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In this article, the authors expose, for critical review and public scrutiny, their challenge to the critical paradigm as an adequate location for the transformational practice development and research approaches that they are developing in healthcare. Whilst they accept the fundamental assumptions of the critical paradigm, in their view it does not recognise the creativity required in their approaches. Neither does it explicitly acknowledge that creativity often requires moral and sacred dimensions as people push out the boundaries of the known within their own practices. In particular, the authors expose these gaps within Fay's eight critical theories for practice. Over the last decade, the authors have addressed these gaps by combining the assumptions of the critical paradigm with their experiences of using creative imagination and expression in their practice development (PD) and action research work. Then through a critical review of their work, they have created a new paradigmatic synthesis to add to the critical paradigm. They call this synthesis "critical creativity". In this article, the authors set out their reflexive journey that has led to the articulation of "critical creativity" as a paradigmatic synthesis for action-oriented development and research. (Contains 3 notes, 3 tables, and 4 figures.)

Aim: The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings. Design: A cross- cultural adaptation and validation of instruments throughout the cross- sectional study. Methods: Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years. Results: All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems. Conclusions: The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live. Impact: The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes. Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used. No Patient or Public Contribution: No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling. [ABSTRACT FROM AUTHOR]

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]

Aim: The aim of the study is to provide insight and facilitate a deeper understanding of family members who have experienced their older family member's suicide. Design: Interpretative phenomenological analysis (IPA) study. Methods: Semi‐structured individual interviews with five family members of older people who died by suicide recruited from a rural area of Shanxi Province, China. Smith's (2009) six steps of IPA was used for data analysis. Results: Three main themes emerged from the study: (a) Initial psychological reactions; (b) Long‐term life effects; (c) Social attitudes. The study shows how the family members of older people who died by suicide have experienced stigmatization and felt largely ignored. A suicide event poses a challenge to the future living quality of the family members. The study also highlights that it is necessary to pay attention to families of older people who died by suicide and providing support is required to improve the quality of life of these family members in rural China. Conclusion: The study adds to the understanding of the lived experience of family members of older people who died by suicide in less economically developed rural areas. Patient or Public Contribution: Patients and the public were not involved in the design, conduct or reporting of this study. Participants of this study helped with recruitment via snowball sampling. [ABSTRACT FROM AUTHOR]

Occupational therapists are encouraged to use research evidence to guide therapeutic interventions that holistically address the consequences of dementia. Recent efforts to use research evidence in practice have emphasized the challenges of doing so in ways aligned to person-centred and professional principles. Using research evidence is a complex process influenced by multiple contextual factors and layers. The influence of context in occupational therapy for dementia is currently unclear. To explore the contextual complexities of using research evidence in practice with people with dementia, and to develop knowledge to improve the approach to using evidence in person-centred, occupation-focused practice. A case study methodology was used, in which the contextual conditions of practice were clarified through the facilitation of critical and creative reflection using the following methods – Think Aloud, practice observation, creative expression and reflective dialogue. Cultural beliefs that affected evidence use included technically-orientated understandings of evidence-based practice. These were underpinned by apprehensions about losing professional identity and taking risks when processes derived from research evidence were adjusted to incorporate a persons' occupations. These cultural factors were perpetuated at the organizational layers of context, where systemic priorities and other team members' needs disproportionately influenced occupational therapists' decisions. Occupational therapists' potential to make reflexive and responsive decisions by adjusting evidence-based processes can be affected by their perceived freedom to address organizational tensions. Raising consciousness of the influence of the organizational context on decision-making about evidence use could adjust occupational therapists' perceptions of their freedom and ability to be person-centred. Intentionality in reflective processes in practice are required to foster reflexivity. [ABSTRACT FROM AUTHOR]

