and how it is positioned in healthcare policy around the world, while recognising a dominant philosophical positioning in Western philosophy, concepts and theories. Second, the evolution of person-centred healthcare over the past five years is reviewed. Published evidence of person-centred healthcare developments is drawn on, as well as information gathered from key stakeholders who engaged with the partner organisations in an Erasmus+ project to develop a European person-centred healthcare curriculum framework. Five themes are identified, which underpin the literature and stakeholder perspectives: • Policy development for transformation • Participatory strategies for public engagement • Healthcare integration and coordination strategies • Frameworks for practice • Process and outcome measurement These themes reflect the World Health Organization's global perspective on people-centred and integrated healthcare, and give some indication of development priorities as person-centred healthcare systems continue to be developed. [ABSTRACT FROM AUTHOR]

Background: In the associated article in this special issue of the International Practice Development Journal, Phelan et al. (2020) offer an analysis of the global positioning of person-centredness from a strategic policy perspective. This second article, an international person-centred education curriculum development initiative, builds on that foundational work. It outlines the systematic, rigorous processes adopted by academics from five European countries to analyse stakeholder data, theoretically frame the data, and thereby identify philosophical and pedagogical principles to inform the development of person-centred curriculum frameworks. Aim: To identify key principles that have the potential to create an international curriculum framework for the education of person-centred healthcare practitioners. Methods: A hermeneutic praxis methodological approach was used, where multiple rounds of data analyses were conducted. These were initially undertaken in each country, then collaboratively with partners, while engaging with other forms of evidence. Findings: The project group generated a set of principles embedded in four philosophical dimensions: (i) transformative; (ii) co-constructed; (iii) relational; and (iv) pragmatic. The purpose of the curriculum was identified as being transformative, facilitating journeying through knowing, doing, being and becoming a competent and committed person-centred practitioner. A person-centred curriculum is built on a philosophy of pragmatism, adopts a co-constructionist approach to curriculum design and implementation, and encourages connectivity with self, other persons and contexts. Pedagogical principles, aligned to the four philosophical dimensions, identified the required learning environment, and the learning, teaching and assessment approaches required to educate person-centred healthcare practitioners. Conclusion: This article represents steps to foster a more focused and engaging way of implicitly and explicitly embedding person-centred care in curricula. Our theoretical framework has enabled us to consider the different layers of practice while staying true to the purpose of curriculum design. The presentation of the framework in this article makes it available for wider critique to those with an interest in this area of study. [ABSTRACT FROM AUTHOR]

Aims: To explore the utility and feasibility of implementing eight person‐centred nursing key performance indicators in supporting community nurses to lead the development of person‐centred practice. Background: Policy advocates person‐centred health care, but few quality indicators exist that explicitly focus on evaluating person‐centred practice in community nursing. Current quality measurement frameworks in the community focus on incidences of poor or missed opportunities for care, with few mechanisms to measure how clients perceive the care they receive. Methods: An evaluation approach derived from work of the Medical Research Council was used, and the study was underpinned by the Person‐centred Practice Framework. Participatory methods were used, consistent with person‐centred research. Results: Data were thematically analysed, revealing five themes: giving voice to experience; talking the language of person‐centredness; leading for cultural change; proud to be a nurse; and facilitating engagement. Conclusions: The findings suggest that implementing the eight person‐centred nursing key performance indicators (KPIs) and the measurement framework is feasible and offers a means of evidencing person‐centredness in community nursing. Implications for Nursing Management: Person‐centred KPI data, used alongside existing quality indicators, will enable nurse managers to evidence a high standard of care delivery and assist in the development of person‐centred practice. [ABSTRACT FROM AUTHOR]

