Browsing by Person "Titchen, Angie"

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A Kaleidoscope of Hope: Exploring Experiences of Hope Among Service Users and Informal Carers in Health Care Contexts
(SAGE, 2017-07-06) McCormack, Brendan; Borg, Marit; Cardiff, Shaun; Dewing, Jan; Jacobs, Gaby; Titchen, Angie; van Lieshout, Famke; Wilson, Valerie
Background: There is a large and diverse literature on the concept of hope in health care. This literature covers a broad spectrum of perspectives, from philosophical, conceptual, and theoretical analysis through to attempts at measuring the concept of hope with differing health care users. Aims: To explore the concept of hope through the secondary analysis of existing data sets, with the intention of understanding hope in the context of person-centeredness. Research Question: What is the experience of hope among service users and informal carers in different health care contexts? Method: Secondary analysis of data derived from three research studies. Findings: We identified four key themes that together illustrate what we describe as a kaleidoscope of hope, reinforcing the view that there is no one presentation of hope and that practitioners must engage authentically with service users to determine the most effective and appropriate intervention strategies. Conclusions: Hope is not a singular phenomenon, and in the context of person-centered practice there is a need for practitioners to engage authentically with service users and listen carefully to what may bring hope for them. 2016, The Author(s) 2016.
Compassion in facilitating the development of person-centred health care practice
(BioMed Central, 2015-06) van Lieshout, Famke; Titchen, Angie; McCormack, Brendan; McCance, Tanya
Background Person-centred practice, which includes compassion, needs to be well facilitated in order to flourish in healthcare settings. Facilitation is known to be complex and requires expert knowing and skills. The importance of adequate facilitator support is recognised. The literature however is unclear about the nature of this support and how it can be offered to facilitators while engaging with others in real world practice contexts. Case description This paper presents a lived experience of a doctoral student working as a facilitator with clinical nurses and their leaders, to develop person-centred health care practice, through action research. Compassion with others and self is apparent throughout the experience. It illustrates a facilitator's felt need to respond to this emotion that is triggered in the engagement with others, but which often is hindered by the context and perceptions of the situation. This causes imbalance within the facilitator, which in turn challenges the achievement of synchronous working with practitioners and the development of person-centred practice. Discussion A strong interplay between contextual and facilitator characteristics in the relationship with others impacts on the development of person-centredness in practice. Therefore compassion, as one of the attributes of person-centred practice, is fragile and fluid when lived in facilitative practice. A compassionate system of support is suggested to enable an understanding of context and self, in order to become and remain a person-centred, compassionate, facilitator in dynamic health care contexts. Conclusion A compassionate system of support has the potential to help professionals to navigate the context, without losing oneself, in the process of enabling person-centred, compassionate practice to thrive. Such support suggest an 'ethic of care' for the facilitator in discovering and engaging with the emotional context of facilitating person-centred practice.
Dancing with stones: critical creativity as methodology for human flourishing
(Taylor & Francis, 2010-11) Titchen, Angie; McCormack, Brendan
Heavy feet of stone Seeking transformation Dancing rocks and flows Critical creativity is a paradigmatic synthesis linking critical social science with creative and ancient traditions. Our haiku summarises the essence of this three part paper. Heavy feet of stone describes the rationale for our creation of critical creativity. Seeking transformation sets out the background and methodology for our inductive, methodological development. Dancing rocks and flows unfolds a new methodological framework for action-oriented, transformational practice development and research that is concerned with human flourishing for those who engage in such work, as well as those for whom the work is intended. Through interplay of story, metaphor, poetry and critical dialogue, we present our methodological development approach for critical creativity and the evolving methodological framework. Within the framework, we focus on conditions and principles that enable our worldview of critical creativity to be used in action research and practice development.
Designing and implementing two facilitation interventions within the 'Facilitating Implementation of Research Evidence (FIRE)' study: A qualitative analysis from an external facilitators' perspective
(BioMed Central, 2018-11-16) Harvey, Gill; McCormack, Brendan; Kitson, Alison; Lynch, Elizabeth; Titchen, Angie
Background The 'Facilitating Implementation of Research Evidence' study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators' ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation. Methods Qualitative data sources included notes from monthly internal-external facilitator teleconference meetings, from closing events for the two facilitation interventions and summary data analyses from repeated interviews with 16 internal facilitators. Deductive and inductive data analysis was led by an independent researcher to evaluate how facilitation in practice compared to the logic pathways designed to guide fidelity in the delivery of the interventions. Results The planned facilitation interventions did not work as predicted. Difficulties were encountered in each of the five elements of the logic pathway: recruitment and selection of appropriate internal facilitators; preparation for the role; ability to apply facilitation knowledge and skills at a local level; support and mentorship from external facilitators via monthly teleconferences; working collaboratively and enabling colleagues to implement guideline recommendations. Moreover, problems were cumulative and created tensions for the external facilitators in terms of balancing the logic pathway with a more real-world, flexible and iterative approach to facilitation. Conclusion Evaluating an intervention that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. At a practical level, relational aspects of facilitation are critically important. It is essential to recruit and retain individuals with the appropriate set of skills and characteristics, explicit support from managerial leaders and accessible mentorship from more experienced facilitators. At a methodological level, there is a need for attention to the balance between fidelity and adaptation of interventions. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, informed by prospective use of process evaluation data and more detailed investigation of the context-facilitation dynamic.
Facilitating Implementation of Research Evidence (FIRE): An international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework
(BioMed Central, 2018-11-16) Seers, Kate; Rycroft-Malone, Jo; Cox, Karen; Crichton, Nicola; Edwards, Rhiannon Tudor; Eldh, Ann Catrine; Estabrooks, Carole A.; Harvey, Gill; Hawkes, Claire; Jones, Carys; Kitson, Alison; McCormack, Brendan; McMullan, Christel; Mockford, Carole; Niessen, Theo; Slater, Paul; Titchen, Angie; van der Zijpp, Teatske; Wallin, Lars
Background - Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. Methods - A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. Results - Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. Conclusions - This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and “doses” of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors.
Learning Embodied Practice Wisdom: The Young Sapling Learning from the Old Tree
(BRILL, 2019) Titchen, Angie; Kinsella, Niamh
A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: An exemplar
(BioMed Central, 2018-11-16) Rycroft-Malone, Jo; Seers, Kate; Eldh, Ann Catrine; Cox, Karen; Crichton, Nicola; Harvey, Gill; Hawkes, Claire; Kitson, Alison; McCormack, Brendan; McMullan, Christel; Mockford, Carole; Niessen, Theo; Slater, Paul; Titchen, Angie; van der Zijpp, Teatske; Wallin, Lars
Background Facilitation is a promising implementation intervention, which requires theory informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice. Methods This realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time-points using multiple qualitative methods: observation (372 hours), interviews with staff (n=357), residents (n=152), next of kin (n=109) other stakeholders (n=128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. Results The content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role, and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators’ (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes. Conclusion The scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally a realist informed process evaluation framework is outlined, which could inform future research of this nature.