Background: bold (Bringing Out Leaders in Dementia), funded by the Life Changes Trust, is a creative and innovative social leadership project for people in Scotland living with dementia. Aim: A key part of bold is the bold programme, which takes a person-centred focus to help people empower themselves to flourish through creative methods and personal development. bold brings together people with a diverse range of skills and abilities on an equal footing in a safe and supported space, in which they can explore themselves as 'social leaders'. Methods: An interdisciplinary team from the University of Edinburgh and Queen Margaret University collaborated with creative artists from the outset to develop the programme that uses a mixture of arts-based methods to encourage creativity, innovation and imagination to explore and develop leadership potential. These include creative writing, working with clay and collage, improvisation, movement, reflective walking, singing and song writing, voice and breathing, and performing arts. In this article we provide an overview of the programme's design from its outset and of how the creative methods have been adapted and developed to work online as a response to the Covid-19 pandemic. Results: A brief overview shows how bold has evolved beyond the online programme and how those who take part continue to find ways to create spaces for people living with dementia to flourish as they become part of the bold community. Implications for practice: • A programme for encouraging and empowering individuals to flourish requires a reflective and person-centred approach in a safe and supported environment • Successful outcomes depend on multiple factors, including careful programme delivery planning, good facilitation, and commitment and belief from those who take part • An inclusive and accessible approach is beneficial when using creative methods for people living with dementia [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: 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]

Objectives: The aim of this study was to explore the lived experiences of a rural dwelling person living with dementia and his children. Using a phenomenological case study methodology, it aims to explore the health-related and personal dilemmas faced by multiple family members who provide care to a person living with dementia in a rural area in Henan, China. The study also investigates the barriers to quality dementia care in this kind of setting in order to inform the relevant stakeholders. Method: A phenomenological case study was designed for this study. The case that formed the focus of the research included a person living with dementia and multiple family members. Semi-structured in-depth interviews were undertaken with the five family members of the person living with dementia. Smith's interpretative phenomenological analysis was used for data analysis. Findings: Three major themes were identified: (1) Dementia as a normal ageing process or a bad disease; (2) Commitment to and challenges of family caring and (3) Life in rural areas. Conclusion: With the development of China's economy and its social-cultural changes, traditional home-based care provision in rural areas of China is being challenged for people with dementia who have multiple children. It suggests that there needs to be an exploration into providing more appropriate care for people with dementia living in rural settings. It also suggests that more support is required to increase dementia awareness and to improve the quality of life of people with dementia and their families in rural China. [ABSTRACT FROM AUTHOR]

To understand the challenges in delivering comprehensive care for patients recovering from stroke in Guangdong Province, China. A cross-sectional qualitative study was conducted in two tertiary hospitals with different socio-economic characteristics in Guangdong Province, Southern China. Interviews were conducted with 16 stroke care providers including doctors, nurses, rehabilitation therapists and care workers. The interviews were audiotaped, transcribed and translated from Mandarin to English. Thematic analysis was used to draw out descriptive and analytical themes relating to care providers' experiences of existing routine stroke care services and the perceptions of challenges in delivering comprehensive stroke care. The interviews with stroke care providers highlighted three key factors that hinder the capacity of the two hospitals to deliver comprehensive stroke care. First, expertise and knowledge regarding stroke and stroke care are lacking among both providers and patients; second, stroke care systems are not fully integrated, with inadequate coordination of the stroke team and inconsistency in care following discharge of stroke patients; third, stroke patients have insufficient social support. While comprehensive stroke care has become a priority in China, our study highlights some important gaps in the current provision of stroke care. Comprehensive integrated stroke care is essential to maximize the effectiveness of stroke services and in China it needs to be further improved. Multidisciplinary stroke care systems should strengthen collaborations across all relevant disciplines and should include a clear role for registered nurses. Follow-up care after discharge needs more engagement with family caregivers. [ABSTRACT FROM AUTHOR]

Purpose: To identify the differences in experiences during wave I and II of the COVID-19 pandemic among healthcare leaders. Background: It is expected, that working conditions for COVID-19-pandemic frontline staff will change, as health care organizations have gained experience with handling the consequences of the disease. Methods: An online survey was sent out to Danish health care leaders during the first and the second pandemic wave. Comparative analyses were performed in relation to three key characteristics: management level, management education and experiences as a leader. Results: Eighty-nine health care leaders completed both surveys. Significant differences were found within the entire group across the key characteristics as they felt more prepared for each stage of the situation, they had more influence on the decisions taken, and they felt more concerned about the quality of treatment and care and their own health. Further significant results related to the three key characteristics were found at 1) Management level: The heads of department experienced being better informed, having more overview of their tasks and that these were meaningful. The ward managers experienced being more able to work in consistency with own beliefs and values, though they felt more overloaded. 2) Level of management education: Leaders, without a formal management education, experienced being more supported by staff. 3) Years of experiences as leader: Leaders with more than five years of experience, experienced being more prepared and informed, had more influence on decision-making, and were more worried about their own health. Conclusion: The learning from experience that happens naturally in crisis situations is the reason why the leaders feel more prepared. However, there is a need for further leadership and practice development, to create contexts where leaders feel more ready for all aspects of their role. [ABSTRACT FROM AUTHOR]

