Background: The aim of this scoping review is to explore whether or not person-centered care (PCC), in its quest to deliver high quality and safe health care, has a relational-ethics perspective. To do so, we first need to relate the extant literature pertaining to PCC and relational ethics. To this extent, the specific features that define PCC and relational ethics were identified. PCC dimensions include: patient and provider concordance, improved health outcomes, improved patient safety, individual expectations, patients' integration within the environment, patient as a person, patient as an active part of society, dialogue and interaction, sharing experience, and documentation of patient's (person's) narrative. Relational ethics framework includes the following actions: mutual respect, engagement, embodied knowledge, environment, and uncertainty.Methods: Data were retrieved through multiple keywords search on PubMed, Medline, and Scopus. Inclusion/exclusion criteria were set, and these were based on year of publication (2008-2018), language, paper focus, research method and document types. A total of 23 articles (N = 23) were selected and reviewed. Content analysis was conducted in order to identify and compare the main features of PCC and relational ethics. Results:The most important relational ethics action referred to in conjunction with PCC features is environment (referred to as person's integration within a social environment/community). This is followed by mutual respect, engagement and embodied knowledge. These were the salient relational ethics actions both directly and indirectly linked to PCC. Uncertainty was the less recurrent relational ethical action mentioned.Conclusions: This paper revealed that while PCC features embrace most of the relational ethics approaches, these are not exploited in their entirety and therefore PCC emerges as a unique ethical stance in healthcare. PCC's ethical approach goes beyond what is explained within provider-patient relational ethics and emphasizes that the patient is an active person and a partner in care with capabilities and resources.Tomaselli et al. Person-Centered Care and Relational EthicsThis distinction enables us to explain the paradigm shift from "patient-centered" to "person-centered" care. The healthcare provider partnership and co-creation of the healthcare plan contributes to the delivery of high quality, safe and cost-contained healthcare.

Acknowledgement:The authors acknowledge the Department of Health Services Management, Faculty of Health Sciences, University of Malta for providing funding for this research and the Mater Dei Hospital managers, Msida, Malta for facilitating this research. Structured Abstract:Purpose: This article aims to develop an integrated patient focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/Methodology/Approach: The study adopts a case study approach. First, a thorough literature review was undertaken to study various healthcare quality management methods. Second, a healthcare quality management framework was developed using combined Quality Function Deployment (QFD) and Logical Framework Approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness, which has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps were undertaken with the stakeholders' involvement. Findings: The major and related problems faced by the hospital staff under study were overcrowding at A&E and beds shortage respectively. The combined framework ensures better A&E services and patient flow. Quality Function Deployment identifies and analyses the A&E issues and challenges and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address A&E service quality. Practical implications: The proposed framework can be easily integrated within any healthcare unit and within entire healthcare systems due to its flexible and user-friendly approach. It could be part of six sigma and other quality initiatives. Originality/value: Although QFD has been extensively deployed in healthcare setups to improve quality, little has been researched on combining QFD and LFA to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This article bridges these gaps. Moreover, little has been written on the Maltese health care system. Therefore, this study demonstrates Malta's emergency care quality. IntroductionIn many tertiary care hospitals, accident and emergency (A&E) unit is the entry point for critical healthcare. The A&E unit is characterised by complexities in health care delivery that warrant a coordinated approach to quality assurance (Shah, 2006;El Sayed, 2012). These complexities include life threatening presenting conditions (e.g., trauma and cardiac arrest); high patient attendances and turnover; fluctuations in work demands and workload particularly when faced with not so co...

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Purpose The purpose of this paper is to identify the extent to which immigrant nurses have integrated within the Maltese healthcare system. Design/methodology/approach This research consisted of a qualitative case study approach which was conducted within Malta’s four public entities in the secondary care sector. In this case study, data were collected through 34 semi-structured interviews with ten nursing managers, 12 Maltese nurses and 12 immigrant nurses. The data were analysed using content analysis. Data were collected between June 2015 and July 2015. Findings Four themes emerged from the data. These were: human resources management, language barrier, cultural differences and discrimination. The recruitment of nurses to Malta from other countries translated into several positive and favourable outcomes, such as the sharing of knowledge. However, a number of negative and unfavourable outcomes are also indicated in the data including language barrier and discrimination. Research limitations/implications This paper presents a discussion of the issues experienced within a healthcare system in relation to the mobility of nurses. Increasingly, the nursing workforce across the globe comprises of professionals from various nationality, origin, training, culture and professional ethos. The findings are presented in an effort to inform policy makers, management and administrative structures regarding the issues pertaining to the prevalent growing reality of mobility in nurse populations. Originality/value This research study provides a unique contribution to the literature regarding the phenomenon of nurse mobility because it embraces the integration of nurses as a two-way process. Since data was collected from immigrant nurses as well as from local nurses and nursing managers, this study hopes to offer a different point of view from previous studies which largely focused on the views of immigrant nurses only.

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