Using two models of workplace facilitation to create conditions for development of a person-centred culture: A participatory action research study

Jan Dewing - ORCID 0000-0002-7968-2213 https://orcid.org/0000-0002-7968-2213Aims and objectives: To examine facilitation in workplace learning where nurses are focused on creating person-centred cultures; to provide a framework for novice and proficient facilitators/practitioners to learn in and from their own workplaces and practices; to provide the conditions where practitioners can gain an understanding of the culture and context within their own workplace. Background: Evidence suggests that person-centred cultures depend on purposeful, facilitated practice based learning activities. For person-centredness to become more meaningful to nursing leaders in their daily work, focus must be placed on their acquisition and use of facilitation skills. The facilitation framework ‘Critical Companionship’ remains an exemplar in the development of expert facilitation skills. Two sequential facilitation models were developed as ‘steps’ towards Critical Companionship, as a framework for novice and proficient facilitators and practitioners to learn in and from their own workplaces and practices. Design and Methods: This research, situated in a critical social science paradigm, drew on participatory action research to devise, explore and refine two facilitation models: Critical Allies and Critical Friends. The researcher adopted an insider approach to work with five nursing leaders, which was subsequently reported using the EQUATOR Guidelines for Best Practice in the reporting of Participatory Action Research. Results: Show the complexity of enabling facilitation within the workplace. Four themes and twelve sub-themes emerged from the data that describe the attributes needed to facilitate workplace learning and reveal that mangers can have an active role in enabling person-centred culture development. Conclusions: This research adds to the body of knowledge on developing person-centred culture. It offers practical stepping stones for novice and proficient facilitators to enable embodiment of the skills necessary to facilitate learning in person-cultures. The models offer a workplace friendly pathway with practical methods and further contribute to our understanding of how we create person-centred cultures. Relevance to Clinical Practice Facilitation of practice development and workplace learning remains the most effective methods to develop person-centred cultures. This research introduces a pathway for clinical leaders/managers to become facilitators with their own teams, maximising the impact on the culture where care is delivered.28pubpub15-1

An exploration of person-centredness in practice

\u27Person-centredness\u27 is a term that is becoming increasingly familiar within health and social care at a global level; it is being used to describe a standard of care that ensures the patient/client is at the centre of care delivery. In this article we explore the relevance of person-centredness in the context of nursing, taking account of the ongoing critical debate and dialogue regarding developments in this field. Person-centredness is recognised as a multidimensional concept. The complexity of the concept contributes to the challenge of articulating its shared meaning and describing how it can be applied in practice. The aim of this paper is to explore some of the issues pertaining to language and conceptual clarity, with a view to making connections and increasing our shared understanding of person-centred care in a way that can impact nursing practice. We begin by describing the development of the concept of person-centredness, after which we discuss the synergies with patient-centredness and other related terms, and consider how nurses can operationalise person-centredness in their practice

Assuring care: are we ready to move beyond compliance measurement against targets?

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Relational ethics in palliative care research: Including a person-centred approach

The traditional approach to research ethics is to ensure that all ethical issues are adhered to through the scrutiny of research proposals by research ethics committees, themselves sitting within national research governance frameworks. The current approach implies that all potential ethical issues can be considered and mitigated prior to the research. This article is a perspective piece whereby we consider how this approach, on its own, is not enough to ensure ethical practice. We draw attention to the limitations of current ethical procedures in the inherent detachment between the researcher and research participants. We argue that applying a person-centred approach to research ethics allows for contextual and situational factors and places the relationship between research participants and researcher as central.https://doi.org/10.1177/263235241988538413pubpu

IPDJ looks forward: Welcome to 2019! (Editorial)

As the International Practice Development Journal comes to the end of its eighth year, the editorial team is already planning the issues for 2019. So we’re not standing still by any means. Of course, the IPDJ still has much to achieve as it moves towards becoming internationally recognised as a high-quality and high-profile open access publication for health and social care practitioners, educators and academics working in practice development and related fields.8pubpub2 [Article: 1

A discussion of the synergy and divergence between Lean Six Sigma and person-centred improvement sciences

Background: This paper discusses if and how the improvement sciences of Lean Six Sigma and person-centred approaches can be melded or blended in the health care context. The discussion highlights the relationship between each approach to improvement science in terms of their respective purposes, intentions and probable outcomes; positioning these as either synergies or divergences. Comparison of the key theoretical and methodological principles underpinning each approach to improvement is also considered and implications for future practice, policy and research are drawn out. The discussion is informed by part of the findings of a realist review of relevant literature.Conclusions: Lean Six Sigma as a process improvement methodology appeals to a wide range of stakeholders in healthcare internationally. Four key synergies and three key divergences between Lean Six Sigma and person-centred approaches were found. The discussion here highlights the need for further research into Lean Six Sigma implementation and its possible contribution to developing person-centred cultures.Impact: Adoption of Lean Six Sigma in health care by stakeholder groups, external to nursing, has been taking place. At the same time there has been a loss of Lean’s original intention of respect for people in favour of a technical efficiency focus on reducing waste and variation. Our findings of four key synergies and three key divergences between both approaches indicate where synergies can be maximised and divergence narrowed to improve implementation and enhance methodological coherence. Researchers, policy makers and practitioners should be aware that use of Lean Six Sigma alone may have a limited impact on developing personcentred care and culture. Use of Lean combined with person-centred approaches may appeal to a wider range of stakeholders. Yet, their combined use and effectiveness has not as yet been evaluated.This paper was supported by Queen Margaret University Edinburgh and University College Dublinhttps://doi.org/10.3844/ijrnsp.2020.10.2311pubpu

