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 DEVELOPMENTS IN PERCEPTIONS OF CARING The data from this evaluation also demonstrated how nurses and care workers perceived their caring role. The person-centred practice framework has been in part derived from research into caring and from theories of caring. Indeed in their most recent publication, McCormack and McCance (2010) demonstrate the relationships between person-centredness and caring and the constructs that capture this relationship are described as the ‘care processes’ in the person-centred practice theoretical framework. Thus, the evaluation of perceptions of caring as an indicator of movement towards a more person-centred work orientation is a legitimate proxy measure of person-centredness. To do this we utilised the Caring Dimensions Inventory (CDI) There was significant change in nurses and care workers ‘perceptions of caring’ as assessed using the CDI. The data analysis shows that staff had shifted their views from one of seeing ‘technical’ aspects of practice as caring (such as the ‘doing of tasks’), to a view that the ‘non-technical’ aspects of caring were more important (such as spending time with a resident) and this shift was reinforced by the observation data. For example the move from standing over and assisting several people to eat at the same time to sitting down and assisting one person at a time and spending more time on providing meaningful activities and occupation for residents. This is an important finding as it suggests a greater orientation towards personcentredness and a change in attitude towards how staff engaged with residents and their families. Participants in this programme were seen to shift their orientation of caring from one where technical tasks were given greater priority to one where relationships with patients and families were more highly valued. This finding supports other international research which suggests that there is a direct relationship between the attributes of an effective workplace culture and patient outcomes (for example Manojlivich and Laschinger 2007; Gunnarsdottir et al 2007). The CDI has been used to ascertain perceptions on caring from the perspective of a range of groups, including registered nurses, nursing students and non nursing students (Watson et al 1999; Watson et al 2003a), between different clinical areas and specialities (Lea and Watson 1995 and 1999; Walsh and Dolan 1999), and from an international perspective (Watson et al 2003b). An evaluation of the use of the 169
The implementation of a model of person-centred practice in older person settings CDI by McCance et al (2008) identified consistent scoring of 12 core statements over five time points, suggesting it provides a strong indicator of nurses and care workers’ perceptions of caring. The findings also mapped onto the person-centred practice framework of McCormack and McCance (2006). Mapping the core statements onto the framework reaffirms the strong correlation between caring and person-centred practice as perceived by participants. In relation to person-centred processes, the statements that remained consistent over time spanned across the five components presented in the Person-centred Practice Framework, with none emerging stronger than any others. This reinforces the validity of the range of person-centred processes presented within the framework and the legitimacy of using these as foci for facilitated discussions about how to develop person-centred ways of engaging in everyday practices with residents. CHANGING PRACTICE The data from the programme days, site specific reports, observations of practice and resident stories, affirm the reality of the shift in focus towards a more personcentred culture. The data from the programme days demonstrates that over the period of 11 facilitated programme days and related development activities in practice, the priorities for care changed among staff teams. Activities such as observations of practice, reflection on the language used among teams and with residents/families and ‘cats, skirts, lipsticks and handbags’ increased staff awareness about a more holistic approach to care that went beyond the doing of tasks: “… For me person-centred care has been in the main about the staff. About developing them to deliver care to our patients that is of the best quality possible. It’s about them learning about their own values and beliefs in order to be able to realise that the patients as people also have a set of values and beliefs that need to be met. My role of facilitator has been in facilitating the growth of the staff at the hospital and supporting them to provide person-centred care. I am very glad I had the opportunity to participate in this programme albeit that on occasion it broke my heart. All I have learned and the networking I have been able to avail of have been of tremendous benefit to me and will continue to be used to benefit the patients lives at this hospital …” (Internal facilitator reflection) 170
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