The Implementation of a Model of Person-Centred Practice In Older ...

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The implementation of a model of person-centred practice in older person settings they may not have had, the opportunity to get to know each other in a meaningful way. Neither would they be used to learning together. The creative activity was designed to help address that. The focus was on them as a person and thus it was role modelling the importance of knowing the person and not making assumptions about other people. Whilst initially there seems to have been some trepidation amongst the groups, once the participants became involved and embraced the challenge, the evaluation from all sites was very positive. One participant commented that: “Starting with the self portrait, put me at ease and promoted a relaxed learning environment”. Another one said: “I knew right away this was going to be a very different way of learning, because of how we started…and I felt both nervous and excited by today” Throughout the first day the participants were introduced to other ways of active learning. The terms of engagement (i.e. how the group was going to work together over the 2 years) were developed and agreed, again using creativity. This was done through the use of cards such as ‘angel cards’ or picture postcards. The focus on this activity was participation, inclusion and hearing everyone’s voice in the room. This approach is in keeping with the principles of collaboration, inclusion & participation known as the CIP principles which are an integral part of practice development work (McCormack et al 2006; McCormack et al 2009). Other activities used throughout the day involved participants with individual reflection, working in small groups and working together as a whole group. Thus setting the scene for the style of learning on the programme. For some of the participants working this way was very new to them. ”Traditionally, the participants would have attended a “study day” where the focus would have been more didactic and directional with the focus been on the presenter/lecturer doing all the teaching mainly through them talking. Many of the participants, in their evaluation, commented that this way of learning was new to them; this is summed up by one participant who said: 107
The implementation of a model of person-centred practice in older person settings “I really like this way of learning, it’s more inclusive usually when I attend study days I just sit and don’t get involved to much”. In summary, the existing culture in the sites was such that at the beginning of the programme sustained attention had to be given to enabling each person, regardless of their role, an opportunity to believe in their self-worth, find and use in positive ways their voice both in the programme days and in the workplace. Further, the morale of the groups tended to be very low and the self-belief also very low. Participants lived with a huge gap between what they wanted to do for residents and how they actually worked. Participants tended to express high levels of powerlessness and very low levels of engagement and empowerment. There was a huge focus on concerns such as rules, perceptions about management and what wasn’t allowed, obstacles and reasons why things couldn’t be done. The most common themes were lack of staff and lack of time. There was a variety of evidence indicating that staff worked to a routinised even ritualistic culture that was in many ways harmful even brutal for them and for older people. Examples from the programme records from different participants at four sites: “We won’t be able to deliver on what we promise” “It’s too much work” “I don’t think other staff will take to this” “What if the managers won’t allow this to go ahead?” Day three The participants, by this time, were generally easily re engaging in the learning ethos of the programme days and there was evidence of trust and team effectiveness emerging from the programme day evaluations. The groups “Terms of Engagements” were starting to be effective as a means of creating and sustaining “group norms” and were being used to set an agreed level of behaviours which guided participants on how to interact with one another. Some quotes from the participants about the “Terms of Engagements” included the following: “Participants feel more confident having these” “Permission to say things – I did not have this before” “More together as a team” “Opened up minds to new ideas to find ways to change” “Important to apply this to the whole team - outside and in the room” 108
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