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.

Using data from mHealth apps to inform person-centred practice: A discussion paper.

BACKGROUND: mHealth applications (apps) are tools that can enhance research by efficiently collecting and storing large amounts of data. However, data collection alone does not lead to change. Innovation and practice change occur through utilisation of evidence. The volume of data collected raises questions regarding utilisation of data by nurses and midwives, and how data from mHealth apps can be used to improve person-centred practice. There is limited empirical evidence and a lack of direction from global health authorities to guide nurses and midwives in this area. AIM: To describe strategies for nurses and midwives that could enhance the effective use of data generated by mHealth apps to inform person-centred practice. The purpose of this paper is to stimulate reflection and generate actions for data utilisation when using mHealth apps in nursing research and practice. METHODS: This discussion paper has been informed by current evidence, the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, and research experience as part of doctoral study. FINDINGS: Before engaging in data collection using mHealth apps, nurses and midwives would benefit from considering the nature of the evidence collected, available technological infrastructure, and staff skill levels. When collecting data and interpreting results, use of a team approach supported by engaged leadership and external facilitation is invaluable. This provides support to operate apps, and more importantly use the data collected to inform person-centred practice. CONCLUSIONS: This paper addresses the limited available evidence to guide nurses and midwives when using mHealth apps to collect and use data to inform practice change. It highlights the need for appropriate technology, external facilitative support, engaged leadership, and a team approach to collect meaningful evidence using mHealth apps. Clinicians, leaders, and researchers can apply the strategies provided to enhance the use of mHealth apps and ensure translation of evidence into practice.

A Systematic Review of Educational Interventions to Equip Health and Social Care Professionals to Promote End-of-Life Supportive Care when a Parent with Dependent Children is Dying with Cancer.

OBJECTIVES: This systematic review aimed to determine the content, mode of delivery, assessment, and outcomes of educational interventions to equip health and social care professionals when delivering end of life supportive care for parents dying with cancer who have dependent children. DATA SOURCES: A mixed-methods systematic review was undertaken. Six electronic database were searched from their inception until September 2023 (Medline OVID, CINAHL, EMBASE, PsycINFO, Web of Science, and ERIC), supplemented by citation chaining, grey literature searches using Google Advanced Search and relevant professional bodies. Quality assessment was conducted independently by two researchers on the included studies. A convergent integrated approach was utilised for data synthesis. CONCLUSION: The review identified two educational interventions; highlighting a dearth of training opportunities to equip health and social care professionals to provide supportive care to families when a parent is at end of life with cancer. Despite health and social care professionals reported need and desire for upskilling in this area of clinical practice, there is a severe lack of evidence-based educational interventions. It is imperative that effective educational interventions are made accessible to professionals. IMPLICATIONS FOR NURSING PRACTICE: There is an imminent need for robust educational interventions to be developed, as health and social care professionals often lack the knowledge, skills and confidence on how best to support families when a parent of dependent children is at end of life. Health and social care professionals engagement with high-quality, evidence-based and theory-driven educational interventions has the potential to impact professionals' provision of family-centred cancer care at end of life. This could lead to better mental and physical outcomes for the whole family at end of life and in bereavement.

Coproducing and Implementing Person-Centered Key Performance Indicators in Ambulatory Cancer Nursing.

BACKGROUND: Policy advocates person-centered healthcare for people living with cancer. Although nurses and patients alike recognize that a good care experience cannot be measured solely by clinical outcomes, the difficulty in finding indicators that measure the delivery of effective person-centered care remains a challenge. OBJECTIVE: The aim of this study was to explore the impact of a coproduced implementation project using the person-centered nursing key performance indicators to support the development of person-centered practice across ambulatory chemotherapy units. METHODS: The study adopted an evaluation approach derived from work of the Medical Research Council. A mobile app was used to collect and analyze 3 cycles of data using 4 measurement tools, with the aim of informing quality improvement activities. Six implementation teams were recruited from chemotherapy units across a region in the United Kingdom. Qualitative interviews were used to evaluate the experience of participants. RESULTS: Data analysis revealed 4 themes: building relationships that nurture the care experience, inspiring nursing staff to flourish, shaping practice and service changes through the nature of the conversations, and becoming person-centered through coproduction. CONCLUSION: This study provides evidence of the value of implementing these person-centered key performance indicators using a model of coproduction in cancer nursing. The data generated by the key performance indicators offer valuable feedback to nurses that can inform the development of person-centered practice and contribute to an enhanced patient experience. IMPLICATIONS FOR PRACTICE: This study provides an innovative and transferable approach for implementing relevant and appropriate key performance indicators within cancer nursing, which can contribute to developing person-centered cultures.

