Nursing

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7188

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Spiritual aspects of nursing: a descriptive study of nurses' perceptions.
(Queen Margaret University, 1992) Waugh, L. A.
This descriptive, exploratory study examines nurses' perceptions of spiritual care. Having reviewed the literature it became apparent that the spiritual dimension can influence health, well-being and quality of life. Moreover, the nursing literature considers spiritual care part of the nurse's role, however, guidelines for its practice are absent. Research on spiritual care, particularly of British origin, is very much in its infance and nothing is known about how British nurses perceive their role in this. A conceptual framework for giving spiritual care using the Nursing Process is, therefore, offered by the researcher, although this still requires testing. The study, believed to be the first of its kind in Britain, ascertain how nurses, working in care of the elderly hospitals in Scotland, perceived spiritual need and spiritual care and professed to have given this care in practice. This was achieved by distributing a purpose designed postal questionnaire to the population of nurses (n=1170) in 1991. A response rate of 67.8% (n=793) was achieved, 58.5% (n=685) of questionnaires being usable. In addition, factors which appeared to influence the spiritual care nurses were identified. Initially clues to possible factors were obtained by conducting a certain statistical analysis using nurses' responses in the questionnaires. Further exploration of factors influencing spiritual care took place through interviewing a sample (n=12) of nurses. Findings revealed that nurses in the larger sample (n=685) seemed able to identify patients' spiritual needs and evaluate the care given, mainly through using non-verbal / indirect verbal cues displayed by patients. Nurses were, however, less willing / able to personally respond to these needs. Whereas for some nurses their reluctance to respond to patients' spiritual needs may have been due to their disclaim of responsibility for spiritual care, for others it seemed to be due to feelings of inadequacy. Charge nurses claiming religious affiliation and working on varied wards in certain geographical locations were most likely to have claimed to have identified patients' spiritual needs. However, it seemed, from the limited sample interviewed, that personal characteristics of the nurse were perhaps more important than the forementioned factors in determining the spiritual care given. Furthermore, factors relating to other professionals, the ward environment and the patient appeared to influence the way in which spiritual care was given to patients. The limitations of the study are acknowledged and the implications of the findings discussed. Given the descriptive nature of the study its prescriptive function is limited which highlights the need for further research in this important area of patient care.
The nature and use of knowledge by district nurses in decision making relating to first assessment visits.
(Queen Margaret University, 2000) Kennedy, C M.
District nurses are the largest group of community nurses in the United Kingdom and an important aspect of their role is the responsibility to assess the health needs of patients at home. To date there has been limited exploration of the knowledge or decision-making underpinning needs assessment in district nursing practice. The aim of this study was to explore knowledge in use by district nurses at the first assessment visit and the relationship of this knowledge to the decisions they make. The inherent difficulties in exploring the knowledge and decision making of experienced district nurses demanded a systematic and interpretative research approach where the impact of the context could be examined. An ethnographic approach was adopted for the study as the focus on perspectives and activities in the natural setting and the substantial reliance on observation of real examples provided a starting point for this study. Eleven district nurses were accompanied on a first assessment visit. Each district nurse was interviewed twice, immediately following the observed visit and then approximately one year later when preliminary data analysis had been undertaken. This approach to the study revealed a breadth and depth of community nursing knowledge that seemed to incorporate an amalgam of theoretical (knowing that) knowledge with practice based (knowing how) knowledge. The study findings depict the range and scope of the knowledge in use by district nurses and challenge the utility of theoretical models which remove knowledge from the context in which it is used and applied. The most striking findings relate to the influence of the context in which the DN/patient interaction takes place and the reflexive character of the assessment process. In particular, the study illuminates the ways in which DNs utilise a range of cues throughout the assessment process. The information search in assessment is often 'paced' to cope with the uncertainty that exists in many of the complex, multifaceted situations encountered by the DN. Understanding assessment as a paced process was linked to making the best judgement at the time of the first visit. A model of district nurse assessment, which seeks to illuminate the process of assessment, is presented. In particular, this model seeks to highlight the reflexive nature of the assessment process. A typology of district nursing knowledge, which conceptualises six dimensions of practice based knowing in district nursing practice, is also presented. Strategies for decision making are revealed through the application of Carroll and Johnson's (1990) theoretical framework. Recommendations are given for future research and the educational and professional context in which DN practice exists. It is suggested that further research should take cognisance of the ongoing nature of assessment in the community setting. A study conducted over a longer period of time, exploring further the impact of the context on the assessment process, seems particularly important. Given the paced approach to needs assessment and the ongoing nature of assessment identified by the study participants, it is suggested that the qualified DN should be contributing to needs assessment on a continuing basis. This recommendation is counter to recent trends in the skill/grade mix in the DN team which emphasise the need to reduce rather than increase the numbers of qualified DNs. Additionally, given the emphasis on family care by the DNs in this study, it is recommended that DNs should record and examine this important area of their work, so that this aspect of the DN role is identified and acknowledged. Finally, the importance of experiential learning depicted by the participants in this study suggests that work-based and problem-based learning approaches may be the most appropriate way in which to teach DN students about assessment. The findings are therefore important for the education of current and future DNs. This study contributes to the knowledge of assessment practice by increasing understanding of the ways DNs work in relation to the first assessment visit. The model of assessment illuminates the process of assessment and the typology aims to provide a conceptualisation of knowledge in use. Furthermore, the ways in which DNs make decisions is revealed. Therefore, the study findings can inform the education of present and future DNs to the potential benefit of patients and their carers.
