Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
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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; McCormack, BrendanIntroduction: 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.Item Co-creating a strategy for transforming person centred cultures(Frontiers Media, 2025-06-04) Tuqiri, Karen; Murray, Suzanne; Shaw, Dan; Hackett, Kate; McCance, TanyaIntroduction: Transforming healthcare systems to support person-centred practice reflects environments where individual values and beliefs are respected and where healthful cultures can flourish. However, there are significant challenges within healthcare systems that impact on the development of healthful workplace cultures. The nursing and midwifery professions need to play an influential role in formulating health policy and decision-making to contribute to health and social care systems that are underpinned by person-centredness. This paper reports the use of a practice development approach underpinned by the Person-Centred Practice Framework to co-create a strategy for nurses and midwives that will enable the development of person-centred healthcare practices. The key objectives are to demonstrate the processes that support co-creation to build consensus on what is strategically important to nurses and midwives; to gain an understanding of the value of external facilitation throughout the process and exploring the challenges encountered during the development of the strategy. Methods: Practice Development methodology was the approach used with skilled facilitation adopted to enable the working with values and beliefs, defining purpose and vision and establishing agreed working principles and behaviours. Consensus building methods were used to co-create draft strategy priorities further defined by wider stakeholder engagement. Results: A 5-year strategy was co-created with senior nursing and midwifery leaders, inclusive of key strategic priority areas and strategic actions. The seven priority areas align to the Person-Centred Practice Framework with underpinning shared purpose and values. (1) Developing Person-Centred Cultures, (2) Creating a Supportive Practice Environment, (3) Building Research Capacity, (4) Building a Dynamic Workforce, (5) Fostering Leadership at all Levels, (6) Enhancing Digital Informatics and New Technologies, (7) Delivering High Quality, (8) Safe Person-Centred Care. Together they provide a roadmap for implementation across the many nursing and midwifery contexts providing a solid foundation for leading and supporting person-centred practice across a large local health district with a focus on what matters most while continuing to be innovative in approaches to practice. The development of a clear shared purpose of person-centred practice and the exploration of values were critical first steps in the development of the strategy and provided a clear foundation from which the nursing and midwifery leaders could utilise for the ongoing strategic priorities and action discussions. Implications for practice: The development of nursing and midwifery strategy using Practice Development Methodology and the Person-centred Practice Framework enables critical dialogue that supports nursing and midwifery leaders identify key influences over nursing and midwifery practice. This approach not only fosters a sense of ownership and engagement among nurses and midwives but also ensures that their values, beliefs, and professional insights are integral to the strategic direction of healthcare practices. By aligning the strategy with the Person-Centred Practice Framework, nurses and midwives are better able to develop a shared understanding of person-centred practice where the individual needs and preferences of patients, families and staff are acknowledged. Overall, this strategy represents a significant step forward in supporting the professional development of nurses and midwives, enhancing the quality of patient care, and fostering a healthful culture where continuous improvement and innovation are at the forefront of the healthcare system.Item Critical review of healthcare financing and a survey of system quality perception among healthcare users in Nigeria (2010–2023)(Public Library of Science, 2025-05-28) Josiah, Blessing Osagumwendia; Enebeli, Emmanuel Chukwunwike; Duncan, Brontie Albertha; Adejumo, Prisca Olabisi; Josiah, Chinelo Cleopatra; Anukam, Lordsfavour; Shittu, Muhammad Baqir; Ncube, France; Alimele, Kelechi Eric; Emmanuel, Mercy; Martins-Ifeanyi, Oyinye Prosper; Opeyemi, Fawole Israel; Akingbade, Oluwadamilare; Adebayo, Abosede Peace; Ibraheem, Busiroh Mobolape; Ekenekot, Ubiebo Ataisi; Edafiejire, Mudiaga Sidney; Olukoya, Solomon Oluwaseun; Mukoro, Ufuomaoghene Jemima; Baghdasarian, Siyouneh; Obialor, Joy Chioma; Alao, Gloria Oluwakorede; Obialor, Blessing Onyinye; Otoboyor, Ndidi Louis; Josiah, Oghosa Gabriel; Okonkwo, Joshua; Ebinehita Imoyera, Precious; Gbolabo, Ajao Adewale; Nganwuchu, Blessing Chiamaka; Oladimeji, Olukayode Joseph; Olaosebikan, Timothy Wale; Kantaris, MariosNigeria aims to enhance its healthcare quality index score of 84th out of 110 countries and its Sustainable Development Goals Index ranking of 146th out of 166. Due to increased population, disease burden, and patient awareness, healthcare demand is rising, putting pressure on funding and quality assurance. The Nigerian healthcare financing and its impacts are complex; this study gives insights into the trends. This questionnaire-based cross-sectional survey (conducted from June to August 2023) and 2010–2023 health budget analysis examined healthcare finance patterns and user attitudes (utilisation, preference and quality perceptions) in Nigeria. Data from government health budgets and a stratified random sample of 2,212 from nine states, obtained from the socioculturally diverse 237 million population, were analysed with a focus on trends, proportions, frequency distributions, and tests of association. Results show that the average rating of healthcare experiences did not vary significantly over the last decade. Healthcare system quality was rated mainly poor or very poor; structure (74.09%), services (61.66%), and cost (60.89%). While 87.36% used government healthcare facilities, 85.00% paid out-of-pocket, and 72.60% of them were dissatisfied with the value for money. Despite a preference for government facilities (71.43%), respondents cited high costs (62.75%), poor funding (85.65%), inadequate staffing (90.73%), and lack of essential medicines (88.47%) as major challenges. The budget analysis reveals an average government healthcare fund allocation of $7.12 compared with an estimated expenditure of $82.75 per person annually. Nigeria allocates only an average of 0.37% of GDP and 4.61% of the national budget to healthcare, comprising a maximum of 13.56% of total health expenditure. This study emphasises the urgent need for policy reforms and implementations to improve Nigeria’s healthcare financing and service quality. Targeted interventions are essential to address systemic challenges and meet population needs while aligning with international health services and best standards.Item Informing transplant candidate and donor education in living kidney donation: mapping educational needs through a rapid review(BioMed Central, 2025-05-03) Truhan, Tayler E.; McMahon, James; Courtney, Aisling E.; Gill, Paul; Mansell, Holly; Noble, Helen; Reid, Joanne; Rosaasen, Nicola; Wood, Alison; McKeaveney, ClareObjectives: Living donor kidney transplantation (LDKT) is a complex medical procedure requiring extensive education for both donors and transplant candidates. With technological advances in healthcare, video educational resources are becoming more widely used. This study aimed to synthesize the existing qualitative evidence on LDKT educational experiences, preferences, and needs from the perspectives of kidney transplant candidates and recipients, donors, and HCPs, to establish the essential LDKT education considerations for candidates and potential donors interested in kidney transplantation. Methods: A rapid review of qualitative studies on LDKT educational needs was conducted. A literature search was undertaken across MEDLINE, Embase, and CINAHL databases from 2013 to 2023. Cochrane Rapid Reviews Methods Group guidance was utilized. Results: Of 1,802 references, 27 qualitative studies were eligible for inclusion. Qualitative data was analyzed from 803 transplant candidates/recipients, 512 living donors, 104 healthcare providers, and 102 family/friends. Three main themes were identified, including Extensive LDKT Education Throughout Treatment; Shared Learning, Social Support, and Family Dynamics in LDKT; and Diversity and Inclusivity for Minorities. Conclusions: Improvements and innovations are needed regarding LDKT education for kidney transplant candidates, donors, and support networks.Item Exploring the Impact of COVID-19 Vaccine Experiences and Safety-Related Reports on Vaccine Confidence among Nursing Students in Delta State College of Nursing Science Agbor, Nigeria(Nigerian Medical Association, 2025-04-01) Josiah, Blessing Osagumwendia; Shittu, Muhammad Baqir; Enebeli, Emmanuel Chukwunwike; Duncan, Brontie Albertha; Josiah, Chinelo Cleopatra; Martins, Oyinye Prosper; Emmanuel, Ifeanyi Mercy; Opeyemi, Fawole Israel; Alimele, Kelechi Eric; Akingbade, OluwadamilareBackground: Vaccine confidence is crucial for public health but remains a challenge in developing nations like Nigeria. This study explores vaccination confidence among nursing students at Delta State College of Nursing Science, Agbor. focusing on trends experiences with vaccines and potential impacts on future vaccination decisions. Methods: A cross-sectional survey of 279 nursing students at DSCNSA was conducted on vaccination experiences, exposure to and impact of safety-related information about COVID-19 vaccines. Results: Only 37.3% had received at least one dose of the COVID-19 vaccine, primarily Moderna and Pfizer, although 47.1% could not remember the brand. A total of 52.8% reported experiencing mild side effects, and one student reported having a seizure. Although many students expressed concerns about safety and efficacy, 91.7% showed a positive perception towards vaccination. Also, 93.6% of the 84.2% who are aware of COVID-19 safety/risk reports trusted the sources, 95.3% say it impacted their overall confidence in vaccines, and 55.1% are truly sceptical about future vaccinations. Vaccine perception shared association with history of COVID-19 vaccination (P = 0.0280). Females were more influenced by safety concerns while males were more likely to consider future vaccinations. Vaccine confidence also varied by religious affiliation, student year, and side effects experienced after COVID-19 vaccination, with those experiencing mild side effects showing a higher inclination to receive future vaccinations. Conclusion: This study indicates that Nigerian nursing students have mixed views on vaccines with concerns about safety and efficacy remaining prominent. Addressing these concerns through accurate information is essential to boosting vaccine confidence. © 2025, Nigerian Medical Association. All rights reserved.Item The context, mechanisms and outcomes of intergenerational programmes involving people living with dementia in Scotland: A realist, qualitative study(SAGE Publications, 2025-02-13) Emond, Heather; Kelly, FionaIntergenerational programmes, involving activity-based interventions designed to promote mutually beneficial interactions between participants, have been used in Scotland and further afield as a means of generating social inclusion between different age groups. There is growing interest in the potential outcomes of intergenerational programmes for people living with dementia in particular, with policy in Scotland recognising that people living with dementia and their carers may be at greater risk of loneliness and social isolation. Given this interest, there is a need to explore what ‘intergenerational best practice’ may look like for people living with dementia. Using data from semi-structured interviews with thirteen stakeholders involved in intergenerational practice and/or dementia policymaking, this study explored the contextual factors, mechanisms, and outcomes of intergenerational programmes in the Scottish context. Stakeholders perceived the concerns of carers, perceptions of risk, along with inaccessible venues and transportation to be important contextual factors. Mechanisms that helped ensure programmes offered full and appropriate participation opportunities included ongoing, flexible programme planning; the provision of purpose and roles; and the use of older participants’ preferences, lived experience, and personhood. Overall intergenerational programmes were perceived to have the potential to promote beneficial outcomes for older participants living with dementia in Scotland.