The experience of staff utilizing data to evaluate and improve person-centred practice: An action research study.

AIM: Explore how nurses and midwives use patient experience data collected from a mobile health app to influence the development of person-centred practice. DESIGN: Participatory action research, underpinned by the Person-Centred Nursing Framework and Practice Development principles. METHODS: Six clinical units in a large health district engaged in three action cycles from 2018 to 2020 using a mobile health app. Nursing/midwifery staff on the units (N = 177) utilized data collected via the app to evaluate and improve person-centred practice. A pre-post survey using the PCPI-S was conducted to evaluate staff perceptions of person-centredness. Data from the surveys (n = 101 in 2018 and n = 102 in 2020) and 17 semi-structured interviews were used to understand the influence working with these data had on person-centred practice. The Guidelines for Best Practices in the Reporting of Participatory Action Research have been used to report this study. RESULTS: Improvements in person-centred practice were noted across both data sets. There was a statistically significant increase in two domains of the PCPI-S in the independent t-test and across all three domains in the paired t-test results. Thematic analysis resulted in the identification of six themes: Getting everyone on board, once we understood, keeping on track, there's a person in the bed, knowing you're doing a good job and improving over time. CONCLUSION: Engaging with the data collected from the app in a facilitated and collaborative way results in increases in person-centredness. IMPACT: This study provides insight into how nurses and midwives used data from a mHealth app to evaluate and improve person-centred practice. Utilizing the data generated by the app resulted in increased person-centredness amongst staff and changes to practice and culture. Nursing and midwifery teams who are supported to engage with patient experience data in an action-oriented way will see person-centred practice improvements, affecting patients and staff.

'Owning the space'-person-centred practice in a 100% single-room acute-care environment: an ethnographic study.

AIMS AND OBJECTIVES: Exploring the influence of the 100% single-room environment on staff and patient experience of person-centred practice in an acute-care setting. BACKGROUND: Current building guidance for the NHS advocates increasing the single-room inpatient environment. There is little evidence of the impact of this design in adult acute-care settings on the experience and delivery of person-centred care. DESIGN: Ethnography, underpinned by McCormack and McCance's Person-centred Practice Framework. METHODS: Data collection took place between March and June 2018. Staff and patients in a National Health Service hospital in the United Kingdom took part in observations of practice (n = 108 hours); face to face inpatient interviews (n = 9); and participatory reflective staff groups (n = 3). A reflexive journal was kept by the researcher throughout the study. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS: Themes relating to care delivery and interactions were identified. Staff and patients' views converged around visibility and isolation. Patients appreciated the privacy afforded by the single rooms, while staff experienced a psychological shift, being viewed (and viewing themselves) as 'visitors'. There was space for more sympathetic presencing, encouraging patients to speak more openly, to facilitate knowing and authentic engagement. However, time remained an issue resulting in more task-focused care. CONCLUSION: Changes to the physical environment have an impact on the delivery and experience of person-centred practice. While the facilities enhance patient experience, the interweaving of engagement, emotional support and the development of therapeutic relationships remain challenging.

How nurses and midwives engage with patient experience data to inform person-centred quality and safety improvements.