Background: Person-centred practice is inherently integrated in palliative care. However, it cannot be assumed that its underpinning values are lived out in day-to-day practice in a hospice. At St Columba's Hospice, Edinburgh, the five-year strategy demonstrated commitment to person-centredness and this prompted an 18-month project focusing on the evaluation and development of a person-centred culture, taking a practice development approach. Aim: To implement a person-centred practice development research project to assess, evaluate and enhance person-centred culture within St Columba's Hospice. Methods: The theoretical underpinnings of the programme were based on the Person-centred Practice Framework. A transformative practice development approach was employed to bring about change in individuals and teams. Twelve multidisciplinary team members from different departments across the hospice formed a core research project group, which was allocated 10 protected learning and development days over the 18-month period. To assess the existing culture, data were collected at the beginning of the practice development programme, including observation in practice and real-time interviews with patients and staff. The data were analysed using a participatory approach, with group members mapping the data collected against the Person-centred Practice Framework and undertaking creative hermeneutic analysis. Discussion: The project created and sustained a space to explore and expose person-centredness within the hospice and raised awareness of what person-centred culture means in day-to-day practice. Fourth-generation evaluation highlighted further areas for action, with teams developing their own action plans aimed at enhancing person-centred culture. Conclusion and implications for practice: The context of day-to-day practice in a hospice setting is complex, and developing person-centred culture is an ongoing process. Hospices can help their staff to flourish by providing the necessary space to reflect and for critical awareness of own practices to be heightened. This could encourage staff to embrace the contradictions inherent in the work they undertake and to learn from it in order to improve their own wellbeing. [ABSTRACT FROM AUTHOR]

Background: Projects initiated to transform and develop health services have to account for a variety of complex factors. There is a need to develop methods to handle this complexity, and in this article we present a flexible and adaptable framework for mapping projects that focus on involvement of persons receiving care and other stakeholders, with an integrated support structure. The method also considers elements in the local context. Aims: To present examples of project mapping, and to explore how the process can enhance quality in complex projects in healthcare services. Methods: The project mappings have been co-designed in processes of deliberate dialogue between the authors of this article, with involvement from other researchers and stakeholders. A threedimensional version of project mapping was developed, and further refined by introducing a twodimensional version and testing the framework in various settings such as a project leader course and the 2018 Enhancing Practice Conference in Basel. Analysis continued through the whole process as preliminary ideas were discussed and documented. We reflected, wrote notes, talked to people, took part in workshops that included a variety of creative methods, and did a qualitative content analysis of key findings to develop themes. Results: The examples of project mapping show that the process of mapping is as important as the map itself. The maps are flexible and can be combined. Project mapping can contribute to quality in projects by helping project facilitators and participants to stay on track. It can also enable co-creation and guide facilitation processes. Conclusion: Engaging in mapping processes represents an approach that can contribute to a shift in thinking and help even out power imbalances between project participants, as well as influencing the working culture in a health service. Mapping can facilitate transformation of practice while simultaneously creating new knowledge about that transformation. [ABSTRACT FROM AUTHOR]

Purpose: Current rehabilitation models emphasize therapy that attempts to return to "normal" the lives of persons who are disabled. An opportunity is available to scrutinize whether this recovery orientation of rehabilitation is necessarily optimal. Method: This conceptual article uses reasoning, informed by experience and a nonsystematic review of literature across diverse disciplines. Results: For some persons with disability, optimizing recovery might be unwanted or insufficient. To expand rehabilitation, we append the Latin "ultra", beyond, to "habilitare", make fit. The resulting term, "ultrabilitate", commits to human flourishing that moves persons toward, around or beyond recovery of particular functioning. Conclusions: By expanding the scope of disability management, ultrabilitation could inform therapy selection and facilitate human flourishing. Empirical research is needed to test our ideas. Implications for rehabilitation: Despite significant progress, rehabilitation limits some people with disabilities. Modern health systems still benchmark therapy for rehabilitation against "normal" or species-typical standards to aid recovery. "Ultrabilitation", meaning "beyond fitness", promotes flourishing, either without an interest in recovery or in moving toward, beyond or around recovery. Biological, social and technological conditions are needed to support ultrabilitation. Ultrabilitation complements rehabilitation when rehabilitation is not sufficient to optimize functioning and personal growth. [ABSTRACT FROM AUTHOR]

