Person-centred Practice Framework Research Articles

Understanding of ‘person-centred care’ in an oncology ICU: Associative group analysis

PurposeTo describe how healthcare professionals, patients, and their significant others understand the concept of ‘person-centred care’ in an oncology ICU. MethodsThis study followed the associative group analysis (AGA) method, a quali-quantitative research approach.The population included healthcare professionals, their patients, and significant others in a four-bed oncology adult intensive care unit. Whole population sampling (n = 22) allowed all healthcare professionals to participate. Maximum variation purposive sampling was used to identify patients and their significant others (n = 22). Data were collected during either face-to-face or telephonic individual interviews. Free associations were weighted using a validated weighting system. Words with similar meanings were then grouped into themes. The themes were then deductively grouped according to the domains of the Person-centred Practice Framework. ResultsParticipants had a limited understanding of person-centred care and could only identify six of the 23 constructs of the Person-centred Practice Framework. Healthcare professionals embraced the idea of person-centred care, but their understanding of the concept remains vague. Person-centred care remains conceptual in this oncology intensive care unit because the interpretation and operationalisation of the concept are misaligned at various health service levels. ConclusionOrganisations should invest in work-based learning to enable staff to understand the concept of person-centred care. Healthcare workers also need to self-evaluate how they work and be able to adjust their working style to be more person-centred.

Clinical supervision, a reflective intervention to support new graduate nurses and midwives enhance their person-centredness: qualitative evaluation

Person-centred care is an international healthcare priority. Strategies are needed to support nurses and midwives to understand the meaning of person-centredness and support them to embed this philosophy into practice. Clinical supervision has been proposed as a strategy to support this but requires more evidence. The aim of this research was to evaluate a newly developed model of clinical supervision, underpinned by person-centred practice theory, to enhance the person-centred practices of new graduate nurses and midwives. Design: Qualitative study (embedded within a mixed methods study) using focus groups Methods: Group, online clinical supervision (named C.A.R.E.) underpinned by the Person-centred Practice Framework was provided to 103 new graduate nurses and midwives once per month for one hour, over six months. The researchers used [Braun, V., & Clarke, V. (2022). Thematic analysis; A practical guide. SAGE]. Thematic Analysis to analyse data. Results: Twenty one participated in the qualitative evaluation. Four themes were identified (1) Person-centredness in Action (person-centredness experienced and delivered by the new graduates) (2) Enhancing the Transitioning Toolkit (professional and personal growth as an outcome of reflection and learning together) (3) The Transitioning Environment (care environment and C.A.R.E. environment) and (4) Challenges to C.A.R.E. (team and organisation, and personal). Conclusion: This supportive safe space allowed new graduates to explore their and other’s practices, in relation to person-centred practice theory. Through sharing their experiences, they increased their knowledge and confidence to incorporate new learning into their own practice. This clinical supervision model underpinned by the Person-centred Practice Framework provides person-centred benefits to the new graduates, patients and families. However, without organisational support the benefits will not be realised.

Exploring undergraduate paramedic students’ understanding and experiences of person-centred care while on practice placement

Objective To explore paramedic students’ understanding and experience of the perceived facilitators and barriers to implementing person-centred care in urgent and emergency practice-based placement situations. Aim To explore paramedic students’ understanding of this concept and how it may be applied to clinical practice. Methods A non-probability convenience sample of participants was drawn from a second-year undergraduate Bachelor of Science (Hons) programme in Paramedic Science, at a United Kingdom university. The programme was underpinned by the Person-centred Practice Framework. Undergraduate paramedic students participated in face-to-face, audio-recorded, semi-structured interviews. A qualitative reflexive thematic analysis was then conducted to identify themes arising from the data. Results Ten participants were interviewed. Four key themes emerged from the data: (1) realising person-centred prerequisites which have two sub-themes – curriculum and reality of practice, (2) challenge of high-acuity calls, (3) developing a rapport with vulnerable people and, (4) factors in the macro environment. Conclusion Paramedic students witnessed moments of person-centred practice and were enabled to reflect on their learning experiences in positive ways, by working with paramedics/practice educators. However, their person-centred ideals were constantly challenged as students negotiated to work in complex, dynamic situations and in a health system under pressure.

