Compassion in facilitating the development of person-centred health care practice

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.sch_nur2pub4155pub

Designing and implementing two facilitation interventions within the 'Facilitating Implementation of Research Evidence (FIRE)' study: A qualitative analysis from an external facilitators' perspective

Acknowledgement: We extend our sincere thanks to FIRE project team colleagues, in particular lead investigators and research fellows involved in data collection and analysis that contributed to the current paper. We also acknowledge the facilitators and their buddy colleagues that we were worked with during the course of the study.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.Funding: The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 223646. The funder had no role in designing, conducting, or interpreting study findings.Funder: FP7 Health, Grants: 223646https://implementationscience.biomedcentral.com/articles13pubpub

Facilitation skills: the catalyst for increased effectiveness in consultant practice and clinical systems leadership

Consultant practitioner is the pinnacle of the clinical career ladder for all health care disciplines in the United Kingdom. Consultant nurse, midwife and health visitor roles build on the clinical credibility and expertise characteristic of advanced level practice, but also possess expertise in: clinical systems leadership and the facilitation of culture change, learning and development; advanced consultancy approaches, and research and evaluation to prioritise person-centred, safe and effective care across patient pathways. This project aimed to help new and emerging consultants to become more effective in their role through a programme of support to develop their expertise. Emancipatory action research, supported by claims, concerns and issues tool, derived from Stakeholder Evaluation, and other methods (active learning, action learning, collaborative workshops and individual tools e.g. qualitative 360 degree feedback and reflective reviews) comprised the supportive intervention which enabled participants to research their own practice. The programme’s methodology and methods helped participants to: research their own practice; theorise from practice; grow the facilitation skills needed to develop and demonstrate their own effectiveness; foster the effectiveness of others and; transform practice culture. Greater effectiveness in their multiple roles was demonstrated, as was the impact of this on others, services and organisations. The study concludes that the support programme augmented by the methodology, facilitation skills and the 10 principles derived from a concept analysis of work-based learning is central to achieving improved effectiveness and transformation of others, services and organisations. Theoretical insights at collective/community levels also resulted. Key recommendations are identified for commissioners, higher education and research

Evaluating the successful implementation of evidence into practice using the PARiHS framework : theoretical and practical challenges

Background The PARiHS framework (Promoting Action on Research Implementation in Health Services) has proved to be a useful practical and conceptual heuristic for many researchers and practitioners in framing their research or knowledge translation endeavours. However, as a conceptual framework it still remains untested and therefore its contribution to the overall development and testing of theory in the field of implementation science is largely unquantified. Discussion This being the case, the paper provides an integrated summary of our conceptual and theoretical thinking so far and introduces a typology (derived from social policy analysis) used to distinguish between the terms conceptual framework, theory and model – important definitional and conceptual issues in trying to refine theoretical and methodological approaches to knowledge translation. Secondly, the paper describes the next phase of our work, in particular concentrating on the conceptual thinking and mapping that has led to the generation of the hypothesis that the PARiHS framework is best utilised as a two-stage process: as a preliminary (diagnostic and evaluative) measure of the elements and sub-elements of evidence (E) and context (C), and then using the aggregated data from these measures to determine the most appropriate facilitation method. The exact nature of the intervention is thus determined by the specific actors in the specific context at a specific time and place. In the process of refining this next phase of our work, we have had to consider the wider issues around the use of theories to inform and shape our research activity; the ongoing challenges of developing robust and sensitive measures; facilitation as an intervention for getting research into practice; and finally to note how the current debates around evidence into practice are adopting wider notions that fit innovations more generally. Summary The paper concludes by suggesting that the future direction of the work on the PARiHS framework is to develop a two-stage diagnostic and evaluative approach, where the intervention is shaped and moulded by the information gathered about the specific situation and from participating stakeholders. In order to expedite the generation of new evidence and testing of emerging theories, we suggest the formation of an international research implementation science collaborative that can systematically collect and analyse experiences of using and testing the PARiHS framework and similar conceptual and theoretical approaches. We also recommend further refinement of the definitions around conceptual framework, theory, and model, suggesting a wider discussion that embraces multiple epistemological and ontological perspectives

