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 This day saw the participants discussing quality of life and comparing their insights with the evidence they had previously collected in the workplace learning activity Cats Skirts and Lipstick with residents. This activity grounded in practice provided all of the participants with the opportunity to relate the lived experiences of residents and participants own knowledge some evidence from research and policy relating to quality of life indicators e.g. “Improving Quality of Life for Older People in Long–Stay Care Settings in Ireland (National Council on Ageing and Older People (2006), HIQA Standards (2007), and NCHRDF (UK) Review (2006). The PCN framework was again useful here in order to establish the complexities of cultural transformations and what would need to be addressed in order to make the quality of life indicators they identified for their residents/patients a reality. This activity revealed that knowing the older person is vital – however it was found to be tokenistic in day-to-day relationships. The participants were introduced to the concept of knowing self as well and in particular High Challenge and High Support. Participants identified with the traditional methods when challenge was needed: either pussyfooting, being so nice that the issue is avoid or clobbering being so punitive that the response is aggressive and wounding (Heron 1999 cited in Brockbank and McGill 2006). A third option of skilled, supportive and enabling confrontation with the challenge being to get it right was the theme for day. In practice development challenge is recognised as essential for helping teams to move forward and become effective. In challenging custom and practice and the taken for granted it can sometimes be perceived as threatening, and may also be threatening in reality (Brockbank and McGill 2006). The participants were encouraged to start looking at how they were using HC/HS in their own areas and to practice the skill in order to become more confident in questioning practice issues. “Challenge and support – I need to understand more about how to best implement it” “Difficulties of High Challenge and High Support - a big risk but it can bring about change. I can see that” 109
The implementation of a model of person-centred practice in older person settings Prior to this programme day participants were introduced to the learning activity Observation of Care. This was a pre planned activity where participants undertook a simplified observation activity, wrote it up and provided feedback in the group on their experience. These experiences were varied from “this was an interesting experience which highlighted both good practices and areas for improvement” while others experienced the “resistance from other members of staff to being observed”. The plan following this activity was for each participant to continue to participate in the Observation of Care activity within his or her own area and offer colleagues feedback. It was proposed that when the participants felt comfortable with the activity they would invite/encourage other staff members to have a go for themselves and be facilitated to identify what they had learned. In summary, by day 3 the groups were informally collecting, analysing and learning from a range of evidence they were collecting from their own workplaces. They were beginning to develop some of the attributes needed to embed a learning culture in the workplace including learning in and from practice and setting up systems for giving and receiving feedback. They were also experiencing the need for role modelling and resilience as they discovered that their colleagues needed repeated challenging and support to adopt new ways of working and relating. Day six By this time in the programme (mid way), each site had its own local action plan based on the evaluation data from timeline 1 that had been collected and analysed. Four themes emerged from day six across the sites: (1) Working effectively as a group: support from the group was found to be encouraging when dealing with common obstacles. Participants said that they feel part of a “special group”. Another group declared that: ”We thought we knew but as a group we have to continue to learn so that we share the message”. 110
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