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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]

Background: Evidence for benefits of physical activity after stroke is unequivocal. However, many people with stroke are inactive, spending > 80% of waking hours sedentary even when they have physical capacity for activity, indicating barriers to physical activity participation that are not physical. WeWalk is a 12-week person-centred dyadic behaviour change intervention in which a person with stroke (PWS) and a walking buddy form a dyad to work together to support the PWS to increase their physical activity by walking outdoors. This pilot study examined the feasibility of recruiting dyads, explored their perceptions of acceptability and their experiences using WeWalk, to identify required refinements before progression to a clinical trial. Methods: Design: A single-arm observational pilot study with qualitative evaluation. Intervention: WeWalk involved facilitated face-to-face and telephone sessions with a researcher who was also a behaviour change practitioner, supported by intervention handbooks and diaries, in which dyads agreed walking goals and plans, monitored progress, and developed strategies for maintaining walking. Evaluation: Descriptive data on recruitment and retention were collected. Interview data were collected through semi-structured interviews and analysed using thematic analysis, guided by a theoretical framework of acceptability. Results: We recruited 21 dyads comprising community dwelling PWS and their walking buddies. Ten dyads fully completed WeWalk before government-imposed COVID-19 lockdown. Despite lockdown, 18 dyads completed exit interviews. We identified three themes: acceptability evolves with experience, mutuality, and person-centredness with personally relevant tailoring. As dyads recognised how WeWalk components supported walking, perceptions of acceptability grew. Effort receded as goals and enjoyment of walking together were realised. The dyadic structure provided accountability, and participants' confidence developed as they experienced physical and psychological benefits of walking. WeWalk worked best when dyads exhibited relational connectivity and mutuality in setting and achieving goals. Tailoring intervention components to individual circumstances and values supported dyads in participation and achieving meaningful goals. Conclusion: Recruiting dyads was feasible and most engaged with WeWalk. Participants viewed the dyadic structure and intervention components as acceptable for promoting outdoor walking and valued the personally tailored nature of WeWalk. Developing buddy support skills and community delivery pathways are required refinements. ISCTRN number: 34488928. [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]

Background: A renewed interest in nursing homes as clinical placement settings for nursing students has been prompted by the growing healthcare needs of an ageing population. However, if future nurses are to be enthusiastic about working in this healthcare context, it is essential that higher education institutions that educate nurses and nursing homes that provide placement experiences to students do so with a supportive, positive, and enriched approach. Methods: To explore first-year nursing students' placement experience in nursing homes, we conducted an exploratory qualitative study in three city-based nursing homes in western Norway. Thirteen first-year nursing students participated in the study. Three focus group interviews were conducted to explore the students' placement experiences. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR). Results: The analysis describes five themes relating to first-year students' placement experience in nursing homes; (1) variations in utility of pre-placement orientation and welcome at placement site; (2) a challenging learning environment; (3) spending considerable placement time with non-registered nurses; (4) considerable variability in supervision practices; and (5) a vulnerable and demanding student role. Conclusions: The research provides insight into the contextual characteristics encountered by first-year students that influence the quality of their placement experiences. Consequently, these characteristics impede access to important role models who lend support to a student's growth and professional development, preventing full utilisation of the learning potential offered in nursing homes. Hence, we propose that targeted efforts are warranted to foster positive placement experiences and enhance students' clinical education in nursing homes. [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]

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]

