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Background: Person-centred healthcare focuses on placing the beliefs and values of service users at the centre of decision-making and creating the context for practitioners to do this effectively. Measuring the outcomes arising from person-centred practices is complex and challenging and often adopts multiple perspectives and approaches. Few measurement frameworks are grounded in an explicit person-centred theoretical framework. Aims: In the study reported in this paper, the aim was to develop a valid and reliable instrument to measure the experience of person-centred care by service users (patients)–The Person-centred Practice Inventory-Care (PCPI-C). Methods: Based on the 'person-centred processes' construct of an established Person-centred Practice Framework (PCPF), a service user instrument was developed to complement existing instruments informed by the same theoretical framework–the PCPF. An exploratory sequential mixed methods design was used to construct and test the instrument, working with international partners and service users in Scotland, Northern Ireland, Australia and Austria. A three-phase approach was adopted to the development and testing of the PCPI-C: Phase 1 –Item Selection: following an iterative process a list of 20 items were agreed upon by the research team for use in phase 2 of the project; Phase 2 –Instrument Development and Refinement: Development of the PCPI-C was undertaken through two stages. Stage 1 involved three sequential rounds of data collection using focus groups in Scotland, Australia and Northern Ireland; Stage 2 involved distributing the instrument to members of a global community of practice for person-centred practice for review and feedback, as well as refinement and translation through one: one interviews in Austria. Phase 3: Testing Structural Validity of the PCPI-C: A sample of 452 participants participated in this phase of the study. Service users participating in existing cancer research in the UK, Malta, Poland and Portugal, as well as care homes research in Austria completed the draft PCPI-C. Data were collected over a 14month period (January 2021-March 2022). Descriptive and measures of dispersion statistics were generated for all items to help inform subsequent analysis. Confirmatory factor analysis was conducted using maximum likelihood robust extraction testing of the 5-factor model of the PCPI-C. Results: The testing of the PCPI-C resulted in a final 18 item instrument. The results demonstrate that the PCPI-C is a psychometrically sound instrument, supporting a five-factor model that examines the service user's perspective of what constitutes person-centred care. Conclusion and implications: This new instrument is generic in nature and so can be used to evaluate how person-centredness is perceived by service users in different healthcare contexts and at different levels of an organisation. Thus, it brings a service user perspective to an organisation-wide evaluation framework. [ABSTRACT FROM AUTHOR]

Aim: We aim to investigate burnout and resilience among hospital based nurse managers post COVID‐19 in order to suggest appropriate person‐centred leadership support. Background: Nurse leaders are central to establishing safe and caring environments for patients and staff. Therefore, their own wellbeing is crucial, particular in times of crisis where they must provide support and guidance. Methods: Cross‐sectional questionnaire included ward managers. Data collected were burnout inventory, brief resilience score and demographic data. To analyse data, we used descriptive statistics. Results: 51.2% answered the questionnaire. Of those, 32.3% displayed symptoms of high personal burnout and 29% of work‐related burnout. 6.5% showed signs of high employee‐related burnout. As a group, ward managers showed moderate to high resilience. Conclusion: Personal and work‐related burnout was highly prevalent among ward managers. Results suggest that the cause of their burnout symptoms cannot be attributed to low individual resilience. We thus suggest a shift in focus from strengthening individual leadership resilience to the establishment of healthful and resilient cultures in accordance with person‐centred leadership. Implications for Nursing Management: Person‐centred leadership has the potential to shift the focus from the resilience of individual leaders to that of collective responsibility for creating a healthful and resilient culture. [ABSTRACT FROM AUTHOR]

The article focuses on the chapter "The Future(s) of Indigenous Horror: Moon of the Crusted Snow" from open access resource CanLit Guides which focuses on horror of Indigenous with examination of novel of author Waubgeshig Rice. Topics discussed include book "Moon of the Crusted Snow" by Rice which discusses Indigenous genre fiction, pedagogy of the chapter focused on indigenous scholarship and knowledge, and prominence gained by Indigenous fiction in Canadian literary pedagogy.

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

Background: 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]

Aim Background Design Methods Results Conclusion Implications for the Profession and/or Patient Care Reporting Method Patient or Public Contribution To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital.Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability.A narrative inquiry.Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data.The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation.Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians.Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly.The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting.The consumer researcher was involved in design, data analysis and publication preparation. [ABSTRACT FROM AUTHOR]

An editorial is presented on how determining the quality of a health system is a complex and challenging endeavor, and mentions variety of perspectives needed to determine quality of Providing the best possible health care has always been a priority for health system leaders.