Understanding the experience of older people in acute health care
(Queen Margaret University, 2008) Irvine, Lindesay
An interest in older people's experiences of acute care and how they make sense of that experience was the starting point for this thesis. Using the epistemological base of social constructionism the thesis examines the experiences of care older people have within acute health care settings and explores the qualified nurse's experiences of care in relation to older people in the context of acute care. Thirteen patients and fourteen nurses from one hospital participated, through semi-structured interviews, in the study. Field notes were used to further illuminate the context of the research. Data was coded using an inductive coding approach, followed by a refining of categories through the use of concept mapping. Data analysis was undertaken manually and cross checking undertaken to establish clear findings. Patient's understandings and explanations of their care were identified, along with the nurse's views and accounts of care within an organisational context. Many factors were found to be influential in the older person's experience of care. Media coverage of care experiences, along with comparison of personal experiences affected the older person's view of their care experience. The impact of the organisational approach to acute care was seen as a major factor in the care experience from the patient and nurse perspective. Lack of a shared philosophy of care within the nurse population led to a lack of continuity and consistency of care for patients. Similarly differing perspectives on the nature of the patient – nurse relationship led to tensions within the care environment causing stress and de-motivation in the nurse population that ultimately affected the patient experience. A conceptual framework was developed that illustrated the complicity between patients and nurses to maintain the illusion of a caring nurse.
The Role of Jordanian Hospital Nurses in Promoting Patients' Health
(Queen Margaret University, 2009) Shoqirat, Noordeen
Background/Rationale: In recent years growing attention has been given to health and the development of health promotion within the hospital setting. This is in order to tackle the soaring medical costs and foster health improvement in the population. Given their unique relationship with patients, hospital nurses are urged to promote the patient's health, yet internationally, little is known about their role in health promotion and, specifically, no Jordanian study was found that examines such a role. Purpose of the Study/ Setting: To understand the nature of nurses' roles in heath promotion in a large teaching hospital in Jordan. Study Design/Methods: An in-depth constructivist case study design using a multiple method triangulation strategy was used. The study involved four phases. The first phase examined nurses' role in health promotion using focus group discussions (n=8), non-participant observations and semi-structured questionnaires. The second phase focused on patients' understanding of health and health promotion using focus group discussions (n=8). The third phase examined health promotion from the perspective of hospital stakeholders and a nursing educator. The fourth phase included documentary review of nurses' job descriptions and nursing philosophy of care. Data Analysis: Whilst quantitative data were analysed using SPSS, qualitative data were thematically analysed using N-Vivo (2) and filing and colour index method. Findings: Generally, hospital nurses' views towards their role in health promotion were positive. However, their perceived role and actual practice of health promotion were largely restricted to individualised information giving and behavioural change approaches. The thesis identified diverse contributing factors to this situation. This includes lack of time, shortage of nursing staff, lack of knowledge in heath promotion, power imbalance between doctors and nurses, low public image of nursing and gender issues related to nursing. Conclusion: The way hospital nurses' role in health promotion is currently perceived and operationalised in practice is inconsistent with the recent health promotion ideas operating at the level of empowerment and political actions. Addressing the identified barriers therefore, together with a radical reform from curative services towards health promoting health agenda, is crucial. Unless this happens, hospital nurses' ability to promote health might continue to be questioned. The thesis develops a conceptual model illuminating Jordanian hospital nurses' role in health promotion together with contributing factors.
An action research study of Palliative Care for people with A Dementia and their carers
(Queen Margaret University, 2009) Smith, Stephen D M.
The objectives of this participatory action research were to: identify the palliative care needs of PWAD and their carers in West Lothian; analyse two dementia care services as they develop practice in the assessment and management of distress for PWAD, and supporting carers; determine implications for practice development and service delivery. Multiple data collection methods were used including; focus groups, interviews, participant observation, reflective accounts, case studies, documentation review, action learning and notes recorded from meetings with staff. The first phase was a dementia palliative care needs assessment. Eight PWAD, 25 carers and 63 service providers participated in interviews and focus groups. Overall findings were that a palliative care approach provided a useful and appropriate framework to understand the needs of PWAD. Recognition of and support for family carers should take a high priority when considering a model for dementia palliative care. More specific needs were identified, these included: the need to develop person centred approaches; enhance the management of pain and distress and enhance individual support for carers. Two services participated in the action phase; a day centre and a hospital ward. Eleven people with a dementia, 28 carers and 86 service providers participated. Services focused on carer support or assessing pain / distress. Carer support findings: implementing an assessment tool enhanced staffs understanding of carers needs; carers preferred flexible and individual support interventions; family carers experienced cumulative factors that restricted access to support. Assessment of distress findings: assessing distress from the behaviour of PWAD was complex. The implementation of the Disability Distress Assessment Tool (DisDAT) identified new evidence that it provided a person centred assessment suitable for PWAD. It was identified that the theoretical concept of relationship centred care, could provide a way of working, that complemented the adoption of a palliative care approach for PWAD, whilst enhancing carer support and assessment of distress practices.
