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 SOUTH AREA Description of the Sites Three hospitals participated in the Person-Centred Practice Program in the HSE South, Cork and Kerry region. St Finbarr’s Hospital is the largest centre of care for older people in the HSE South, and is also the largest unit in the country to participate in the program. The current site was first designated as a workhouse in 1838 and received its first ‘inmates’ in 1840. This former workhouse now forms the basis of the St Finbarr’s Hospital site. It consists of nine long stay and two rehabilitation wards. Services for the older person include: rehabilitation (2x40 bed wards), respite facilities, day hospital and residential care (155 beds). St Josephs’ Unit is a 24 bedded residential care unit, situated on the second floor of Bantry General Hospital and is the smallest unit to participate in the program. Eighteen beds are designated for residential care, five for respite and one for palliative care. St Columbanus Care Home operates under the Primary Community and Continuing Care Services. It was opened as the Killarney Union workhouse in 1845 and was designed to accommodate 800 inmates. It is now a 130 bedded residential care facility, providing continuing care primarily for older adults. St Columbanus provides residential and palliative care. These services are delivered through three nursing units namely, Hawthorn, Heather and Fuschia. Each nursing unit has a variety of 2 – 8 bedded wards, a single side ward, sitting room, dining room and social areas. Program Groups St Finbarr’s program participants group consisted of ward managers, nurses, care attendants and ward kitchen staff. At the end of the first year a community nursing unit was opened up on site and 50% of the participants group were redeployed to this service. Approximately 4 weeks later a further 25% of participants were lost to the program team through staff relocation to other wards. This necessitated the recruitment of new participants to the team. This was challenging for the Internal Facilitator as program days had to be structured to accommodate these new participants and they also required extra support to develop their action plans. While 97
The implementation of a model of person-centred practice in older person settings their initial involvement meant that all program processes had to be reviewed, this, while challenging at the time, proved beneficial to the group as a whole, as existing participants reported this review helped them to understand the principles of Person- Centred Care more thoroughly. St Joseph’s program group included nurses and care assistants. At the beginning of the second year, there was a change of both external and internal facilitators. Initially these changes led to disruption of the program, but they also led to fresh ideas and new personalities. St Columbanus program group consisted of CNM2, CNM1, staff nurses, care assistants and an activities therapist. Phase 1 data collection findings (January 2008) Preparations for the program commenced in the Spring of 2007. Data were collected on three occasions during the period of the program delivery, namely January 2008, November 2008 and June 2009. The baseline findings from the first round of data collection in January 2008 informed the participants about the needs of residents and about some organisational issues that needed to be addressed. For example: • Residents had limited access to outdoors or to spaces where they could share private time with their families. • Residents had limited choice around mealtimes and activities, or if residents were unable to inform staff of their choice/need, how could staff address this? • Staff felt there was not enough time available to spend with or chat to residents. They felt disempowered with little autonomy and that care delivery was task orientated, with the emphasis on the biomedical model of nursing. Action Plans arising from phase 1 data collection Team building exercises assisted the participants in progressing their action plans. They reminded each other daily about the language being used and becoming more person-centred. An agreed process for giving and receiving feedback was developed, and for managing high challenge/high support. Activities were developed in order for residents to have more choice. More meaningful conversations with residents were encouraged and residents’ narratives were obtained. 98
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