The development and structural validity testing of the Person-centred Practice Inventory-Care (PCPI-C).

Person-centred healthcare focuses on placing the beliefs and values of service users at the centre of decision-making and creating the context for practitioners to do this effectively. Measuring the outcomes arising from person-centred practices is complex and challenging and often adopts multiple perspectives and approaches. Few measurement frameworks are grounded in an explicit person-centred theoretical framework. In the study reported in this paper, the aim was to develop a valid and reliable instrument to measure the experience of person-centred care by service users (patients)-The Person-centred Practice Inventory-Care (PCPI-C). Based on the 'person-centred processes' construct of an established Person-centred Practice Framework (PCPF), a service user instrument was developed to complement existing instruments informed by the same theoretical framework-the PCPF. An exploratory sequential mixed methods design was used to construct and test the instrument, working with international partners and service users in Scotland, Northern Ireland, Australia and Austria. A three-phase approach was adopted to the development and testing of the PCPI-C: Phase 1 -Item Selection: following an iterative process a list of 20 items were agreed upon by the research team for use in phase 2 of the project; Phase 2 -Instrument Development and Refinement: Development of the PCPI-C was undertaken through two stages. Stage 1 involved three sequential rounds of data collection using focus groups in Scotland, Australia and Northern Ireland; Stage 2 involved distributing the instrument to members of a global community of practice for person-centred practice for review and feedback, as well as refinement and translation through one: one interviews in Austria. Phase 3: Testing Structural Validity of the PCPI-C: A sample of 452 participants participated in this phase of the study. Service users participating in existing cancer research in the UK, Malta, Poland and Portugal, as well as care homes research in Austria completed the draft PCPI-C. Data were collected over a 14month period (January 2021-March 2022). Descriptive and measures of dispersion statistics were generated for all items to help inform subsequent analysis. Confirmatory factor analysis was conducted using maximum likelihood robust extraction testing of the 5-factor model of the PCPI-C. The testing of the PCPI-C resulted in a final 18 item instrument. The results demonstrate that the PCPI-C is a psychometrically sound instrument, supporting a five-factor model that examines the service user's perspective of what constitutes person-centred care. This new instrument is generic in nature and so can be used to evaluate how person-centredness is perceived by service users in different healthcare contexts and at different levels of an organisation. Thus, it brings a service user perspective to an organisation-wide evaluation framework.

Towards Automated Evaluation of Patient Centered Care-Assessing the Potential of Electronic Health Records.

Providing patient centered care is a crucial element of high quality care. It can be defined as a responsive way of caring for and empowering patients, embodying compassion, empathy, and responsiveness to the patient's needs. The aim of this study was to assess the potential of using EHRs as information source in the development of tools for assessing PCC. An annotation guide following the Person-centred Practice Framework proposed by McCance and McCormack was developed for the purpose of this study. Twenty patients' documents were manually annotated, resulting in 539 expressions. All dimensions of the framework were covered in the documents, with 61.3% of expressions describing the activity of engaging authentically with the patient. The results of this study indicate that electronic health records are one potential source of information in automated evaluation of patient centered care, however more information is still needed on how to interpret this information.

“They talk to you like you're a person”: Validating McCormack and McCance’s Person-Centred Practice Framework through a qualitative study of older people’s experiences of person-centred integrated care (PCIC).