Devolution and nursing workforce policy and planning in the four countries of the United Kingdom 1997-2009
(Queen Margaret University, 2013) Milne, Pauline
This thesis examines how political devolution in the UK impacted upon nursing workforce policy and planning by investigating the following research questions:  What has been the impact of devolution on nursing workforce policy and planning across the four countries of the UK (1997-2009)?  How and why have the approaches to nursing workforce policy and planning changed across the four countries of the UK (1997-2009)? The research methodology used was a mixed methods approach which included semi-structured interviews with 30 stakeholders from the fields of nursing, healthcare policy or workforce planning across the UK. A purposive sampling strategy was adopted and the distribution of interviewees was England (11), Scotland (7), Wales (6) and Northern Ireland (6). A realist review approach to inquiry was taken which involved establishing what works for who, in what circumstances and why? The qualitative data from the interviews was supplemented by analysis of quantitative data on nursing workforce trends and information from the analysis of health policies from the four countries. The key findings include: changing patterns of power and influence in the devolved administrations; continued cycles of ‘boom and bust’ in nursing workforce supply; variable growth in the nursing workforce across the UK; the unwillingness of England to ‘let go’ and the perception by interviewees that some national nursing policies were unimportant. The conclusions were that although devolution enabled greater freedoms in terms of policy and workforce flexibility, just under half of the interviewees reported that devolution had a positive impact upon nursing. There was reluctance from senior nursing leaders to share and learn from good practice across countries and despite the rhetoric from numerous reports around the need to improve nursing workforce planning, there was little evidence of lessons being learned which would have improved the effectiveness of planning the future nursing workforce.
Working in a storied way.The development and evaluation of a narrative based approach to practice development in an older adult residential care setting.
(Queen Margaret University, Edinburgh, 2015) Buckley, Catherine
This thesis presents the development, implementation and evaluation of a methodological framework for a narrative based approach to practice development and person-centred care in residential aged care settings. The study is underpinned by practice development, person-centred care and narrative methodologies. Narrative focuses on a way of being, paying attention to past present and future, and also as a way of doing, as the means through which action is understood and made meaningful. Carried out between 2010 and 2014 and underpinned by theories of narrative inquiry, person-centred care, practice development and action research, this study is guided by the philosophical perspectives of Heidegger (1962). Forty six interviews, collected as part of a national research programme, (Person-Centred Care Practice Development Programme 2007-2010), were analysed for key themes by myself, 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. Combined, this analyses led to a single set of themes that were used to develop a Framework of Narrative Practice. This framework consists of four pillars, prerequisites, care processes, care environment and narrative aspects of care. The framework further includes three narrative operational elements, narrative knowing, narrative being and narrative doing. Working with the four foundational pillars and the three narrative elements enabled staff to 'work in a storied way' and provide person-centred outcomes and a narrative informed philosophy of care for older adults. Using an action research approach with work-based learning groups, the framework was implemented in two residential care settings that were comprised of 37 residents and 38 staff. Three action cycles (1) narrative practice and culture identification, (2) developing narrative practice and (3) working in a storied way emerged during the implementation. Using these action cycles, staff developed action plans to address areas where changes could improve practice and quality of life for the residents. These plans included communication/intercommunication, homely environment, having more going on with and for the residents and meals and mealtimes. By taking account of their biography, the framework confirmed the identity of older people. Three key areas emerged, however, that warranted further conceptualisation. These were, how staff and residents responded to change (narrative being), development of shared understandings (narrative knowing) and intentional action (narrative doing).
How do the characteristics of context influence the work of facilitators when implementing a standardised educational intervention targeting nursing home staff to reduce restraint in dementia care?
(Queen Margaret University, Edinburgh, 2015) Mekki, Tone
This research is part of a larger study - a sequential mixed method education intervention targeting staff in 24 Nursing Homes (NHs) in Norway to reduce use of restraint and psychotropic drugs. Building on a previous successful intervention, we used the Promoting Action on Research Implementation in Health Services (PARIHS) prospectively to combine cluster randomized controlled trial, participatory action research (PAR) and ethnography to design and evaluate the effectiveness of 2 day staff education and 1 hour monthly coaching during 6 months in two rounds (12 x 2 NHs). In my research that is the primary focus of this thesis, four teams of eight facilitators facilitated the intervention and simultaneously participated in PAR to co-construct knowledge of hindering and promoting implementation factors. A 'Creative Hermeneutic Knowledge Co- Production' (CrHeKCoP) model blending paradigmatic and epistemological assumptions from critical and participatory worldviews was created and used in spirals of 10 mini-cycles of actions to co-construct knowledge of the implementation process.