Aim: To investigate the family members' experiences with receiving help and support while their loved one develops dementia and their subsequent placement in nursing homes. Background: As the dementia disease progresses, some family members will struggle with the option of nursing home placement. This situation can precipitate feelings of anger, disappointment and guilt, all of which can be overwhelming. Methods: A qualitative descriptive study with in‐depth interviews (n = 19) was carried out in several nursing homes of Slovenia's North Eastern Region. Results: Inductive thematic analysis identified two main themes: (i) developing the diagnosis and (ii) accommodation process. Family members noticed the progressive behavioural changes in their loved ones. While they were searching for help at the primary health care level, they experienced a lack of help and support. Conclusions: When family members detect behavioural changes in their loved ones, the primary health care team should establish an early diagnosis of dementia and provide adequate decision‐making support. Implications for Nursing Management: The findings are useful to prepare guidance for a family member to inform them of the types of support available and from which associations and organisations. To achieve adequate management support, primary health care teams need to be aware of family member experiences. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to identify the differences in experiences of Danish healthcare leaders in the beginnning of the coronavirus (COVID-19) pandemic and to generate knowledge for future leadership during and post crises. Background: The global spread of COVID-19 has affected healthcare systems worldwide and has forced healthcare leaders to face challenges few were prepared for. It is expected that the pandemic may hit in several waves within the next year and therefore healthcare leaders must be prepared for these waves. Methods: An online survey was developed, and comparative analyses were performed. Results: One hundred and sixty hospital leaders were invited, and 72% completed the questionnaire. Significant differences were found within three selected characteristics: 1) Management level: significantly more heads of departments experienced taking complex decisions (P=0.05), being able to work in a way consistent with their beliefs and values (P=0.05), and they were less likely to experience that collaboration with other leaders was adversely affected by the COVID-19 situation compared to ward managers (P=0.04). On the other hand, ward managers were significantly more often worried about both their own health (P=0.01) and their family's health (P=0.04). 2) Management education: those with a formal management education more often experienced having the managerial competences to effectively manage the COVID-19 situation (P=0.00), and performing meaningful tasks during the situation (P=0.04). 3) Years of experience: significantly more leaders with more than five years of experience identified having the managerial competences to effectively manage the situation (P=0.01). Conclusion: Leadership support during a healthcare crisis like the COVID-19 pandemic should strategically focus on ward managers, leaders with no formal management education and leaders with less than two years of experience. Hospital leaders may use this knowledge to re-contextualize what is already known about targeted leadership support during healthcare crises and to act accordingly. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the experiences of family carers supporting a relative living with dementia during and after the move to technology-enriched supported accommodation (TESA). The paper explores the informal carers (ICs) roles, the factors prompting the move to TESA, alongside their perceptions of their relatives' experience of the move and of life in a technology-enriched environment. Within a qualitative study 25 semi-structured interviews were conducted with ICs and data were analysed following a thematic approach. Four themes were identified, reflecting the shift in roles and identity of both ICs and persons living with dementia. The move to TESA was linked to a perceived reduction in care-giving pressures, with positive outcomes reported for both the ICs and the people living with dementia. Smart home technologies in the facilities did not appear to impact on the decision-making during transition, however, they were valued as part of the lived experience for the people living with dementia within the TESA facilities. These findings are relevant to policy makers, commissioners and providers of services to highlight the engagement of all stakeholders in the provision of care for people living with dementia and their families early from diagnosis in order to facilitate person-centred practices in community settings. [ABSTRACT FROM AUTHOR]

This paper presents the experiences of formal carers working in technology-enriched supported accommodation for people living with dementia, examining their care-giving role from a person-centred care perspective. Within a qualitative study, 21 semi-structured interviews were conducted with formal carers and data were analysed following a thematic approach. Four main themes were identified that mapped to the attributes of the person-centred practice framework (PCPF): promoting choice and autonomy, staffing model, using assistive technology and feeling that 'you're doing a good job'. Central to person-centred practice in these settings was the promotion of choice, autonomy and independence. The dichotomy between safety and independence was evident, curtailing the opportunities within the environmental enablers and associated embedded assistive technologies. Formal carers reported considerable job satisfaction working in these settings. The small-scale, home-like facilities seemed to have a positive effect on job satisfaction. These findings are relevant to policy makers, commissioners and service providers, highlighting the facilitators of person-centred care in community dwellings for people living with dementia and the role of formal carers in promoting this approach. [ABSTRACT FROM AUTHOR]