Raising the question of dignity through knowledge about tacit practices and politics: sharing learning from the Norwegian welfare state

The focus of this special issue is some of the main tacit policies and practices in the Norwegian welfare state. By looking at what is tacit, mute, unarticulated and neglected we will contribute to raising and presenting knowledge about the social and ethical question of dignity in welfare. This introductory article will first give a short overview of the historical background of the Norwegian welfare state and some of its current features. This will be followed by our positioning of the Norwegian welfare state as situated within complex practices, political discourses and dimensions that might be characterised as tacit, implicit or unarticulated. The article aims to discuss the concept of dignity in welfare services, at the individual and structural level, by asking ‘what kind of practices and structural conditions preserve dignity and where might dignity be violated, ignored or left out?’The various articles in this special issue of the International Practice Development Journal illuminate what can be said and what is mute and tacit in different ways, and consider a range of practice-based responses. By revealing tacit dimensions in the Norwegian welfare this issue offers important insight into practices and discourses where dignity is at stake. It is a requirement of us all that we revisit dignity and its location and representation in our health systems to ensure it is not left behind as the state and other systems within it evolve.publishedVersio

Developing facilitation skills amongst undergraduate nursing students to promote dementia awareness with children in a higher education institution (innovative practice)

Final year students on a BSc Hons Nursing programme in Scotland were supported to become Dementia Friends facilitators and develop interactive dementia awareness sessions for children from local schools. The children were invited to indicate phrases and images they associated with ‘dementia’ at the outset and end of the session. Analysis of the responses suggested that there were positive changes in the children’s values and beliefs when thinking about a person living with dementia during the sessions. We suggest that peer learning is a valuable strategy to increase public and professional awareness about dementia and supports the development of graduate attributes.</p

Exploring mediating effects between nursing leadership and patient safety from a person-centred perspective: A literature review

Aims: To evaluate the mechanism through which nursing leadership impacts patient safety.Background: Patient safety has received considerable attention among policy makers, governments and public sectors with the emphasis in healthcare settings on minimising the risk to patients. Claims are made leadership plays a crucial role in patient safety However, the incidents of adverse events are consistently high in hospitals.Evaluation: Published English-only research articles that examine the mechanism by which nursing leadership impacts patient safety were selected from seven electronic databases and manual searches. Data extraction, quality assessments and analysis were completed for ten research studies.Key Issues: There is evidence of significant mediating effects between nursing leadership and decreased adverse patient outcomes specifically with regard to workplace empowerment, leadernurse relationship and the quality of the care environment.Conclusion: The findings suggest that nursing leadership has a significant indirect impact on patient safety outcomes. From a person-centred perspective the care environment requires workplace empowerment and effective relationships between leaders and nurses.Implications for Nursing Management: To improve patient safety outcomes, managers must strive to emphasise workplace empowerment, leader-nurse relationship and the quality of the care environment. Managers must consider these domains as part of an effective workplace culture.https://doi.org/10.1111/jonm.13226pubpu

Living on: an exploration of healthful cancer survivorship among grey nomads

Aim: To explore the experiences of grey nomads living with a diagnosis of cancer. Background: Cancer is primarily both a life-limiting and a chronic condition of ageing and older people. Older people, however, are not a homogeneous group; there are several generations and many different groups to be considered. Grey nomads are one such group and are characterised as being retired and travelling domestically for extended periods of time, usually in a caravan or motorhome. Design: Prospective qualitative phase of a larger, sequential, explanatory, mixed-methods project. Methods: A series of 14 semi-structured, in-depth interviews were conducted over six months in 2016 with 14 self-identified grey nomads living with a diagnosis of cancer. Interviews were analysed using thematic analysis. Results/Findings: Participants travelled despite of, and because of, their cancer diagnosis. These two key themes, with their associated sub-themes, explain how older people incorporated their cancer-related work, that is to say, managing their cancer-related follow-up and treatment health needs into their travelling life; how they normalised it; and how they developed strategies for healthful survivorship. Conclusion: Participants were living healthfully in that they were living a lifestyle that promoted their well-being. Participants developed strategies in response to their changed environment and thus created new capacity to support what they wanted to do. Despite being cancer survivors — some of whom were undergoing active treatment — participants gained ‘healthfulness’ through their chosen nomadic lifestyle.This study was funded by the University of Wollongong, School of Nursing Research Fund.http://www.cambridgepublishing.com.au/19