School of Health Sciences

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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, Duncan
This 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.
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, Kelly
Background: 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.
MU-BEING: MUSIC THERAPY WITH YOUNG PEOPLE FROM MULTICULTURAL BACKGROUNDS IN SOUTH KOREA
(Queen Margaret University, Edinburgh, 2025-05) Oh, Joon
This study began with reflective questions regarding the fundamental meaning of music therapy in a multicultural context. The purpose of this study is to explore how music therapy can support the well-being of young people from multicultural backgrounds, how young people and their communities experience music therapy, and what role the therapist’s beliefs, values, and attitudes play in the process. Five young people participated in ‘Mu-Being,’ a music therapy programme developed from the values of Person-Centred Practice and an understanding of the unique contexts of young people and their community. A multimethod based on a multi-paradigmatic approach, consistent with the project’s motivating values and ideas evolved: it included measuring multidimensional well-being, interpretive phenomenological process guided by lifeworld existentials, and arts-based work. The improvement in the social aspects of well-being highlights the role of music therapy practice in challenging and unprecedented contexts. Young people’s music, histories, and the ways in which they participated played a key role in collaboratively developing the conditions for flourishing. Mu-Being facilitated a safe, creative space for young people to experiment and integrate their identities and needs, a transcendent time to cross various existential boundaries, and transformative relationships through shared musical experiences with the local community. Reflective music composition as a way of knowing demonstrated the potential of music to explore aspects of experience that are difficult to identify through numbers and text. The project places music therapy practice at the intersection of well-being theory, personcentred practice framework, and arts-based inquiry, and its transdisciplinary nature fosters multifaceted discussions and resources that can contribute to the development of programmes encompassing the authentic voices of young people and their context; offers an understanding of how person-centredness can be realised in practice; demonstrates how data from various sources can be used together to explore music therapy experiences and their impact.
Sharing decision‐making between the older person and the nurse: A scoping review
(2022-10-09) Marriott-Statham, Kelly; Dickson, Caroline; Hardiman, Michele
Abstract: 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.
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 Ahmad
In 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.