Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
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Item Portal hypertension and varices: pathophysiology and clinical management(RCN Publishing (RCNi), 2025-12-15) Price, NatashaPortal hypertension is a condition that describes increased pressure within the portal vein, an important structure that drains blood from the gastrointestinal tract and conveys it to the liver. This article describes the normal structure of the liver and its circulation. It also explains how cirrhosis leads to the development of portal hypertension and varices, and considers the latest evidence and guidance for safe clinical management. As liver disease is a leading cause of morbidity and mortality, nurses commonly encounter patients experiencing the effects of portal hypertension in practice, and professional bodies have highlighted a need for increased foundational nursing knowledge to enable informed care and optimise patient outcomes. Therefore, this article aims to enhance nurses’ knowledge of the underlying pathophysiology, clinical manifestations and recommended management of portal hypertension and varices in the context of end-stage liver disease, with specific consideration of the nurse’s role.Item Person-centred approach for people with learning disabilities in palliative care: the challenges(Queen Margaret University, Edinburgh, 2025-11-30) Wilson, Ashleigh; Young, Julie; Haraldsdottir, ErnaBackground People with a learning disability (PWLD) are living longer with a greater need for palliative care. Research has identified that people with a learning disability experience challenges when accessing palliative care with concerns that person-centred care is not being achieved. Aim The overall aim of this study is to present a meta-synthesis of qualitative studies. Focusing on the challenges of achieving person-centred care for PWLD and palliative care needs, to gain a deeper understanding of the challenges they experience. Method A qualitative meta-synthesis literature review using a seven-phased model by Noblit and Hare was undertaken. An online literature search was conducted between 8 July 2024 and 31 July 2024 across four databases: SAGE publications, PubMed, Wiley Online Library and CINAHL. Results 10 studies were reviewed with 226 participants ranging from PWLD, support workers, health professionals and family members. Main themes identified were: a deficiency of knowledge, the importance of the environment, challenges in achieving effective communication and advance care planning to achieve better outcomes. Conclusion This qualitative meta-synthesis identifies the challenges of achieving person-centred care for PWLD and palliative care needs. It draws attention to person-centred theory and how this supports good person-centred care for PWLD. This paper went further to identify how person-centred theory links with the wider context of healthcare practice while exploring recommendations to improve practice and gaps in research.Item Medical Rehabilitation for Life Changing Conditions [Editorial](Mark Allen Group, 2025-11-25) Jesudason, Edwin C…the experienced doctor thinks in larger units of time, not just backward to cases in the past but, more interestingly, forward, trying to see into the patient’s indeterminate future. (Sennett, 2008, p247) …the meanings of stories are found, and from them people draw both moral and practical guidance on how to carry on. (Ingold, 2011, p210) What makes a condition life changing? Lasting physical impairment is one answer. Another, perhaps less obvious, is the disruption of two vital functions that serve as life’s maps and compass. Respectively, imaginative functioning conjures what we could do, while our ethical functioning evaluates what we should (Jesudason, 2025). On this view, illness becomes life changing when it disables the prospective imagination with which we normally create our lives. Retrospection and interoception take over as we interrogate the past for causes and the body for threats (Horhota et al, 2012; Fani et al, 2024; Opdensteinen et al, 2025). Pre-occupied, we struggle to envision a future, losing trust in it. Ethical evaluations then curdle into recriminations, as we lose our sense of the right way to turn. Being creative and evaluative, these two functions shape what we make of our other capabilities, so their disruption by illness is of wide consequence, particularly when seeking to rebuild. Despite this importance, such imaginative and ethical dysfunction is commonly just medicated, labelled respectively as anxiety and low mood. Alongside talking therapies, these generic approaches can leave patients with troubling and particular medical concerns. This editorial argues, instead, for the specific rehabilitation of imaginative and ethical functioning, using expert medical counsel from specialists in Physical and Rehabilitation Medicine (PRM). While medical specialties often focus on minimising mortality and morbidity, PRM advocates a broader view of life, with emphasis on functioning as a key marker of health (Stucki and Bickenbach, 2017). Pursuing health rather than just the limitation of disease, the specialty uses the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF) to work across the range of human capabilities, from biophysical to psychosocial (World Health Organization, 2001).Item Perspective Chapter: Rekindling the Vision for Palliative and End-of-Life Care for Future Practices(IntechOpen, 2025-02-05) Haraldsdottir, Erna; Bullock, KarenThis chapter will focus on the original philosophy of palliative care as developed by Dame Cicely Saunders. Attention will be paid to the development of palliative care and the challenges to remain close to the original vision as practice develops further within a traditional medical environment. The overall purpose and focus of the chapter are for the reader to engage with the inherent holistic and person-centered approach of palliative and end-of-life care as developed by Cicely Saunders and to gain an understanding and insight into how to maintain her vision as an essential element