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

Background: 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]

Problem with How We Have Flattened the (Epidemic) Curve In seven months, between the declaration of a pandemic by the World Health Organization (WHO) on March 11, 2020 ([22]) and the public announcement of an available vaccine on November 9, 2020 ([5]), the number of global cases of COVID-19 rose exponentially from just over 100,000 to approximately 50 million. The first fundamental canon of the Code of Ethics published by the National Society of Professional Engineers of the United States is, "Engineers, in the fulfillment of their professional duties, shall hold paramount the safety, health, and welfare of the I public i " (emphasis added) ([15]). Conclusion Environmental engineers have an opportunity to contribute to building back better as the public health system is improved in the aftermath of the COVID-19 pandemic. [Extracted from the article]

An introduction is presented in which the editor discusses various reports within the issue including the difficult politics of making home, Indigenous knowledge in support of environmental justice and the ethics of poetry.

Background: In this article we reflect on the experience of the first author (Berit Margrethe Sandvik) of conducting seven qualitative research interviews with public health nurses trained in parenting guidance by the International Child Development Programme at the University of South-Eastern Norway. The interviews focused on how the nurses use a particular set of competencies in their daily work at the health centre. A person-centred practice framework was used to reflect on whether personcentred prerequisites and processes could be recognised in the completed interview processes, and how a greater focus on a person-centred approach could improve the quality of data collection. The results of this reflection are presented in this paper. Aim: To understand how a researcher can use person-centred principles to facilitate qualitative interviews. Findings: Being reflexive is essential to a person-centred approach in qualitative research interviews. It relates to the researcher's ability to facilitate an engagement that promotes authenticity, selfdetermination and reciprocity. Knowing oneself without letting conscious or unconscious values and perceptions overshadow the opportunities that arise in gaining an understanding of the participant's values and perceptions is essential. Through being vigilant in all senses, an holistic, mutually respectful dialogue can be created, through which new knowledge and understandings can be generated. Conclusion: It is important to consider person-centredness in the planning and undertaking of research methods. While there is an increasing evidence base about person-centredness in health and social care practice, there continues to be a dearth of publications that focus on its role in research methods. Implications for practice: •Developing the ability to facilitate mutually respectful dialogue in research interviews is important in researcher development programmes •Facilitating flow and creativity through engaging all senses in the dialogical situation has the potential to create a more person-centred approach to interview practices •Being open to and aware of the lifeworlds of others, and having the ability to adjust one's own pre-understanding, facilitates an engagement that promotes authenticity, self-determination and reciprocity •There is a need for more studies to use person-centred principles and practices explicitly in the conduct of research. This article provides a reflexive framework for doing that and suggests principles that can be applied in future research studies. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the meaning of home for six baby boomers and consider how this insight can be used when caring for older people in hospital or residential settings. Background: Feeling at home is important to help retain a sense of autonomy, security and well‐being, but home is a complex concept to understand. The baby boomers are a large cohort entering later life and understanding their sense of home is not only an example of anticipatory gerontology but it could also provide the tools to explore home with the current older population, who may be in a variety of care settings. Design and methods: A qualitative hermeneutic approach was adopted to explore the meaning of home of six baby boomers. The participants were asked to take photographs showing what home meant to them and interpret these in a recorded photo‐elicitation interview. Small teams then reviewed the images to provide further insight. Finally, all the data were reviewed to provide an overall analysis of the revealed meaning of home. Results: Having possessions or stuff was important for the meaning of home; being familiar with the local environment was also “homely,” as well as certain textures and familiar sounds and smells; relationships with others and the ability to have choice in where and how the participants live were also significant for their meaning of home. Conclusions: The meaning of home is complex. Nevertheless, in this study, an evocative sense of home was revealed and these insights could be used in discussions with older people in care settings to help increase their sense of autonomy, security and well‐being. Furthermore, these insights could also be used to develop a framework to help nursing staff guide these discussions. Relevance to clinical practice: By considering the multisensory nature of the meaning of home, nurses can create a sense of home for patients. Feeling at home can improve the well‐being and a sense of autonomy for patients. Enabling patients to feel more autonomous recognises the importance of a person‐centred approach to care. [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]