Whispers and song: a phenomenological inquiry to discover nurses' lived experience of person-centred dementia care
(Queen Margaret University, Edinburgh, 2016) Wareing-Jones, Sian
Person-centred is now a widely used term to describe much dementia care in the UK and Jersey. This existential hermeneutic phenomenological research seeks to discover the lived experience of person-centred dementia care for nurses in Jersey and through this, the essences and meanings of person-centred care. It is grounded in Merleau-Ponty’s ideas of embodiment for being in the world and Buber’s primacy of relationships and includes complimentary ideas within Lévinas, Gendlin and Vanier’s philosophies. Its methodology is inspired predominantly by van Manen, it is hermeneutic in its interpretive and poetic stance and is existential in its focus on nurse’s lived experiences. Eight nurses, working in care homes and specialist dementia care units, took part in semi-structured interviews which were recorded and transcribed. Deep immersion into these texts followed using the six existentials of corporeality, relationality, temporality, spatiality, materiality and mood, proposed by van Manen and Todres, as lenses to get closer to the participants’ lived experiences, essences and meaning of person-centred dementia care. This research has been amongst the first to use six existentials for data analysis; it demonstrates the accessibility of this methodology for counsellors from its parallels with therapy; it demonstrates the potential of poetry and metaphor images to uncover the essences and meanings of phenomena; and its enhanced focus on the experience of person-centred care reveals considerable rhetoric in the use of the term in mission statements and care philosophies. This research shows that the term, and the models and frameworks associated with it, are not well understood, indicating the need to embrace a new understanding of person-centred care from the macro context to individual practitioners; the need for more effective training, education and practice development together with new support structures for nurses and better communication throughout the services. It also proposes a new vision focussed more on ‘caring’ than ‘care’ and for a uniting Jersey Dementia Strategy to help refine and define systems, policy, practice and care.
Trends, motivations and experiences of Czech migrant nurses: a mixed methods study
(Queen Margaret University, Edinburgh, 2016) Di Cara, Veronika
The migration of nurses is currently an important political theme, and it is only expected to intensify in the future, because of the current demographic trends. Considering the facilitating policies and the differences between salaries, the intra-European migration of nurses is rather small, but its monitoring is not very exact. The migration of Czech general care nurses remains under-researched. I used mixed research with explorative sequential design in this study. In the initial embedded qualitative strand, I interviewed informants with expert knowledge on the migration of Czech nurses. The second quantitative strand consisted of a survey of self-selected Czech migrating nurses using an electronic questionnaire. The last strand used a focus group technique with Czech nursing migrants to clarify some of the previously researched topics. Some findings from this study are similar to the previously conducted research, and some differ substantially. Almost all of the respondents and participants felt that their professional skills improved because of their migration. More than half eventually returned to the Czech Republic, often they provided direct care in the Czech Republic, and mostly they reported not being able to utilize all of the new knowledge gained abroad. The main destination country was Saudi Arabia, therefore the respondents often cooperated with a recruiting agency. Their families were typically not involved in the decision to migrate and the migrants only rarely sent remittances home. Instead, they invested their earnings in real estate. Consistent with the literature, the professional communication in a foreign language and the different nursing practices of the destination country were rated as difficult. Findings from all three strands suggested that the nurses were transformed by the migration. It is generally understood that nurses are vital for providing health care services, thus we should offer them motivating working conditions to prevent more extensive migration and use the potential of brain circulation.
Virtuous, invisible and unconcerned: nurses, nursing and the media
(Queen Margaret University, Edinburgh, 2017) Balaam, Martina
This study, underpinned by a hermeneutic methodological strategy, investigates how British nurses make sense of representations of nurses in the popular media, and their perceptions of the potential implications of media representations for nursing as a profession and their own sense of self. The study was designed because of a number of factors: the popularity of hospital dramas and the increasing prevalence of hospital based 'fly on the wall' television programmes, a plethora of press coverage about the poor quality of nursing care, concerns from the nursing profession that the media representation of nurses have a detrimental effect on the nursing profession and nurses' sense of self, and a scarcity of research which has explored nurses' perceptions of representations of nurses in the popular media. Twenty-five nurses from a broad spectrum of nursing areas were recruited to the study. Eighteen participated in focus groups and a further seven nurses were interviewed individually. A thematic analysis of participants' descriptions, perceptions of, and emotional response to the representation of nurses in the media, revealed that nurses hold diverse, contradictory and ambivalent views of media representations. Whilst the way nurses describe representations in the media is consistent with previous research, which argues that nurses are represented by a number of stereotypes, there are novel and significant findings presented in this thesis, which may have implications for the nursing profession. The study reveals that some nurses hold a virtuous understanding of the profession and secondly, that some nurses hold a stereotypical understanding of nurses. Despite participants dismissing the media as 'just entertainment', having no consequence to the status of the profession or their sense of self, they nonetheless expressed concern at the 'negative' way they were represented in the media. Consequently, there is a need for nurses to challenge both existing media representations and the way they talk about nurses and the profession.
