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 Re-evaluation of findings, action plans and achievements (Second Phase) The process of gathering and evaluating data (formal and informal) informed the participants about the culture of their organisation and the direction that was required to improve health and social needs and end of life care for residents/patients. With regards to the patients it was planned to ensure that the initiatives would contribute to the delivery and achievement of some of the HIQA standards and the action planning explicitly addressed actions relating to them. • The use of patient’s “Life Stories”/”Narratives” was one such example of how information could be utilised to move towards a new culture of care. This new culture, while involved in the physical aspects of care is concerned equally with the promotion and maintenance of personhood, in which a person is actively involved and lives a meaningful life. According to Kitwood (1997) biographical knowledge about a person is essential if their identity is to be protected, and one way of contributing to this is through the development of life-story work. The stories included both happy and sad memories, and in many cases assisted the staff in forming a more emphatic, therapeutic relationship with the residents/patients. Furthermore, one could go so far as to recommend, “story sharing” between residents and staff. According to Heliker (2009) unlike “story telling” in which one person is the focus, story sharing assumes an equal and mutual exchange and honours the space “in between” teller and listener, one speaking and one listening reflectively and interpreting the significance of the story being told. • Another tool used in the gathering of data that impacted on the participants regarding the need for cultural change was the Workplace Culture Critical Analysis Tool (WCCAT). Seeing practice, raising consciousness about taken-forgranted practices and assumptions and reflecting on them were key components of the observations. Stepping outside their usual role of ‘doing’ and trying to observe the environment from a different perspective and its possible impact on resident/patients was enlightening. Providing feedback to the staff in the form of a “critical dialogue” was essentially to challenge practice by highlighting the differences between values espoused and those observed in practice. These activities highlighted the need to see things from a different perspective and to 67
The implementation of a model of person-centred practice in older person settings facilitate therapeutic/relationship based care that could be sustained and thus transform healthcare delivery. According to Person and Marsh (2002) transformative change calls for new ways of “thinking”, “being” and “doing”. • Structured reflection was an integral part of the programme whereby the participants could reflect in and on experiences and explore the environment in which they work and see themselves in the context of their practices. This provided the participants with the opportunity to stand back and try to make sense of the experience and to question what it is they do and what they would like to do better. • Following the analysis of both the quantitative (questionnaires) and qualitative data (observation of care and patients narratives) and the interpretation of the findings the participants identified and prioritised their action plans. The emerging themes from the three sites centred on improving quality of life issues and included: o Privacy and respect o Choice o Loneliness/family/connectedness o Improved communication o Maintaining identity o Creating a homely environment o Meaningful activities o Meal times and choice These themes mirrored the national themes (7) towards the end of year one of the programme (McCormack et al 2007 and 2009): o Privacy and Dignity o Choice and Power o Hope and Hopelessness o I’m just a Task (Task Orientation) o Environment o Communication and Interaction o Staffing and Team Work The term ‘person-centred’ was not only concerned with the care older people received, it focused on the management and organisational systems available to all 68
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