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 development programme groups were established. The groups represented staff from different areas within the units and different grades i.e. Clinical Nurse Mangers, Staff Nurses, Health Care Assistants, Housekeeping, Catering and Administration staff. The participants from the sites met with the internal facilitator from within their unit and the external facilitator from the NMPDU for a formal programme and skills development day every 6 weeks. As the first year progressed a range of interim meetings and discussions groups were established within the workplace in between these days. In year two these session evolved into project working and action plan implementation groups. The programme had a number of visible activities that took place on a regular basis. Overarching these ‘events’ the programme activities principally involved: (i) developing an understanding of what the work/practice development involves and the competence and confidence to role model the processes to be used (ii) becoming familiar with the Person Centred Framework and Practice Development Model as the frameworks used for the programme and for achieving the above (iii) developing an understanding of workplace culture and ‘change’ processes (iv) awareness raising activities for different staff groups, older people and families in the programme sites (v) developing a shared vision using Values Clarification Exercises involving the Residents/Patients Families/Carers and all staff within their work place (vi) Active Learning in the workplace (vii) structured reflection (vii) facilitation skills development (viii) developing greater appreciation of skills in effective group and team working and (iv) working with evaluation methodology and methods. PROGRAMME EVALUATION The processes and outcomes from the practice development programme were evaluated within a framework of cooperative inquiry. In addition, a number of ‘evaluation instruments’ were used. These instruments have been developed as components of previous research and development in person-centred practice and have established validity and reliability. The project leaders, lead facilitators and project participants all acted as co-researchers in the collection and analysis of the data. Thus this programme has the added benefit of developing evidence gathering and research skills among participants. Data were collected at three time points during the programme: approximately between December 2007 - March 2008 and again at two more time points (January-February 2009 and August-September 2009). 15
The implementation of a model of person-centred practice in older person settings Data collected using the Context Assessment Index, Environment Awareness & Impact, and the observation of care tools were analysed at a local level only and the data used to inform the development of local action plans. Data collected using the Person Centred Care (PCCI) and Nursing Indices (PCNI), Culture observation tool (WCCAT)l and user (older people) narratives were analysed at a local level to inform the development of action plans and collectively at a national level to inform the effectiveness of process and outcome achievement across the programme as a whole. All the data was analysed using a participatory approach with programme participants, programme facilitators and programme leaders. In addition to this data, stakeholder perceptions of the programme have been gleaned throughout the first year of the programme through various stakeholder events. This data collection ceased in year 2 as a consequence of the national HSE embargo. As an alternative method, at timeline 3, data was collected through a questionnaire with key stakeholders (for example Directors of Nursing from the sites and NMPDUs, service and general managers). However, the response to this was very low thus limiting the usability of the data. The notes from the programme days across all the sites detailing learning evaluations and feedback to Directors were also collated and analysed for evidence of progression. The evaluation of this specific part of the programme identified a variety of active learning activities that were utilised. Many of the activities are now being replicated and refined in an Australian practice development program, again indicating their usefulness within practice development. SUMMARY OF FINDINGS The personal and professional growth for individuals across different roles and within the health care teams was evident in the analysis of the programme day notes, thus active learning activities were found to be acceptable to the participants and utilised throughout the programme day and in practice. Further, the acceptability and usability of active learning across all the sites and throughout all the days was high, further indicating its usefulness. The outcomes from this program also demonstrate that practice development programmes can be led from a distance and that a group of facilitators can be 16
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