This article is part of a captivating series on Sigma members who have recently achieved one of the highest honors in the field of nursing research: induction into Sigma’s International Nurse Researcher Hall of Fame.
“I’ve been watching you. And I’m going to tell you something.”
That was how one of the most vivid recollections I have from my time as a newly registered nurse in the 1980s began.
I was working on a surgical ward and caring for a patient who had just had surgery to remove her second breast following a recurrence of her cancer. One afternoon, she called me over to her bed. For the past few days, she had not received the lunch meals that she had ordered. She asked two questions: Why did anyone bother to take meal orders if the requested food was not delivered, and how could she trust a system with her care if it couldn’t get such a seemingly simple thing as the correct food?
Then she said, “I am going to discharge myself from this hospital tomorrow if I don’t get the meal that I have ordered, and I am trusting that you will be able to sort this as I have been watching you.”
The next 24 hours, as you can imagine, were fraught with all sorts of activities and conversations to allay the potential discharge. The right meal was delivered, and the patient did not discharge herself. She thanked me for what I had done.
This taught me how systems impact the individual. When things don’t work as they should, it creates a lack of confidence and trust in the ability of the whole system to do what it is supposed to do. It reinforced the fact that, as nurses, we are watched and evaluated constantly, and views are generated about how capable and trustworthy we are. And finally, this encounter demonstrated to me how important it is to get the fundamentals of care right. A test of a system’s ability to deliver the meal that was ordered translated, in this case, into trusting the system to help the person manage their cancer.
This encounter stimulated my enduring interest in the therapeutic role of the nurse and how they could lead transformational change in practice. It became the focus of my PhD.
I was also intrigued by understanding the nature of care, particularly how we as nurses integrate a person’s fundamental or essential care needs into their clinical care. From that surgical meal experience, I learned two things: that fundamental care affects both mental and physical well-being, and that nurses play a key role in building trust with patients.
I always found myself reacting against the ‘task-and-time’ mindset of nursing and tried my hardest to ‘think-and-link’ the care I was giving.
After completing my PhD at the University of Ulster in Northern Ireland, I worked at the Royal College of Nursing in London to establish their Standards of Nursing Care Program.
The late 1980s was an incredibly dynamic period for nursing in the UK. Many great nursing leaders taught me so much about politics and making change in organisations. I was involved in and led a number of national programs on standards of nursing care, clinical leadership, and developing clinical guidelines. During this time, I also helped to establish the first clinical practice development research unit in Oxford, called the National Institute for Nursing.
This work led me to study how innovations or evidence are implemented into practice. Colleagues at the National Institute for Nursing and I developed an implementation framework called Promoting Action on Research Implementation in Health Services (PARIHS) framework. This framework has subsequently been used globally, and we have gathered a lot of evidence to explain how it works in everyday practice. The revised version—the integrated or i-PARIHS—framework is still going strong and continues to be used by both interdisciplinary research teams and practitioners.
My enduring curiosity in how nurses learn how to care for our patients, for ourselves, and for our teams has also led me down some fascinating paths in my career. I was influenced by a national event that unfolded in the UK in the early 2000s. A hospital was accused of failing to care for its vulnerable patients. Evidence showed systemic neglect. What was most disappointing was that nurses were blamed for “not caring” for their patients. The rhetoric suggested that nurses lacked kindness or compassion, as though systemic failures were less significant than individual actions.
In response to this, in 2009, along with a group of international nursing and healthcare leaders, I helped establish an advocacy organisation called the International Learning Collaborative (ILC). It is now a global network of leaders, researchers, academics, and clinicians who want to make a difference to person-centred fundamental care. We work collaboratively with organisations and develop learning resources, produce position papers, and conduct research around person-centred fundamental care. We run leadership programs for front-line clinicians. We’re increasingly attracting more allied health and other healthcare professionals.
After my time in executive leadership roles in the UK, I moved to South Australia to accept an exciting position at the University of Adelaide, and then led the transformation of two schools into a new dynamic college at Flinders University. During these very busy leadership times, my “happy space” was supervising my doctoral and post-doctoral students, doing research, and working with clinical teams on evidence implementation projects. I also established the Caring Futures Institute, becoming the Foundation Director in 2019. This research institute is dedicated to researching self-care and caring interventions across the life-course. It has been very successful in attracting top researchers, early and mid-career researchers, and PhD students to work in a vibrant research and scholarship community.
My own research continues around my two passions—implementation science and understanding the nature of care. Along with colleagues from the Caring Futures Institute, we are publishing a new book on integrated knowledge translation entitled Navigating Knowledge Translation in Health and Care. As Chair of the ILC, I continue to work with colleagues globally to uncover the complexities of delivering person-centred fundamental care. I’m also working on understanding how care needs can be assessed and measured across a person’s life-course, and this is my latest major piece of work, culminating in a book.
Being inducted into Sigma’s International Nurse Researcher Hall of Fame in 2025 was a tremendous honour. It validated the need for our wonderful profession to continue exploring the nature of care, to understand how we generate evidence for our practices, and how we translate that evidence into everyday care. As a young registered nurse over 40 years ago, I never imagined that my experience of trying to make sure a patient received the right meal would have such a lasting impact on my pursuit of knowledge and trying to improve the seemingly simple things in our practice. So, make sure you reflect on the fundamentals of care as you practice, lead, educate, and research. And never stop asking “why does this happen?
Alison Kitson, DPhil, BSc(Hons), RN, FRCN, FAAN, FAAHMS, is Chair of the International Learning Collaborative and an independent implementation science and research consultant. She holds honorary professorships at several universities globally and has two honorary doctorates as well as fellowships of national professional and research organisations. She is a member of Sigma’s Psi Eta Chapter.