AIMS AND OBJECTIVES: To explore how nurses and midwives engage with patient experience data collected via a mobile health app to inform person-centred practice improvements. BACKGROUND: A large amount of data is collected in healthcare, yet there is limited evidence outlining how nursing and midwifery staff utilise patient experience data to inform person-centred quality and safety improvements. METHODS: This study utilised action research, underpinned by Practice Development methodology and has been reported using the SQUIRE 2.0 checklist. Six clinical units (medical short stay, acute medical, surgical, oncology/haematology, day surgery and maternity) in a large health district in Australia engaged in three cycles of data collection using a mobile health app. The app captured patient experience data relating to the person-centred KPIs developed and tested by McCance et al. (2012). Staff used the data to develop and evaluate person-centred practice. RESULTS: A number of improvements in scores and practice occurred through engaging with the data in a cyclical way. All six clinical units saw an improvement in four or more of the KPIs in the patient survey results from cycle one to cycle three, with two clinical units improving in all eight. On average across the six units, there was also an increase in time nurses/midwives were visible to their patients, an increase in clinical documentation reflecting the patients' needs and what was important to them, an increase in positive comments and a decrease in negative comments in patient stories. CONCLUSION: This study shows that collecting and utilising data from the person-centred KPIs in a collaborative and cyclical way lead to enhanced patient experience and the development and implementation of person-centred quality and safety improvements. RELEVANCE TO CLINICAL PRACTICE: Capturing and utilising data that are meaningful to nursing/midwifery teams in a cyclical, action-orientated approach result in person-centred practice improvements that enhance the experience of those that are receiving and delivering patient care.

Examining the Theoretical Relationship between Constructs in the Person-Centred Practice Framework: A Structural Equation Model.

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.

Exploring how key performance indicators influence nursing and midwifery practice: A mixed-methods study.

AIMS: To scope the key performance indicators (KPIs) used in nursing and midwifery across the United Kingdom and Republic of Ireland and explore how they influence practice in healthcare organizations. DESIGN: The study adopted a sequential, exploratory mixed-methods design. METHODS: Phase 1 incorporated a multiple-choice questionnaire completed by 77 Directors of Nursing recruited using voluntary response sampling. In phase 2, 35 nurses and midwives who were working at executive, senior manager and clinical levels, participated in semi-structured interviews. Data collection of both phases was conducted from January 2016 to October 2016. FINDINGS: Quantitative data revealed over 100 nursing and midwifery-specific KPIs. National requirements were a deciding factor in KPI selection, while clinical involvement was mainly through data collection. Respondents stated that they used patient experience KPIs, but only one was assessed as valid. Thematic analysis identified two themes: The leadership challenge (including 'voiceless in the national conversation', 'aligning KPIs in the practice context' and 'listening to those who matter'); and taking action (including 'establishing ownership and engaging staff', 'checks and balances' and 'closing the loop'). CONCLUSION: The large volume of KPI measurement taking place makes meaningful evaluation of performance and quality of care difficult, both in and across organizations. Nurses and midwives require enhanced knowledge of the nature and purpose of KPIs, as evidence gained from KPI data collection is insufficient to lead to improvements in practice. A practice context that encourages collective leadership, where multiple sources of evidence are gathered and everyone is included in KPI evaluation and subsequent decision-making, is key. IMPACT: This study adds to the body of evidence on KPI understanding. It informs the future effective management of indicators that will facilitate the delivery of meaningful care and reduce the cost, time and effort invested in the implementation of KPIs and data management.

Maintaining momentum in action research.

BACKGROUND: Action research (AR) provides a robust platform for collaboration to develop and evaluate nursing practice. It results in several outcomes, including changes in evidence-based practice, the development of research capacity, and the evaluation and sustainability of interventions, all of which can be seen as benefits compared to other approaches. However, the methodology involves cycles of action, reflection, theory and practice, so it can be challenging to maintain momentum when engaging with teams over long periods of time. AIM: To offer strategies for maintaining momentum when using AR in nursing research. DISCUSSION: Three strategies for maintaining momentum when undertaking AR are covered. Theory, literature and experience of using AR in which the strategies of 'connecting as people', 'working with the context' and 'understanding the influence of the leadership team' made a considerable difference in maintaining momentum and are drawn on. CONCLUSION: Maintaining momentum in studies that use AR can be arduous, but critical reflection enables researchers to identify and overcome the challenges that arise. Researchers undertaking AR can apply the three strategies provided or other approaches to maintain momentum during all phases of a study. IMPLICATIONS FOR PRACTICE: Maintaining momentum in AR studies is more successful when researchers connect with those with whom they are undertaking research. It is advantageous for nurse researchers to reflect on and understand the influence of the leadership team and context rather than try to adapt them to the study's or their own needs.

