Background: Innovative teaching methods are needed to ensure end-of-life care is provided by nurses through a person-centered approach. Aims: This study was designed to (a) explore the self-identified impact of reading dying patient experiential narrative accounts on undergraduate nursing students; and (b) explore the teaching usefulness of patient experiential narrative accounts for enhanced undergraduate nursing student awareness of the need to pro- vide person-centered end-of-life care. Methods: Qualitative descriptive study, with 31 undergraduate nursing students reading experiential narra- tive accounts of dying patients and reflecting on them. A thematic analysis was carried out on the written student reflections. Descriptive statistics were used to summarize student socio-demographic data and their answers to questions on a reaction response sheet designed to assess how useful this activity had been from their perspective. Findings: Three main themes were identified: (1) gaining an insightful understanding of the relationship between the nurse and the person with advanced-terminal illness; (2) gaining awareness of themselves as nurses in their clinical practice; (3) pointing out how nurses should behave and what they should do to place the person living with advanced-terminal illness at the center of nursing practice. Among all respondents, 87.09% of students thought this was a useful learning activity. Conclusions: Reflecting on patient experiential accounts is an innovative teaching method, which help with nursing students value and gain insight into person-centered end-of-life care.

Background. Person-centred practices - following national and international developments in health-care policies - have become a key approach in healthcare. The Person-Centred Practice Inventory - Staff is an instrument based on the theo-retical framework Person-Centred Practice that focuses on the staff's perspective and how they experience person -cen-tred practices. Here, the aim of this study is to obtain the first Spanish version of the PCPI-S translated and adapted into the Spanish context. Methods. The translation and adaptation of the instrument followed the Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice, which included a consulting session with experts. Content va-lidation measures on clarity and relevance were assessed for every item (I-CVI) and the survey as a whole (S-CVI/Ave). Results. No major difficulties were registered to reach an agree-ment on the 12 items that needed to be clarified. Regarding cla-rity and relevance. The validity index per item (I-CVI) obtained excellent scores for clarity in 53 items and for relevance in 59; the S-CVI/Ave showed excellent results (>= 90). Conclusions. This first version of the Person-Centred Practice Inventory - Staff instrument adapted to the Spanish context is conceptually and semantically equivalent to the original one. This valuable tool will be of great help to identify the perception of healthcare professionals on person-centred practices.

Background Nurses' political engagement is needed for societal advancements. Purpose The purpose of this study was to explain why and how nurses became politically active, and what they achieved. Methods Qualitative, constant-comparative data analysis was used for this study. After 10 elected or politically-active Canadian nurses were interviewed, data saturation was confirmed. Findings All were motivated by early life events to realize the importance of social justice and good government. Their nursing education and work equipped them to be capable of engaging in political spheres. All had developed knowledge of relevance for political purposes; in addition to confidence, communication skills, and other abilities to be effective politically. All highlighted the importance of being encouraged and assisted to engage politically. Positive micro-, meso-, and macro-level benefits of this involvement were identified. Conclusions More nurses should be inspired and helped to become active politically. It is critically important for nurses to inform and advance public policy, through direct political activities.

Background. 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 theoreti-cal 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 con-text. Methods. We translated the PCPF following the Translation and cul-tural 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. Results. We encountered no significant difficulties to reach agree-ments 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). Conclusions. The adapted Spanish version is clear, significant, and conceptually equivalent to the original PCPF. It will allow a better com-prehension of the person-centered practice framework in the Spanish context and facilitate the implementation of this approach in clinical practices.

A study of the bereavement programs provided by hospices in Ireland and the Canadian province of Alberta was done to determine if and how these are evaluated for efficacy. All but one hospice offered multiple different bereavement programs, with routine in-house evaluations of all programs performed. In all cases, staff and client unsolicited and solicited comments made during and at the end of each program provided data for continuing program refinement. Most hospices also routinely employed a self-devised questionnaire to gain specific sought information to retain or change programs. Other information, including news about program developments elsewhere, was also actively sought for program adoption or for the improvement of existing programs. With most bereavement programs having been in place for many years, participants were confident their programs are needed, safe, and effective. Their continuing quest for high-quality programming, however, meant they were active in monitoring these programs and in seeking developments in this field.

Background: Clinical narratives may be used as a means to improve the acquisition of clinical competences. Even though there are studies that recognize the potential value of clinical narratives to promote nursing professional development, there is no evidence that shows their value as a tool to improve nurses' competences to provide person-centred nursing care. Purpose: To evaluate the preliminary efficacy of narratives for the development of three nursing professional competences -respect, intentional presence and knowing the person- for providing person-centred care. Method: Using a pre-post quasi-experimental design, a pilot study with a total of 34 nurses enrolled in a training course of nursing specialization was conducted between September 2016 and June 2017. All the nurses received a multi-component intervention based on the Critical Reflective Inquiry model. The strategies of this programme consisted of writing three narratives, attending two masterclasses, participating in a discussion group, and participating in a face-to-face interview. The NarratUN Evaluation tool was used to assess the outcomes. Changes among nurses were analysed using the Wilcoxon signed Rank test. Results: The difference in the means between the pre- and post-intervention scores were statistically significant for respect [0.59 (95% CI 0.23-0.95; p = 0.001)], intentional presence [0.75 (95% CI 0.32-1.17; p < 0.0001)] and knowing the person [0.62 (95% CI 0.25-0.99; p = 0.001)]. The difference in the mean score for use of the narrative and reflection also increased significantly [0.65 (95% CI 0.32-0.98, p < 0.001)]. Conclusions: The use of narratives combined with other reflective strategies (masterclass sessions and discussion groups) proved to be effective for the development of professional competences of nurses.

