Making person-centred practice and policy a reality
Submitting InstitutionUniversity of Ulster
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Nursing, Public Health and Health Services
Summary of the impact
Research at the university of ulster into the theory and practice of person-centredness has resulted
i. the development of person-centred practices that lead to better outcomes for patients, staff
ii. the influencing of policy for the development of person-centred services.
The underpinning research has been derived from over 15 years of activity in the field of person-centred nursing. The research has focused on theory development, implementation studies and
the development and testing of instruments and processes for evaluating person-centred nursing.
The Person-Centred Nursing (PCN) Theoretical Framework was developed by McCormack and
McCance1 and was derived from previous empirical research focusing on person-centred practice
with older people2 and the experience of caring in nursing3. Both original frameworks were
philosophically consistent with caring science principles as those that focused on: dignity,
compassion, relationships and overall respect for persons. A review of the frameworks indicated a
high degree of consistency across individual concepts and thus a high degree of face validity. The
resulting Theoretical Framework was first published in 2006 and since then its reach has been
worldwide, with it being translated into several different languages and tested in several different
contexts and countries (for example McCormack B and McCance T (2013) Personcenterad
omvårdnad, in J Leksell and M Lepp (eds.) Sjuksköterskans Kärnkompetenser, Liber Publishers,
Stockholm. Pp: 81-110 http://www.liber.se/Hogskola/Medicin-vard-och-halsa/VardOmvardnad/Omvardnad/Sjukskoterskans-karnkompetenser/#furtherdescription)
The significance of the work is most prominent in its use as a guide for informing implementation
studies that have focused on the development of person-centred nursing in a variety of contexts.
Through the use of the framework in this way, we have been able to identify and refine
relationships between concepts as well as identify new areas of research. We have undertaken
implementation studies in residential care settings for older people, in a variety of secondary and
tertiary care settings, in community care and in palliative care4, 5. In these studies, the framework
has been used to promote an increased understanding of person-centred nursing with the aim of
enabling practitioners to recognise key elements in their practice, generate meaning from data that
can inform the development of person-centred nursing, and most importantly to focus the
implementation and evaluation of improvements in practice towards cultures of care that are more
dignified and compassionate.
A number of instruments have been developed through these studies, all of which have enabled
the identification of key processes in the development of person-centred nursing and resulting
outcomes for service users, staff, teams and organisations. We have developed and tested the
Person-centred Nursing Index, the Context Assessment Index and the Workplace Culture Critical
Analysis Tool6. These instruments have been used in a variety of international studies that have
shown outcomes from the implementation of person-centred nursing. The systematisation of other
processes such as the collection of `patient stories' have also emerged through this research.
Details of the Research team:
Brendan McCormack has been a Professor of Nursing Research at the University of Ulster since
September 2000. Tanya McCance was appointed as a Professor of Nursing in 2007. Professors
McCormack and McCance have led the research into the development and testing of the person-centred nursing framework, since 2001. The original research was undertaken separately by
McCormack and McCance and then combined through systematic processes of inquiry. Dr Paul
Slater has collaborated with McCormack and McCance since 2002, focusing in particular on
instrument development and testing.
References to the research
Impact factors (IFs) [where available], citation reports, related
funding, and google analytics have been included as quality indicators of the underpinning
2. McCormack B (2003) A conceptual framework for person-centred practice with older people.
International Journal of Nursing Practice; 9:202-209
IF: .796. 132 citations in Google Scholar
3. McCance, T.V (2003) Caring in nursing practice: the development of a conceptual framework.
Research and Theory for Nursing Practice: An International Journal, Vol.17, No.2, pp.101-116
31 citations in Google Scholar
5. McCormack B, Dewing J, Breslin E, Coyne-Nevin A, Kennedy K, Manning M, Tobin C and
Slater P (2010) Developing person-centred practice: nursing outcomes arising from changes to
the care environment in residential settings for older people, International Journal of Older
People Nursing 5, 93-107
12 non-self citations in Scopus. 18 non-self citations in Google Scholar
6. McCance T, Slater P and McCormack B (2008) Using the Caring Dimensions Inventory (CDI)
as an Indicator of Person-Centred Nursing, Journal of Clinical Nursing, 18: 409-417
IF: 1.118. 20 non-self citations in Scopus. Output listed in REF 2
Grant awarded to: Prof Brendan McCormack, University of Ulster
Title: Collaborative practices with older people living at home with mental health problems: A
Sponsor: Research Council of Norway:
Period: August 2012 - July 2015
Value: £740 000
Grant awarded to: Prof Brendan McCormack, University of Ulster
Title: Development of a narrative framework for the collection of older people's stories of hospital
Sponsor: BUPA Foundation:
Period: January 2004 - June 2006
Value: £90 000
Grant awarded to: Prof Brendan McCormack, University of Ulster and Prof Geraldine McCarthy,
University College Cork
Title: Development and testing of the context assessment index
Sponsor: Northern Ireland R&D Office and the Health Research Board, Republic of Ireland,
cross-border collaborative project scheme:
Period: January 2005 - March 2006
Value: £90 000
Grant Awarded to: Prof Tanya McCance, University of Ulster
Title: Developing Capacity to Facilitate Person-centred Practice
Sponsor: Department of Health, Social Services and Public Safety/Belfast Health and Social Care
Period: April 2012 - November 2012
Value: £20 000
Details of the impact
The development of person-centred practices that lead to better outcomes for patients, staff
High profile implementation studies in Northern Ireland, The Republic of Ireland and in Australia
have been informed by the Person-centred Nursing Theoretical Framework (the framework).