Aims and objectives: How does person‐centred leadership manifest in clinical nursing. Background: Person‐centred practice fosters healthful relationships and is gaining increasing attention in nursing and health care, but nothing is known about the influence of a person‐centred approach to leadership practice. Most leadership models used in nursing were originally developed outside of nursing. Design: A 3‐year participatory action research study where participant leaders planned, researched and learned from their practice development. Methods: After an orientation phase, four action spirals focused on: critical and creative reflective inquiries into leadership practice change; leading the implementation and evaluation of a new nursing system; facilitating storytelling sessions with staff; and annually reflecting on personal leadership change. Multiple data gathering methods offered insight into leadership development from several perspectives. Results: Critical and creative thematic data analysis revealed a set of attributes, relational processes and contextual factors that influenced the being and becoming of a person‐centred leader. Comparing the findings with nursing leadership literature supports a conceptual framework for person‐centred leadership. Conclusions: Person‐centred leadership is a complex, dynamic, relational and contextualised practice that aims to enable associates and leaders achieve self‐actualisation, empowerment and well‐being. Relevance to clinical practice: This study and its conceptual framework is of relevance to practitioners, educationalists and researchers interested in developing a relational approach to nurse leadership and person‐centred cultures. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the effects of the implementation of a methodological framework for a narrative‐based approach to practice development and person‐centred care in residential aged care settings. Background: Care in long‐term residential settings for older people is moving away from the biomedical approach and adopting a more person‐centred one. Narrative can help shape the way care is planned and organised. The provision of person‐centred care that is holistic and that takes account of resident's beliefs and values can be enhanced by incorporating narrative approaches to care within a practice development framework. Design: The chosen methodology was participatory action research. Methods: Between 2010–2014, a methodological framework of narrative practice was implemented in two residential care settings, comprising 37 residents and 38 staff, using an action research approach. Three action cycles: (i) narrative practice and culture identification, (ii) developing narrative practice and (iii) working in a storied way emerged during the implementation. Results: Key outcomes emerged in relation to the findings. These were based on narrative being, knowing and doing and centred around the key outcomes of (i) how people responded to change (narrative being), (ii) the development of shared understandings (narrative knowing) and (iii) intentional action (narrative doing). Conclusion: The implementation of a framework of narrative practice demonstrated that how people respond to change, the development of shared understandings and intentional action were interrelated and interlinked. It illustrated the importance of ensuring that practice context is taken account of in the implementation of action research and the importance of ensuring that narrative being, knowing and doing are clear and understandable for change to occur. Relevance to clinical practice: Implementation of a narrative approach to care can develop new ways of working that value biography and promote the development of a co‐constructed plan of care. [ABSTRACT FROM AUTHOR]

