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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 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]

Rationale Besides a growing demand for safe high-quality care for older people, long-term care ( LTC) often struggles to recruit appropriately qualified nursing staff. Understanding what LTC staff value in their work may contribute to a more comprehensive understanding of what can attract staff and support person-centred care. Aim To explore staff experience of the advantages of working in LTC settings for older people. Methods Narrative descriptions of 85 LTC staff in Ireland, the Netherlands and Sweden on what they value in their work were analysed with qualitative content analysis. Ethics Ethical approval was obtained according to the requirements of each country, and participants provided informed consent prior to the individual interviews. Findings Working in LTC signifies bonding with the older people residing there, their next of kin and the team members. It means autonomy in one's daily tasks amalgamated with being a part of an affirmative team. Participants reported a sense of accomplishment and fulfilment; caring meant consideration and recognition of the older people and the relationships formed, which provided for professional and personal growth. The sharing of compassion between staff and residents indicated reciprocity of the relationship with residents. Study limitations The findings may be transferable to LTC in general although they address only the positive aspects of caring for older people and only the experiences of those staff who had consented to take part in the study. Conclusions The findings add to what underpins the quality of care in nursing homes: compassion in the nurse-resident relationship and person-centred care in LTC. They indicate reciprocity in the relations formed that may contribute to the empowerment of older people, but further studies are needed to explore this in more detail. [ABSTRACT FROM AUTHOR]

This paper explores the concept of practice development in the context of professional development and strategies for facilitating learning in practice. In this paper we present the background to the methodology of emancipatory and transformational practice development. Key concepts underpinning a contemporary definition of practice development are unravelled and nine principles for effective practice development proposed. An example of a large-scale national practice development programme with older people residential settings in the Republic of Ireland is presented to illustrate the processes in action. The findings of the first year of the programme are offered and these findings demonstrate the ways in which practice development systematically uncovers the deeply embedded characteristics of practice cultures – characteristics that often inhibit effective person-centred practice to be realised. [ABSTRACT FROM AUTHOR]

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

The article profiles mental health and general nurse Brendan McCormack. McCormack is a professor of nursing research, and director of the Institute of Nursing Research at the University of Ulster. He said that his passion for older people care developed while he was training as a mental health nurse in the 1980s. The views and sentiments of McCormack on geriatric nursing are also cited.

Research relating to person-centred practice continues to expand and currently there is a dearth of statistical evidence that tests the validity of an accepted model for person-centred practice. The Person-centred Practice Framework is a midrange theory that is used globally, across a range of diverse settings. The aim of this study was to statistically examine the relationships within the Person-centred Practice Framework. A cross sectional survey design using a standardized tool was used to assess a purposive sample ( n = 1283, 31.8%) of multi-disciplinary health professionals across Ireland. Survey construct scores were included in a structural model to examine the theoretical model of person-centred practice. The results were drawn from a multi-disciplinary sample, and represented a broad range of clinical settings. The model explains 60.5% of the total variance. Factor loadings on the second order latent construct, along with fit statistics, confirm the acceptability of the measurement model. Statistically significant factor loadings were also acceptable. A positive, statistically significant relationship was observed between components of the Person-centred Practice Framework confirming it's theoretical propositions. The study provides statistical evidence to support the Person-centred Practice Framework, with a multidisciplinary sample. The findings help confirm the effectiveness of the Person-Centred Practice Index for-Staff as an instrument that is theoretically aligned to an internationally recognised model for person-centred practice.

Background: Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process., Aims: To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people., Methods: Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs., Results: This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: "realising commitment"; "negotiating conditions"; and "encouragement to keep momentum going." The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the "building of a bridge" emerged as one way of understanding the findings., Linking Evidence to Action: Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved., (© 2016 Sigma Theta Tau International.)

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., (© 2013 John Wiley & Sons Ltd.)

Aim: To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people., Design: The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the 'Person-Centred Nursing Index'., Findings: Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses' perceptions of caring, indicating a shift from a dominant focus on 'technical' aspects of care, to one where 'intimate' aspects of care were more highly valued., Relevance to Clinical Practice: The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships., (© 2010 Blackwell Publishing Ltd.)

Background: Incontinence of both bladder and bowel is a major health care problem and adversely affects the lives of many people living at home or in health service facilities. The prevalence and severity of incontinence is a global concern that has, in recent years, prompted investigation across several countries. Current approaches to continence care indicate an emphasis on safety and reduction of risk, rather than on detailed individualised assessment and management., Aim: To show approaches to assessment, diagnosis, and management of urinary and faecal incontinence in two rehabilitation settings for older people in Ireland. The study forms part of a larger 2-year case study to identify the determinants of practice "context" that enable or hinder proactive approaches to promoting continence and the treatment of incontinence in rehabilitation settings for older people., Method: The Royal College of Physicians Audit Scheme was used to record the assessment and management of urinary and faecal incontinence. This scheme also includes questions regarding resources available to enable effective continence management. Over 6 months, 220 patients who suffered from incontinence participated in two study sites: a 78-bed rehabilitation unit in Northern Ireland and an 80-bed rehabilitation unit in Southern Ireland., Results: Findings indicated that 60% of incontinent patients had urinary incontinence, 3% faecal incontinence, and 37% mixed urinary and faecal incontinence; however, a specific continence assessment and specific rationale for treatment decisions or continuation of care were lacking. The focus was on continence containment rather than on proactive management. The examination of resources available for continence promotion and management showed that even though guidelines for continence management were available to staff in one unit, there was a dearth of appropriate education or support for staff in continence care., Implications for Practice: Because incontinence remains an issue for older people and the clinical implications of sustained incontinence are multifaceted, strategies should focus on the development of practice towards evidence-based multidisciplinary approaches to continence promotion and management.