These programmes of implementation research have involved working collaboratively with large
numbers of practitioners, patients/clients, families and service managers (> 600 in the Republic of
Ireland Programme; >2000 in Australia and >450 in Northern Ireland). Through these studies we
have shown improved outcomes in:
(i) the delivery of nursing and healthcare (Source 1a) [such as pain management post-operatively in acute care and the management of mealtimes in residential settings
(ii) culture change to support more person-centred ways of working (Source 2) [such as
improved leadership, better care coordination and more effective team-work];
(iii) improved care experiences by patients/clients (such as increased `hope', more dignified
care and more involvement in care http://onlinelibrary.wiley.com/doi/10.1111/j.1748-3743.2010.00216.x/abstract);
(iv) more person-centredness experienced by staff in the workplace (Source 2) (such as
increased commitment, role clarification, more effective communication and more access to
on-going professional development.
Further impact from this research can be demonstrated through the international adoption of the
framework. For example in Australia the `Aspire to Inspire' Care Programme has used the
framework to systematically change practices in residential care settings in New South Wales
(Source 3a; see page 9 for reference to framework). As a part of this work, an indigenously-sensitive version of the framework has been developed and utilised with indigenous populations in
order to ensure that their care is dignified and sensitive to their needs (Source 3a, page 23). In
addition, the framework is used within the programmes `continuous improvement' monitoring
system (Source 3b). These programmes of work have not just used the framework to guide
implementation but the associated instruments have been used to evaluate the effectiveness of
processes and resulting outcomes.
The influencing of policy for the development of person-centred services.
Examples of policy impact are the use of the framework to underpin key strategic developments in
Northern Ireland, The Republic of Ireland, Great Britain, Australia and New Zealand. In Northern
Ireland the framework has been used as the theory of choice to underpin the Chief Nursing
Officer's Nursing Strategy (Source 4; see page 14 of strategy document for reference to
framework), the Northern Ireland Cancer Network's Service Framework (Source 5; letter from lead
nurse) and the DHSSPS Older People's Services Policy Framework (Source 6; see pages 52-53
for reference to framework). The Royal College of Nursing adopted the framework to inform its
development of `Principles of Nursing Practice' and these are being implemented across the UK
(Source 7; letter from RCN Head of Nursing and `Principles of Nursing Practice' policy document —
see pages14-16 for reference to framework). In the Republic of Ireland the framework has been
used to develop a `National Practice Development Strategy' commissioned by the Chief Nurse and
which has been implemented throughout the Health Services Executive service areas (Source 1a).
This has resulted in changes to how nursing professional development is organised, how care
practices are developed and how patient care is delivered (for example end of life care in acute
hospitals — Source 1b). In Australia, a development programme (The Essentials of Care
Programme [EOC]) in over 600 clinical areas that is facilitated by The Chief Nurse of New South
Wales Health Department is based on the framework (Source 8; letter from Chief Nurse).
Examples of outcomes from this work show, a 70% reduction in medication incidents;
improvements in communication with patients/families; improvements in the patient care
experience; increased awareness of the impact of the environment on the delivery of patient care;
more consistent identification and implementation of patient safety initiatives that are congruent
with NSW Health priorities; and staff being able to use the change process learned from the EOC
programme to implement mandated changes e.g. bedside handover (Source 9; see page 47 for
reference to framework). This focus on learning has been continued in New Zealand, where the
framework has been adapted to inform a learning strategy for continuing specialty nursing
education over 3 District Health Boards (Source 10a; See page 1 for reference to the framework).
Use of this education framework, informed by person-centredness is being used to change the
culture of nursing in the Region (Source 10b: See pages 45-46 for reference to framework)
Overall, implementation of research arising from the development, refinement and evaluation of the
usability of the person-centred nursing theoretical framework in practice has resulted in outcomes
for individuals (patients, families, staff), teams and organisations that collectively demonstrate
changes to workplace cultures towards ones that are more person-centred.
Sources to corroborate the impact
1a - A letter from the Office of the Director of Nursing and Midwifery Services, Health Services
Executive (HSE), Republic of Ireland and the HSE `Practice Development Strategy'.
1b - End of Life Care Project Report
2 - Final evaluation report of the person-centred practice programme, Belfast Health & Social Care
3a - An overview document of the `Aspire to Inspire' development programme.
3b - Aspire to Inspire development programme `quality monitoring form'
4 - HPSS Nursing Strategy.
5 - A letter and supporting presentation from the NICAN Director of Nursing highlighting the way in
which the framework underpins the programme of work.
6 - Northern Ireland's Older Peoples' Service Framework.
7 - A letter and supporting document from the Head of Nursing Policy at the Royal College of
Nursing verifying the use of the framework in the development of their `Principles of Nursing'.
8 -A letter from the Chief Nurse, NSW Health and the final evaluation report of the Essentials of
Care programme showing the use of the framework and the outcomes achieved.
9 - Letter outlining progress with the use of the framework in their strategic education work.
10 - Education Strategy Document from New Zealand.