Background: Palliative care is aimed at improving the quality of life of an individual with chronic noncommunicable disease and their care partners. Limitations in the provision of palliative care are mainly lack of knowledge and experience by nurses, fear of treating palliative persons, loss of control over treatment and fear of providing poor‐quality palliative care to persons and care partners. Aim: The aim of this study was to investigate the perception, knowledge and attitudes of palliative care by nurses who use palliative care approaches in practice, as well as the difference in perception, knowledge and attitudes of palliative care between nurses in Slovenia and Finland. Methods: We conducted a cross‐sectional descriptive study. The survey included 440 nurses in clinical environments in Slovenia and Finland with a completed bachelor, master or doctoral level of education. Results: We found statistically significant differences between both countries in the perception of palliative care. Differences between the two countries in the knowledge of palliative care were not confirmed. We confirmed statistically significant differences between both countries in the attitudes of palliative nursing care. Conclusion: Early person‐centred palliative care is an important part of the holistic and integrative treatment of a person who has a disease with disturbing symptoms. For such an approach, it is important to educate nurses about knowledge, expectations, values and beliefs in developing a concept of person‐centred palliative care to improve quality of life. The better perception, knowledge and attitudes of palliative care by nurses may help persons to improve and raise their quality of life, as well as diminish stress in their care partners and improve quality of life. [ABSTRACT FROM AUTHOR]

In this paper, we explore how the development of historical research methodologies during the last centuries can contribute to more diverse and interdisciplinary research in future caring science, especially towards a care focus that is more person‐centred. The adding of a historical approach by professional historians to the theory of person‐centredness and person‐centred care can develop knowledge that enables a more holistic understanding of the patient and the development of the patient perspective from the past until today. Thus, the aim was to show how developments within historical methodology can help us to understand elements of care in the past to further develop caring science in future. Historical research methodologies have advocated a "history from below" perspective, and this has enabled the evolution of systematic approaches to historical research that can be explored and critically analysed. Linked with this, the development of a more social and cultural oriented understanding of historical research has enabled historians to explore and add knowledge from a broader societal perspective. By focusing on the life of ordinary people and taking social and cultural aspects into account when trying to reconstruct the past, we can get a deeper understanding of health, care and medical development. However, an interdisciplinary research focus on person‐centredness and person‐centred care that includes professional historians can be challenging. In this paper, we argue that a historical perspective is necessary to meet the challenges we face in future delivery of health care to all people, in all parts of society in an ever more global world. [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 explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes. Background Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents. Design Qualitative exploratory study with thematic analysis. Methods A purposive sampling strategy was applied. Fourteen semi-structured one-to-one interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015-March 2016. Results Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff. Conclusion Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home. Relevance to clinical practice Families could provide much needed support to nursing home nurses, care assistants and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case-by-case basis as well as providing appropriate support or services. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore how older people living at home with mental health needs and their care partners experienced the practices of collaboration within and between services. Background Many healthcare strategies for community mental health services for older people espouse a person-centred approach or principles that are similar in focus. Design This study reports on the first stage of a three-year action research project that focused on improving mental health services for older people and their care partners living at home. Data were collected through individual interviews. Twenty people were interviewed. Data were analysed continuously and in parallel with data collection for the identification of themes. Results We focus on two particular themes, 'acknowledgement, recognition and respect' and 'the prestige hierarchy of mental illness in older people'. We highlight how older people and their care partners experience discontinuities in their everyday interactions with nurses and care workers and that this impacts on their experience of person-centred care. Conclusions Older people with mental health needs and their care partners need high levels of energy to express their needs and have them met in a way that reflects principles of partnership working. Relevance to clinical practice Nurses and care workers need to consider how 'tasks' can be used as a vehicle for creating emotional connections with service users. Service managers and leaders need to consider the implications of discontinuities in care on service user, care partner, nurses and care workers experiences. [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: There is an urgent need for the development of simple communication tools that convey the strengths, assets, and healthcare needs of people living with dementia. A Healthcare Passport may improve communication with range of health and social support services, enhancing quality and continuity of care, and to permit a consideration of the challenges and how these might be managed effectively and compassionately. This study aims to evaluate the acceptability and use of this type of intervention for people living with dementia and their carers.Methods/design: This is a qualitative longitudinal study informed by a critical realist review. The participants will be individuals identified as having mild-moderate dementia and informal carers. The in-depth interviews will occur at three points over the course of 18 months as they use the passport. This will be supplemented by analysis of the content of the passports and information from health and social care providers on the daily practicalities of using the passport in a range of healthcare settings.Discussion: By using a critical realist review and a qualitative, longitudinal approach, the study allows for the assessment of a complex intervention in a manner which goes beyond evaluating the basic efficacy of the passport, but looking more deeply at how it worked, for whom, and in what context. It has the potential to develop new data on how interventions improve communication across a range of service providers, while encouraging health and social care professionals to respect and encourage the development of self-management and retention of personhood throughout the progression of life-limiting illnesses. [ABSTRACT FROM AUTHOR]

