Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7188
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Item EXPLORING THE MEANING OF FACILITATION IN PRACTICE DEVELOPMENT IN COLLABORATION WITH REGISTERED NURSES AND HEALTHCARE ASSISTANTS: A PARTICIPATORY RESEARCH STUDY(Queen Margaret University, Edinburgh, 2025-10) Breslin, ElizabethBackground This research study aimed to explore the meaning of facilitation in Practice Development (PD). My co-researchers were registered nurses and healthcare assistants (practice co-researchers) working in two residential care facilities in Ireland. PD is an approach to developing person-centred cultures of care grounded in critical social science that integrates collaborative, inclusive, and participatory approaches to achieve person-centred and evidence-based care. Central to PD is person-centred facilitation, which is the focus of my research, examining the meaning of facilitation in the reality of practice. Research Methods Using a person-centred methodological approach, this study was conducted in two residential care facilities in Ireland and underpinned by participatory and emancipatory principles. Research fieldwork was conducted over fourteen months. A range of Practice Development (PD) methods were used, including one-to-one interviews, reflective accounts, observations of practice, facilitation workshops, and informal conversations. These activities were conducted over fourteen months to support engagement and foster trust. A creative hermeneutic data analysis was used to interpret how facilitators experienced and made sense of facilitation in practice. In the later phase, experienced co-researchers joined the analysis process to critically reflect on and deepen their understanding of the emerging outcomes. Research Outcomes In this research, five key elements emerged that illuminate the meaning of facilitation in PD: autonomy, courage, understanding person-centredness, embracing active learning, and flourishing. Person-centred relationships between individuals are underpinned by trust, knowledge of self and others, learning to be creative, having time, and having a supportive space to work together towards a shared purpose in practice.Item Finding Our Way, Telling Our Stories: A Story-Informed Transformation Toward Person-Centred Culture and Practice after Australia’s Oakden Report: An introduction and critical appraisal in partial fulfilment of the Doctor of Philosophy degree by retrospective publication.(Queen Margaret University, Edinburgh, 2025-10) McKellar, DuncanThis doctoral study by retrospective publication examines the transformation of health, aged and social care environments from dehumanised and dysfunctional into compassionate, person-centred cultures. The research is grounded, firstly, in my experience as a reviewer of South Australia’s Oakden Older Persons’ Mental Health Service, a profoundly flawed institution whose exposure led to several national inquiries and, secondly, in my subsequent experience as the strategic clinical lead of systemic reforms occurring after the report’s publication. Through immersive, embodied scholarship, involving practice-based learning, reflective practice, and autoethnographic research, this study explores the role of storytelling as a mechanism for culture change. The thesis explores the relationship between storytelling, organisational culture, and person-centred care, synthesising insights from philosophy, theology, and social science. It argues that a story-informed approach—where storytelling and story-listening are embedded in work and care practices—enhances empathy, disrupts power hierarchies, and fosters psychologically safe environments. This principle, alongside the co-designed Culture Framework developed in the Oakden reform process, provides a strategic model for sustainably embedding person-centred values into health, aged, and social care services. The critical appraisal considers theologically informed personalism as an ontology, functioning as a wellspring for a dynamic embodied scholarly practice. It also positions storytelling as an epistemology that humanises care and builds ethical, empathetic, and inclusive cultures. It evaluates the study’s methodological foundation in evocative autoethnography and reflexive scholarship, addressing the ethical complexities of narrating lived experience. The findings affirm that systemic failures, such as those at Oakden, are often rooted in the erosion of personhood and relational care. By offering an applied model of cultural transformation, this thesis contributes new knowledge to the field of person-centred practice, advocating for narrative as a central mechanism in achieving sustainable, compassionate care environments.Item THE INFLUENCE OF THE PRACTICE ENVIRONMENT ON SHARING DECISION MAKING BETWEEN OLDER PERSONS AND NURSES IN RESIDENTIAL AGED CARE: AN AUSTRALIAN PERSON-CENTRED STUDY(Queen Margaret University, Edinburgh, 2025-05) Marriott-Statham, KellyBackground: With an ageing population and recent recommendations from the Australian Royal Commission into Aged Care Quality and Safety, there is a need to understand how older persons are enabled to participate in care decisions. While sharing decision making is promoted widely in healthcare, the practice environment plays a key role in shaping how these decisions are made and how older people are included