Nursing

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‘It’s a nice place, a nice place to be’. The story of a practice development programme to further develop person-centred cultures in palliative and end-of-life care
(Foundation of Nursing Studies (FoNS), 2018-05-16) Dickson, Caroline; Smith, Tracy; Ford, Hilary; Ludwig, Steffi; Moyes, Rhona; Lee, Laura; Adam, Elaine; Paton, Tracy; Lydon, Brigid; Spiller, Juliet; McCormack, Brendan
Background Palliative and end of life care services need to be person-centred. However, it cannot be assumed that such services are ‘naturally’ person-centred as in reality they face the same pressures and challenges as any other service. This is the case in the practice development research reported in this paper. Whilst the service had good patient and family feedback/satisfaction, the context of care provision for staff did not reflect these same levels of satisfaction. This contrast poses challenges for organisations in the context of staff well-being and the sustainability of person-centred care. The work undertaken in this project aimed to address this issue. Aim To implement a programme of practice development to further the development of a culture of person-centred practice in the Marie Curie Care (MCC) Edinburgh Hospice. Methods The programme was theoretically informed by The Person Centred Practice Framework of McCormack and McCance (2017) and operationalised through the methodology of Transformational Practice Development. Thirteen multidisciplinary team members formed a project group and participated in 10 x 4 hour workshops of learning and development, spread over a 12-month period. Practice development activities were planned in-between the workshops to be undertaken by the group members. Evaluation data were collected prior to the practice development work commencing, as a continuous process throughout the 12-months and at the end of the project period. Data collected included patient and staff stories, practice observations, creative expressions and routinely collected data. These data were analysed through a participatory approach with the group members and theorised through the lens of human flourishing. Findings The findings are located within a framework for exploring the conditions for human flourishing. They illustrate the tension between person-centred care and person-centred cultures. Key findings demonstrate the need for all persons to be ‘known’ in order for effective person-centred relationships to exist, the significance of shared values, the importance of addressing ‘small’ practice changes as well as the need to ensure the hearing of different voices. Findings fromn routine collected data further demonstrate the relationship between the development of a person-centred culture with patient and staff outcomes. Conclusions and Implications for Practice This project is one of the first to explicitly use a framework for human flourishing to analyse the relationship between person-centred culture and care provision. The programme demonstrates the importance of person-centred cultures for sustainable person-centred care. Implications for practice include: 1. Practice settings need to be clear about the difference between patient and person-centredness. 2. The engagement of a multidisciplinary team in interdiscioplinary systematic transformational practice development has the potential to transform the culture and context of care and produce sustaiunable outcomes. 3. Human flourishing is an appropriate focus to adopt in exploring how practice settings embrace the principles of person-vcentredness for all persons.
From root to fruit – flourishing in change. Evaluation of a development programme for practice development facilitators in end-of-life care
(Foundation of Nursing Studies (FoNS), 2018-05-16) Dickson, Caroline; Legg, Melanie; Penman, Pam; Smith, Tracy; Marie Curie
Background: This paper outlines the structure, processes and outcomes of a 12-month development programme for nurses who were transitioning from a practice-based training role to a practice development role. The programme was part of organisational commitment to develop a person-centred culture. A new team of Practice Development Facilitators across the UK was formed at Marie Curie. Marie Curie, a UK-based charity supporting people with palliative and end of life care needs. Aims and Objectives: The overall aim of the programme was to enable PDFs to engage with the theory and practice of practice development to develop as enablers in the delivery of person-centred practice. Methods: A co-designed multi-method evaluation of the programme that adopted emancipatory practice development and active learning methodologies. Data collection included 4th Generation evaluation, reflective writing, participant stories and examples of practice change. Findings: The programme supported a change in focus of their role from technical to emancipatory. The team identified new ways of engaging together which enabled them to embody person-centredness. By experiencing active learning they came to understand themselves and their practice. Throughout the programme the team experienced a range of organisational challenges which impacted on their progress throughout the programme. Development of their facilitation skills and a strong community of practice will assure embeddedness and sustainability of their new role. Conclusions: Facilitators of Practice Development are a catalyst in developing person-centred cultures which are indicative of flourishing organisations but this needs to be included in organisational strategy. Experiencing flourishing creates a sense of well-being and renewed commitment to develop practice in ways that keep person-centred care at its heart. Key messages: • Making explicit values and beliefs at the beginning of a programme enable social learning and innovation in practice • Investment in PD can be a catalyst to developing person-centred cultures • Role-modelling person-centredness has an impact on staff well-being and person-centred practices • Embedding communities of practice will main momentum in new ways of working

Nursing

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