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 year two. We have discovered that, for all groups, developing skills in reflection would require more work in year 2 of the programme. The data has not been included in the evaluation research because of the low levels of reflectivity. See the discussion chapter for further consideration. • Facilitation Skills Development: Listening, the use of enabling questions, high challenge, high support, giving and receiving feedback are all components of facilitation that have been explored and developed in the programme. Participants have been introduced to these skills and were encouraged to further develop their confidence in using these skills in their every day work and across their workplaces to help develop a more person-centred culture. Active learning methods were used to enable participants to enhance their skills in a focused way. • Developing an understanding and gaining direction on how practice development processes will impact positively on the achievement of the National Standards for Residential Care developed by the Health Information and Quality Authority (HIQA). All the objectives and development processes have been mapped to the HIQA Standards and these are being used to explore the findings from the evaluation data collection and inform action plans developed. • Developing greater appreciation of and skills in effective group and team working. • Introduction to the evaluation methodology used for the programme and involvement in the collection of the evaluation data. A range of evaluation tools and processes have been used in this programme (detailed later in this chapter). Wherever possible programme participants have been involved in collecting and analysing this data and informing the identification of outcomes. This intention further contributed to changing the social power within their workplaces. Programme Evaluation The processes and outcomes from the practice development programme were evaluated within a framework of co-operative inquiry as outlined earlier, primarily drawing upon reflective dialogue data between lead facilitators, project participants and the project leaders; interview data with all participants and records of developments. In addition, a number of ‘evaluative instruments’ were used. These instruments have been developed as components of previous research and development in person-centred nursing and have established validity and reliability data. The project leaders, lead facilitators and project participants all acted as coresearchers in the collection and analysing of data. Thus the framework has the 37
The implementation of a model of person-centred practice in older person settings 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). The tools used, and listed below, have been developed as components of previous research and development in person-centred care and have established validity and reliability data: 1. Context Assessment Index (CAI) (McCormack et al 2009): This tool assesses the practice context and its receptivity to person-centred ways of working. 2. Person-centred Nursing Index (PCNI) (Slater & McCormack 2007): This tool measures the processes and outcomes of person-centred nursing from both nursing and patient perspectives. 3. Person-centred Caring Index (PCCI) (Slater & McCormack 2007): This tool measures the processes and outcomes of person-centred caring from healthcare worker perspectives (including healthcare assistants and other care workers in the care setting who contribute to patient care). It was piloted in sites within the North West region prior to national use. 4. Cultural observation tool (WCCAT) (McCormack et al, in press): this recently developed observation of practice tool explores the culture of a workplace at a number of levels in order to inform the degree to which changes in practice are achieving a change in culture. 5. User Narratives: Utilising a framework developed by Hsu and McCormack (2006) for collecting and analysing older peoples’ stories about the quality of care, this data would serve to bring richness and depth to the other data sets. The project leaders and lead facilitators all acted as co-researchers in the collection and analysis of data. Thus the framework has the added benefit of developing evidence gathering and research skills among the programme team and the programme participants. Data collected using the CAI, environment awareness and 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. 38
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