The development and structural validity testing of the Person-centred Practice Inventory-Care (PCPI-C).

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.

Emerging issues in fisheries science by fisheries scientists.

The current epoch in fisheries science has been driven by continual advances in laboratory techniques and  increasingly sophisticated approaches to analysing datasets. We now have the scientific knowledge and tools to proactively identify obstacles to the sustainable management of marine resources. However, in addition to technological advances, there are predicted global environmental changes, each with inherent implications for fisheries. The 2023 symposium of the Fisheries Society of the British Isles called for "open and constructive knowledge exchange between scientists, stakeholders, managers and policymakers" (https://fsbi.org.uk/symposium-2023/), a nexus of collaborative groups best placed to identify issues and solutions. Arguably, the Centre of Environment, Aquaculture and Fisheries Science (Cefas) and their Scientific Advice for Fisheries Management (SAFM) Team sit at the centre of such a network. SAFM regularly engages with managers and stakeholders, undertakes scientific research, provides fisheries advice to the UK government, and are leading experts within the International Council for the Exploration of the Sea (ICES). As such, this paper is an opinion piece, linked to individual authors specialisms, that aims to highlight emerging issues affecting fisheries and suggest where research efforts could be focused that contribute to sustainable fisheries.

Support with nutrition for women receiving chemotherapy for breast cancer.

Nurses are in a unique position to provide nutritional advice and information to women with breast cancer who are undergoing chemotherapy, supporting them with making decisions regarding nutrition and diet. This narrative review evaluated the research evidence relating to the nutritional challenges experienced during chemotherapy and the most effective approaches for supporting women in dietary choice. Weight gain was identified as a specific problem for women undergoing chemotherapy. The evidence indicated that information about nutrition and food preparation support may go some way in assisting women to overcome some of the nutrition-related difficulties experienced during chemotherapy treatment for breast cancer. However, further research is required to better inform person-centred nursing practice in this area.

Delivering dignified care: A realist synthesis of evidence that promotes effective listening to and learning from older people's feedback in acute care settings.

AIMS AND OBJECTIVES: To explore effective mechanisms for listening to and learning from feedback from older people in the context of acute care. BACKGROUND: Maintaining the dignity of older people in acute care has become an issue of international concern. In the United Kingdom, recommendations for care improvement have led to the formation of an implementation group, the "Listening and Learning Hospitals Pilot Project." This literature review forms phase 1 of the project. DESIGN: Realist synthesis was used to explore and synthesise wide-ranging evidence. METHODS: Using 12 databases, literature was scoped to propose four principles that underpin the context, mechanism and outcomes (CMO) of effective relation-based interventions with older people and their care partners in the acute care setting. A search was carried out in order to synthesise data to refute or support each principle. A total of 137 studies and 11 sources of grey literature were appraised and included. A final synthesis of evidence across all principles identified key mechanisms for effective relation-based interventions. RESULTS: Eight essential mechanisms support effective care interventions. CONCLUSIONS: This review adds depth and breadth to current nursing knowledge in this field through the process of realist synthesis. Acute care organisations need to make a commitment to supporting relational care at organisation and unit levels. Additionally, they need to value and support the well-being of the nurses delivering it so that interventions to improve care for older people can succeed. RELEVANCE TO CLINICAL PRACTICE: Essential mechanisms synthesised from the review, together with other suggested interventions for improving dignified care of older people in acute care by listening to them and learning from their feedback, may contribute towards practice development in acute care.

Patient perceptions of regional anesthesia: influence of gender, recent anesthesia experience, and perioperative concerns.

BACKGROUND AND OBJECTIVES: Anesthesiologists often find that patients would prefer a general anesthetic (GA) to a regional anesthetic (RA) for surgery. We surveyed patients' attitudes to RA in an Australian tertiary-care hospital, hoping to understand the reasons for acceptance or refusal. We explored how 3 main factors influence the patient's choice for subsequent RA: gender, type of anesthetic on the day of surgery, and perioperative concerns. METHODS: Consecutive patients at a single institution were interviewed on the first postoperative day by a research nurse, either as a face-to-face interview or by telephone after ambulatory surgery. A short description of RA and GA was given, and preferences for future anesthesia and concerns were recorded. RESULTS: Complete data were obtained from 1000 patients. More women preferred GA compared with men (76.3% vs 69.0%). Patients who received only RA during their surgery on the previous day were almost 3 times more likely to express a future preference for RA compared with those who received any GA, using hypothetical examples of arm or hip surgery (83.2% vs 21.1%, P = 0.00001). Patients expressed more concerns about hearing or seeing the surgery than experiencing a complication, and 84% preferred sedation. CONCLUSIONS: More patients, especially females, may accept RA if reassured appropriately about not hearing or seeing the surgery. Once patients have experienced RA, they are more likely to choose it in future. Modification of our discussion and consent process may increase the uptake of RA techniques.

Assessing the educational needs of palliative care link nurses.

BACKGROUND: A key aspect of the provision of high-quality palliative care is ensuring that qualified staff have ongoing education in this area. AIM: To explore the educational needs of palliative care link nurses. METHOD: A quantitative approach was adopted, using a questionnaire distributed to all of the palliative care link nurses (n=80) in an integrated health and social care trust in one UK region. FINDINGS: Participants demonstrated a clear commitment to and enthusiasm for their role. More than two thirds had already completed some form of palliative care training and considered themselves to already possess the necessary skills, confidence, and competence to be palliative care link nurses. However, this competence tended to relate more to skill-based elements and less towards practice issues. CONCLUSIONS: Education for palliative care link nurses needs to incorporate strategies to develop competence and confidence in practice (knowing how) alongside skill-based learning (knowing that).