Aims and objectives To implement and evaluate the effect of using the Person-Centred Situational Leadership Framework to develop person-centred care within nursing homes. Background Many models of nursing leadership have been developed internationally in recent years but do not fit with the emergent complex philosophy of nursing home care. This study develops the Person-Centred Situational Leadership Framework that supports this philosophy. It forms the theoretical basis of the action research study described in this article. Methods This was a complex action research study using the following multiple methods: nonparticipatory observation using the Workplace Culture Critical Analysis Tool ( n = 30); critical and reflective dialogues with participants ( n = 39) at time 1 (beginning of study), time 2 (end of study) and time 3 (6 months after study had ended); narratives from residents at time 1 and time 2 ( n = 8); focus groups with staff at time 2 ( n = 12) and reflective field notes. Different approaches to analyse the data were adopted for the different data sources, and the overall results of the thematic analysis were brought together using cognitive mapping. Results The Person-Centred Situational Leadership Framework captures seven core attributes of the leader that facilitate person-centredness in others: relating to the essence of being; harmonising actions with the vision; balancing concern for compliance with concern for person-centredness; connecting with the other person in the instant; intentionally enthusing the other person to act; listening to the other person with the heart; and unifying through collaboration, appreciation and trust. Conclusions This study led to a theoretical contribution in relation to the Person-Centred Practice Framework. It makes an important key contribution internationally to the gap in knowledge about leadership in residential care facilities for older people. Relevance to clinical practice The findings can be seen to have significant applicability internationally, across other care settings and contexts. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore holistic facilitation as an approach to enable the healthcare team to critically analyse practice and enhance patient care. Background Globally, the challenge of changing healthcare practices for enhanced patient care is the focus of much attention. Facilitation is emerging as an important approach to assist healthcare teams to explore and improve their practice. Within the Promoting Action on Research Implementation in Health Services framework, which has been tested in an international arena, facilitation is a key element of operationalising collaborative changes in practice. This study uses the framework to explore holistic facilitation and the concept of psychological safety. Design An Emancipatory Action Research approach was used. Methods Facilitated critical reflection was undertaken with the healthcare team working in an abdominal surgical unit. In addition, the lead researcher maintained a reflexive journal. Data were analysed using thematic analysis. Eighty-five per cent ( n = 48) of nursing staff and individual participants from other parts of the healthcare team ( n = 3) participated in the two-year study. Results Data revealed 14 sub-themes that impacted upon the culture of the unit. These were as follows: support, leadership, oppressed behaviours, communication, interruptions, power imbalance, horizontal violence, threat, autonomy, distorted perceptions, vulnerability, value, trust and time. Psychological safety, leadership and oppressed behaviours emerged as three key themes in the practice context. Conclusions There is a need to create psychologically safe spaces in environments where insufficient support, weak leadership and oppressed behaviours are apparent. Psychological safety enables individuals to feel safe to engage in difficult conversations and consider changes to practice. In a theoretical contribution to the area of facilitation, it is proposed that the additional element of psychological safety needs to be incorporated into facilitation models, in particular, the Promoting Action on Research Implementation in Health Services framework, to more accurately reflect the complexities of working with healthcare teams. Relevance to practice The pressure on healthcare environments continues to increase. To achieve the necessary skills to lead and develop services requires more than simply highlighting what is wrong with practice. Creating psychologically safe spaces, using holistic facilitation, is essential to enabling healthcare teams to critically analyse practice and enhance patient care. [ABSTRACT FROM AUTHOR]

Aims To explore the expertise of Registered Nurses in residential care for older people. Background As older people in residential care have many complex dependencies, nursing expertise is an essential component of care excellence. However, the work of these nurses can be invisible and, therefore, unrecognized. Thus, additional attention is required to illuminate such nursing expertise. Design A mixed method design was used in this study. Methods The research took place in 2012 in the Republic of Ireland. Twenty-three case study nurses were recruited from nursing homes. Each case study nurse involved five data collection methods: shadowing, interview with a colleague, interview with a resident, a demographic profile and a director of nursing survey. The study was also informed by a modified focus group. Qualitative data were analysed using directed content analysis using a conceptual framework generated from the literature on nursing expertise. Quantitative data were analysed using SPSS and presented in descriptive statistics. Findings The findings from the case studies and the modified focus group are presented in seven themes, which represent nursing expertise in residential care of older people: transitions, context of the nursing home, saliency, holistic practice knowledge, knowing the resident, moral agency and skilled know how. Conclusion Nursing expertise in residential care of older people is a complex phenomenon which encompasses many aspects of care delivery in a person-centred framework. By rendering this expertise visible, the need for appropriate and adequate skill mix for a growing residential care population is presented. [ABSTRACT FROM AUTHOR]