This paper concerns the findings of a qualitative study exploring service user experiences of PCIC. Using McCormack and McCance’s Person-Centred Practice (PCP) Framework, with a focus on the process and outcome domains at the micro level, the research validates the utility of the framework in an integrated care context. Drawing on a case study methodology, thirty interviews were conducted with service users engaging with integrated care services across three sites within the National Integrated Care Programme for Older Persons in the Republic of Ireland. 
 The PCP framework is an internationally recognised theoretical framework that supports healthcare service providers and teams in understanding the dimensions of person-centredness and how these can be represented and realised in practice (Slater, McCance and McCormack, 2017). The PCP framework centralises the establishment of the therapeutic relationship between the service provider and the service user, including their families and carers and identifies person-centred processes and consequent outcomes. 
 In particular, this paper will focus on this micro level component, i.e. the outcome and process domains, of the framework. The findings of the study validate the outcome and process domains as key in service user experiences of PCIC. While the three sites differ in terms of the integrated care model applied, findings indicate that the processes of engagement; having a sympathetic presence; providing holistic care; engaging in shared decision making; and working with patient’s beliefs and values are evident; are all both experienced and valued by service users. In addition, across the three cases, service users identify the impact of their care as manifesting all four person-centred outcomes included in the framework: satisfaction with care; involvement with care; and feeling of well-being; and creating a therapeutic culture between service user and care professional.
 The findings also indicate key components pertinent to service user experiences of PCIC which may be considered as possible extensions to the framework’s stated outcomes. These include consideration on the felt experience of integration and coordination in terms of outcomes for the service user. While the framework includes the felt experience of feeling treated as an individual and being involved in care in outcome domains, the felt experience of coordination and integration could also be included. Findings of the study elucidate the importance of the biographical narrative and reveal how diversity of individuals’ personal and social resources and capacities impact on the differentiated nature of agency and its expression as part of the care experience. This agency of the older person, whether relating to their educational, economic or other capacities or their social network and ancillary informal social supports and care, will impact on how they engage with and participate in care processes and related care needs. Consideration of this key biographical information, in addition to individuals’ beliefs and values, will impact on how service providers can optimise supports provided and will inform processes around participation and shared decision making. The findings reveal how this framework can be successfully used and potentially extended as a meaningful evaluative tool to explore experiences of PCIC.

Developing a person-centred care environment aiming to enhance the autonomy of nursing home residents with physical impairments, a descriptive study

BackgroundEnhancing autonomy is important within the context of the care environment in nursing homes. A nursing home is a place for older adults with physical impairments, who need assistance, to live and where staff work who help them to exercise autonomy. Previous research shows that older adults and staff are influenced by the care environment to apply autonomy-enhancing activities. Therefore, organisational policies regarding the care environment seem promising for enhancing autonomy. The aim is to gain a deeper insight into the development and implementation of organisational policies aimed to enhance the autonomy of older adults with physical impairments.MethodsA qualitative descriptive design was chosen, using two methods. A document study was conducted on the policies, plans and proceedings in two care organisations. Moreover, interviews were conducted with 17 stakeholders involved in the policies, such as managers and members of the client council. The fragments of the 137 documents and 17 verbatim transcripts were coded and deductively categorised into the seven aspects (i.e., power-sharing, supportive organisational systems, appropriate skill mix, potential for innovation and risk-taking, the physical environment, effective staff relationships and shared decision-making systems) of the key domain care environment, as defined in the person-centred practice (PCP) framework developed by McCormack and McCance.ResultsThe aspect of power-sharing was used the most in the policies of the two participating organisations. The organisations expected much from the implementation of indirect interventions, such as access to the electronic care plan for residents and the development of staff towards self-managing teams. Less attention was paid to interventions in the physical environment, such as the interior of the building and privacy, and the collaboration processes between staff.ConclusionsThe PCP framework poses that all aspects of the key domain care environment are important to develop a person-centred practice. This is not yet the case in practice and the authors therefore recommend using all seven aspects of the care environment in a balanced combination with the other key domains of the PCP framework to achieve person-centred practice and as a result the enhancement of the autonomy of nursing home residents with physical impairments.