Background: Increasingly, it is being suggested that translational gaps might be eradicated or narrowed by bringing research users and producers closer together, a theory that is largely untested. This paper reports a national study to fill a gap in the evidence about the conditions, processes and outcomes related to collaboration and implementation.Methods: A longitudinal realist evaluation using multiple qualitative methods case studies was conducted with three Collaborations for Leadership in Applied Health Research in Care (England). Data were collected over four rounds of theory development, refinement and testing. Over 200 participants were involved in semi-structured interviews, non-participant observations of events and meetings, and stakeholder engagement. A combined inductive and deductive data analysis process was focused on proposition refinement and testing iteratively over data collection rounds.Results: The quality of existing relationships between higher education and local health service, and views about whether implementation was a collaborative act, created a path dependency. Where implementation was perceived to be removed from service and there was a lack of organisational connections, this resulted in a focus on knowledge production and transfer, rather than co-production. The collaborations' architectures were counterproductive because they did not facilitate connectivity and had emphasised professional and epistemic boundaries. More distributed leadership was associated with greater potential for engagement. The creation of boundary spanning roles was the most visible investment in implementation, and credible individuals in these roles resulted in cross-boundary work, in facilitation and in direct impacts. The academic-practice divide played out strongly as a context for motivation to engage, in that 'what's in it for me' resulted in variable levels of engagement along a co-operation-collaboration continuum. Learning within and across collaborations was patchy depending on attention to evaluation.Conclusions: These collaborations did not emerge from a vacuum, and they needed time to learn and develop. Their life cycle started with their position on collaboration, knowledge and implementation. More impactful attempts at collective action in implementation might be determined by the deliberate alignment of a number of features, including foundational relationships, vision, values, structures and processes and views about the nature of the collaboration and implementation. [ABSTRACT FROM AUTHOR]

Background: Leadership programmes have been used to support nurse leaders in developing their skills and equiping them as transformative change agents in healthcare organisations around the world. For this purpose, the Royal College of Nursing's Clinical Leadership Programme has been adapted, implemented, and evaluated in Switzerland. Although a shared vision is a key element in leading organisations and in change, the impact of such a vision on clinical practice is rarely described in the literature. Aims and objectives: To determine qualitatively the benefits of a shared vision as one essential feature of leadership behaviour. Methods: In the context of a mixed methods research study, individual interviews with nurse leaders, as well as focus group interviews with their respective teams, were recorded and transcribed verbatim prior to qualitative content analysis. In order to integrate all findings, a triangulation protocol was applied after separate analysis. Findings: Having a vision helped leaders and their teams to become inspired and committed to a shared goal. Moreover, the vision was a strong driving force for ongoing and systematic practice development and thus established a culture that favoured quality and safety improvement in patient care. However, the strategic direction needed to be tempered; the positive impact on teams and their care practices generated a great deal of enthusiasm, which had the potential to overload the organisation through taking on more than could reasonably be accomplished. Conclusion: The study found that a vision provides orientation and meaning for leaders and their teams. It helps them to focus their energies and engage in the transformation of practice. However, it is very important for leaders to monitor closely the energy level of teams and the organisation, in order to maintain the balance between innovation/transformation and relaxation/recovery. Implications for practice: A vision provides orientation and meaning for leaders and their teams and is a strong driving force for ongoing and systematic practice development The enthusiasm at the beginning brought about the danger of starting too many activities, thus overloading the organisation. Therefore, it is important for leaders to maintain the balance between innovation/transformation and relaxation/recovery Care should be taken to ensure that a vision and corresponding core values are realistic and achievable. Otherwise, the vision might remain an unattainable illusion, and the individuals who are supposed to turn it into reality may become frustrated and demotivated. [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]

