Promoting person-centred practice within acute care: the impact of culture and context on a facilitated practice development programme

Background: The promotion of person-centredness in practice has the capacity to make a critical difference to the care experience of patients and staff. While there is growing international evidence to suggest that emancipatory practice development programmes can develop person-centred cultures, understanding of how person-centredness is effectively operationalised in practice remains an underdeveloped area.Aim: The research aim was to explore how the culture and context of acute care practice settings impacts on the engagement of practitioners in a facilitated practice development programme.Methods: The methodology used was programme evaluation, using multi-methods including process evaluation, reflective accounts and focus group interviews. Data analysis was undertaken using a creative hermeneutic approach.Findings: The findings highlighted that the programme enabled a level of engagement that was characterised by positive ways of working, building relationships and maintaining momentum. This in turn impacted on the ability to embrace person-centred values in practice and reflected nurses’ confidence and competence. Person-centredness in practice was also impeded by conflicting priorities characterised by a sense of feeling pressurised, limited staffing and resources, and the challenges of an evolving context, particularly within the provision of services in acute hospitals. Conclusions: The findings are confirmatory and add to the existing evidence regarding the effectiveness of practice development as an approach that facilitates teams to explore their own practice. The findings, however, add to existing evidence by highlighting new insights that should be taken into account when delivering a facilitated practice development programme. These insights reflect the tussle between the impact of context and the development of cultures that support person-centredness in everyday practice.