Fast-track and person-centred care in geriatric traumatology in a German-speaking Swiss hospital – A practice development project

IntroductionElderly persons have an increased risk for negative health-related outcomes, including higher mortality rates. A centre for geriatric traumatology was established in a German-speaking Swiss hospital to provide more specialised, person-centred care and to lower negative health outcomes. Adaptations and changes in the patient pathway were made by implementing fast-track and person-centred care to better address individual needs. MethodsThe current patient pathway was analysed by an interprofessional and interdisciplinary geriatric traumatology expert team. The practice development methodology and the Person-Centred Practice Framework (PCP-Framework) were used throughout this engagement process. In consensus within the expert team, the sample was defined as elderly persons aged 65 years or older with suspected hip joint closed fractures. The focus was on three elements of “practice environment” from the PCP-Framework. These were: (1) supportive organisational systems; (2) the physical environment; (3) appropriate skill mix. ResultsSeveral adaptations and changes were made addressing the three elements of “practice environment”. These were for example: (1) use of specific assessments, shared decision-making; (2) proper and effective use of aids; (3) integration of Advanced Practice Nurses. The adaptations in the patient pathway were integrated into the standard operating procedures. ConclusionsThrough active engagement with the practice development methodology and the focus on person-centredness, the process of care for elderly persons was adapted. Thus, by addressing individual needs, fast-track and person-centred care in geriatric traumatology is provided. Further research is needed to evaluate and to verify implications in clinical practice.

Into a place where thoughts can bloom: a reflection on how raising awareness of our multiple intelligences can support learning and growth

A prerequisite of the Person-centred Practice Framework is ‘knowing self’ (McCance and McCormack, 2021). ‘Knowing self’ includes being aware of our own values and beliefs, and is essential for authentic facilitation. Active learning supports the development of this awareness as it can enable a deeper understanding of our perceptions, emotions, values and beliefs (Dewing and Lynch, 2021). According to those authors, the methodology of active learning has six principles, one of which is: ‘In-depth drawing on the primary senses (including seeing, noticing and observing), and multiple social intelligences’ (2021, p 270). I first became aware of the concept of multiple intelligences a year ago and this article will focus first on what multiple intelligences are and why they are useful to consider. Following this, I will share how I am discovering which of the intelligences I favour and how I can use them to develop knowledge. Finally, I will consider what changes I have made so far.

The four domains of the person-centred practice framework from the perspective of critical care nurses in intensive care units during a pandemic

ObjectivesThe aim was to describe the Person-Centred Practice Framework's four domains (prerequisites, care environment, person-centred processes, and person-centred outcomes) through the perspectives of critical care nurses working in intensive care units during the second year of the COVID-19 pandemic. Furthermore, the aim was to investigate the relationships between prerequisites, care environment, person-centred processes, and person-centred outcomes. Design/methodsA cross-sectional study involving questionnaires. Prerequisites were measured using person-related conditions, the care environment by using the Person-Centred Climate Questionnaire–Staff version, the person-centred processes by using the Person-Centred Care Assessment Tool and person-centred outcomes were measured with one question about present health and well-being and by using Self-rated Exhaustion Disorder. Descriptive and analytic statistics were used. Data was collected from July 2021 to November 2021. SettingCritical care nurses (n = 217) working in 15 Swedish adult intensive care units. ResultsParticipants’ average length of experience in intensive care units was 14 years, and most participants experienced increased nursing care responsibilities. They perceived the climate as safe but had limitations in terms of its everydayness and community. Participants perceived the organisations both supported and hindered personalized care. Most participants experienced a variety of exhaustion symptoms, and their health had positive relationship with community. ConclusionBy showing how prerequisites, care environment, person-centred process influences critical care nurses’ health and well-being, organisations might identify aspects in the work environment that require targeted interventions to reach healthy workplaces. Implications for clinical practiceTo preserve the health and well-being of critical care nurses and to flourish as humans in their professional roles, they need to interact with and form relationships with their colleagues, patients, and relatives. Organisations should have a person-centred approach for every individual in the workforce to harness each critical care nurses’ knowledge and skills for individuals to growth in their roles.