Background: Palliative and end-of-life care services need to be person centred. However, it cannot be assumed that such services are 'naturally' person centred as, in reality, they face the same pressures and challenges as any other service. This is the case in the practice development research reported in this article. While the service had good patient and family feedback/satisfaction, the context of care provision for staff did not reflect these same levels of satisfaction. This contrast poses challenges for organisations in the context of staff wellbeing and the sustainability of person-centred care. The work undertaken in this programme aimed to address this issue. Aim: To implement a programme of practice development to further the development of a culture of person-centred practice in the Marie Curie Edinburgh Hospice. Methods: The programme was theoretically informed by the Person-centred Practice Framework of McCormack and McCance (2017) and operationalised through the methodology of transformational practice development. Thirteen multidisciplinary team members formed a 'core group' and participated in 10 three-hour workshops of learning and development, spread over a 12-month period. Practice development activities were planned in between the workshops to be undertaken by the group members. Evaluation data were collected at the beginning of the practice development programme and as a continuous process throughout the 12 months. Data collected included patient and staff stories, practice observations, creative expressions and routinely collected data. These data were analysed through a participatory approach with the group members and theorised through the lens of human flourishing. Results: The findings are located within a framework exploring the conditions for human flourishing. They illustrate the tension between person-centred care and person-centred cultures. Key findings demonstrate the need for all persons to be 'known' in order for effective person-centred relationships to exist, the significance of shared values, the importance of addressing 'small' practice changes as well as the need to ensure the hearing of different voices. Findings from routine collected data further demonstrate the relationship between the development of a person-centred culture with patient and staff outcomes. Conclusions and implications for practice: This programme is one of the first explicitly to use a framework for human flourishing to analyse the relationship between person-centred culture and care provision. The programme demonstrates the importance of person-centred cultures for sustainable person-centred care. Implications for practice include: • Practice settings need to be clear about the difference between patient- and person-centredness • The engagement of a multidisciplinary team in interdisciplinary systematic transformational practice development has the potential to transform the culture and context of care, and produce sustainable outcomes • Human flourishing is an appropriate focus to adopt in exploring how practice settings embrace the principles of person-centredness for all persons [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]

An introduction is presented in which the editor discusses articles in the issue on topics including the notion of Canadian literature as a kind of home for criticism and the use of the word "meanwhile" in the poems of author Emily Nilsen's collection Otolith.

An interview with Canadian novelist Lawrence Hill is presented. When asked about his most recent novel, "The Illegal", Hill says that it is his most political book yet and how he feels that literature and politics are closely related. Hill says that his novel, which deals with policies relating to refugees and immigration can help influence the way his readers view the world.

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]

Background: Engagement is being more frequently and widely referred to in person-centred practice research and scholarship, and likewise in practice development, without any clear definition. Aims and objectives: To present a summary discussion on engagement in the context of person-centred practice and research, and to offer a working definition. Methods: The critique in this paper was informed by a focused literature review of 30 publications from the field of positive organisational scholarship and a hand search of policy reports from the past five years. Findings/results: Engagement, as a predictor of effectiveness, is supported by various researchers’ theoretical and empirical work. The definition of engagement from positive organisational scholarship offers a complementary empirical starting point on which researchers in person-centred practice research can build. Current definitions have limitations for care settings as they only apply to workers rather than including service users, and they privilege cognitive knowledge and/or psychological processes. We therefore recommend a revised definition for use in person-centred practice research. Conclusions: A revised definition that balances different ways of knowing and can be used with all people is proposed in this paper. However, further research is needed to explore what engagement is, what it looks like in different types of workplace cultures and what it offers person-centred practice. Implications for practice: • Engagement requires and leads to enhanced vigour, dedication and absorption • Other outcomes of engagement are energy and vitality – necessary for personal, team/group and workplace culture development • Engagement is an intrapersonal, interpersonal and social/group process, and an outcome that promotes enhanced engagement, learning and transformation (that is, thriving and flourishing) • Engagement is a short-term process and outcome and needs continuous nurturing in all persons [ABSTRACT FROM AUTHOR]

