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Chapter 6 Phase Two
to be overcome. Hence the focus of cycle two was to overcome these barriers.
This included finding time to introduce this change in practice and developing
individual nurse’s competence and confidence with care planning. The actions
for this cycle included education and facilitation in order to help the co-
researchers to develop their care plan skills especially to enable autonomy for
very dependent and cognitively impaired residents. Involving families was
essential in this process. I decided to adopt a “critical companionship” approach
at this point (a description of critical companionship is included in Appendix 26)
in order to support the co-researchers with the implementation of this new
change in their practice.
Critical companionship (Wright and Titchen, 2003) is similar to mentoring in
that an expert or facilitator works closely with a staff member supporting them
and guiding them through a change process. I worked alongside the co-
researchers in order to help them to engage with the residents in introducing the
new approach to care planning and to help them in developing their negotiation
skills. Furthermore by doing this we could identify together what was working
well in the implementation and what wasn’t working so well. Cheevakasemsook
et al (2006) state that some of the barriers to successful care planning include
limited nurses’ competence, motivation and confidence, ineffective nursing
procedures and inadequate nursing audit, supervision and staff development.
Martin, Hines and Felix (1999) reported that nurses find it difficult to get the
balance between a professional style to their writing and capturing the emotional
and spiritual style necessary when recording peoples daily lives (cited in Pearson
and Peels, 2009). Thus critical companionship aims to help with reducing some
of these barriers. Regular meetings on the unit were scheduled so that the
progress of the change could be discussed and evaluated and so that everyone
could continue to drive the change and feel part of it. Reflection excerpt no.3
gives a snapshot account of the implementation stage of this research.