German translation, cultural adaptation and validation of the Person-Centred Practice Inventory—Staff (PCPI-S)

BackgroundThe person-centred practice framework represents the cornerstone of a middle-range theory. Internationally, person-centredness has become an increasingly common topic. The measurement of the existence of a person-centred culture is complex and subtle. The Person-Centred Practice Inventory—Staff (PCPI-S) measures clinicians’ experience of a person-centred culture in their practice. The PCPI-S was developed in English. Therefore, the aims of this study were (1) to translate the PCPI-S into German and to cross-culturally adapt and test in the acute care setting (PCPI-S aG Swiss) and (2) to investigate the psychometric properties of the PCPI-S aG Swiss.MethodsThe two-phase investigation of this cross-sectional observational study followed the guidelines and principles of good practice for the process of translation and cross-cultural adaptation of self-reporting measures. Phase 1 involved an eight-step translation and cultural adaptation of the PCPI-S testing in an acute care setting. In Phase 2, psychometric retesting and statistical analysis based on a quantitative cross-sectional survey were undertaken. To evaluate the construct validity, a confirmatory factor analysis was implemented. Cronbach’s alpha was used to determine the internal consistency.ResultsA sample of 711 nurses working in a Swiss acute care setting participated in testing the PCPI-S aG Swiss. Confirmatory factor analysis indicated a good overall model fit, validating the strong theoretical framework, which underpins the PCPI-S aG Swiss. Cronbach’s alpha scores demonstrated excellent internal consistency.ConclusionThe chosen procedure ensured cultural adaptation to the German-speaking part of Switzerland. The psychometric results were good to excellent and comparable with other translations of the instrument.

Translation and transcultural adaptation of the theoretical Person-Centred Practice Framework to the Spanish context

Person-centered care has become a key global approach that seeks to provide answers to all factors of the complex health care-related processes. This has led to the development of theoretical frameworks that represent the components of person-centered care. The internationally recognized Person-Centred Practice Framework (PCPF) (McCormack and McCance) allows multidisciplinary teams to understand and operationalize the dimensions for the development of person-centered care. The aim of this study was to obtain the first Spanish version of the PCPF translated and adapted to the Spanish context. We translated the PCPF following the Translation and cultural adaptation process for Patient-Reported Outcomes (PRO) Measures guidelines. A consulting session with experts was part of the process and content validation on clarity and relevance for each domain was performed. We encountered no significant difficulties to reach agreements on most of the terms except for Having a sympathetic presence. Not only was a complex term to translate but also to trans-culturally adapt. Regarding relevance and clarity, the content index by construct (I-CVI) and the global framework (S-CVI/Ave) were consistent with their original counterparts (>0.90). The adapted Spanish version is clear, significant, and conceptually equivalent to the original PCPF. It will allow a better comprehension of the person-centered practice framework in the Spanish context and facilitate the implementation of this approach in clinical practices.

Development of a framework for person-centred physiotherapy

Background There is a growing call for healthcare to focus on person-centred practice. This can lead to improved outcomes for patients in terms of physical and psychological health. Challenges exist around how person-centredness is understood in physiotherapy. Having a physiotherapy framework would help support a shared understanding of the meaning of person-centred physiotherapy. Aim The aim of this study was to locate and synthesise studies which have a conceptualisation of person-centred physiotherapy practice. These were used to develop an overarching conceptual framework for person-centred physiotherapy practice. Methods The framework was developed through a systematic process involving a systematic literature search, screening studies against eligibility criteria, data extraction, data synthesis, naming and defining core constructs of person-centred physiotherapy practice, and generation of a pictorial representation of an overarching conceptual framework. Results The person-centred physiotherapy framework is comprised of four constructs: physiotherapist characteristics, which focuses on the knowledge and skills for clinical proficiency, attributes of the physiotherapist, reflection and self-awareness; person-physiotherapist interaction(s), which focuses on partnership, empowerment and self-management; the environment, which focuses on coordinated healthcare delivery, culture of the organisation and practice environment, and the physical environment; and the ongoing unique journey of the person and self-management. The relationships between the constructs reflect the complex nature of person-centred practice. Conclusions The framework presented can be used to better understand person-centred physiotherapy with a view to enhancing practice. The framework needs to be tested further through empirical research to establish its utility.