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: Person-centred approaches to practice are synonymous with effective healthcare. It is therefore important that the nursing workforce values, recognises and demonstrates person-centred practice. This has implications for nursing education and how curricula prepare students for personcentred practice. Aim: To conduct a meta-synthesis of person-centredness in nursing curricula. Method: Meta-synthesis. Results: The meta-synthesis included 48 papers. Four themes were identified: • Moving beyond mediocrity (dissatisfaction with current teaching and learning approaches, and a desire to enhance curricula to promote person-centredness) • Me, myself and I (promoting person-centredness in nursing curricula requires all participants in nursing education to have self-knowledge) • The curricular suitcase (nursing curricula have finite capacity so the inclusion of personcentredness is an essential requirement for the career journey) • Learning elevators (it is important to prioritise learning cultures and experiences that help students understand and enact person-centred practice) Conclusion: This study has found that nurse educators aspire to and are committed to the promotion of person-centred practice. Internationally, a range of pedagogies and curricular developments to promote person-centredness have been positively evaluated. However, there is generally a lack of conceptual clarity about the nature of person-centredness and no evidence of a systematic approach to whole-curriculum development that reflects the theoretical principles of person-centred practice. Implications for practice development: • Person-centred practice is a prominent concept in healthcare policy. If the future nursing workforce is to be prepared for person-centred practice then proficiency standards and nursing curricula should consistently reflect this • Nursing curricula need to be developed to encompass a breadth and depth of learning experiences in academic and practice settings, in order to optimise student learning about those issues that matter most to people in need of healthcare. [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: Collaboration with care partners is a political aim in recent white papers in Norway and internationally. Home care services regularly work closely with care partners, but there are many indications that the collaboration does not work satisfactorily. Aim: To explore home care staff and leaders' experiences of collaborating with care partners of older people with mental health problems through a personhood perspective. Methods: The study had a qualitative design and comprised eight health professionals in two focus groups and in‐depth interviews with three leaders in one home care district. The data were analysed using a thematic framework analysis building on previous research on personhood. criteria for reporting qualitative reporting guidelines were used to ensure comprehensive reporting. Results: Four themes were identified in the analysis: 'non‐negotiated relationships', 'contradictory agendas', 'weak paternalism' and 'moral compromise'. Conclusion: There seems to be a lack of facilitation of collaborative relationships through all levels of the home care organisation. The interactions between care partners and home care staff sometimes appear to produce low or negative levels of emotional energy, and situations where the personhood of neither of them is respected occurs. Paying attention to the four modes of being as a framework for understanding personhood creates the foundation for a person‐centred approach that enhances the potential of creating stronger partnership in care relationships. [ABSTRACT FROM AUTHOR]

Background: Person-centred practice is advocated internationally across multiple healthcare contexts and professions. Originating in nursing and medicine, its enactment in physiotherapy requires careful consideration. Aim: To explore perceptions of person-centred practice within nursing and physiotherapy in online social media communities to gain insight into differences and similarities in how it can be enacted professionally. Methods: A large, online focus group was undertaken through an international tweetchat within the existing social media communities WeNurses and Physiotalk. Participants were fully informed before participation. Tweets from the tweetchat, which lasted for the planned hour plus an extra 15 minutes, were downloaded via the healthcare social media analytics platform Symplur. Analysis was conducted using an interpretative phenomenological approach, with consideration of group development of insight and meaning. Tweets were analysed if they were from nurses and physiotherapists, related to the research aim and interpretable. Results: A selected 233 of 504 tweets from 38 nurses and 23 physiotherapists were analysed. Four themes are discussed here: relationship between professionals and patients,perceptions of who holds the power,treating the condition not the person,and impact of organisational demands. Nurses and physiotherapists were seen to share many perceptions of person-centred practice, with the latter demonstrating a focus on informed decision making and education to empower. Discussion also showed that a biomedical approach was often taken by physiotherapists. Patient privacy was highlighted by nurses. Explanatory theory was produced to incorporate the views of physiotherapists alongside established perceptions of person-centred practice from the nursing literature, expanding insights into profession-specific applications. Conclusions: Perceptions of person-centred practice described by participants were generally supportive of existing frameworks. Insights suggested some physiotherapists might perceive their professional role in a way that is not completely consistent with person-centred practice,this would benefit from further exploration. The importance of education to empower patients within collaborative relationships was emphasised in relation to physiotherapy. Implications for practice: •Discussion supported many similarities in the perceptions of person-centred practice between nursing and physiotherapy online communities that resonate with existing frameworks, including prioritisation of what matters to the person and empowerment through relationship, and the barriers to this resulting from structures and cultures within workplaces •Participants from both professions emphasised the importance of focusing on the beliefs, values and priorities of the person in development of a collaborative relationship, with shared decision making •Physiotherapists involved in the tweetchat placed additional emphasis on the need to empower patients through education to enable greater participation in informed and shared decision making •Tweets suggested there are professional barriers to the enactment of person-centred practice among physiotherapists. Some may focus on the condition rather than the person, and view the professional as expert with greater power in the therapeutic relationship. [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 identify and synthesise the needs of care partners of older people living at home with assistance from home care services. Background: “Ageing in place” is a promoted concept where care partners and home care services play significant roles. Identifying the needs of care partners and finding systematic ways of meeting them can help care partners to cope with their role. Design/methods: This study is based on the PRISMA reporting guidelines. The systematic review of qualitative and quantitative studies was guided by the Joanna Briggs Institute methodology. Results: In total, 16 studies were included in the review, eleven qualitative and five quantitative. Three main categories were revealed in the analysis: the need for quality interaction, the need for a shared approach to care and the need to feel empowered. Conclusion: Care partners of older people have several, continuously unmet needs. A person‐centred perspective can contribute new understandings of how to meet these needs. A knowledge gap has been identified regarding the needs of care partners of older people with mental health problems. There is a need to develop a tool for systematic collaboration between home care services and care partners, so that the identified needs can be met in a more thorough, systematic and person‐centred way. Relevance to clinical practice: The carers in home care services need competence to identify and meet the needs of care partners. The implementation of person‐centred values in home care services can contribute to meet the needs of care partners to a greater extent than today. Future research on the needs of care partners of older people with mental health problems needs to be undertaken. [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 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]

