The Implementation of a Model of Person-Centred Practice In Older ...

The implementation of a model of person-centred practice in older person settings
This reflection and the programme days evaluation clearly demonstrates that making
these changes is not easy. This evidence is consistent with the international practice
development evidence which demonstrates that changing cultures of practice from a
routinised to a person-centred approach is challenging at individual, team and
organisational levels (McCormack et al 2007). Because the essence of
emancipatory and transformational development is that of changing ‘self’, i.e.
adjusting my perspective(s) of situations, then to do this requires considerable
commitment and dedication of staff to engage the analysis of ‘self’. For the most
part, we exist on a day-to-day basis within largely routinised ways of engaging and
behaving – the ‘crisis’ (Fay 1987) that occurs when the comfort of such routines is
challenged requires skilled facilitation. The crises that occur and the facilitation
interventions necessary are not a one off event but reoccur to form a pattern until the
individual can transcend it. The facilitation interventions to work with these crises are
evident in this practice development programme. The evidence from the programme
illustrates just how challenging it is for facilitators to engage staff who are feeling
threatened by the approach being used, and to ‘hold’ staff as they make their own
journeys in coming to terms with the realities of practice and maintaining momentum
so that real changes can occur within a set time frame:
“When I began the programme 2 years ago I had totally underestimated the
commitment required to be part of the programme. I’ve always welcomed new
challenges and looked forward to this one. I found the weekend in Athlone to
commence the programme was absolutely vital to give me a great foundation
towards facilitation and practice development. Having a mentor in [NMPDU
Facilitator] and [external facilitators] always available was crucial to my ‘survival’.
There were times when I felt like I was the only person in our unit that was interested
in PCC. Without this sounding negative, if I knew at the start of the programme all the
challenges I would meet, I’d have found it difficult to enlist …” (Internal facilitator
reflection)
However, the data illustrates the extent of changes made to the practice cultures in
the participating units and also to the lives of older people who are residents in these
units. There are multiple examples of staff offering to make things happen that really
mattered for the older person; such as going out for a meal or going shopping, going
to see their old home and village, going to their old church. Other significant changes
included clarification in roles including separating out housekeeping and care
responsibilities, changes to the physical environments and considering evidence
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