Nursing students’ experience of learning ethical competence and person-centred care through simulation

Background: Ethics is a difficult subject for nursing students to grasp and learn but, like person-centredness, it has an important role in the relationship between nurses and patients. Simulation has been found to be a suitable method for learning nursing procedures and actions, and the researchers wanted to explore whether it could be a suitable learning strategy for acquiring ethical skills, which are a prerequisite for delivering person-centred care. Aim: In response to the research question How can nursing students develop ethical competence through simulation? the study sought to consider how students could learn ethical reflection and decision making through simulated ethical dilemmas, and whether this could enhance their ability to deliver person-centred care. Design: The study was qualitative and exploratory, and based on students acting in scenarios representing general ethical dilemmas in nursing. There were four focus group interviews with nine nursing students in their second year, during their clinical practice. Students were recruited by self-selection. Data were transcribed and analysed using Graneheim and Lundman’s content analysis. Findings: The students gained experience through participation and acting in simulation exercises. The shared experience was a good starting point for guided reflection on ethical and tacit knowledge, and the acquired experience led to knowledge that is transferable to similar situations in clinical practice. Conclusion: This study shows that simulation is a valuable method for learning ethical reflection in nursing education. It found simulation to be suitable for developing ethical awareness that helps prepare nursing students to deliver person-centred practice. It has become a permanent learning strategy within nursing training at Nord University. Implications for practice: • Nursing students benefit from learning to practise critical ethical thinking as early as possible in order to become ethically aware and reflective during their training and later as nurses • Simulation is a valuable way to practise personal relationships with patients and colleagues • Simulated clinical scenarios improve competence in critical thinking and ethical conduct, and help prepare nurses to deliver person-centred practice. They can be used in all healthcare settings.

Editorial: The power of collaboration

Since Covid-19 appeared almost two years ago, strategic leaders and academics have offered their wisdom to leaders ‘in the field’ in terms of what worked for them during previous crises. Learning from others’ experiences may be helpful, but the unprecedented nature of the context in which we are living and working has called for innovation, creativity and collaboration, to ‘work things out’. A theme of positivity runs through literature, encouraging leaders to foster hope through being available, listening, responding and showing compassion at a time when there seemed little reason to be positive. Over the difficult period of the pandemic, though, there have been so many stories of close collaborations, person-centred ways of being, helpfulness and kindness, and collaboration is a central theme in this issue of the IPDJ. Over recent months, we have reviewed and refined the aim and scope of the journal, alongside our key stakeholders at the Foundation of Nursing Studies, the International Practice Development Collaborative (IPDC) and the Person-centred Practice International Community of Practice (PCP-ICoP).

Exploring work engagement in the context of person-centred practices: a qualitative study in municipal long-term care facilities for older people

Background: To provide high-quality and cost-effective person-centred care, organisations need employees who are committed to perform at their best. Employee work engagement, defined as a positive, fulfilling approach to work, is known to correlate favourably with employee wellbeing and performance and with the service climate. Extended understanding about the meaning of work engagement can promote the development of environments that are both conducive to person-centred practices and good places to work. Aim: To explore the meaning of work engagement in the context of person-centred practices in municipal healthcare facilities for older people. Methods: A total of 16 individual interviews were conducted with a purposive sample of registered nurses and nursing assistants working in municipal healthcare facilities for older people in Norway. Data were analysed using a stepwise-deductive-inductive approach. Findings were generated inductively from the themes that emerged in the interviews and were later reflected on in relation to both theory and practice. Findings: Work engagement is manifest at individual and collective levels, involving intrapersonal, interpersonal and social/group components. Engagement is experienced as contributing to employee work capacity and team effectiveness with respect to person-centred processes. Conclusion: At individual, collective and environmental levels, employee engagement facilitates the development of person-centred practices in organisations providing long-term care for older people, to the benefit of residents and staff. Implications for practice: • Work engagement should be recognised as a condition that fosters employees’ ability and willingness to suspend judgment and appreciate the service user’s perspective • Individual-level engagement is contagious, facilitating development of supportive work environments, which, in turn, enables person-centred practices • Engagement should be approached simultaneously as an intrapersonal, interpersonal, and social/group process, with individual- and group-level outcomes

Development and evaluation of a new model for person-centred goal setting using practice development and appreciative inquiry approaches in a rehabilitation unit