in their care. Aims and Objectives: The aim of this research was to explore how the constructs of the practice environment domain within the Person-centred Practice Framework influence sharing decision making between older persons and nurses in residential aged care. Approach and Methods: Using a person-centred methodological approach, the research utilised emotional touchpoint interviews, observations of practice and practice development methods in a residential aged care facility in Australia. A creative hermeneutic analysis was used with participants to interpret how the practice environment shaped decision making. Findings: Seven components were found to influence the relational connectedness and sharing decision making between older persons and nurses: affirming personhood, reciprocal trustworthiness, time as presence, intentional way of being, negotiating relational boundaries, organisational values in action, and policies in practice. This research contributes a new perspective of sharing decision making as a relational process continuously influenced by people, processes and structures within the practice environment. Conclusions and Implications: This research highlighted the practice environment as key to how decision making occurs between older persons and nurses. To support sharing decision making processes, aged care organisations need flexible policies, power sharing structures, and workforce models that prioritise relationship building. Nurses should be supported to develop emotional intelligence and have the time to connect meaningfully. Creating conditions where older people are respected, heard and genuinely involved in care must be embedded within the elements of the practice environment.Item UNDERSTANDING HOW ENGLISH-SPEAKING EXPATRIATE NURSES CARE FOR EMIRATIS WHO HAVE BEEN INVOLVED IN SUBSTANCE MISUSE: A HERMENEUTIC PHENOMENOLOGY STUDY(Queen Margaret University, Edinburgh, 2025-05) Daradkeh, Fares AhmadIn the UAE, English-speaking expatriate nurses are the backbone of substance misuse treatment facilities. This research aims to study their experiences and perceptions, exploring their lived experiences while caring for Emiratis who have been involved in substance misuse. The study adopted hermeneutic phenomenology, to uncover the meaning of the nurses’ experiences. This study is the first to explore this phenomenon in the UAE. Twenty English-speaking expatriate nurses working in substance misuse treatment facilities in the UAE were purposefully recruited for face-to-face semi-structured interviews. The results were analysed structurally and compared to the existing literature. The findings of this phenomenological perspective provide new insights into the lived experiences of English-speaking expatriate nurses, highlighting the unique challenges they face, reflecting the essence of lived experiences, meaning, feelings, needs, and unique challenges while caring for Emiratis involved in substance misuse. Four main themes were identified: “Behind the Scene”, “Clinical Facilitators”, “Professional Identity of Nurses”, and “Expatriate Nurses’ Coping Strategies”, with significant findings concerning workplace violence, professional jealousy, a lack of specialist nurses, poor verbal communication and working language. In addition, the role of nursing leaders is crucial in providing specialist nurses and establishing professional development education programs and orientation programs that upscale the knowledge and skills of nurses. The concern of not “Being Trusted or Respected” by service users also negatively impacted the nurses’ motivations, feelings, thoughts, and coping strategies. The four themes reflect these findings. It is necessary to improve the working environment to address the identified issues and significantly improve the care provided by English-speaking expatriate nurses to Emiratis involved in substance misuse. These insights are relevant to contemporary nursing leaders and expatriate nurses and offer valuable directions for future research on nursing within the UAE, instilling a sense of optimism for the future of nursing in the region.Item LIVING AND COPING WITH HIV-RELATED UNCERTAINTIES: A CRITICAL REALIST APPROACH(Queen Margaret University, Edinburgh, 2025-03-12) Tsigkas, GeorgiosBackground: This research explores the lived experiences of individuals with HIV, focusing on uncertainty and coping through the lens of Critical Realism (CR). While uncertainty and coping have been studied in the HIV field, they have not been examined using a CR approach. Approach and methods: Seventeen participants were interviewed using a semi-structured approach. Field notes and analytic memos supported the data, which were transcribed verbatim and coded using NVivo 12 software. Data analysis followed three CR-consistent stages: identification of demi-regularities (stage 1), abduction or theoretical redescription (stage 2), and retroduction (stage 3). Findings: Four demi-regularities emerged in the first data analysis stage, reflecting the empirical and actual levels of CR reality: social networks, personal identity, understanding uncertainty and coping, and HIV infection-related demiregularity. These were analysed and conceptualised using pertinent theories, setting the stage for retroduction. Retroduction identified two dual generative mechanisms: self-acceptance or self-rejection and societal