The development and validation of the Person-centred Practice Inventory-Student instrument: A modified Delphi study.

BACKGROUND: Global health care policy and regulatory requirements indicate that nursing students must be prepared for person-centred practice. Despite this, there is no evidence of a theoretically derived instrument to measure students' perceptions of person-centred practice. OBJECTIVES: To adapt the Person-centred Practice Inventory-Staff instrument for use with healthcare students and to test the adapted instrument. DESIGN: This study involved a two-phased, modified Delphi Technique. In Phase 1 students' views about items in the Person-centred Practice Inventory-Staff were explored to gain consensus about items for inclusion in an adapted student version. In Phase 2, the psychometric properties of the adapted instrument were tested. SETTING: A UK university. PARTICIPANTS: Pre-registration nursing students. METHODS: Phase 1 involved an iterative process including three focus groups (n = 13) followed by Delphi surveys (Round 1: n = 382; Round 2: n = 144). Thematic analysis was used to analyse students' comments and consensus percentages were calculated after each Delphi round. Phase 2 involved a survey using the adapted instrument (n = 532). The measurement model was analysed using confirmatory factor analysis. RESULTS: The results indicated stability in the measurement model with this sample. Item correlation scores were between 0.22 and 0.74 with no evidence of collinearity and factor loadings ranged from 0.44-0.86. Fit indices indicated goodness of fit between the observed data and the respective domains in the Person-centred Practice Framework (chi-squared to degrees of freedom ratio of <3, root mean square estimations of approximation 0.06 for all domains and between 0.05 and 0.07 at 90% confidence interval. Comparative fit index estimates ranged from 0.90-0.97). CONCLUSION: This study provides initial validation of the Person-centred Practice Inventory-Student instrument which is offered as a measure of students' perceptions of their person-centred practice. The instrument has utility in assessing the efficacy of curricula in preparing students as person-centred practitioners.

Implementing and measuring person-centredness using an APP for knowledge transfer: the iMPAKT app.

OBJECTIVE: The aim of the study was to evaluate a technological solution in the form of an App to implement and measure person-centredness in nursing. The focus was to enhance the knowledge transfer of a set of person-centred key performance indicators and the corresponding measurement framework used to inform improvements in the experience of care. DESIGN: The study used an evaluation approach derived from the work of the Medical Research Council to assess the feasibility of the App and establish the degree to which the App was meeting the aims set out in the development phase. Evaluation data were collected using focus groups (n = 7) and semi-structured interviews (n = 7) to capture the impact of processes experienced by participating sites. SETTING: The study was conducted in the UK and Australia in two organizations, across 11 participating sites. PARTICIPANTS: 22 nurses from 11 sites in two large health care organizations were recruited on a voluntary basis. INTERVENTION: Implementing the KPIs and measurement framework via the APP through two cycles of data collection. MAIN OUTCOME MEASURES: The main outcome was to establish feasibility in the use of the App. RESULTS: The majority of nurse/midwife participants found the App easy to use. There was broad consensus that the App was an effective method to measure the patient experience and generated clear, concise reports in real time. CONCLUSIONS: The implementation of the person-centred key performance indicators using the App enhanced the generation of meaningful data to evidence patient experience across a range of different clinical settings.

Implementing person-centred key performance indicators to strengthen leadership in community nursing: A feasibility study.

