Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
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Item A realist inquiry to identify the contribution of Lean Six Sigma to person-centred care and cultures(MDPI, 2021-10-03) Teeling, Sean Paul; Dewing, Jan; Baldie, DeborahA lack of fidelity to Lean Six Sigma’s (LSS) philosophical roots can create division between person-centred approaches to transforming care experiences and services, and system wide quality improvement methods focused solely on efficiency and clinical outcomes. There is little research into, and a poor understanding of, the mechanisms and processes through which LSS education influences healthcare staffs’ person-centred practice. This realist inquiry asks ‘whether, to what extent and in what ways, LSS in healthcare contributes to person-centred care and cultures’. Realist review identified three potential Context, Mechanism, Outcome configurations (CMOcs) explaining how LSS influenced practice, relating to staff, patients, and organisational influences. Realist evaluation was used to explore the CMOc relating to staff, showing how they interacted with a LSS education Programme (the intervention) with CMOc adjudication by the research team and study participants to determine whether, to what extent, and in what ways it influenced person-centred cultures. Three more focused CMOcs emerged from the adjudication of the CMOc relating to staff, and these were aligned to previously identified synergies and divergences between participants’ LSS practice and person-centred cultures. This enabled us to understand the contribution of LSS to person-centred care and cultures that contribute to the evidence base on the study of quality improvement beyond intervention effectiveness alone.Item Review of developments in person-centred healthcare(Foundation of Nursing Studies, 2020-09-30) Phelan, Amanda; McCormack, Brendan; Dewing, Jan; Brown, Donna; Cardiff, Shaun; Cook, Neal F.; Dickson, Caroline; Kmetec, Sergej; Lorber, Mateja; Magowan, Ruth; McCance, Tanya; Skovdahl, Kirsti; Štiglic, Gregor; van Lieshout, FamkeIn recent years, there has been a shift in orientation towards person-centredness as part of a global move towards humanising and centralising the person within healthcare. Person-centredness, underpinned by robust philosophical and theoretical concepts, has an increasingly solid footprint in policy and practice, but research and education lag behind. This article considers the emergence of person-centredness, including person-centred care, and how it is positioned in healthcare policy around the world, while recognising a dominant philosophical positioning in Western philosophy, concepts and theories. Second, the evolution of person-centred healthcare over the past five years is reviewed. Published evidence of person-centred healthcare developments is drawn on, as well as information gathered from key stakeholders who engaged with the partner organisations in an Erasmus+ project to develop a European person-centred healthcare curriculum framework. Five themes are identified, which underpin the literature and stakeholder perspectives: Policy development for transformation Participatory strategies for public engagement Healthcare integration and coordination strategies Frameworks for practice Process and outcome measurement These themes reflect the World Health Organization’s global perspective on people-centred and integrated healthcare, and give some indication of development priorities as person-centred healthcare systems continue to be developed.Item Relational ethics in palliative care research: Including a person-centred approach(SAGE, 2019-12-19) Haraldsdottir, Erna; Lloyd, Anna; Dewing, JanThe traditional approach to research ethics is to ensure that all ethical issues are adhered to through the scrutiny of research proposals by research ethics committees, themselves sitting within national research governance frameworks. The current approach implies that all potential ethical issues can be considered and mitigated prior to the research. This article is a perspective piece whereby we consider how this approach, on its own, is not enough to ensure ethical practice. We draw attention to the limitations of current ethical procedures in the inherent detachment between the researcher and research participants. We argue that applying a person-centred approach to research ethics allows for contextual and situational factors and places the relationship between research participants and researcher as central.Item Using two models of workplace facilitation to create conditions for development of a person-centred culture: A participatory action research study(Wiley, 2019-04-24) Hardiman, Michele; Dewing, JanAims and objectives: To examine facilitation in workplace learning where nurses are focused on creating person-centred cultures; to provide a framework for novice and proficient facilitators/practitioners to learn in and from their own workplaces and practices; to provide the conditions where practitioners can gain an understanding of the culture and context within their own workplace. Background: Evidence suggests that person-centred cultures depend on purposeful, facilitated practice based learning activities. For person-centredness to become more meaningful to nursing leaders in their daily work, focus must be placed on their acquisition and use of facilitation skills. The facilitation framework ‘Critical Companionship’ remains an exemplar in the development of expert facilitation skills. Two sequential facilitation models were developed as ‘steps’ towards Critical Companionship, as a framework for novice and proficient facilitators and practitioners to learn in and from their own workplaces and practices. Design and Methods: This research, situated in a critical social science paradigm, drew on participatory action research to devise, explore and refine two facilitation models: Critical Allies and Critical Friends. The researcher adopted an insider approach to work with five nursing leaders, which was subsequently reported using the EQUATOR Guidelines for Best Practice in the reporting of Participatory Action Research. Results: Show the complexity of enabling facilitation within the workplace. Four themes and twelve sub-themes emerged from the data that describe the attributes needed to facilitate workplace learning and reveal that mangers can have an active role in enabling person-centred culture development. Conclusions: This research adds to the body of knowledge on developing person-centred culture. It offers practical stepping stones for novice and proficient facilitators to enable embodiment of the skills necessary to facilitate learning in person-cultures. The models offer a workplace friendly pathway with practical methods and further contribute to our understanding of how we create person-centred cultures. Relevance to Clinical Practice Facilitation of practice development and workplace learning remains the most effective methods to develop person-centred cultures. This research introduces a pathway for clinical leaders/managers to become facilitators with their own teams, maximising the impact on the culture where care is delivered.