Background: This article explores the use of a mixed-methods participatory approach to bring about transformative change to goal setting in an 18-bed, subacute rehabilitation unit in New South Wales. Aim: To use a blended approach underpinned by practice development and appreciative inquiry approaches, to develop and evaluate a model of person-centred goal setting for rehabilitation clients. Methods: Evaluative methods were co-designed and co-agreed by members of the rehabilitation team, based on what the team hoped to achieve in terms of establishing goals for clients in their care and what this meant to clients and each other. Data sources included team discussions, semi-structured interviews with individual team members and clients, a survey and stories using emotional touchpoints. Interpretation of the data involved content analysis for generation of themes and the use of Statistical Package for Social Science software for analysis of the survey. Results: Nine themes emerged. Clients highlighted: barriers to goal achievement; incorporation of goals into daily care; goal achievement; and a sense of purpose. The rehabilitation team highlighted: becoming person-centred; their role in goal setting; and barriers to establishing goals. The survey responses showed the team used person-centred approaches to achieve person-centred goals. Conclusion: Changes to goal setting allowed staff to feel person-centred in their care delivery and gave them the satisfaction of knowing they were doing something meaningful for those in their care. There was strong agreement that a unified team approach to goal setting was key to client satisfaction and achievement of the goals. Clients felt valued and included in making decisions surrounding their care. Implications for practice: • Using the practice development principle of developing collaborative partnerships among healthcare teams leads to greater involvement of clients in their care • Involving clients in goal setting leads to greater success and improved client satisfaction • Appreciative inquiry and practice development approaches are effective in developing partnerships between team members • Staff who treat clients with dignity and respect improve participation in goal setting by the clients • Creating a space in which the emotional needs of clients can be heard and acted on is crucial for success in goal achievement • Appreciative inquiry generates a greater appreciation and understanding of how to deliver person-centred care

PLATO: a practice development approach to reconsidering student learning partnerships

Background: This article explores the use of a practice development approach to support nursing students’ engagement in learning partnerships in clinical practice settings. Aim: To reflect, using the model proposed by Rolfe and colleagues (2001), on the development of ‘PLATO’ – an educational tool to help nursing students explore their role in building learning partnerships in clinical settings. Conclusion: A practice development approach to clinical learning partnerships can support an effective learning culture. As a result, nursing students can gain greater empowerment and take increased responsibility for their learning. Implications for practice: • Facilitating learning partnerships with students is important for achieving person-centred care • Partnership working provides opportunities for true collaboration and for learning with and from our students • Developing collaborative spaces can facilitate nursing students to reflect in and on their practice

Creating healthful cultures through Critical Creativity

During Covid lockdown in 2021, I was invited to offer a masterclass to masters students at Queen Margaret University, Edinburgh: ‘In the leadership module we have a masterclass, groupwork, study time and a plenary that ties together. We even have a book club!!! The aim is to be generic, not nursing/health focused. The learners make space to consider application in their own areas/specialisms. ‘We were wondering if you would like to/could do a masterclass within the strand of healthfulness. We really value your storytelling and know you are really passionate about healthfulness from an ecological perspective. We would love it if you could draw on your experiences of politics, environment... The more creative the better. ‘We would want learners to consider their role in creating healthful cultures and ways that they might go about it.’ How could I resist, given my decades-long passion for transformational practice development and inquiry within a critical creativity landscape in health and social care? In my retirement, I have continued to work successfully in this way in a variety of contexts, including political activism. I responded: ‘I would love to show how healthful cultures can be created, with stories from my person-centred community engagement work in creating a neighbourhood plan [for 21st century local housing development] and campaigning for positive personal and community political responses to the climate and ecological emergency. Stories that show up something of how conditions can be created to enable the ecology of human flourishing to be embodied in action. Also, how I am seeing the stirrings of transformative change in local politics that have previously been very traditional in the way they work with people.’ This article is based on that webinar, because students not only enjoyed it, but we heard that some were also able to transfer the learning to their different professional contexts. Therefore, for this paper, I repurposed and elaborated the material for a wider audience. Health and social care services are increasingly offered in new ways in the community and I imagine more health and social care professionals will be setting up innovative ways of working. I hope, therefore, that sharing my experience of creating cultures where everyone flourishes by doing things differently, as well as critically and creatively with the whole self, will be helpful. I will share four stories of how I do that in a variety of contexts and show you, through images and metaphors, how I have gone about that, first in health and social care but primarily for now in political and campaigning contexts. Through the stories, I will show you what it takes as a person to create healthful cultures. Woven through the article is an introduction to critical creativity and its three mandalas. They are there for you to look at with soft eyes/letting the words wash over you – without digging into meaning at this point. My hope is that you begin to get a sense of where the mandalas fit into the stories and, if you so choose, into your own stories and practice. The parts of the mandalas are italicised in the text as they are mentioned.