AIMS: To explore the utility and feasibility of implementing eight person-centred nursing key performance indicators in supporting community nurses to lead the development of person-centred practice. BACKGROUND: Policy advocates person-centred health care, but few quality indicators exist that explicitly focus on evaluating person-centred practice in community nursing. Current quality measurement frameworks in the community focus on incidences of poor or missed opportunities for care, with few mechanisms to measure how clients perceive the care they receive. METHODS: An evaluation approach derived from work of the Medical Research Council was used, and the study was underpinned by the Person-centred Practice Framework. Participatory methods were used, consistent with person-centred research. RESULTS: Data were thematically analysed, revealing five themes: giving voice to experience; talking the language of person-centredness; leading for cultural change; proud to be a nurse; and facilitating engagement. CONCLUSIONS: The findings suggest that implementing the eight person-centred nursing key performance indicators (KPIs) and the measurement framework is feasible and offers a means of evidencing person-centredness in community nursing. IMPLICATIONS FOR NURSING MANAGEMENT: Person-centred KPI data, used alongside existing quality indicators, will enable nurse managers to evidence a high standard of care delivery and assist in the development of person-centred practice.

The Use of Data Collected From mHealth Apps to Inform Evidence-Based Quality Improvement: An Integrative Review.

BACKGROUND: The global acceptance and use of technology in health care has resulted in an abundance of mobile health (mHealth) applications (apps) available for use in the delivery and improvement of care. With so many apps available to patients and clinicians, it is important to understand how data from apps are being used to inform quality improvement in practice. AIM: The aim of this integrative review is to establish current knowledge of how mHealth apps are used to produce data to inform quality improvement in health care. METHODS: Scopus, Web of Science, CINAHL, and Medline Plus Full Text databases were searched for peer-reviewed papers written in English. The inclusion criteria comprised of full-text, empirical research studies relating to mobile health application use (not development) in clinical care. RESULTS: Nineteen studies met inclusion criteria. The functions of the apps outlined in the studies can be summarized into four different categories: communication, illness management, clinical management, and education/information. The types of data collected by the apps included numerical, textual, photographic, and graphical with several apps able to collect a variety of data types. Analysis of the studies showed that although data collection is rarely outlined as the explicit purpose of mHealth apps, data collected through such technology are and can be used to inform practice change both in real time and retrospectively. LINKING EVIDENCE TO ACTION: This review highlights while this is an emerging area, data obtained from mHealth apps can and are being used to inform quality improvement in health care. Further research is required in this area to adequately understand how data from mHealth apps can be used to produce quality improvement, specifically in relation to nursing. This review also highlights a need for the development of apps that aim to capture data to inform quality improvement, particularly from the patient perspective.

The experience of person-centred practice in a 100% single-room environment in acute care settings-A narrative literature review.

AIMS AND OBJECTIVES: To review published research into the staff and adult patient experience of person-centred practice in a 100% single-room environment in acute care. BACKGROUND: There has been a significant move towards the 100% single-room environment within healthcare systems. Furthermore, there has been a global move for developing person-centred practice in a range of healthcare settings. Some studies have linked the role of the physical environment to patient outcomes and improved patient satisfaction; however, these are limited. Overall, there is little evidence in the international literature of the experience of care in single rooms in adult, acute care settings. DESIGN: A narrative description was developed using the major constructs of the person-centred practice framework (PcPF). The PRISMA checklist provided additional rigour. METHOD: Problems, Exposure, Outcomes (PEO) refined the search terms to: person-centred, adult acute care, single room, staff experience and patient experience. CINAHL, Medline Ovid, Psycinfo, Embase, Web of Science and Scopus were searched for full-text English language papers of empirical studies published between 2012-2017. PRISMA illustrated final paper determination, and the CASP/EPHPP frameworks were used for a critical appraisal of the 12 selected papers. RESULTS: The literature recognises the increasing complexity of health care in the acute care environment globally. The international literature available identifies staffs' desire to practise person-centredness, but much of the evidence is focused on care delivery. The impact of the single-room environment on person-centred practice links mainly to the constructs of the care environment and person-centred processes within the PcPF. CONCLUSION: This review focuses on empirical studies relating to person-centred practice in the single-room environment published in the last 5 years. While there is a significant body of work relating to person-centredness and the delivery of person-centred practice, and the impact of the environment on care delivery, there appears to limited evidence linking person-centred practice, staff and patient experience and the single-room environment. RELEVANCE TO CLINICAL PRACTICE: By understanding the context in which care is delivered, multiprofessional teams can explore how the delivery of person-centred practice may be influenced by the physical environment and what changes to culture, systems and processes may be required to enhance the experience of care for patients and the delivery of care for staff.