Background: Developing person-centred cultures is a key focus of practice development. To do so requires engagement with learning approaches that are creative and critical. In preparing students for a future as person-centred practitioners, educators need to engage with creative approaches to the facilitation of learning. National standards in nursing (for example) as well as the international literature on adult learning endorse the need for creativity in learning. Yet, educators continue to be challenged to engage in creativity and to use creative learning strategies in their practice. This paper provides a reflective overview of the experiences of a group of educators in one school of nursing who participated in a programme of creative engagements that focused on exploring 'self' as a key concept in person-centredness. Objectives: 1. Explore through different media, contrasting aspects of 'self' as an educator 2. Engage in playful activity in a safe space to explore own creativity and ways in which this creativity could be surfaced and integrated into everyday practice 3. Through engaging with different media explore the potential of creativity in person-centred approaches to teaching, learning and research 4. Experience 'risk taking' in a facilitated environment in order to develop potential for meaningful connections with others - students and colleagues Conclusions: Through a systematic process of creative engagement, this critical reflection highlights the challenges associated with integrating creative engagement strategies in teaching and learning. The paper highlights in particular the challenges associated with 'letting go' in learning situations and the importance of exploring 'self' in the context of person-centred learning processes. Implications for practice: Practice development depends on effective facilitation undertaken by facilitators who are critical and creative. Whilst there is an increasing literature on facilitation models and processes, there is less attention paid to 'understanding self' as a facilitator of person-centred cultures. Practice development methodologies need to make such exploration an explicit part of their work in order to engage in authentic facilitation of learning and development. [ABSTRACT FROM AUTHOR]

Aims and objectives To report on the development of a framework of narrative practice, in residential care settings for older people. Background Residential care settings for older people provide care for people who are no longer able to live in their own home. To date, the impact and structure of nursing practice on care provision in these settings has proved difficult to conceptualise within a specific nursing theory framework. Design A hermeneutic approach incorporating narrative methods was used. Methods Forty-six narrative interviews with older people in residential care were secondary-analysed for key themes through a three-stage process: by the first author, four focus groups of 12 clinical nurse managers and two independent experts. Themes were also derived from a focus group of eight residents who explored person-centredness and narrative. Finally, the combined findings were used to derive a single set of themes. Results The secondary data analysis process led to the development of a framework of narrative practice for the care of older people in residential settings. The framework is influenced by narrative enquiry, person-centred practice and practice development. It has four pillars, prerequisites, care processes, care environment and narrative aspects of care. To operationalise the framework of narrative practice, three narrative elements, narrative knowing, narrative being and narrative doing, need to be considered. Working with the foundational pillars and the narrative elements would enable staff to 'work in a storied way' and provide person-centred outcomes and a narrative informed philosophy of care for older adults in residential care. Conclusion This framework provides nurses with a template that confirms the identity of the older person taking account of their biography. Relevance to clinical practice The framework outlines an approach that provides staff with a template on how to provide person-centred care in a narrative way. [ABSTRACT FROM AUTHOR]

Objectives: In theory, greater interaction between researchers and practitioners should result in increased potential for implementation. However, we know little about whether this is the case, or what mechanisms might operate to make it happen. This paper reports findings from a study that is identifying and tracking implementation mechanisms, processes, influences and impacts in real time, over time in the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). Methods: This is a longitudinal, realist evaluation case study. The development of the conceptual framework and initial hypotheses involved literature reviewing and stakeholder consultation. Primary data were collected through interviews, observations and documents within three CLAHRCs, and analysed thematically against the framework and hypotheses. Results: The first round of data collection shows that the mechanisms of collaborative action, relationship building, engagement, motivation, knowledge exchange and learning are important to the processes and outcomes of CLAHRCs' activity, including their capacity for implementation. These mechanisms operated in different contexts such as competing agendas, availability of resources and the CLAHRCs' brand. Contexts and mechanisms result in different impact, including the CLAHRCs' approach to implementation, quality of collaboration, commitment and ownership, and degree of sharing and managing knowledge. Conclusion: Emerging features of a middle range theory of implementation within collaboration include alignment in organizational structures and cognitive processes, history of partnerships, responsiveness and resilience in rapidly changing contexts. CLARHCs' potential to mobilize knowledge may be further realized by how they develop insights into their function as collaborative entities. [ABSTRACT FROM AUTHOR]