Background: Person-centred practice is now firmly embedded in the nursing and healthcare discourse. While there is a growing body of development and research activity in the field, there is increased recognition of the need for further advances in the body of existing knowledge. This is reflected in the different approaches to person-centredness being adopted by healthcare systems internationally. Aims: To provide an overview of person-centredness and ways in which person-centred practice has been adopted in healthcare systems internationally. Methods: A summary review of the evidence underpinning the concepts and theory of personcentredness, incorporating an overview of national strategic frameworks that influence the development of person-centred practice in different countries. Findings: While there have been considerable advances in the development of person-centredness, there is a lot of work to be done in the adoption of more consistent approaches to its development and evaluation. In particular, a shared discourse and measurement tools are needed. Internationally, person-centredness is gaining momentum and many countries have strategic frameworks in place to direct its development and implementation. Conclusions: Significant developments in the theory and practice of person-centredness in nursing and healthcare have taken place. However, as evidenced by the accounts of in-country developments, internationally there is a need to develop more strategic multiprofessional approaches to the development/implementation and evaluation of person-centred practices. Implications for practice: • National developments in person-centred healthcare need to reflect the diversity of strategic approaches internationally • While a common language of person-centredness is emerging, there is a need for clarity over how this is operationalised in everyday practice situations [ABSTRACT FROM AUTHOR]

Background: As part of the launch of a new nursing strategic framework for the Division of Nursing at Queen Margaret University, Edinburgh, we decided to host a TEDx event with the theme of ‘Flourishing People, Spaces and Places’. This theme is the core of the vision for nursing in the division which focuses on flourishing people, spaces and places as the bases for inspiring nurses. Launching the strategy with this key phrase as the central theme of the TEDx event allowed students, staff, practitioners and our community to see, sense and be challenged about what flourishing means. In addition it enabled these different stakeholders to engage with and become part of the nursing vision as we move forward. Making the launch of the strategy a TEDx event and not a nursing conference offered an exciting and fresh way of engaging with stakeholders. We also discovered that, to date, there had been no TED talks on flourishing. The nursing team considered the TEDx formula to be a creative and meaningful way to engage with our key stakeholders. As nurse academics we recognise the need to continue to find new ways to engage in creativity and to use creative learning strategies in our practice (McCormack et al., 2015). The TEDx ethos/formula, which differs from the normal conference package, offered us this opportunity. This paper provides a reflective overview, using a variety of media, of our experiences of organising and delivering a TEDx event with the core theme of flourishing. Objectives of the TEDxQMU event: • To introduce the TEDx formula to a new audience and to deliver a new idea to students, staff and our community • To allow our audience to be challenged on a personal and professional level by a diverse set of speakers on what flourishing meant to them • To launch our strategy and vision for the future in an inclusive and creative way • To explore, through engaging with different media, what flourishing meant to individuals and groups Conclusions: This reflective paper has allowed us to share our experiences of a new and creative way of engaging with staff and colleagues across a university and our wider community, to not only share our strategy but to challenge and facilitate flourishing. [ABSTRACT FROM AUTHOR]

An introduction to the periodical "Canadian Literature" alongwith table of contents is presented.

OBJECTIVE: The aim of this study is to explore the relations of workplace culture on nursing-sensitive organizational factors. BACKGROUND: The need for standardized and valid measures for nursing-sensitive organizational outcomes has already been recognized in the literature. METHODS: A cross-sectional questionnaire survey of 21 inpatient acute care units in 9 organizations at the municipal primary healthcare level was conducted. Participants included licensed practical nurses, registered nurses, and nurse managers. RESULTS: Workplace culture, especially the overarching factor of stress, correlated with the use of supplemental nursing staff and patients' length of stay. CONCLUSION: It is essential to find and test workplace-sensitive indicators so that managers will have a wider range of methods to plan and evaluate nursing outcomes. [ABSTRACT FROM AUTHOR]

In this paper we explore 'human flourishing', a concept that we articulate through embodied creative methods of inquiry. In contemporary organisations, the recognition that persons need to exist in contexts that enable their potential to be maximised and realised has promoted a greater focus on identifying conditions that can help people to flourish in the workplace. In helping relationships in a variety of health and social care organisations, we seek to create the conditions for human flourishing. We do this work in our transformational research, development and facilitated learning practices, which are located in a critical creativity worldview. For the past eight years, we have been exploring this worldview philosophically, theoretically and methodologically. In addition, we have been helping others to utilise methods that are consistent with a critically creative methodology and to reflect on the experiences of doing so. The goal of critical creativity is 'human flourishing' and so in this paper we present the results of an embodied and creative exploration of that concept. We set out the methods we used, the metaphors that have emerged through our creative inquiry and the meaning of these metaphors in the context of contemporary literature and perspectives. The paper is framed through a poem and photographs that, together with dialogue, offer an holistic and symbolic perspective of human flourishing. Each section of the paper explores a particular verse of the poem in order to unfold what we describe as an ecology of human flourishing with no beginning and no end. As an outcome of our inquiry so far, we offer a definition of human flourishing and invite readers to engage in inquiries of their own flourishing at work. [ABSTRACT FROM AUTHOR]