Postgraduate nursing education in Nigeria: understanding registered and graduated students’ experiences in their journeys to programme completion or withdrawal
(Queen Margaret University, Edinburgh, 2018) Onwe, Simon Nwigboji
Background: Nigerian nursing education has developed from initially limited numbers of missionary schools to a more substantial expansion of urban, hospital-based institutions since 1945. Postcolonial emancipation sparked the University of Ibadan into opening the first Department of Nursing in Nigeria in 1965. This triggered the creation of further university-based undergraduate programmes across Nigeria, though many hospital-based schools offering diploma level training have also been retained. The first postgraduate nursing programme commenced in 1988 at the Obafemi Awolowo University, followed by the University of Ibadan and the University of Nigeria, Nsukka. These three universities are still the main postgraduate nursing education providers in Nigeria today. The Nigerian Government and professional stakeholders including the Nigerian Nursing and Midwifery Council are concerned by the low graduation rate of nursing students in relation to the standard programme duration of one year for masters’ and three years for PhD programmes (10%), and their relatively high rate of attrition (20%). Objectives; The study seeks to understand the experiences of postgraduate nursing students in Nigeria. Research method: The research participants included registered and graduated postgraduate nursing students, lecturers, and the staff of nursing education coordinating bodies. They were recruited to this study purposively and by snowballing. The research employed a qualitative inquiry method using face-to-face interviews, the methodology being informed by a critical realist worldview with regard to agency and structure. Result: The key findings revealed that the students’ experiences of delay in completing their programme were influenced by student factors (allocation of time between full-time work and full-time study, and sponsorship); lecturer factors (workload and workforce development); policy issues (programme structure and implementation); and social structures and mechanisms in Nigeria. Recommendation: The researcher recommends further studies on the impact of gender on nursing education, the relationship between postgraduate nursing students’ experience and their expectations, and the effect of international partnerships on postgraduate nursing education in Nigeria. He further recommends a review of the postgraduate nursing curriculum. Conclusion: Findings from such studies would further help to improve the students’ experiences.
THE ROLE OF A FACILITATOR IN ENABLING REGISTERED NURSES TO TRANSLATE REFLECTIVE APPRAISAL INTO WORK-BASED LEARNING AND AN EVALUATION OF THE OUTCOMES OF THIS LEARNING
(Queen Margaret University, Edinburgh, 2019) Williams, Caroline Vivien
This research set out to develop a detailed understanding of the role of the facilitator in enabling registered nurses to translate reflective appraisal into work-based learning (WBL). In doing so the research identified contextual issues that impact on WBL, facilitative processes that enable WBL, and outcomes from WBL. A person-centred, action-oriented, participative methodology was developed specifically for this study. It combined a conceptual framework for facilitation (Critical Companionship) with constructs for a critical enquiry. The methodology was operationalised through two year-long action cycles. In each cycle a facilitator/researcher worked in a 1:1 relationship with five registered nurses to facilitate their learning. Each 1:1 session was audio recorded, and a reflective process review was completed. Three times in each action cycle the participants and facilitator/researcher met up as a group to undertake data analysis using a creative reflective approach. The outputs from this were themed by the facilitator/researcher, and the resultant themes and sub-themes were illustrated with extracts from the 1:1 sessions. A reflective synthesis of each theme enabled the development of a model for a Professional Learning Partnership. A Professional Learning Partnership contains a facilitation triad that requires a trusting partnership; activities to maintain stability; and activities to stimulate growth. The facilitation takes place during a professional conversation in a safe space in work. The contextual factors that impact on the learner are their commitment, how safe they feel in work; and how able they are to act. The outcomes for the learners are changes to self, a changed way of being, and professional growth. These lead on to changes to individual practice. This research has added a new methodology to the field of person-centred healthcare research, and a model for a Professional Learning Partnership that contributes to understanding how a facilitator can enable nurses to learn through their work. Key Words: Facilitation; Work-based learning; Professional learning; Person-centred research; Action-oriented methodology;
An exploration of how healthful relationships between students and clinical supervisors influence transformational learning: A person-centred inquiry
(Queen Margaret University, Edinburgh, 2020) Mackay, Maria
Background: There is an emerging body of knowledge regarding the influence of person-centred pre-registration curricula on student learning. However, a gap exists in our current knowledge regarding the attributes and foundations of healthful relationships and transformational learning in the context of practice learning. This PhD research based at the University of Wollongong NSW Australia, explored how healthful relationships between students and clinical supervisors influence transformational learning. Approach and Method: The blending of specific aspects of critical theory, person-centred practice research, and transformational learning theory underpinned this research. Embedded within a person-centred methodology, the research explored healthful relationships and their influence on transformational learning in the clinical practice context. Methods included reflection on practice using emoji, the use of Dadirri as a form of contemplation (Ungunmerr 1988) and reflection, critical dialogue and interviews. A creative synthesis of information collected across the PhD journey was undertaken. Findings: The findings from this research revealed the influence of healthful relationships on transformational learning in practice across three connected perspectives: personhood; belonging; and transformation. Information was synthesised to illuminate the crafting of healthful relationships between students and clinical supervisors in the context of practice. Further, understanding emerged of how healthful relationships influenced person-centred transformational learning from the perspectives of Knowing, Doing, Being and Becoming. The discoveries indicate that emotional preparation influences the ability to create healthful relationships that enable person-centred transformational learning in practice. Conclusions and Implications: There is a need for emotional preparation for practice for students and clinical supervisors to enable them to achieve person-centred transformational learning. Respecting personhood and enabling belonging to know self has the potential to lead to the creation of healthful relationships and improved clinical placement experience. Healthful relationships influence person-centred transformational learning by enabling an emotional connection of the mind and heart with an openness to learn. Keywords: curricula, Dadirri, emoji, healthful relationships, nursing education, person-centred, transformational learning.
