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 vitality contribute to thriving in the workplace. In addition, they argue thriving also promotes related constructs such as resilience, flourishing, and more positive selfevaluations. Willingness to think of new ideas, explore new possibilities and behave creatively may require a number of facilitated conditions including ‘Active Learning’ about day-to-day work within the workplace (Dewing 2009). The developments in the workplace culture taking place in the care settings started to enable staff to make better use of the staff complement (no staff increases took place in this time and there was a freeze on recruitment due to the embargo) and to develop more effective ways of working together. This suggests a shift in the practice culture to one where staff supported each other better, made better use of their resources and engaged in more effective collaborative working. The observations of practice data at times 2 and 3 reinforced the occurrence of these changes and showed a more effective approach to planning and delivering care to residents as illustrated by this observation of practice: The leadership evident today is transformational – it feels like an organised team. Staff look relaxed and are interacting with residents at a slow pace … good evidence of resident involvement in [named] assessments and personal profiles (observation notes) The embargo however had a significant impact on the engagement of the managers (Directors of Nursing) with the programme facilitators as the facilitated days with managers were stopped due to the ban on travel. Thus this aspect of the programme did not fully evolve. This may have had consequences for what changes took place in some of the sites. What is also clear from the data is that in particular settings where less improvement was made in the way that staff supported each other and in the development of a person-centred culture, there was evidence of poor support from managers of the developments that were taking place as measured through the PCNI. Table 4.5 shows the changes (at a statistically significant level) that occurred in each of the participating sites, with site 1 achieving only one change and site 10 achieving change in 10 of the 12 constructs we evaluated through the PCNI. Whilst these findings are interesting statistically, they are also of interest when they are explored from the perspectives of management and leadership support and engagement. Site 1 had recurring reported problems with management support for the programme and 167
The implementation of a model of person-centred practice in older person settings indeed there was evidence to demonstrate that it was continuously undermined as illustrated by the following reflection from the NMPDU Facilitator: “… The work was so unsupported and undermined that at times it was difficult to know how it could continue. The challenges she [internal facilitator] faced were so non-person-centred and critical that it fuelled the staff who were resistant to change. This meant that every little development was hugely challenging and was continually undermined …” In contrast, site 10 (achieving change in 10 of the 12 constructs) had a highly supportive director of nursing who took an active interest in the programme and actively participated in the programme activities and the support of the internal facilitator as illustrated by this reflection from the internal facilitator from site 10: “… My DON was very supportive, but as time went on I found that when I requested a day to type up or prepare notes (no clerical support for this), I was usually not covered on the ward. This meant that as a ward manager my work was left for me to catch up when I came back. I did become slightly resentful of this as when the DON originally asked me to facilitate the programme she had promised to support me in any way she could. However once I discussed this with her she told me to inform the CNM 2 responsible for off duty when I needed a day and it would be covered. She was also extremely accommodating with regard to programme days …” These contrasting reflective accounts provide support to the statistical data that the achievement of change in the practice cultures was to a large extent dependent on the engagement of the directors of nursing/managers in the programme, their overt support for the practice development processes and the internal facilitator and their personal effective with core leadership skills. Data from the programme days also shows how different sites made progress with their workplace learning activities and the way in which they ‘talked’ about management support for the programme also supports findings in the PCNI. In summary, adequate staffing levels, good inter-professional relationships and effective nurse management/leadership at a unit level, (requisites of person-centred practice) have causal links with higher levels of professional satisfaction and nurses/care workers ability to engage in person-centred practice with residents (Manojlivich and Laschinger 2007; Gunnarsdottir et al 2007). 168
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