FIRE (facilitating implementation of research evidence) : a study protocol

Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids

Action research: genesis, evolution and orientations

Background: Action research is used to bring about systematic change at the same time as developing fresh understanding about the change strategy and its impact. It has been around since the 1940s in a variety of forms and for different purposes. It is increasingly used as a practice development research strategy in healthcare professions. Aim and objectives: The aim is to provide an overview of action research to enable understanding of the flow and the cumulative, interactive nature of action research and its evolution. The objectives of the paper are practical, historical and paradigmatic in nature. Methods: Drawing on personal and others’ development and on experience of action research, the paper is a blend of scholarly writing, practical examples and the metaphor of a tidal river estuary. The metaphor uses continuous reshaping of sandbanks to symbolise the coming together and moving apart of different streams of action research. Exposition: The origins and evolution of action research, with its different purposes, orientations and emphases, are shown through an analysis and critique of different definitions of action research over time. With differences identified, common characteristics of action research and the creation of action hypotheses are set out, followed by the history and evolution of action research, separated into four major modes. Paradigmatic origins and assumptions of these modes are critiqued. Conclusion and implications for practice development research: In common with all researchers, practice development researchers need to consider carefully which paradigmatic assumptions are most relevant to their questions and purposes because those assumptions will help them to locate their work in an appropriate specific or blended research paradigm. The choice of paradigm will affect everything they do and are, so the choice needs to be made from an informed and embodied position

Flowing like a river: facilitation in practice development and the evolution of critical-creative companionship

Beginnings: Using a river landscape metaphor, the purpose of this paper is to locate critical creativity in the evolution of practice development in the UK and show how it can be facilitated through critical-creative companionship. Critical creativity is a new landscape for practice development that has evolved through three decades of a deepening understanding of: the philosophical foundations of practice development (bedrocks); paradigms (landscapes); projects/studies (gardens); and practice development/research roles, relationships and skills (gardeners). As a practice development practitioner, facilitator and researcher, I have helped shape the course of the river, peaking with the slow-burn, yet intense, co-creation of critical creativity. Panorama, flow and transformation: A panoramic view of the river is offered as it changes over time. This view includes the river’s changes of flow and direction, powered by different philosophical and theoretical influences and resultant transformations in practice development practice/research and facilitation. Unfolding: I telescope in on the critical creativity landscape, showing how it is a synthesis of previous influences and how the critical companionship of my earlier work flowed gently into critical-creative companionship. I show broad-brush how critical-creative companions help people to use the philosophical, theoretical and methodological mandalas of critical creativity, not only in their practice development, but also in their own being and becoming critical-creative companions. Conclusion and implications for practice development and inquiry: Critical-creative companions help people to work in the gardens of critical creativity to embody and live what might seem difficult, complex and mysterious. Becoming a critical-creative companion takes time. It requires a scholarly approach to practice and the development of enabling facilitation skills and experiential and theoretical understanding. Reading resources are suggested

Dancing with stones: critical creativity as methodology for human flourishing

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.sch_nur18pub3453pub

Learning Embodied Practice Wisdom: The Young Sapling Learning from the Old Tree

Niamh Kinsella - ORCID: 0000-0001-8160-3812 https://orcid.org/0000-0001-8160-3812Item is not available in this repository.https://doi.org/10.1163/9789004410497_017pubpu

Telling people's stories : creating authentic approaches

Angie: Debbie, we need to clarify what we mean by “stories”. Debbie: Yes, it’s a rather slippery term; I find it quite hard to say what I mean. I can say that I don’t mean using the actual mode and structure of the story as a research method. I don’t mean any particular methodology. Angie: Definitely not for me either, although it is for some researchers. Perhaps it would be easier if we explained how we have used stories in our research. In my thesis I used stories: first, they were a means for getting at what participants know consciously and can readily express about the phenomenon being studied or their experiences of it