A realist evaluation of the contribution of Lean Six Sigma to person-centred cultures in a university hospital
(Queen Margaret University, Edinburgh, 2020) Teeling, Sean Paul
Background: Lean Six Sigma, a quality improvement methodology, has been used in healthcare since 2001. Person-centred approaches to healthcare improvement are now widely advocated in political, policy and practice discourse. Literature shows quality improvement practitioners are often unaware of or pay little attention to Lean Six Sigma’s philosophical roots, seeing it less as an organisational philosophy but more as a quality improvement tool for continuous improvement. A lack of fidelity to Lean Six Sigma’s philosophical roots can create a division between person-centred approaches to transforming care experiences and services, and quality improvement methods focusing solely on efficiency and clinical outcomes. There is little research into, and a poor understanding of, the mechanisms and processes through which Lean Six Sigma education influences healthcare staff’s person-centred practice. Aim: To address the question: whether, to what extent and in what ways, Lean and Six Sigma in healthcare contribute to person-centred care and cultures. Design and methods: Realist review identified three potential Context, Mechanism, Outcome configurations (CMOcs) that explained how Lean Six Sigma influenced practice, relating to staff, patients and organisational influences. A realist evaluation explored how staff interacted with a Lean Six Sigma education programme (the intervention). Specifically, the CMOc relating to staff was adjudicated by study participants to determine whether, to what extent and in what ways it influenced person-centred care and cultures. Data collection was informed by person-centred principles and took place through a series of workshops and semi-structured interviews, followed by a review of research participants’ improvement projects outcomes. Findings: Three focused CMOcs, Aspects of Organisational Culture, the Organisation’s Receptivity and Participants’ Self-perception, emerged from the adjudication of the CMOc relating to staff, illuminating the contextual factors (C) that facilitated the outcomes (O) that arose from the underlying mechanisms (M) that were active when the contextual factors (C) were present. Synergies (respect for persons, voice of the customer, staff empowerment and observational studies), an influencer (quality) and divergences (core values, standardisation and first principles) between participants’ Lean Six Sigma practice and person-centred care and cultures were also revealed. Discussion: A return to Lean Six Sigma’s philosophical roots facilitates coherence in the philosophy, intention, methods and outcomes between Lean Six Sigma and person-centred approaches. Their combined use is not only possible but may also be desirable, enabling Lean Six Sigma practitioners to work in ways that support the development of quality, person-centred care that takes account of the outcomes for, and experiences of, patients, their families and staff. Incorporating person-centred principles into the research design, whilst adhering to the principles and rigour of realist evaluation, resulted in a new way of adjudicating CMOcs and novel methods of working with research participants. This study contributes to the evidence base on the study of quality improvement beyond the effectiveness of interventions alone. The findings will be of interest to researchers, policymakers and practitioners globally. Keywords: Lean, Six Sigma, Lean Six Sigma, Process improvement, Person-centredness, Person-centred care, Person-centred cultures, Kaizen.
Coming to understand the professional artistry of nursing practice and facilitating its development: A critical creative collaborative inquiry
(Queen Margaret University, Edinburgh, 2020) Frost, Donna Michelle
This thesis explores the concept of professional artistry in nursing practice. In particular, as it was uncovered and understood by nursing professionals working in hospital, primary care and long term care settings in the Netherlands. Despite the many pressures and challenges within the healthcare system some nurses do manage to practise with beauty and graceful skill while nursing in person-centred and evidence-based ways. These nurses demonstrate that effective, beautiful, perhaps even transformative practice is possible. Practice of this kind has been called professional artistry. A collaborative, critical and creative methodology was developed specifically for this study to enable groups of nurses to inquire together using methods that would take account of the embodied, embedded and creative nature of professional practice. This research has demonstrated that professional artistry in nursing can be understood as a set of ontological and praxiological assumptions which are expressed in five patterns of engagement and result in an enlargement of the space for becoming. The patterns of engagement are described as the creation of a sheltered, shared space; being committed to the ideal; working with the parts and the whole; working with the now and the not yet, and, taking or enabling transformative action. This research has furthermore demonstrated that it is possible within busy, real life nursing environments for nurses to engage in an iterative and systematic process of embodied learning through which they can develop shared understandings of their professional artistry, involve their colleagues, patients and other stakeholders in co-creation of these understandings, and experience both perspective transformations and further development of their professional artistry. Iterative inquiry into professional artistry via a critical, creative and collaborative process not only supports the embodied understanding of professional artistry in one’s own practice, but creates the conditions in which it can be further developed.