of care within modern palliative and end-of-life care.Item Pharmacist Review of Medicines Following Ambulance-Attended Falls—A Multi-Methods Evaluation of a Quality Improvement Initiative(MDPI AG, 2025-10-18) Mulrooney, William; Wilson, Caitlin; Pilbery, Richard; Fisher, Ruth; Whiterod, Sarah; Smith, Heather; Turner, Emily; Edmonds, Heather; Webster, Peter; Prestwich, Graham; Bell, Fiona; McLaren, RebeccaBackground: Falls in older adults are a leading cause of morbidity, particularly when compounded by polypharmacy. There is mixed evidence of the efficacy of medicine reviews, but there is little work exploring this in the ambulance setting. A new referral pathway enabling ambulance staff to connect patients to primary care pharmacists aimed to address this. This study explored staff and patient experiences with the pathway and its potential to improve medication safety after a fall. Methods: A mixed-method service evaluation was conducted to assess the implementation and impact of this pathway. Routine data from an ambulance trust and pharmacist proformas were used to address objectives relating to referral rates, clinical appropriateness, and fall recurrence. Patient and staff stakeholder perspectives were gathered through two cross-sectional surveys designed to explore emotional, behavioral, and practical responses to the intervention. Quantitative data were analyzed descriptively and using ordinal logistic regression where appropriate. Free-text responses were analyzed thematically. Results: Between May 2019 and March 2020, referrals were initiated for 775 older adults after ambulance attendance for a fall, with pharmacists completing medicine reviews on 340 patients. Survey data revealed improvements in patients’ emotional responses to their medicines. Ambulance clinicians identified patient disclosure, stockpiling, and the presence of expired medicines as key indicators of poor medicines management and valued the ability to refer patients. Conclusions: Overall, referral to the pathway demonstrates a marginal improvement in recontact rates in the short-term but does not necessarily represent an improvement in overall patient safety. The cost of such an intervention and patient expectations need further exploration to prove efficacy and patient satisfaction.Item Developing person-centred care in hospices through the voice and leadership of nursing: lessons from the United Kingdom(Frontiers Media, 2025-10-15) Haraldsdottir, Erna; Cooper, Marie; Richardson, HeatherIntroduction: Nursing leadership and the voice of nurses are crucial for developing person-centred care in hospices. Concerns have been raised that, as palliative care has evolved from its original vision and become more integrated into the mainstream healthcare system, it has increasingly become medicalised. This paper presents an emancipatory practice development programme aimed at enhancing the visibility and voice of nursing and nurse leadership to improve person-centred care in hospices across the United Kingdom. Methods: The project was a 10-month collaborative education programme for nursing practice leaders in hospices throughout the United Kingdom, running from September 2023 to July 2024. A total of 24 clinical and practice development leaders from eight different hospices participated. The Kirkpatrick model for evaluating learning programmes was adapted to create a framework for assessing the programme's outcomes and impact. The evaluation process utilised Collaborative Critical Creative Inquiry. Results: The key findings from the evaluation indicate that the programme created conditions for the participants to gain transformative insights and understanding that positively impacted their practice through emancipatory practice development. Discussion: The programme enabled leaders of person-centred care in hospices to rekindle their vision for palliative care practice. The participants became more aware of how care was constructed within their organisations and recognised the assumptions that were often taken for granted—assumptions that influenced daily care practices that sometimes leaned towards a traditional medical model. They acquired new skills and knowledge that empowered them to engage more intentionally in making changes to enhance person-centred care. Conclusion and implications for practice: Humanising healthcare is a global agenda, and within hospice care, nurses are at the heart of transforming care to be more person-centred. They are well-positioned to reclaim the core principles of palliative care, as developed by Cicely Saunders, and push back against the medical model that has overshadowed the development and integration of palliative care into current healthcare systems. Nurses are expert practitioners and leaders who hold positions of authority within their organisations. Yet, for many, their change-making potential is not realised. Innovative learning and development programmes are an essential part of humanising healthcare, and emancipatory practice development programmes can unlock nurses' potential to lead this transformation.Item Testing Realist Programme Theories on the Contribution of Lean Six Sigma to Person-Centred Cultures: A Comparative Study in Public and Private Acute Hospitals(MDPI, 2025-09-04) Teeling, Sean Paul; Baldie, Deborah; Daly, Ailish; Pierce, Anthony; Wolfe, Nicola; Fagan, Gillian; Garry, CatherinePerson-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures.Item One Chance to Get it Right: Exploring Perspectives and Experiences in Care Home Discharge Decision-Making in the Acute Hospital(Wiley, 2025-09-05) Stevenson, Gemma; Burton, Jennifer Kirsty; Shenkin, Susan D.; MacArthur, Juliet; McCormack, Brendan; Clare Halpenny; Rhynas, SarahBackground Discharge from acute hospital to new care home is a complex and life changing process often involving several key stakeholders in decision-making such as the older person, their significant person and members of the multidisciplinary team. There is limited research exploring the perspectives of these stakeholders, including factors that influence decision-making and