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

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]

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

In this paper we explore 'human flourishing', a concept that we articulate through embodied creative methods of inquiry. In contemporary organisations, the recognition that persons need to exist in contexts that enable their potential to be maximised and realised has promoted a greater focus on identifying conditions that can help people to flourish in the workplace. In helping relationships in a variety of health and social care organisations, we seek to create the conditions for human flourishing. We do this work in our transformational research, development and facilitated learning practices, which are located in a critical creativity worldview. For the past eight years, we have been exploring this worldview philosophically, theoretically and methodologically. In addition, we have been helping others to utilise methods that are consistent with a critically creative methodology and to reflect on the experiences of doing so. The goal of critical creativity is 'human flourishing' and so in this paper we present the results of an embodied and creative exploration of that concept. We set out the methods we used, the metaphors that have emerged through our creative inquiry and the meaning of these metaphors in the context of contemporary literature and perspectives. The paper is framed through a poem and photographs that, together with dialogue, offer an holistic and symbolic perspective of human flourishing. Each section of the paper explores a particular verse of the poem in order to unfold what we describe as an ecology of human flourishing with no beginning and no end. As an outcome of our inquiry so far, we offer a definition of human flourishing and invite readers to engage in inquiries of their own flourishing at work. [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]

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]

Purpose: To demonstrate that practice development is an effective strategy to enable an aged care team to embed a palliative approach to care of dying people into practice culture. Method: Practice development methodology was integrated with an action research evaluation framework, as a systematic and reflexive process of inquiry aimed at achieving innovative and transformative end of life care. Drawing on multiple sources of observational, group and interview data, evidence-based guidelines and the use of arts-informed active learning methods, a multidisciplinary aged care team explored personal and professional values and beliefs about principles of care delivery. These were creatively translated into meaningful expressions of evidence-informed end of life care and embedded into daily clinical practice. Results: Reflexive analysis of multiple sources of data, alongside the use of evidence-based guidelines, supported the collaborative development of a 'palliative care chest of drawers' (PCCOD). As an artefact and one outcome of using practice development in the implementation of a palliative approach to care, the PCCOD brought visible, shared meanings and new ways of working to support care of people who are dying, their families, other facility residents and staff. The PCCOD enabled the aged care team to embed practice innovations into normative patterns of care. Conclusion: Practice development strategies are effective in enabling practitioner-led innovation in clinical practice through integrated inquiry and transformative processes. Implications for practice: The use of a practice development, arts-informed approach: • Enables the creation of space for workbased learning and innovation, such as the development and use of the PCCOD to support the process of implementation of changes in practice • Makes visible changes to practice, based on shared meanings of a palliative approach to end of life care that reflects the culture of the workplace • Provides a creative strategic tool to engage others in the processes of transformation and collaboration, which takes initiatives from a small active learning group into the workplace • Enables what was previously a 'hidden' part of care to be a distinctive care package that engages residents, families and all members of the aged care team. [ABSTRACT FROM AUTHOR]

Background: Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why? Methods: The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use. Results: 24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents' function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches. Conclusion: This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care. [ABSTRACT FROM AUTHOR]

The author contemplates on the value of nursing in a time of crisis like the COVID-19 pandemic. He cites that due to the pandemic student nurses became a subsidiary workforce to replace the chronic shortage of nurses that existed prior to the pandemic. He also states the significance and importance of nursing knowledge according to the American Academy of Nurses (AAN).