Exploring the relationship between life experiences and early relapse among imprisoned users of illegal drugs in Oman: A focused ethnography
(Queen Margaret University, Edinburgh, 2020) Al Harthi, Hamida Hamed Said
Background: Illegal drug use is a rising problem that affects Omani youth. This research aimed to study a group of young Omani men who were imprisoned more than once for illegal drug use, focusing on exploring their lifestyle experiences inside and outside prison and whether these contributed to their early relapse and re-imprisonment. This is the first study of its kind from Oman conducted in a prison setting. Methods: 19 Omani males aged 18–35 years imprisoned in Oman Central Prison were recruited using purposive sampling. Focused ethnography was conducted over 8 months to explore the drug-related experiences outside prison and during imprisonment. Face-to-face semi-structured interviews with the participants yielded detailed transcripts and field notes. These were thematically analysed, and results compared with the existing literature. Results: The participants’ voices yielded new insights into the lives of young Omani men imprisoned for illegal drug use, including their sufferings and challenges in prison. These included: entry shock, timing and boredom, drug trafficking in prison, as well as physical and psychological health issues. Overall, imprisonment was reported to have negatively impacted the participants’ health, personality, self-concept, emotions, attitudes, behaviour and life expectations. The participants reported how their efforts to reintegrate into Omani community after release from prison were rebuffed due to stigmatisation and rejection from the society and family. They also experienced frequent unemployment, police surveillance, accommodation problems and lack of rehabilitation facilities. The immensity of the accumulated psychophysiological trauma contributed to their early relapse and reimprisonment. Conclusion: This thesis concludes that imprisonment is largely ineffective in controlling drug use in Oman. Urgent action is required across multiple sectors to improve the lives and prospects of users of illegal drugs within and outside prison to minimise factors contributing to early relapse. Key Words: illegal drugs, drug users, Oman, addiction, Omani culture, prisoners, relapse, re-imprisonment, qualitative research, ethnography
Sexual expression in persons living with dementia in a nursing home context: A phenomenological inquiry
(Queen Margaret University, Edinburgh, 2020) Rennie, Karen
Introduction: Research shows that sexual expression provides emotional and physical benefits throughout life and does not diminish with age or loss of capacity (Rennie et al. 2017). Older persons, living in care home, including people living with dementia see themselves as sexual beings and with a continuous need and desire to embody sexual expression. However, evidence demonstrates that sexual needs of ‘residents’ living in nursing or care homes are not viewed as an important part of nursing care (Bauer et al. 2013). Sexual expression is often overlooked as an important part of life in persons with dementia and is still considered the most difficult ‘symptom’ of the behavioural and psychological symptoms of dementia (BPSD) model to manage by nurses (Tucker 2010). Aims and Objectives: This study aimed to generate new knowledge on the meaning of sexual expression in persons living with dementia for person-centred nursing practice and theory. This study also aimed to understand more about how sexual expression effects nurses working in care homes and how sexual expression influences the care of persons with dementia. Methodology: Drawing on existential phenomenology, and person-centred theory as well as new principles drawn from the sensuous literature, I had conversations with four persons living with dementia to explore the nature and meaning of sexual expression. I was able to explore this sensitive topic in a dignified and respectful way by working with a rigorous process consent framework that enabled inclusion of adults with incapacity. I observed eleven nurses and carers and had dialogues with them at work to find out about their experiences of sexual expression within caring. Drawing on four existential principles, I was able to produce rich contextualised descriptions of the participant’s experiences of sexual expression. Findings: Findings show that for persons living with dementia, three topics were unconcealed within the phenomena of sexual expression. They were: (1) embodied sensuous-sexuality; (2) meaningful sexual relationships and (3) sexuality and nursing home culture. For the nurses, findings show that the following topics were significant in nurses experiences of caring for persons living with dementia who express themselves sexually: (1) personal values and beliefs on older persons sexuality; (2) cultural norms around sensuous-sexual expression; (3) the ageing body and (4) lack of awareness and education. Finally, I have developed a ‘Sensuous-Sexual Expression Framework’, which is a new practice framework, and an alternative to BPSD, to view sensuous-sexual in persons living with dementia. Conclusions: This is the first study to explore sexual expression which included persons living with dementia living in nursing homes and to gain valuable insights to their experiences of sexual expression. Practically, this study generates new principles for how nurses can provide better person-centred care for persons living with dementia. Academically, this research adds to existing research that challenges the BPSD model and its underpinning ideas and reframes sexual expression as sensuous-sexual expression. Key words: Sexual expression; Persons living with dementia; Person-centredness; Sensuousness; Existential phenomenology; Participatory principles
Constructing spaces of authentic engagement through embodied practice: an exploration of deaf peoples’ and nurses’ experiences of interacting