Phenomenology of practice is a useful, rigorous way of deeply understanding human phenomena. Therefore, it allows research to be conducted into nursing's most sensitive and decisive aspects. While it is a widely used research approach and methodology in nursing, it is seldom addressed and made use of in its practical and applied value. This article aimed to approach the global outlook of van Manen's hermeneutic¿phenomenological method to better understand its theoretical background and to address and support the contribution this method can make to nursing, if rigorously applied. For a professional discipline like nursing, van Manen's approach is especially interesting because, in addition to contributing to the body of knowledge of nursing, it provides a special kind of knowledge that allows nurses to act in a more reflective manner, and with tact and skill, in certain situations and relationships that arise in their daily practice. A more in¿depth understanding of this research methodology may help nurse¿researchers make good use of it and also harness knowledge derived from this type of research. This comes as a result of assuming that phenomenological texts, the final product of the research, have tremendous educational potential for people who read them carefully

Aims To offer a complete outlook in a readable easy way of van Manen's hermeneutic¿phenomenological method to nurses interested in undertaking phenomenological research. Background Phenomenology, as research methodology, involves a certain degree of complexity. It is difficult to identify a single article or author which sets out the didactic guidelines that specifically guide research of this kind. In this context, the theoretical¿practical view of Max van Manen's Phenomenology of Practice may be seen as a rigorous guide and directive on which researchers may find support to undertake phenomenological research. Design Discussion paper. Data sources This discussion paper is based on our own experiences and supported by literature and theory. Our central sources of data have been the books and writings of Max van Manen and his website ¿Phenomenologyonline¿. Implications for nursing The principal methods of the hermeneutic¿phenomenological method are addressed and explained providing an enriching overview of phenomenology of practice. A proposal is made for the way the suggestions made by van Manen might be organized for use with the methods involved in Phenomenology of Practice: Social sciences, philosophical and philological methods. Thereby, nurse researchers interested in conducting phenomenological research may find a global outlook and support to understand and conduct this type of inquiry which draws on the art.

Background: Concern has existed for many years about the extensive use of hospitals by dying persons. In recent years, however, a potential shift out of hospital has been noticed in a number of developed countries, including Canada. In Canada, where high hospital occupancy rates and corresponding long waits and waitlists for hospital care are major socio-political issues, it is important to know if this shift has continued or if hospitalized death and dying remains predominant across Canada. Methods: Recent individual-anonymous population-level inpatient Canadian hospital data were analyzed to answer two questions: (1) what proportion of deaths in provinces and territories across Canada are occurring in hospital now? and (2) who is dying in hospital now? Results: In 2014-2015, 43.9% of all deaths in Canada (excluding Quebec) occurred in hospital. However, considerable cross-Canada differences in end-of-life hospital utilization were found. Some cross-Canada differences in hospital decedents were also noted, although most were older, male, and they died during a relatively short hospital stay after being admitted from their homes and through the emergency department after arriving by ambulance. Conclusion: Over half of all deaths in Canada are occurring outside of hospital now. Cross-Canada hospital utilization and inpatient decedent differences highlight opportunities for enhanced end-of-life care service planning and policy advancements.

Healthcare services are one of the twelve determinants of population health. While all types of healthcare services are important, timely access to hospital-based care when needed is critical. For three decades, long waits and wait lists for hospital admission and inpatient care have been a concern in Canada. Undersupply of hospital beds to meet population needs may be the cause of this as hospitals were downsized due to government funding cutbacks and hospital expansion has not occurred since despite population growth and aging. The availability of hospital beds for palliative population health needs may therefore be an issue, particularly as longstanding concern exists about terminally-ill and dying people being frequently admitted to hospital and having long hospital stays. A decline in hospital deaths in many developed countries, including Canada, could indicate that palliative population needs for hospital-based care are not being met. This paper compares the number of hospitals and hospital beds that exist in 9 Canadian provinces and 15 developed countries in relation to population and spatial considerations in an attempt to determine an optimal number of hospital beds for the general public and thus also palliative population health needs. Methods: Document analysis. Publicly-available hospital, population, and geographic information was sought for 9 Canadian provinces and 15 developed countries and compared. Results: Major differences in citizen to hospital bed ratios and citizen to hospital ratios across provinces and countries were found. The availability of hospitals and hospital beds clearly varies. Conclusion: Some regions may have too few hospitals and hospital beds to meet the palliative and other care needs of their citizens. Sufficient beds should exist so necessary admissions to hospital can occur without harmful delay.