Person-Centered Practice in Hospitalized Older Adults with Chronic Illness: Clinical Study Protocol.

The aging trend in the population, the high rate of hospitalization, the affliction by multiple chronic illnesses, and the increased vulnerability of older people when hospitalized undoubtedly require a person-centered approach to healthcare—an approach that values a person’s participation in the healthcare relationship, supports shared decision making and mutual understanding, and respects a person’s values, preferences, and beliefs. However, despite widespread recognition that the adoption of such a clinical practice paradigm is paramount, its implementation and development are still challenging for various health systems and professionals worldwide. The implementation strategy for such a healthcare paradigm must be based on each country’s health system organization and practice contexts, as well as the professionals involved. The present work aims to provide guidelines for the understanding of the state of development of person-centered practice in the daily care of hospitalized older adults with chronic illnesses within the internal medicine department of a secondary hospital in an urban area of Portugal. We focus on the characterization of (i) the perceptions of a multidisciplinary team working at an inpatient hospital department of person-centered practice, (ii) the perceptions of hospitalized older adults with chronic illnesses about person-centered practice, (iii) the work culture of an inpatient hospital department with a high prevalence of older adults with chronic illnesses, (iv) the Person-Centred Practice Framework at the organizational and structural levels of the healthcare system, and (v) the elements that influence the implementation of person-centered practice at the individual, organizational, and structural levels in this specific hospital context. To this end, a mixed-methods analysis with a convergent design was planned to use questionnaire instruments to collect data in parallel and independently from distinct samples of health professionals and older inpatient adults within this department. Furthermore, health policies and strategic plans will be analyzed to identify and evaluate references and guidelines for the practice of person-centered care. Studying the dimensions of clinical practice in this specific healthcare context following the Person-Centred Practice Framework can allow us to understand the extent of its development in terms of prerequisites, care environment, care processes, and the macro-context of the healthcare system. Therefore, it is possible to identify and characterize the dimensions achieved and those that need to be improved and, thus, establish a starting point for the definition of new strategies to advance practice towards person-centeredness and monitor changes in healthcare practice.

Qualitatively exploring the attributes of adaptability and resilience amongst recently graduated nurses

AimTo explore newly graduated nurse’s understandings and practices of adaptability and resilience in clinical environments. BackgroundThe everyday practice of nursing work involves managing emotional and practical everyday demands related to the role. Adaptability and resilience are two critical attributes that equip nurses for this by enabling them to manage challenges and be flexible with their practices and expectations in the face of rapidly changing and unpredictable circumstances. DesignInformed by the theoretical underpinnings of the Person-centred Practice Framework, semi-structured interviews using topic guides were conducted with nine newly graduated registered nurse participants recruited through purposive sampling. Interviews occurred between March-October 2020 with participants working across seven different healthcare settings in three Local Health Districts in NSW, Australia. ResultsAnalysis of the data generated the core themes of: 1) ‘Making sense’ explored how nurses defined resilience and adaptability; 2) ‘Surviving as the nurse’ focused on how nurses experienced adaptability and resilience as a newly qualified nurse; 3) ‘Trusting oneself’ reflected the interconnection of nurses’ developed adaptability and resilience to their clinical self-assurance; and 4) ‘Doing it again’ described how adaptability and resilience can be further supported by the university sector. Findings demonstrated that adaptability and resilience in combination are essential attributes and required for effective nursing practice post-graduation. However, both collegial and organizational support were found to be lacking in positively reinforcing these attributes in this study. ConclusionNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways. Tweetable abstractNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.