Person-centred leadership: A relational approach to leadership derived through action research.

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.

Perceived caring attributes and priorities of preregistration nursing students throughout a nursing curriculum underpinned by person-centredness.

AIM AND OBJECTIVE: To explore preregistration nursing students' caring attributes development through a person-centred focused curriculum. BACKGROUND: Developing caring attributes in student nurses to the point of registration has historically been challenging. Globally, curricula have not yet demonstrated the ability to sustain and develop caring attributes in this population, despite its centrality to practice. DESIGN AND METHODS: This longitudinal cohort study tracked how University preregistration nursing students (N = 212) developed their caring attributes over the 3 years of their programme using repeated measures at the end of each year with the same cohort. The Caring Dimensions Inventory (35 item version with 25 caring items under three constructs (technical, intimacy and supporting) and 10 inappropriate or unnecessary construct items) was used and data analysed using Mokken scale analysis to create a hierarchy of actions that students deemed as caring. Repeated measures of analysis of variance enabled evaluation of changes in responses over time. RESULTS: Students developed their caring attributes throughout their programme, ranking 22 of 25 items as caring (with statistical significance) at the end of year 1, 18 at the end of year 2 and all 25 caring items at the end of their final year. No unnecessary or inappropriate construct items were ranked as caring at any data collection point. Participants consistently ranked assisting a person with an activity of living, listening to a patient and involving them in their care as the most caring actions. CONCLUSION: This study found caring attributes can not only be sustained, but can also be developed throughout a preregistration nursing education programme grounded in person-centredness. RELEVANCE TO CLINICAL PRACTICE: Internationally, caring attributes are challenging to develop and sustain throughout preregistration education, largely being diminished over time. Little published evidence evidences how person-centred frameworks are successfully integrated into preregistration nursing curricula to develop person-centred nurses.

The development of the Person-Centred Situational Leadership Framework: Revealing the being of person-centredness in nursing homes.

AIMS AND OBJECTIVES: To implement and evaluate the effect of using the Person-Centred Situational Leadership Framework to develop person-centred care within nursing homes. BACKGROUND: Many models of nursing leadership have been developed internationally in recent years but do not fit with the emergent complex philosophy of nursing home care. This study develops the Person-Centred Situational Leadership Framework that supports this philosophy. It forms the theoretical basis of the action research study described in this article. METHODS: This was a complex action research study using the following multiple methods: nonparticipatory observation using the Workplace Culture Critical Analysis Tool (n = 30); critical and reflective dialogues with participants (n = 39) at time 1 (beginning of study), time 2 (end of study) and time 3 (6 months after study had ended); narratives from residents at time 1 and time 2 (n = 8); focus groups with staff at time 2 (n = 12) and reflective field notes. Different approaches to analyse the data were adopted for the different data sources, and the overall results of the thematic analysis were brought together using cognitive mapping. RESULTS: The Person-Centred Situational Leadership Framework captures seven core attributes of the leader that facilitate person-centredness in others: relating to the essence of being; harmonising actions with the vision; balancing concern for compliance with concern for person-centredness; connecting with the other person in the instant; intentionally enthusing the other person to act; listening to the other person with the heart; and unifying through collaboration, appreciation and trust. CONCLUSIONS: This study led to a theoretical contribution in relation to the Person-Centred Practice Framework. It makes an important key contribution internationally to the gap in knowledge about leadership in residential care facilities for older people. RELEVANCE TO CLINICAL PRACTICE: The findings can be seen to have significant applicability internationally, across other care settings and contexts.