Aim. The aim of the study was to examine the usefulness of narratives of older peoples' hospitalisation experiences as a focus for informing practice and service developments. Background. Narrative inquiry provides an option for exploring personal experiences and for providing insight into treatment decisions that can help guide how healthcare services are developed and provided. Methods. Participants were aged 65 and upwards and had been patients in a rehabilitation unit. They were cognitively and physically able to communicate and give consent to take part in the study. Narrative interviewing methods were used for data collection. A problem-solution pattern framework enabled the reconfiguring of narratives in the context of the older persons' past, the here and now and the context of their usual level of well-being or ill-being. Seminars with multidisciplinary professionals were used to analyse the narratives in the context of how they informed the need for practice and service developments. Results. Twenty-eight narrative interviews were undertaken. Through reading and discussing the reconfigured narratives, the multidisciplinary team evaluated whether care procedures were appropriate and identified ways of improving care delivery. Challenges to the integration of narrative approaches were identified. Narrative interviewing was implemented in practice by some of the nurses who participated in the study. Conclusions. Narrative inquiry enhances the assessment of care needs and interactions between healthcare professionals and patients. The framework used for translating stories into plans for practice and service developments needs to be used in further studies and with a broader range of healthcare and social care professionals to determine its usefulness. Relevance to clinical practice. Narrative inquiry is a valuable methodology for understanding older peoples' experiences of health care. Stories developed from older peoples' hospitalisation experiences are a useful basis for identifying aspects of practice that could be developed. [ABSTRACT FROM AUTHOR]

martin j.s., mccormack b., fitzsimons d. & spirig r. (2012) Journal of Nursing Management 20, 72-80 Evaluation of a clinical leadership programme for nurse leaders Aim This is an evaluation study of the impact of the adapted RCN Clinical Leadership Programme on the development of leadership competencies of nurse leaders in Switzerland. Background Transformational leadership competencies are essential for delivering high-quality care within health-care organizations. However, many countries have identified a lack of leadership skills in nurse leaders. Consequently, the development of leadership competencies is a major objective for health-care centres. Methods This article describes the quantitative results of a mixed methods study. A one-group pre-test-post-test quasi-experimental design was used. A convenience sample of 14 ward leaders were assessed three times using the Leadership Practices Inventory (LPI). Descriptive and inferential data analysis techniques were employed. Results In total 420 observer-assessment questionnaires and 42 self-assessment questionnaires were distributed. Our main finding was that nurse leaders following the programme, demonstrated significant improvement in two subscales of the LPI -'inspiring a shared vision' and 'challenging the process'. Conclusion This study showed improvement in two leadership practices of nurse leaders following a programme that has been adapted to Swiss health care. Implications for nursing management Findings concur with others studies that suggest that investments in educational programs to facilitate leadership skills in nurse leaders are justified. [ABSTRACT FROM AUTHOR]

The key epistemological assumption in participatory research is the belief that knowledge is embedded in the lives and experiences of individuals and that knowledge is developed only through a cooperative process between researchers and experiencing individuals. There are various notions about the nature and processes of participation in this type of research. This paper focuses on specific processes that are used for a "genuine" participation by experiencing individuals as research participants. It also identifies processes that are critical for researchers to engage with, in order to become pro-participatory in their approaches to qualitative research. The paper draws on a particular project as an exemplar-"The Crisis Resolution and Home Treatment Project." This project uses various participatory research processes to elicit and include voices of health-care professionals, service users, and family members. The main objective of the research project is to develop knowledge for new forms of community-based practices for people experiencing mental health crisis. We present the participatory research methodology applied in this research, and discuss two sets of processes used to enhance "participation" in research-one set to encourage and elicit participation by research participants; and the other set to engage researchers in reflection within the participatory research process. This will mitigate the paucity of literature regarding the processes and approaches necessary to make participatory research truly "participatory" both for research participants and researchers. [ABSTRACT FROM AUTHOR]

