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.Item Constructing spaces of authentic engagement through embodied practice: an exploration of deaf peoples’ and nurses’ experiences of interacting(Queen Margaret University, Edinburgh, 2021) Dickson, MeganBackground: 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 hermeneuticsItem ‘Muchness’ as the subjective experience of well-being: a participatory inquiry with nurses(Queen Margaret University, Edinburgh, 2021) Sanders, CatherineBackground: 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 methodsItem Sexual expression in persons living with dementia in a nursing home context: A phenomenological inquiry(Queen Margaret University, Edinburgh, 2020) Rennie, KarenIntroduction: 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
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