Background: Ophthalmology in the Republic of Ireland has one of the longest waiting lists in healthcare, with around 44,000 people awaiting a first outpatient appointment. In the north-east region, 12,500 people are waiting. The North-Eastern Region Integrated Eye Care Service (NERIECS) was established in 2021 to improve patient care and access to services. A key driver for the team was to understand ‘how we work together’ to enable a shared vision of change within regional services. Aim: To support hospital and community ophthalmology services, which comprise eight organisations in the region, to prepare for the development of system-level integration of eyecare services. Methods: We integrated a popular process-improvement methodology, Lean Six Sigma, with a person-centred approach to support staff to develop a shared vision of change and to deliver improvements for ophthalmology services. Findings: The integrated approach enabled staff to work in ways that supported the development of good quality, person-centred care that takes account of the outcomes for and experiences of ophthalmology patients and their families, and of staff. Conclusions: Our work builds on a recent study that identified coherence in the underlying philosophy, intention, method and outcomes of Lean Six Sigma and person-centred approaches to healthcare improvement, highlighting the added value of an integrated approach in enabling improvement that positively impacts patient outcomes and healthcare culture. Implications for practice: The application of an integrated approach to process improvement in healthcare is shown to be effective beyond a single study site, having a positive impact across geographic and organisational boundaries, and across levels of care (primary, secondary, tertiary and post-acute) The integrated approach puts the focus on synergies between both methodological approaches and avoids improvement work being reduced to the use of a decontextualised toolkit

This paper is derived from research I undertook as a part of my honours degree in nursing. My research produced a thesis that examined person-centred care in Australian residential aged-care settings. The idea for this came from my 15 years’ experience as an aged-care nurse and questions arising from my lived experience of person-centred care not being a reality for residents, families and staff despite being widely espoused in the aged-care sector. The sector in Australia is undergoing a system redesign, with proposals for a new Aged Care Act put forward this year by the Royal Commission into Aged Care Quality and Safety (RCACQS, 2021) after a review of the aged-care system between 2018 and 2021. The review looked into the prevalence of elder abuse and estimated that almost 40% of residents may have experienced emotional, physical or neglectful abuse (RCACQS, 2020a). Person-centred care could be an important concept to establish in Australian residential aged care in order to tackle the experience of abuse and embed high-quality, safe services.

When thinking about the subject for this editorial, we found it hard to look beyond the current context of health and care and the continuous challenges faced by those striving to develop person-centred cultures, to enable the best outcomes and experiences for all. Through our work with clinically based practitioners, we have both noticed a concerning downward turn, with increasing reports of staff fatigue and ill health, workforce shortages and frequent changes in management, all at a time of growing levels of patient need. A perfect storm! As I (Kate) prepared a presentation recently, I found myself thinking about the story of Hans, a small boy who found a leak in a dike and used his finger to plug the hole and save his town from a potential deluge of water. This reminded me of a recent supervision session, when I used the metaphor of a dam to help someone to explore the pressure they were experiencing. What was contributing to the force of water? What, if any, were the sources of water that were in their control to divert before they reached the dam? What was the nature of the bricks the dam was built from? How could the bricks be supported and strengthened? Where could more bricks be found? But holding back the water is not in the gift of one individual. We need to share the load and work collaboratively to understand what is important and what matters to people (patients and staff), to prioritise where we put our efforts and energy. We also need to be innovative and creative, to explore what is possible, to enable people to be the best that they can be, and to offer hope and joy at a time when it is in short supply. And so, what is encouraging, as we share this issue of the International Practice Development Journal with you, are the many ways in which the authors are doing just that.

Background: Intimacy and sexuality are essential aspects of quality of life for older adults in long-term care. Numerous tools and interventions are available to support healthcare professionals in their conversations about intimacy and sexuality but they are often unfamiliar with these, or do not know when or how to use them. Aim: To develop a tool to help healthcare professionals choose from existing interventions to facilitate conversations with older adults on the subject of intimacy and sexuality. Methods: A design study, comprising five substudies and 16 workshops, was carried out in inpatient and outpatient settings for older adults. Participants were healthcare and design professionals, older adults and their relatives, undergraduate students and researchers. Data collection and analysis took place in several iterations, with insights from one phase guiding the design of the next. Findings: A paper brochure and a digital knowledge programme (IntiME) was developed to inform the selection of interventions and tools to initiate conversations about intimacy and sexuality with older adults. Initial experiences with IntiME suggest it can support healthcare professionals in this area. Conclusions: The IntiME tool has the potential to improve person-centred care around intimacy and sexuality by matching the personal characteristics of healthcare professionals and older adults with available interventions and tools. Further research into experiences with the use of IntiME is warranted. Implications for practice: IntiME has the potential to improve person-centred care by matching the personal characteristics of staff and older adults with available interventions and tools Co-creation with older adults and staff plays an important part in designing tools for person-centred care Using IntiME may help staff become more aware of their own needs and thereby enhance competence in conversations about intimacy and sexuality