acceptance or societal rejection. Conclusions and implications: This research demonstrates how selfacceptance or self-rejection and societal acceptance or societal rejection influence uncertainty and coping in the context of HIV. From a CR perspective, social structures shape human agency. Health and social care practitioners, as part of these structures, play a crucial role in influencing uncertainty and coping. Encouraging individuals with HIV to embrace change can facilitate selfacceptance, thereby enhancing coping and reducing uncertainty.Item BECOMING A PERSON-CENTRED FACILITATOR OF LEARNING: A participatory action-oriented inquiry exploring the experience of embodying person-centredness by educators working in hospital settings(Queen Margaret University, Edinburgh, 2024-05-08) Robinson, Betty AnnBackground: Many educators working in the hospital setting are not well-prepared for their role. They rely on the expert teacher-centred model which is not aligned with nor contributing to developing person-centred cultures. As these educators are positioned to contribute to developing and advancing person-centredness, it is imperative they are enabled to become person-centred in their practice. Little is known about how educators transform from the expert teacher-centred approach to a person-centred facilitation approach. This study investigated how educators become person-centred facilitators. Approach and Methods: With a participatory, action-oriented research design informed by four person-centred methodological principles predicated on practice development and relational inquiry, educators in the hospital setting co-investigated their experience of becoming person-centred facilitators. Collective and individual capacity development activities enabled educators to co-create a pathway to embodying person-centredness. Data was analyzed through five phases of relational inquiry infused critical creative hermeneutics. Findings: A conceptual framework representing becoming person-centred emerged and a Roadmap for Becoming Person-centred was developed. Transformation was guided by three principles, Starting with Self, Developing Community & Belonging, and Bumping Against Culture & Inviting Transformation. Becoming occurred intrapersonally, interpersonally, and contextually through moments of discovery, reconciliation, and action. Findings indicate the four person-centred methodological principles, developed into the RACC Model, are effective in providing educational theory and working in person-centred ways. These principles enable educators to contribute to advancing person-centredness within the realities and complexities of the hospital setting. Conclusions and Implications: Educators working in hospital settings can be enabled to become person-centred facilitators by providing them person-centred learning opportunities and support over time. As pedagogy, the four person-centred methodological principles should be used within orientation programs so educators attain competence in educational theory and person-centredness and use these principles within their own practice. As educators embody being person-centred facilitators, they can contribute to advancing person-centredness.Item Sharing decision‐making between the older person and the nurse: A scoping review(2022-10-09) Marriott-Statham, Kelly; Dickson, Caroline; Hardiman, MicheleAbstract: Background: Sharing decision‐making is globally recognised as an important concept in healthcare research, policy, education and practice which enhances person‐centred care. However, it is becoming increasingly evident shared decision‐making has not been successfully translated into everyday healthcare practice. Sharing decision‐making has strong links with person‐centred practice. Core to person‐centredness and shared decision making, is the need to recognise that as we age, greater reliance is placed on emotion and life experience to inform decision making processes. With the world's ageing population, older persons facing more complex decisions and transitions of care, it is more important than ever it is understood how shared decision‐making occurs. Objectives: This scoping literature review aims to find out how sharing decision making between nurses and older persons in healthcare settings is understood and presented in published literature. Methods: This scoping review utilised the Arksey and O'Malley methodological framework, advanced by Levac et al. Electronic databases and grey literature were searched, returning 362 records which were examined against defined inclusion criteria. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR). Results: Twenty‐two records met inclusion criteria for the review. Results indicate while shared decision‐making is included in research, education and policy literature, it has not been effectively translated to inform practice and the relationship between a nurse and an older person. The records lack definitions of shared decision‐making and theoretical or philosophical underpinnings. There is also no consideration of emotion and life experience in decision‐making and how nurses ‘do’ shared decision‐making with older persons. Conclusions: The findings demonstrate sharing decision‐making between nurses and older persons is not well understood in the literature, and therefore is not translated into nursing practice. Further research is needed.