Factors associated with older persons’ perceptions of dignity and well-being over a three-year period. A retrospective national study in residential care facilities

BackgroundDignity and well-being are central concepts in the care of older people, 65 years and older, worldwide. The person-centred practice framework identifies dignity and well-being as person-centred outcomes. Older persons living in residential care facilities, residents, have described that they sometimes lack a sense of dignity and well-being, and there is a need to understand which modifiable factors to target to improve this. The aim of this study was to examine the associations between perceptions of dignity and well-being and the independent variables of the attitudes of staff, the indoor-outdoor-mealtime environments, and individual factors for residents over a three-year period.MethodsA national retrospective longitudinal mixed cohort study was conducted in all residential care facilities within 290 municipalities in Sweden. All residents aged 65 years and older in 2016, 2017 and 2018 were invited to responded to a survey; including questions regarding self-rated health and mobility, the attitudes of staff, the indoor-outdoor-mealtime environments, safety, and social activities. Data regarding age, sex and diagnosed dementia/prescribed medication for dementia were collected from two national databases. Descriptive statistics and ordinal logistic regression models were used to analyse the data.ResultsA total of 13 763 (2016), 13 251 (2017) and 12 620 (2018) residents answered the survey. Most of them (69%) were women and the median age was 88 years. The odds for satisfaction with dignity did not differ over the three-year period, but the odds for satisfaction with well-being decreased over time. Residents who rated their health as good, who were not diagnosed with dementia/had no prescribed medication for dementia, who had not experienced disrespectful attitudes of staff and who found the indoor-outdoor-mealtime environments to be pleasant had higher odds of being satisfied with aspects of dignity and well-being over the three-year period.ConclusionsThe person-centred practice framework, which targets the attitudes of staff and the care environment, can be used as a theoretical framework when designing improvement strategies to promote dignity and well-being. Registered nurses, due to their core competencies, focusing on person-centred care and quality improvement work, should be given an active role as facilitators in such improvement strategies.

Achieving congruence in 'being and doing' community nursing.

Conceptual and theoretical frameworks for person-centred community nursing practices have not yet been fully developed. There is a need to explore this further in order to guide future district nursing, which forms part of the community nursing discipline in the UK. The contemporary district nursing role is undergoing change, although there appears to be little consensus about the district nurse's (DN) vision across the UK, and little indication of the theoretical position underpinning this change. Meeting strategic requirements (National Health Service (NHS), 2019; Scottish Government (SG), 2017a&b), DNs have advancing clinical expertise and are recognised for their technical skills. However, one may contend that this emphasis on 'doing' in practice contributes to practice decisions made exclusively on task performance by strategic decision-makers, and DNs continually viewing themselves as invisible (National Assembly for Wales,, 2019; Queens Nursing Institute (QNI), 2006; Dickson 2018; 2020). District nursing education may contribute to this lack of clarity as curricula are based on borrowed theory from other disciplines that continue to focus on 'how to do', with little emphasis on 'how to be' a DN, and the continued decrease in DN numbers across the UK may be a consequence. In this paper, I explore current evidence that underpins district nursing practice, education and research in the UK, and advocate the use of the Person-centred Practice Framework (PCPF) (McCormack and McCance, 2017) as a means of unifying and guiding 'being a person-centred DN.' This will enable practitioners who can draw on multiple forms of evidence to inform their advancing practice. This article offers philosophical and pedagogical principles to underpin person-centred education going forward. I argue this will promote congruence between 'doing' and 'being' a DN, giving a voice to DNs, and direction to their specialism.

