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 that they believed were not being interpreted accurately. This was a remarkable change especially as the nurses involved were so accepting of the feedback and challenge and the whole group were engaging as a team of equals. Interestingly this group were least resistant to undertaking the exercise. Debriefing in another PD group highlighted the issue of members unable to identify issues they had regarding what they liked least about individual contributions. When this was discussed it became obvious the extent of the culture of reluctance to challenge in this site. This group had the most opposition to undertaking the process review exercise and some members wanted to leave the group there and then if the exercise was continued. The issue of challenge became so obvious that it became impossible to ignore and the quality of the learning from this positively influenced the quality of engagement within the group: ...”I never realised what it feels like to get feedback from a colleague” “It wasn’t as bad as I thought”. “I am more aware of how to give feedback that is supportive rather than criticism”. Facilitation evaluation – Heron’s Matrix One of the methods used to map developments in facilitation within the PD groups was the use of an adapted form of Heron’s Matrix (1999) originally developed as a self-assessment guide for facilitators and used in this programme for the same purpose and adapted to suit the context. This matrix was very useful in identifying the level of facilitation and learning within the group. Evidence on how adults learn, strongly indicates that it is no longer acceptable to just impart knowledge and do things to students but to facilitate their self-directed learning (Heron, 1999). The matrix assisted the facilitators initially and then is one site the whole group to identify where their facilitation development was in relation to six dimensions: planning, structuring, meaning/making sense, challenging/confronting, supporting/valuing and meaning under three evaluation areas: hierarchy, cooperation, autonomy with a heading for issues identified. Figure 2.4 outlines the guide used to start incorporating the matrix in the end-of-day evaluation of our PD sessions. The benefit of using this matrix is that it can give a clear picture of how the group is developing and raises awareness for facilitators of their style of facilitation so that it is varied according to the progress of the group. This matrix was used towards 85
The implementation of a model of person-centred practice in older person settings the end of the programme but with the benefit of hindsight would be beneficial to use from the beginning of facilitation work as an evaluation method and a learning tool. PRACTICE DEVELOPMENT PROGRAMME Debrief/Evaluation Template Planning ♦ Operational Planning ♦ Implementation ♦ Evaluation Structuring ♦ Using Processes ♦ Relationship Building ♦ Decision Making Meaning – making sense ♦ Active Listening. ♦ Understanding. ♦ Empathy Challenging/Confronting ♦ Effective Questioning ♦ Handling Questions/Issues ♦ Resolving Conflict Supporting/valuing ♦ Feedback-Giving ♦ Feedback-Receiving ♦ Staying Neutral Feeling ♦ Being Self Awareness. ♦ Identify and Accept ♦ Manage feelings. Hierarchy Co-operation Autonomy Issues Plan for the group in consultation Structure learning initiatives for the group and supervise the implementation You make sense of what is happening in the group – it is your understanding Facilitator identifies the behaviour to and for the group Facilitator takes the initiative and indicates their regard for them Facilitator directs the dynamics of the group and decide on what they will respond to etc Co-operative construction of the timetable by seeking agreement and views Structure with the group, group collaborate with facilitator to design and direct exercises Group participants are involved in understanding what is going on then add your views Raise consciousness about behaviour. Collaborate conscious raising Create mutual value and respect within the group, collaborate to develop self-created persons Encourage views from the group and collaboration of dynamics in the group Delegate the planning to the group and encourage them to design own course They design, direct and supervise exercises as a group Meaning is generated within the group Group identify avoidance, defensiveness in the group. Facilitator creates the climate Group identify their value and personal identity and develop in their own way as a group Facilitator provides space for the group to manage own feelings and emotions Figure 2.4: Group Process Review Framework Adapted by NMPDU Facilitators for Older Person Services National Practice Development Programme. (2008) from Heron’s Group Matrix. Heron, J. (1999) The Complete Facilitator’s Handbook, London: Kogan Page Empowerment Working together as a group and using group processes, practice development processes and facilitation theories along with problem solving strategies began to make more sense and therefore started to be incorporated in PD sessions. There was less need to explain connections between espoused values and beliefs and what actually happens in practice because the groups were doing these for themselves. The sense of empowerment was a slow but steady realisation that change is possible, supported by practice knowledge and a new approach to delivering care. This was a significant and powerful development for the three groups and indicated real empowerment. In gaining this confidence, the PD groups started to use the processes and really started to understand what their values and beliefs were. 86
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