Nursing

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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, Brendan
Introduction: 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.
Reaching for the rainbow: Person-centred practice in palliative care
(Foundation of Nursing Studies, 2020-05-13) Haraldsdottir, Erna; Donaldson, Kim; Lloyd, Anna; Barclay, Irene; McCormack, Brendan
Background: Person-centred practice is inherently integrated in palliative care. However, it cannot be assumed that its underpinning values are lived out in day-to-day practice in a hospice. At St Columba’s Hospice, Edinburgh, the five-year strategy demonstrated commitment to person-centredness and this prompted an 18-month project focusing on the evaluation and development of a person-centred culture, taking a practice development approach.
Mind the gap: Patients’ experiences and perceptions of goal setting in palliative care
(Taylor & Francis, 2019-10-13) Boa, Sally; Duncan, Edward; Haraldsdottir, Erna; Wyke, Sally
Background: Palliative care aims to support people to live as actively as possible until death. A rehabilitative approach which includes goal setting could be an important way of achieving this. Goal setting is well established in best practice guidelines for palliative care. However little is known about how the process of goal setting actually happens in practice, especially from patients’ points of view. We aimed to investigate patients’ expectations, experience and perceptions of goal setting in one hospice.
‘It’s a nice place, a nice place to be’. The story of a practice development programme to further develop person-centred cultures in palliative and end-of-life care
(Foundation of Nursing Studies (FoNS), 2018-05-16) Dickson, Caroline; Smith, Tracy; Ford, Hilary; Ludwig, Steffi; Moyes, Rhona; Lee, Laura; Adam, Elaine; Paton, Tracy; Lydon, Brigid; Spiller, Juliet; McCormack, Brendan
Background Palliative and end of life care services need to be person-centred. However, it cannot be assumed that such services are ‘naturally’ person-centred as in reality they face the same pressures and challenges as any other service. This is the case in the practice development research reported in this paper. Whilst the service had good patient and family feedback/satisfaction, the context of care provision for staff did not reflect these same levels of satisfaction. This contrast poses challenges for organisations in the context of staff well-being and the sustainability of person-centred care. The work undertaken in this project aimed to address this issue. Aim To implement a programme of practice development to further the development of a culture of person-centred practice in the Marie Curie Care (MCC) Edinburgh Hospice. Methods The programme was theoretically informed by The Person Centred Practice Framework of McCormack and McCance (2017) and operationalised through the methodology of Transformational Practice Development. Thirteen multidisciplinary team members formed a project group and participated in 10 x 4 hour workshops of learning and development, spread over a 12-month period. Practice development activities were planned in-between the workshops to be undertaken by the group members. Evaluation data were collected prior to the practice development work commencing, as a continuous process throughout the 12-months and at the end of the project period. Data collected included patient and staff stories, practice observations, creative expressions and routinely collected data. These data were analysed through a participatory approach with the group members and theorised through the lens of human flourishing. Findings The findings are located within a framework for exploring the conditions for human flourishing. They illustrate the tension between person-centred care and person-centred cultures. Key findings demonstrate the need for all persons to be ‘known’ in order for effective person-centred relationships to exist, the significance of shared values, the importance of addressing ‘small’ practice changes as well as the need to ensure the hearing of different voices. Findings fromn routine collected data further demonstrate the relationship between the development of a person-centred culture with patient and staff outcomes. Conclusions and Implications for Practice This project is one of the first to explicitly use a framework for human flourishing to analyse the relationship between person-centred culture and care provision. The programme demonstrates the importance of person-centred cultures for sustainable person-centred care. Implications for practice include: 1. Practice settings need to be clear about the difference between patient and person-centredness. 2. The engagement of a multidisciplinary team in interdiscioplinary systematic transformational practice development has the potential to transform the culture and context of care and produce sustaiunable outcomes. 3. Human flourishing is an appropriate focus to adopt in exploring how practice settings embrace the principles of person-vcentredness for all persons.

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