how this is communicated. Objective This study explored how decisions are made to discharge older people directly from hospital to care home, considering the perspectives and experiences of those involved. Methods A case study design was used to explore the experiences of six older people admitted to acute hospital from home for whom discharge to care home was planned. Six datasets were formed, each comprising semi-structured interviews with the person, their significant person(s) (if applicable), multi-disciplinary professionals and review of health and social-work records. Datasets were analysed using an inductive thematic approach before cross-dataset analysis. Results Findings emphasised the complex and personal nature of decision-making. The older person was often keen to talk about their decision. Significant people highlighted the complexity of balancing risk and care needs. However, the magnitude of the decision to older people and their significant persons appeared to go underacknowledged by professionals. The hospital context was significant as a location for decision-making. Communication was integral to the experiences of those involved; however, uncertainty and lack of role clarity impacted this. Conclusions This study offers new insights into the complexity of discharge to care home from hospital. This life-changing decision requires greater recognition by professionals. Improved understanding of the process and well-developed communication is central to enhancing the experience for those involved. Implications for Practice The significance of this oftentimes final decision should not be underestimated. The findings indicate a clear need for interdisciplinary education about care home discharge, and the importance of professionals' availability and approachability throughout decision-making. Professionals are encouraged to recognise a shared responsibility for the provision of information and guidance, and create opportunities for open and supportive conversations with older people and their families to explore the decision and discuss their feelings.Item The contribution of a person-centred model of Lean Six Sigma to the development of a healthful culture of health systems improvement(Frontiers Media, 2025-08-18) Teeling, Sean Paul; Baldie, Deborah; Daly, Ailish; Keown, Anne Marie; Igoe, Aileen; Dowling, Ciara; McNamara, MartinBackground: A failure to distinguish between person-centredness, person-centred care, and person-centred cultures can result in improvement initiatives focusing solely on improvement initiative metrics and outcomes, excluding the authentic experiences of patients and staff. Building on the foundational work of Dewing and McCormack, we have designed, piloted, and implemented the Person-centred Lean Six Sigma (PCLSS) model in public and private acute and community healthcare settings across Ireland. This model uses Lean Six Sigma, a widely adopted improvement methodology, through a person-centred lens with which improvement practitioners and healthcare staff can inspect their Lean Six Sigma practice and critically evaluate whether, to what extent, and how it is synergistic with person-centred approaches. Aim: This paper explores the deployment of the PCLSS model across four clinical study sites and examines its alignment with McCance and McCormack's conceptual work on healthful cultures, evaluating its contribution to creating cultures that support sustainable improvement, compassion, and respect. Methods: The PCLSS model was embedded within a university-accredited education programme for healthcare staff. The model was applied across four distinct healthcare settings in Ireland: a public acute teaching hospital, a private full-service acute hospital, an integrated ophthalmology service bridging hospital and community care, and a public rehabilitation hospital. A case study methodology was used to examine implementation and impact. Results: Across all four sites, the PCLSS model facilitated improvements in operational efficiency, staff and patient engagement, interprofessional collaboration, and reflective practice. The model supported leadership at all levels, fostered sustainable change, and successfully mapped onto key domains associated with healthful cultures, as articulated in the work of McCance and McCormack. Conclusion: The PCLSS model represents a sustainable, values-based approach to improvement that aligns operational excellence with person-centred principles. Its application contributes meaningfully to the development of healthful cultures in healthcare organisations.Item Implementation of learning into person-centred practice: evidence of impact from community nursing preparation programmes(Frontiers Media S.A., 2025-08-08) Tyagi, Vaibhav; Churchill, Julie; Dickson, CarolineIntroduction: There has been a global move towards personalising and “humanising” healthcare and promoting caring cultures. Education is addressing this agenda by incorporating person-centred principles into teaching and learning. The aim of this research was to explore the implementation of person-centred learning into healthcare practice. More specifically, this study aims to explore community nurses' implementation of learning about person-centredness in their practice and to demonstrate the impact of person-centred curriculum. Methods: A cross-sectional quantitative survey design was used with community nursing graduates and current students who engaged with person-centred curricula. Results: Significant improvements were found in three constructs of person-centred practice—clarity of beliefs and values, knowing self and developed interpersonal skills. Discussion: These findings provide support for the development of pre-requisites of person-centred practice, rather than person-centred processes in pre-registration curricula. With key pre-requisites for person-centred practice such as leadership attributes of knowing self and of advanced communication skills, learners and graduates will be able adopt healthful leadership practices which are vital in developing others and in creating person-centred cultures.