PARLOUR R and MCCORMACK B. Nursing Inquiry 2012; 19: 308-321 Blending critical realist and emancipatory practice development methodologies: making critical realism work in nursing research This paper examines the efficacy of facilitation as a practice development intervention in changing practice within an Older Person setting and in implementing evidence into practice. It outlines the influences exerted by the critical realist paradigm in guiding emancipatory practice development activities and, in particular, how the former may be employed within an emancipatory practice development study to elucidate and increase understanding pertinent to causation and outcomes. The methodology is based upon an emancipatory practice development approach set within a realistic evaluation framework. This allows for systematic analysis of the social and contextual elements that influence the explication of outcomes associated with facilitation. The study is concentrated upon five practice development cycles, within which a sequence of iterative processes is integrated. The authors assert that combining critical realist and emancipatory processes offers a robust and practical method for translating evidence and implementing changes in practice, as the former affirms or falsifies the influence that emancipatory processes exert on attaining culture shift, and enabling transformation towards effective clinical practice. A new framework for practice development is proposed that establishes methodological coherency between emancipatory practice development and realistic evaluation. This augments the existing theoretical bases for both these approaches by contributing new theoretical and methodological understandings of causation. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2010; 24; 620–634 Exploring person-centredness: a qualitative meta-synthesis of four studies Person-centredness as a concept is becoming more prominent and increasingly central within some research literature, approaches to practice and as a guiding principle within some health and social care policy. Despite the increasing body of literature into person-centred nursing (PCN), there continues to be a ‘siloed’ approach to its study, with few studies integrating perspectives from across nursing specialties. The purpose of this paper is to present the results of a study undertaken to explore if the secondary analysis of findings from four different and unrelated research studies (that did not have the main aim of researching person-centredness) could inform our understanding of person-centred nursing. A qualitative meta-synthesis was undertaken of the data derived from the four unrelated research studies undertaken with different client groups with long-term health conditions. A hermeneutic and interpretative approach was used to guide the analysis of data and framed within a particular person-centred nursing framework. Findings suggest ‘professional competence’ (where competence is understood more broadly than technical competence) and knowing ‘self’ are important prerequisites for person-centred nursing. Characteristics of the care environment were also found to be critical. Despite the existence of expressed person-centred values, care processes largely remained routinised, ritualistic and affording few opportunities for the formation of meaningful relationships. Person-centred nursing needs to be understood in a broader context than the immediate nurse–patient/family relationship. The person-centred nursing framework has utility in helping to understand the dynamics of the components of person-centredness and overcoming the siloed nature of many current perspectives. [ABSTRACT FROM AUTHOR]

Developing person-centred care is not a one-time event; rather it requires a sustained commitment from organisations to the ongoing facilitation of developments, a commitment both in clinical teams and across organizations. Contextual factors pose the greatest challenge to person-centredness and the development of cultures that can sustain person-centred care. We will begin with a general comment on 'context' and its meaning before exploring three particular factors that influence the practice context, namely, workplace culture, learning culture, and the physical environment. Next we explore a particular approach to developing person-centred care through emancipatory practice development. We highlight the importance of facilitation through emancipatory practice development programmes and describe how person-centred care can be developed through the presentation of a case study that illustrates the principles and processes of emancipatory practice development as well as the outcomes achieved. We conclude with an application to clinical practice. A key consideration for all organisations in the development of person-centred care is to move from what we suggest are 'person-centred moments' (individual, ad hoc experiences of person-centredness) to 'person-centred care' as an underpinning culture of teams and organisations. [ABSTRACT FROM AUTHOR]