Human skin is a complex multi-layer material. Many existing numerical skin models accurately simulate several of its complex mechanical characteristics. However, few models simulate wrinkling - a phenomenon common to all human skin. In this study, a multi-layer model of skin was developed to simulate wrinkling. The model consisted of the stratum corneum, dermis and underlying hypodermis. The results of the simulations were compared with results of in vivo wrinkling experiments performed on the volar forearm. The proposed three-layer skin model simulates wrinkling more realistically than models of fewer layers. The size of the wrinkles predicted by the model fell within the range of the wrinkle sizes measured in the experiments. The maximum range and average roughness differed by 34 and 43% from the corresponding mean experimental results, respectively. Applications of the model include simulating skin aging, designing more realistic artificial skin and the development of surgical simulators. [ABSTRACT FROM AUTHOR]

Background: The PARiHS framework (Promoting Action on Research Implementation in Health Services) has proved to be a useful practical and conceptual heuristic for many researchers and practitioners in framing their research or knowledge translation endeavours. However, as a conceptual framework it still remains untested and therefore its contribution to the overall development and testing of theory in the field of implementation science is largely unquantified. Discussion: This being the case, the paper provides an integrated summary of our conceptual and theoretical thinking so far and introduces a typology (derived from social policy analysis) used to distinguish between the terms conceptual framework, theory and model -- important definitional and conceptual issues in trying to refine theoretical and methodological approaches to knowledge translation. Secondly, the paper describes the next phase of our work, in particular concentrating on the conceptual thinking and mapping that has led to the generation of the hypothesis that the PARiHS framework is best utilised as a two-stage process: as a preliminary (diagnostic and evaluative) measure of the elements and sub-elements of evidence (E) and context (C), and then using the aggregated data from these measures to determine the most appropriate facilitation method. The exact nature of the intervention is thus determined by the specific actors in the specific context at a specific time and place. In the process of refining this next phase of our work, we have had to consider the wider issues around the use of theories to inform and shape our research activity; the ongoing challenges of developing robust and sensitive measures; facilitation as an intervention for getting research into practice; and finally to note how the current debates around evidence into practice are adopting wider notions that fit innovations more generally. Summary: The paper concludes by suggesting that the future direction of the work on the PARiHS framework is to develop a two-stage diagnostic and evaluative approach, where the intervention is shaped and moulded by the information gathered about the specific situation and from participating stakeholders. In order to expedite the generation of new evidence and testing of emerging theories, we suggest the formation of an international research implementation science collaborative that can systematically collect and analyse experiences of using and testing the PARiHS framework and similar conceptual and theoretical approaches. We also recommend further refinement of the definitions around conceptual framework, theory, and model, suggesting a wider discussion that embraces multiple epistemological and ontological perspectives. [ABSTRACT FROM AUTHOR]

The article presents an overview of the methodology and methods utilized in a literature review which examined the evidence around practice development (PD) in Scotland. It cites the use of PD in describing various approaches to supporting changes in health care. It explains the use of the review methods of realist synthesis in reviewing published PD literature. It also outlines the steps for utilizing the realist synthesis approach.

Objectives: To explore the lived experiences and support needs of the care partners of older people with mental health problems living at home with assistance from home care services. Care partners face significant challenges in their care role and they often feel unsupported. An understanding of their experiences may help improve home care to support their needs. Method: An exploratory qualitative approach was used. The study is based on the SRQR and COREQ reporting guidelines. In‐depth interviews were conducted with six Norwegian care partners from two municipalities. Data were collected during 2012–2013 and 2016. The data were analysed using Gadamer's hermeneutics. Results: Three themes were identified: "invisible cornerstones," "dimensions of collaboration" and "unwanted roles." Conclusion: Few or no routines for collaboration exist between care partners and home care, and the care partners seem to have little knowledge of legal rights. They request more information, spare time and the opportunity to remain in their original family role. However, their main focus is for the patient to receive the necessary help from home care. Home care have restricted resources for meeting these needs and share a sense of powerlessness and lack of influence over their own everyday life with the care partners. There is a need for a systematic, person‐centred approach to collaboration. A correlation is necessary between what is communicated at the system level and the means of realising this in practice for home care to meet care partners' needs. [ABSTRACT FROM AUTHOR]