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 Plans are under way to install a new computer into the diversional therapy unit where the residents will have access to the computer and have the opportunity to learn new skills. Gardening has also been included into weekly activities; this was highlighted by one of the residents in his narrative. In St Brigid’s Hospital, one resident in his narrative expressed a desire to have more autonomy and control at meal times. In particular he wanted to have his own tea pot. While it appeared to be a very simple and normal request, it proved a challenge for the team to implement. There were issues raised initially from staff around health and safety. The IF along with the team developed a plan of action addressing the concerns of the staff. The resident along with others now have their own tea pots at meal times. This achievement has led to other initiatives being introduced where staff in the past would have resisted, citing concerns around health and safety. Daily activity programmes for the residents have become much more focused on providing activities that are appropriate and meaningful to the residents. Such new activities included the availability of a minibus and driver one day a week to facilitate outings for the residents in two of the sites. This service is provided free of charge from a local community organisation. Innovative trips have been organised from going on boat trips, trips to the theatre to attend their 'Elevenses club' that shows old time movies in the morning followed by a trip to the local “McDonalds” In St Brigid’s they have developed community links, this was something that had not happened previously. Visits from Foroige youth club, local traditional and folk groups are now a regular feature. Other activities include involvement in an inter care setting Boccia league organised by Mountmellick Development Association in conjunction with Sport Le Cheile. St Brigid’s have two teams involving 10 residents. Using Person-centred Care Planning formats and processes, the internal facilitator along with the residents and staff has completely revamped the activity programme to include many more meaningful activities: we use Cats Skirts Lipstick exercise, Poole Activity Level, activity questionnaires, My Way My Day and talk with family members also. Residents have requested more social afternoons/evenings, social’s are now organized in the revamped dining room where everyone is invited to attend. Facilitating Residents to have a voice and to be involved in decision making was identified from the observations and narratives across the sites. 47
The implementation of a model of person-centred practice in older person settings In St Brigid’s, the residents action group was well established and running very well with regular meetings. In BCNU while a resident’s forum had been established for the unit, an evaluation of its effectiveness identified the need to re-view it. Following consultation with the residents and staff it was agreed to establish a residents forum on each of the three units. In St Vincent’s Hospital a forum was set up at ward level which was facilitated by a programme participant and the ward manager. Meetings are now held every 4-6 weeks and residents have identified areas for development and action. For those residents who are unable to communicate a relatives/advocate has been invited to attend. The hospital volunteer advocate also attends some of these meetings. All three sites have the groups up and running and are now an established part of life in the sites. In St Vincent’s Hospital and BCNU linkages were made with the National Advocacy programme to participate in it. In St Vincent’s they now have introduced an advocacy service to one of the wards and plans are in place to extend that service. Environmental changes have been made in different sites to promote/develop a more homely person-centred environment that reflects the vision statements. Action plans were developed around numerous areas for improvement. At each data collection phase, further improvements were made to the environment. Some improvements identified, needed to be incorporated into the overall service plan. Décor in general needed to be improved, some areas had a complete makeover. In St Brigids hospital the observations of care and environmental walk about highlighted in particular the dining area as not very conducive to a homely environment. Practices at mealtimes were identified as somewhat institutionalised and routinised. A project team involving residents, family/carer and members of the Multidisciplinary Team (MDT) was established to look at the whole mealtime experience from the practices to the environment. This project was completed throughout the programme. The dining room area was completely transformed. As well as changing the environment, education and training programmes were delivered to all staff on nutrition, assessment, assisting residents at mealtimes and other specific issues related to nutrition. Facilities are now available within the dining area for relatives to come and have refreshments with the residents at any time of the day. Ongoing auditing and observation of mealtimes have become an integral part of staff development and practice development in the unit. 48
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