(Queen Margaret University, Edinburgh, 2021) Dickson, Megan
Background: British Sign Language (BSL) is the visual-spatial language of deaf people in Scotland. For deaf, BSL users all contact with the NHS takes place in a hearing led context where spoken English is the primary mode of communication. Healthcare can therefore be challenging for deaf people to access and engage in. The implicit assumptions of the biomedical perspective, that views deafness as an illness to be ‘cured’, often underpin and shape healthcare practices. In this context, there is a lack of acknowledgement of deaf peoples’ linguistic and cultural status. There has been recognition in healthcare literature that access to healthcare is problematic for deaf people. However, the majority of this literature is informed by the biomedical perspective, privileging positivist approaches to treating deaf people. This has resulted in knowledge that does acknowledge the social world in which deaf peoples’ experiences of healthcare take place. Conceptualising healthcare as a form of social relationship, this research explored nurses’ and deaf peoples’ experiences of interacting with one another. Approach and methods: This research is situated in the critical creative paradigm and underpinned by Gadamer’s hermeneutics and Merleau-Ponty’s philosophy of embodiment. The hermeneutic perspective enabled exploration of participants’ relational and contextual experiences of interacting, and creative methods enabled access to the participants’ and researcher’s embodied knowledge of these experiences. Semi-structured interviews with deaf, BSL users and nurses who had provided care for a deaf person were undertaken over a period of 10 months. A focus group of BSL/English interpreters was also carried out. Findings: The findings revealed that nurses often articulated and embodied predominantly biomedical understandings of what it means to be deaf. Approaching care from this perspective, nurses often struggled to acknowledge or respond to deaf peoples’ visual-spatial ways of being and knowing. Healthcare environments were therefore frequently experienced by deaf people as hearing spaces in which they were systematically disempowered due to the oppression of their visual-spatial nature and language. This created divisive boundaries between deaf people and nurses that limited the potential for an effective nursing relationship to develop. Nurses who displayed qualities of openness and curiosity developed alternative ways of thinking about deafness. These had the potential to transform their approaches to practice that enabled collaborative relationships to develop. Conclusions and implications: This research has demonstrated that healthcare spaces are relational and therefore constructed by the social actions of the people in them. For nurses to construct spaces that are respectful of and embodied deaf culture, the significance of the whole body in developing relational practice must be recognised. Such understanding and knowledge could enable nurses to approach practice with an awareness of how both their own and deaf peoples’ embodied experiences can inform care. This necessitates reflexivity in which nurses recognise and question the assumptions that underpin their practice. Recognising the significance of deaf peoples’ visual-spatial experience and embodied understanding of the world has the potential to contribute to emancipatory and empowering approaches to caring for deaf people. Keywords: deaf, British Sign Language, embodiment, embodied practice, creative hermeneutics
‘Muchness’ as the subjective experience of well-being: a participatory inquiry with nurses
(Queen Margaret University, Edinburgh, 2021) Sanders, Catherine
Background: My interest in muchness was stimulated upon reading a blog which considered quotes from ‘Alice in Wonderland’ identifying what lessons they might offer healthcare today. One such quote was: ‘You used to be much more “muchier”. You’ve lost your muchness’, said the Mad Hatter. Supported by my experiences of working with nurses who reported feeling overworked, undervalued and undermined, I propose that some nursing staff have lost their muchness - their subjective experience of well-being. This impacts on their readiness to develop themselves, their practice and workplace cultures towards person-centredness. Methods: Drawing upon the work of Paulo Freire and Mark Johnson, theoretical and subsequent person-centred and participatory methodological principles were developed. An innovative research method – Virtual Picture Voice, was created enabling nurses internationally to: • Create and share stories of muchness, generating knowledge about muchness as subjective well-being • Participate in the analysis and synthesis of these stories, contributing to the creation of the Muchness Model Version 1 A metasynthesis process, drawing upon wider theoretical evidence, supported the development of the Muchness Model Version 2. Findings: Situated within virtue ethics, the Muchness Model Version 2 advocates a full-life understanding of well-being for nurses: a balance between the pursuit of feeling fulfilled and feeling good. It values the use of embodied and experiential knowledge to inform and evaluate actions towards nurses experiencing muchness and flourishing in the workplace. Conclusions and implications: A holistic approach to the facilitation of well-being should be adopted, that includes individuals and organisations, working at micro, meso and macro levels, to enable nurses to determine what is important/matters to them personally and professionally; how this can be used to inform: their nursing work; their relationships; their workplace contexts towards enhancing their muchness or subjective experiences of wellbeing. Keywords: Arts-informed approaches, Freire, participatory inquiry, person-centredness, Photo-Voice, subjective well-being, virtual methods