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: We aim to explore healthful leadership practices in nursing and midwifery evident within the COVID‐19 pandemic in the United Kingdom, the contextual facilitators, barriers and outcomes. Background: Globally, the health and care sectors are under pressure and despite nurses and other professionals, demonstrating resilience and resourcefulness in the COVID‐19 pandemic; this has negatively impacted on their health and wellbeing and on patient care. Evaluation: Two searches were conducted in July 2021 and December 2021. Inclusion/exclusion criteria were identified to refine the search, including papers written since the beginning of the pandemic in 2020. A total of 38 papers were included principally from the United States and United Kingdom. Ten were research papers; the others were commentaries, opinion pieces and editorials. MS Teams literature repository was created. A unique critical appraisal tool was devised to capture contexts, mechanisms and outcomes whilst reflecting more standardized tools, that is, the Critical Appraisal Skills Programme and the Authority, Accuracy, Coverage, Objectivity and Date tool for reviewing grey literature to refine the search further. Key issues: Six tentative theories of healthful leadership emerged from the literature around leadership strategies, which are relational, being visible and present; being open and engaging; caring for self and others; embodying values; being prepared and preparing others; and using available information and support. Contextual factors that enable healthful leadership practices are in the main, created by leaders' values, attributes and style. The literature suggests that leaders who embody values of compassion, empathy, courage and authenticity create conditions for positive and healthful relations between leaders and others. Nurse and midwives' voices are however absent from the literature in this review. Conclusion: Current available literature would suggest healthful leadership practices are not prioritized by nurse leaders. Perspectives of nurses' and midwives' about the impact of such practices on their wellbeing is also missing. Tentative theories are offered as a means of identifying healthful leadership strategies, the context that enable these and potential outcomes for nurses and midwives. These will be explored in phase two of this study. Implications for Nursing Management: Nurse leaders must be adequately prepared to create working environments that support nurses' and midwives' wellbeing, so that they may be able to provide high‐quality care. Ensuring a supportive organizational culture, which embodies the values of healthfulness, may help to mitigate the impact of the COVID‐19 pandemic on nurses' and midwives' wellbeing in the immediate aftermath and going forward. [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]

Background: Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question 'what interventions and strategies are effective in enabling evidence-informed healthcare?' The strengths and challenges of conducting realist review are also considered. Methods: The realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses. Results: Based on key terms and concepts related to various interventions to promote evidence-informed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area. Conclusions: Realist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review. [ABSTRACT FROM AUTHOR]

lynch b.m., McCormack b. & McCance t. (2011) Journal of Nursing Management 19, 1058-1069 Development of a model of situational leadership in residential care for older people Aim The aim of the present study was to present the process used to develop a composite model of situational leadership enacted within a person-centred nursing framework in residential care. Background Transforming the culture of the residential unit from a restrictive institution to a vibrant community of older adults requires transformational leadership. Situational leadership is one form of transformational leadership, which claims that there is not one leadership style that works in all situations. Method A model of situational leadership in residential care was developed through a series of systematic steps that identified direct linkages between situational leadership and the main constructs of the Person-Centred Nursing Framework. The process included reviewing the evidence, undertaking a comparative analysis, identifying key concepts, connecting the concepts and developing a model. Conclusion A conceptual model is presented which integrates person-centredness with leadership thinking in order to effectively impact on the follower's performance in managing the care environment and delivering person-centred care. Implications for Nursing Management Currently the model is being utilized in an action research study to evaluate the role of leaders in the practice setting of long-term care. While some of the connecting concepts have been identified in the present study, more work needs to be done to unravel these connections in further study of leaders in practice. [ABSTRACT FROM AUTHOR]

Background: This paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice. While the intention of the project was to identify and change factors in the practice context that inhibit effective person-centred pain management practices with older people (65 years or older), reflective critical engagement with the findings identified that enhancing pain management practices with older people was dependent on cultural change in the unit as a whole. Methods: An EAR approach was utilised. The project was undertaken in a surgical unit that conducted complex abdominal surgery. Eighty-five percent (n = 48) of nursing staff participated in the two-year project (05/NIR02/107). Data were obtained through the use of facilitated critical reflection with nursing staff. Results: Three key themes (psychological safety, leadership, oppression) and four subthemes (power, horizontal violence, distorted perceptions, autonomy) were found to influence the way in which effective nursing practice was realised. Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice. Conclusions: Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature. Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments. [ABSTRACT FROM AUTHOR]

Heavy feet of stone Seeking transformation Dancing rocks and flows Critical creativity is a paradigmatic synthesis linking critical social science with creative and ancient traditions. Our haiku summarises the essence of this three part paper. Heavy feet of stone describes the rationale for our creation of critical creativity. Seeking transformation sets out the background and methodology for our inductive, methodological development. Dancing rocks and flows unfolds a new methodological framework for action-oriented, transformational practice development and research that is concerned with human flourishing for those who engage in such work, as well as those for whom the work is intended. Through interplay of story, metaphor, poetry and critical dialogue, we present our methodological development approach for critical creativity and the evolving methodological framework. Within the framework, we focus on conditions and principles that enable our worldview of critical creativity to be used in action research and practice development. [ABSTRACT FROM AUTHOR]