Background: The school of nursing at the University of Wollongong developed an innovative approach entitled the ‘Students as Researchers Internship’ to provide an opportunity for students who identify as Aboriginal or Torres Strait Islanders to experience research as co-researchers. This programme was developed in response to a need to increase the number of Aboriginal and Torres Strait Islander persons who complete research degrees and progress to academic careers in nursing. The initial programme included two students who identified as Aboriginal women in their final year as bachelor of nursing students, with both employed as research assistants. Aim: This article aims to share the students’ perspective of their learnings from participating in the Students as Researchers Internship programme through a critical reflection using the Mezirow model of reflection. Conclusion: The opportunity to be a research assistant and co-researcher during the final year of the bachelor of nursing degree offered the students a platform to gain skills, and an understanding of the research process and the application of research in practice. It also provided the experience of being supported in their academic studies. Implications for practice: Mezirow’s model of reflection provides an effective framework for students to unearth their assumptions and learnings from experience Developing skills and experience in research can transform undergraduate students’ understanding of the application of research in their practice Participation in writing ethics applications and research publications offers students insight into the skills of referencing, academic writing and critical thinking The experience as co-researchers enabled students who identify as Aboriginal or Torres Strait Islanders to consider future career opportunities in research

Background: This article describes the development and refinement of a component of a first-year nursing course called ‘Theoretical perspectives in nursing care: complexities in seniors care’. Initially developed in 2020 in response to the pandemic restrictions and guided by the philosophy of person- centredness and person-centred practice, a senior mentorship programme called ‘Engaging with your senior mentor in the community’ has become an important element of the broader theoretical course. Aim: To report on the experiences of older persons living in the community who volunteered to be mentors to first-year bachelor of nursing students, and explain how their experiences informed person-centred quality improvements for future courses. Methods: Appreciative inquiry principles guided the study. Qualitative descriptive design methods – online surveys and focus groups – were employed to evaluate the senior mentorship initiative. Thematic analysis was performed to identify themes that described what the experience of participating in the initiative was like from the perspective of the senior mentors themselves. Findings: Our analysis identified five themes: (a) sharing; (b) contributing; (c) listening; (d) self-reflecting; and (e) communicating expectations. Conclusion: Sharing wisdom informed by lived experience can be a rewarding part of ageing. Senior mentors believed they had contributed in a meaningful way to the student nurses’ learning. Implications for practice: This article reaffirms that older persons are keen to participate in education initiatives Insights from the senior mentors will inform educators in health and social sciences who want to incorporate the voices of older persons in their classroom and practice teaching Older persons should be considered potential partners who can help educators develop a culture of person-centredness to help students prepare to appreciate the older persons in their care

Background: A community of practice was established in 2020 by three doctoral nursing students during the Covid-19 pandemic, when in-person learning was on hold. The group members were intentional about using the community of practice as part of their personal and collective reflexive learning strategies. An expanded ‘Community of Practice’, open to doctoral students in the health professions, developed from the core group’s initiative. Aim: The aim of this article is to critically reflect on the experience of participating in a community of practice focused on the development of an intentional reflexive practice, and to explore how self-knowledge as students and novice researchers was cultivated through collective reflection and discussion. Conclusion: This article contributes to the literature on communities of practice in the context of doctoral nursing studies. Participation in a community of practice provides a person-centred approach to learning and self-knowledge for novice researchers. Implications for practice: A community of practice can create space for an intentional reflexive practice for doctoral researchers Engaging in collective reflexive inquiry has potential to expand the perspectives and outlook of individual researchers Participation in a community of practice can transform the doctoral student experience by encouraging a participatory, person-centred approach that promotes student flourishing as novice researchers

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.

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

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