Background: There is a large and diverse literature on the concept of hope in health care. This literature covers a broad spectrum of perspectives, from philosophical, conceptual, and theoretical analysis through to attempts at measuring the concept of hope with differing health care users. Aims: To explore the concept of hope through the secondary analysis of existing data sets, with the intention of understanding hope in the context of person-centeredness. Research Question: What is the experience of hope among service users and informal carers in different health care contexts? Method: Secondary analysis of data derived from three research studies. Findings: We identified four key themes that together illustrate what we describe as a kaleidoscope of hope, reinforcing the view that there is no one presentation of hope and that practitioners must engage authentically with service users to determine the most effective and appropriate intervention strategies. Conclusions: Hope is not a singular phenomenon, and in the context of person-centered practice there is a need for practitioners to engage authentically with service users and listen carefully to what may bring hope for them. [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 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]

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]

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]

boomer c.a.& mccormack b. (2010) Journal of Nursing Management  18, 633-644 Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders Aim To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. Background The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. Methods Programme evaluation methodology to determine the 'worth' of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. Results Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. Conclusions Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. Implications for nursing management Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators. [ABSTRACT FROM AUTHOR]

Background: The drive towards person-centred approaches to care delivery has been increasingly promoted. This is in response to the significant challenges within health and social care organisations, which impact on the care experience for patients and their families. Objective: The aim of this paper is to illuminate the experiences of patients of care received in hospital wards during the intervention phase of a programme to develop person-centred practice. Design: A narrative enquiry study was conducted which is a particular way of exploring complex cultural or social patterns. Structural narrative analysis was used to generate explanation and interpretation of in-hospital patients' care experience. Setting: Recruitment was from four different hospital sites in one health care organisation, focussing on patients who were admitted to the nine wards/units where the nursing teams were participating in a practice development programme that had the intention of promoting person-centredness. Participants: Participants were people aged over 18 and receiving care and treatment in the identified wards/units. Twenty-six patients were recruited. Methods: Narrative interviews were audio-recorded at four month intervals and transcribed. The records were subjected to a process of structural analysis. Results: The findings offer insight into patients' experiences of care in a range of clinical settings in which an explicit intervention to promote person-centred practice was underway. There was one overriding theme formulated: Vulnerability at the junctures of systems, care processes and nurses' responses. From this main theme, we derived four sub-themes: (1) confronting vulnerability, (2) experiencing exemplary care, (3) experiencing misalignments in systems, care processes and nurses' responses, and (4) sharing in a sense of belonging with ward nurses. Conclusions: In-hospital patients are exposed to vulnerability in the care experience. They placed value on exemplary care. Experiences of misalignments in systems, care processes and nurses' responses disempower patients and heighten a sense of vulnerability. The ward nursing teams were generating a family like atmosphere. Patients responded by sharing a sense of belonging with ward nurses. These findings confirm components that have influenced the development of person-centred practice, such as the importance of the context and culture of care. They also offer new insights that may contribute to on-going practice development work. [ABSTRACT FROM AUTHOR]