Facilitating person-centred leadership support during the Covid-19 crisis

Background: The Covid-19 crisis has created new and difficult working conditions for all frontline healthcare staff and leaders. Ward managers in particular have faced significant challenges. The practice development initiative described in this article began at a hospital in Denmark immediately after the country’s first Covid-19 wave. The hospital has person-centredness as its vision for care and research. Aim: The purpose of this article is to offer a reflection on the ways in which our research and its findings enabled us to learn from the experiences of ward managers so as to support them and strengthen their network during a difficult time, using principles of practice development. Conclusion and implications for practice: The evidence produced in the project was found to be relevant to leadership practice by the ward managers and led to a strengthened position at a time of crisis. This implies that: • It is possible to establish collaborative and useful evidence for clinical practice under difficult circumstances • By using principles of practice development it is possible to facilitate constructive dialogues between ward managers and executive managers • At a time of a major crisis, the role of ward managers should not be underestimated

Enabling nursing students to have a voice in designing a learning resource to support their participation in a clinical placement

Background: There appears to be a gap in the literature with regard to nursing students’ participation in designing learning resources to prepare them for the reality of clinical placements. In addition, the existing research on preparation focuses on skills competency and overlooks the emotional preparation required to navigate the practice context, while preparation of early-year students is not prioritised. Aim: This study had two aims: to provide nursing students with processes and tools to give them a voice in the development of learning resources to prepare for clinical placement; and to address some of the power imbalances between nursing students and clinical supervisors. Methods: This action research study was undertaken collaboratively with students and academic staff as co-researchers and was underpinned by the theoretical perspectives of transformational learning and person-centredness. It used a range of creative methods, such as workshops, critical creativity and critical dialogue. Conclusion: Emotional connection and vulnerability were found to enhance healthful (supervisory) relationships. The co-researchers developed a Student-Led Conversation Form and a process to support students to undertake and lead a conversation with their clinical supervisors and create shared values. Significantly, emotional preparation for clinical placements was found to be important for nursing students facing the reality of practice. Implications for practice: • Innovative approaches to curriculum development are enabled when academic staff authentically engage with nursing students • First-year nursing students experience a sense of empowerment when they engage in student-led learning • Person-centred learning requires academic staff and nursing students to be challenged to develop emotional literacy skills

Evaluating the use of narrative pedagogy in person-centred care and human factors in perioperative practice education

Background: There is an international effort to develop understanding from human factors theory and implement this in healthcare to improve person-centred care and patient safety. Aim: This project aimed to evaluate the use of narrative pedagogy to teach human factors to perioperative personnel in the workplace. Methods: Using the action research model, an interactive learning session based on lessons from serious incidents was developed and delivered to perioperative staff in an NHS Trust within a practice development programme. Data were collected in the form of questionnaires and peer reviews to evaluate the learning session, and thematically analysed. Findings: The use of narrative pedagogy to explore human factors theory empowered participants to speak up, and this influenced the workplace safety culture. Conclusion: Narrative pedagogy reconnects healthcare employees with compassionate approaches to person-centred care, and this provides powerful motivation to improve the safety culture. Further studies should focus on different applications of narrative pedagogy in workplace learning, and creative approaches to teaching human factors. Implications for practice: • Narrative pedagogy can be a conduit to develop person-centred practice • Engaging staff through interactive practice development sessions can encourage expansive learning about human factors and their application in practice • Narrative pedagogy motivates healthcare staff to improve the safety culture in practice

Book Review: Towards the Compassionate University: From Golden Thread to Global Impact

Towards the Compassionate University: From Golden Thread to Global Impact Editor: Katherine Waddington Oxford: Routledge If you are not employed in, or have little engagement with, universities, you might wonder if this book is relevant to you. I’d agree with the authors – compassion is everybody’s business and the exploration of compassion as ‘love in action’ in this book has something to offer to learners, practitioners, educators, students and policymakers alike. The book is structured in three parts: context setting in Part 1: ‘The need and foundations for compassion’; Part 2: ‘Compassion in action’; and Part 3: ‘Towards the compassionate university’. I found the book theoretically dense, with a use of unfamiliar concepts that may seem a little inaccessible to some readers. There are several places where I believe more explanation would have been helpful and there is little consistency in the way the chapters are presented. However, where there are scenarios and ‘real’ examples, the theoretical content comes to life. I imagine the book will lend itself to ‘dipping in and out’; there is clear signposting within the chapters that will make this possible and, although the result is some repetition, this will not be a problem for the occasional visitor to the book.