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Chapter 6 Phase Two
to become co-researchers and to find time to introduce this change in their
practice whilst developing individual nurse competence and confidence with care
planning and care plan documentation. Education, facilitation and critical
companionship were fundamental to helping staff to care plan and encourage
autonomy for very dependent and cognitively impaired residents. Involving
families and health care assistant staff was essential in this process.
The researcher recognises that commencing resident centred care planning only
enhances some aspects of resident autonomy and phase one of this research
identified many other problems in relation to resident autonomy which need to be
addressed in the case study site. It is argued however that resident focused care
planning can be a useful first step in enhancing resident autonomy. The cyclical
nature of this type or research means that the staff and the residents will continue
to work on enhancing the residents autonomy based on the findings from phase
one and the newly acquired skills for making change. Reflection excerpt no. 5 is
taken from one of the reflections towards the end of this phase of the research.
Reflection Excerpt no.5
Many nurses wonder why a care plan which works well somewhere else will it
not work in their area. I believe from this experience that it is because it doesn’t
suit or match their care environment, patient profile and services available. If
care plans are to be successful a bottom-up approach is called for whereby all
staff are involved in designing, piloting and evaluating the documentation. We
saw from this research that this led to a user-friendly document which staff
embraced with pride. This user-friendliness will enable the care plan to be kept
active and not just left in a folder on a shelf gathering dust. Keeping care plans
active will enable healthcare professionals to see their benefits rather than
viewing them as another piece of documentation that just needs filling out. There
is also a better chance that if the documentation is designed by the staff it will
not require the same level of repetition or duplication of information. Mason
(1999) supports this by offering that two important factors are involved in
successful care plan introduction: being clinically driven and having local
ownership.
It is also recognised that there are some limitations with action research
methodology. Critics question how the AR cycles can be made clear and how the
researcher differentiates from one step to another. Tutton (2005) explained that
AR is a dynamic, cyclical process of planning, action and evaluation, in which