Relationships, roles and person-centred practices – collaborative birthing care in Nova Scotia

Background: Collaboration is an important factor in creating and maintaining safe and effective spaces in perinatal healthcare. Family-centred care has been used by perinatal nurses to provide care that focuses on the family. Woman-centred care is defining for midwifery, and centres care around women’s expert knowledge and decision making. Person-centred care extends these approaches to include all persons involved in healthcare. The ongoing integration of midwives into existing perinatal healthcare teams in Canada has created new opportunities for collaboration. Understanding how midwives and nurses collaborate can offer insights into how collaboration is influenced by different approaches. Aim: The aim of this study was to understand how midwives and nurses collaborate in Nova Scotia, Canada. Methods: Feminist poststructuralism guided this case study. The data collected included 17 individual participant interviews, document review and field notes. Feminist poststructuralist discourse analysis was used to analyse the data. Results: The two main themes discussed in this article were negotiating roles and practices, and sustaining relationships. In the first theme, participants talked about how they negotiated their roles, how their skills and practices crossed over and the importance of communication and anticipation. In the second theme, participants described how they test trust, the ways in which midwives depend on nurses, and a need for more opportunities to work, learn and socialise together. Conclusion: The relationships between midwives and nurses in Nova Scotia support their collaboration and contributions to ensuring their workplaces are safe and effective. The participants described intuitive engagement with person-centredness. Implications for practice: The Person-centred Practice Framework should be used to facilitate collaboration in perinatal healthcare Individual, institutional and systemic commitments to intentional engagement with practice development are needed to support healthful cultures in perinatal healthcare Research is needed to explore how family-centred and woman-centred care approaches may support person-centred practices and cultures

Healthcare provider person-centred practice: relationships between prerequisites, care environment and care processes using structural equation modelling

BackgroundThe translation of person-centred care concepts into practice requires fulfilment of necessary components, including person-centred values and practice held by the employees and having a supportive system. The objectives of this study were multifold: firstly, to evaluate the measurement model, secondly, to examine the roles of prerequisite or attributes of healthcare providers and care environment and how they affect delivery of person-centred processes; and finally, to examine the mediating effect of care environment towards the relationship between prerequisite and care processes.MethodsA cross sectional study was conducted among healthcare providers working in primary care facilities in a state in Malaysia. The Person-centred Practice Inventory-Staff instrument (PCPI-S) was distributed and completed by respondents. The instrument structure, reliability and validity were assessed through confirmatory factor analysis, while the framework’s unidirectional hypothesis and the mediation path hypothesis were analysed using structural equation modelling.ResultsThe overall goodness of fit verifies the original Person-centred Practice Framework, allowing some correlation errors. There were significant relationships between prerequisites of healthcare providers and care environment (β = 0.826, p < 0.001), as well as between care environment and care processes (β = 0.785, p < 0.001). This analysis also proved that care environment plays a partial mediating role in the relationship between prerequisites and care processes.ConclusionsIn order to successfully move towards delivering person-centred practice, it is imperative to equip healthcare providers with person-centred values and beliefs, while at the same time transform current work culture to align with person-centred care. This will allow successful delivery of person-centred processes.Trial registrationNMRR-18-309-40,447.

Factors Associated with Older Peoples′ Perceptions of Dignity and Well-being at Residential Care Facilities.

Dignity and well-being should be promoted in care of older people living at residential care facilities (RCFs). In addition, care should be person-centred. Dignity and well-being can be interpreted as person-centred outcomes. Older people living at RCFs experience a lack of dignity and well-being. To promote this, it is important to understand the associated factors to target. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to attitudes of staff, the care environment and individual issues (age, gender, self-rated health and dementia) among older people living at RCFs. A national cross-sectional study was conducted retrospectively. All older people 65 years and older (n=71,696) living at RCFs in 2018 were invited to respond to the survey. The survey included the areas: self-rated health, indoor-outdoor-mealtime environment, performance of care, treatment from staff, safety, social activities, availability of staff and care in its entirety. Age, gender and diagnosed dementia were collected from two national databases. Data was analysed using ordinal logistic regression models. The result indicated that respondents who had experienced disrespectful treatment, who did not thrive in the indoor-outdoor-mealtime environment, who rated their health as poor and respondents with dementia had higher odds of being dissatisfied with dignity and well-being. There is a need to improve the prerequisites of staff regarding respectful attitudes and to improve the care environment. The Person-centred Practice framework, targeting the prerequisites of staff and the care environment, can be used as a theoretical framework for designing future improvements.