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 (2) The dual experience of positivity and challenge: “Going forward is a challenge; bringing person-centred care forward is hard work”. At the same time participants could see and feel “we have seen how much we have achieved and we are getting stronger, we’ve achieved what others thought we could not”. Participants were beginning to realise that transformations were focused on the implementation of numerous small changes that they had the power to lead and embed, e.g. trying to move away from task-orientated to resident choice; to be more observant; to ensure person-centred language is used. (3) Getting action plans in motion: this required another burst of energy to get interest and involvement from other staff, residents, and where possible relatives and friends in order to progress the implementation using CIP principles. (4) Critical reflection and reflective practice: in the programme to date, the groups were finding reflection to be central to understanding the way care affects the resident. A few groups were starting to find group reflection to be very effective as “a way of debriefing after an incident on the unit before going home”. However, apart from two sites, most groups and facilitators were still not systematically building in the reflection sessions that were included in the programme days thus there was minimal recording written reflections as part of the programme days. Sharing critical reflection in writing or in a group using a structured method was probably the biggest and longest challenge that participants and facilitators experienced. Throughout the two years this continued to be an issue. See discussion chapter where this is given further consideration. Day eleven Sixty participants in total attended the specific programme day (day 11) from the 11 sites. This figure is offered as it gives some indication of the continued commitment of participants and facilitators to the programme. The breakdown of nurses and non nurses who attended was approximately 67% registered nurses (ADON, CNMs and Staff Nurses) and 33% non nurses (healthcare attendants, catering staff, housekeeping staff). Towards the end of the programme the local facilitators and participants were now devising the detail of the programme days themselves and sending them to the 111
The implementation of a model of person-centred practice in older person settings programme leads for review. It was evident from the notes at this stage, that the workshop days were becoming more varied or contextualised in some respects. Although they had common themes such as evaluation and analysis, planning for sustainability, conducting observations of care, patient narratives work and action planning. By this point in the programme, creative methods to learning were more accepted and the local facilitators were actively experimenting. Different activities were used by the participants as an opening activity to day 11. The use of artefacts was used in three of the sites. The participants in one of sites were asked to describe using their artefacts in relation to …. What does PD and PCC mean you over the last two years? One of the participants described “…a spider’s web as… catching flies, catching people and catching attitude”. Another participant used the analogy of a Laurel Leaf to describe PD and PCC as ”bright smooth and shiny, but can have different meaning… naive at the start of the programme – but, relationships are getting closer between staff and staff and staff/patients”. Creating pictures, collages and poetry were utilised by the facilitators and participants to explore the learning and understanding of PCC and PD and the transfer of the learning to working with residents in a different way. The involvement of residents and their families was more evident in the data by programme day 11. Some of the sites had held joint learning sessions with residents to explore change and how to improve practice. Observations of care and discussion of the findings within the group were taking place in several groups on an ongoing basis indicating some sustainability of this method. Participants were also involved in regular observational environmental walk abouts together as a group, and discussed the importance of involving residents and their families and wider community in the process. Overall the learning from this process of participating in and carrying observations of care was positive and powerful in relation to understanding and gathering evidence to change and improve practice. Through dialogue with other group members the participants described ”how this was a powerful way of looking differently at the way we do things and really makes you think and puts you in a different place for that period of time …”. At some sites, participants on programme day 11 worked outside in the garden area in two of the sites specifically looking at HIQA Standards about outside space, 112
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