Moving from crisis intervention towards person-centredness.

Worldwide health care systems are challenged to provide high quality and safe care to all citizens. South Africa is no exception in this regard but as a nation it does have unique challenges in making this happen. At a national level, health care is delivered through a pluralistic health care system with separate public and private sectors, but each responsible for the delivery of the total health services to a population that has both third and first world health conditions (Rowe and Moodley, 2013). Furthermore, owing to the high incidence of acute and chronic diseases and high levels of societal violence, there is an ever-increasing demand for critical care services through designated critical care units. The Department of Health (2012) indicated that South Africa’s predominant nurse-based health care system therefore requires nurses to have knowledge and skills to deliver quality patient care. However, nursing is in a crisis, not only is there a shortage of nurses, but nurse leaders, managers and the public opinion reveal poor standards of nursing care. Headlines in the media (News24 2013) too demonstrate a growing perception that the quality of nursing in South Africa is a concern. Given the number of press reports and media accounts suggesting that nursing may have lost its way in delivering quality compassionate person-centred care (Parliamentary and Health Service Ombudsman, 2011), there is a need to consider how to address this problem. At the heart of these challenges, plaguing health care services is the disengagement of nurses from their work and workplace cultures (Duffield et al., 2009). The situation has led to recommendations for fundamental shifts in health care cultures, encouraging positive practice environments and the recognition of person-centred approaches. Addressing these recommendations may lead to enhancing the well-being of nurses, have a positive impact on nurse motivation, productivity and performance and in turn support quality patient care (Department of Health 2012:21; McCormack et al., 2007). The South African Department of Health and International Council of Nurses advocate that one of the critical areas that should be given attention to address the shortage of nurses in South Africa is the empowerment of nurses. This can be accomplished by participation in decision-making and sharing responsibilities for achieving quality patient care (Department of Health, 2012; Littlejohn et al., 2012). Health care services in South Africa attempt to resolve the nursing crisis by providing training using traditional education practices. The topics covered during these sessions are mainly policy driven and utilizes a ‘top-down approach’. This approach is of concern because learning is separated from the working environment, and educational approaches used consist of mainly lectures and workshops. Although there is a major focus on monitoring and evaluating patient safety using clinical governance teams and implementing for example ‘best care always’ evidence-based practices, the educational approaches used neither promote evidence-based health care nor contribute to or address the development of person-centred care cultures. Research data of two unpublished studies reveal that lectures and workshops presented at two private hospitals were not attended despite health care services providing these sessions as on-duty time (Lategan et al., 2013; Viljoen et al., 2013). The South African Department of Health and the Report of the National Nursing Summit (2011) have emphasized the need for nurses to re focus on taking responsibility for nursing care delivery, create stronger links between theory and practice and establish more effective leadership roles. Emancipatory and transformational practice development methodologies, with their focus on the development of evidence-informed and person-centred cultures, have been used internationally for many years and have been shown to be effective in changing culture, enhancing person-centredness and improving the experiences of giving/receiving care (Manley et al., 2008; McSherry and Cox, 2008). Reflecting on the crisis in critical care nursing in South Africa and the limited effectiveness of existing (mainly training) strategies for addressing this, academics from the Department of Nursing, University of Pretoria, envisioned the facilitation of change through practice development with the intent of moving the existing workplace culture towards one that would be more person-centred. The methods embraced by practice development methodology enable the recommendations of the South African Department of Health and the Report of the National Nursing Summit to be made real as they focus on shared team values, individual and team effectiveness, the use of evidence in practice, learning in and from practice using work-based and active learning approaches and the development of leadership. A collaborative agreement has been formed between the University of Pretoria and Queen Margaret University Edinburgh